Brittle diabetes in the elderly

The term 'brittle diabetes' is now commonly used to describe patients whose lives are disrupted by major variations in metabolic control, whatever their cause. Most reports have focused on the occurrence of such problems in young people, but little attention has been paid to brittle diabetes occurring in elderly patients. We describe six such cases and comment on differences in aetiology and management when compared with younger patients. Although less rigorous objectives for tight blood glucose control as compared with younger people, and more ready acceptance of insulin administration being supervised by another person, such as a district nurse, may reduce swings in blood glucose control in the elderly, accidental mismanagement by the patient as a result of incipient or established senile dementia may be an important factor in generating instability, as was evident in three cases. In one instance, the onset of unstable diabetic control was the earliest clinical feature of mental deterioration.