[Unstable diabetes (author's transl)]

Unstable diabetes is characterized by the appearance of irregular and unpredictable variations of the glycemia; because of this it is very difficult to achieve an acceptable metabolic control. There are different criteria (continuous monitorization, M value, MDDG, AMEG, etc.) for the evaluation of the degree of instability. Unstable diabetes may be transitory (generally related to exogenous factors or erroneous management) or permanent. The Somogyi effect must always be taken into account in unstable diabetes. The two most important pathogenic factors could be the absence of the pancreatic insulin reserve and the presence of small quantity of anti-insulin antibodies of high affinity. Other factors such as glucagon, growth hormone, catecholamines, etc. seem to play a secondary role. At the moment the treatment of unstable diabetes is not very satisfactory.