Brittle diabetes revisited: a description of erratic and difficult-to-control diabetes in an elderly woman with Type 1 diabetes: a description of erratic and difficult-to-control diabetes in an elderly woman with Type 1 diabetes

Background Brittle diabetes is frequently attributed to psychological stressors causing insulin omission in young women with Type 1 diabetes. It has received little attention in the recent medical literature. Case report We report the case of an 87-year-old woman who had recurrent episodes of unexplained diabetic ketoacidosis. Despite frequent inpatient monitoring of capillary glucose, her blood glucose levels remained erratic. She experienced a total of 12 episodes of ketoacidosis (some occurring during hospitalization), with 11 episodes occurring over a 3-month period. Several episodes of ketoacidosis required care in a high-dependency unit and up to 32 h of intravenous insulin and fluids. Extensive investigations failed to identify any underlying cause of the recurrent ketoacidosis. Ultimately, the introduction of a continuous subcutaneous insulin infusion pump resulted in improved glycaemic control and avoided the need for further hospitalizations. Conclusion Individuals of advanced age can benefit from insulin pump therapy. The original definition of brittle diabetes referred to patients whose lives were constantly disrupted by episodes of hypo- or hyperglycaemia. Our case reminds us that this clinical entity can result from altered biology and is not always related to psychological stressors.