Table 1.

Etiologies of brittle diabetes.

Generally resulting in hyperglycemia/ketoacidosis a.Endocrinopathies (thyrotoxicosis, acromegaly, Cushing's Syndrome glucagonoma, and pheochromocytoma) b.Systemic infection c.Stiff-Person Syndrome Generally resulting in hypoglycemia a.Diabetic gastroparesis b.Syndromes of lipodystrophy c.Insulin receptor antibody d.Untreated Addison Disease in someone with pre-existing type 1 diabetes e.Untreated celiac disease or other malabsorption disorders f.Change in insulin clearance (renal failure, hypothyroidism) Generally resulting in either hyperglycemia or hypoglycemia a.Psychological disease including Munchausen's Syndrome, malingering, and eating disorders b.Lipohypertrophy c.Dementia and milder forms of cognitive impairment d.Insulin or food insecurity e.Drug or alcohol addiction f.Steroid dependence, particularly when changing doses frequently required