Could brittle diabetes be the cause for why diabetes ketoacidosis (DKA) is on the rise? DKA or severe high blood sugar is a diabetes emergency associated with death in people with type 1 diabetes, and also in type 2 diabetes, but much less so. The rise in hospitalization for DKA in western countries (US, UK) is similar to the trends observed in other countries, but why?1 No cause is known. While some formidable researchers direct our attention to the “brittle diabetic”, it’s obvious in our diabetes community today that the lack of affordable insulin in the USA and other low-income countries, a decrease in doctors specializing in type 1 diabetes care worldwide, and low awareness of DKA are all much greater causes of the current DKA rise.
What is brittle?
Brittle diabetes is often cited from a renowned clinician, Robert Tattersall, who researched the subject quite a bit:
“The brittle diabetic is most simply deﬁned as the patient whose life is constantly being disrupted by episodes of hypo- or hyperglycaemia whatever their cause…”2
That sounds like me, and possibly every day, although nothing severe. I may have an 8-hour period of pure bliss with 70-120 mg/dL. It’s also likely on that day I have been on-the-move constantly: working, walking the dogs or trying to catch a train. Perhaps after a dinner of salad, my “blood sugar” begins to spiral up. I’m at 200 mg/dL, and it’s not clear why. I decide to correct mildly. Fifteen minutes later, I begin to fall, then crash. I am now at 40 mg/dL. I drink some glucose. Unfortunately, my counter-regulatory hormones take over and my CGM has two double arrows going up. They’ll calm down, but it’s nearly bedtime and I know the best remedy is a dose (.5 units insulin) along with a brisk walk around my NYC neighbourhood. I get home at 11:30 and I’m beat. My blood sugar is a reasonable 130 mg/dL and steady. I collapse into bed.