My uncle, who is said to have “brittle diabetes”, frequently has episodes during which he is lethargic, glassy-eyed and confused, and he says he does not feel it coming on. When this happens, we have to give him something to eat (usually something sweet) rather quickly to bring him back to normal. How can this be better controlled? Can it? Is it possible that he could not be taking care of himself properly? We are extremely concerned!

Unfortunately, brittle diabetes has been taken to mean a form of diabetes with no ability to be controlled. However, I would suggest that it refers to the results of diabetes care that are not satisfactory.

For instance, many patients with frequent high and low sugars are termed brittle. In reality, they do not monitor, cannot predict lows coming on, and have rebound high sugars.

Yes, this can be better treated. Your uncle has to establish care with a provider who will have him monitor frequently, review the sugars, and make changes in the insulin regimen that allow for smoother control. Individuals who have frequent lows set themselves up for a loss of early warning symptoms from their diabetes. There is some evidence that he can regain some of the early warning symptoms if he can stop the continuous episodes of lows.

JTL