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Difficult Diabetes

  1. Simon A. Saunders1,
  2. Gareth Williams2

Published Online: 15 MAR 2004

DOI: 10.1002/0470862092.d0810

International Textbook of Diabetes Mellitus

International Textbook of Diabetes Mellitus

How to Cite

Saunders, S. A. and Williams, G. 2004. Difficult Diabetes. International Textbook of Diabetes Mellitus. .

Author Information

  1. 1

    University Hospital Aintree, Longmoor Lane, Liverpool, UK

  2. 2

    University of Bristol, Tyndall Avenue, Bristol, UK

Publication History

  1. Published Online: 15 MAR 2004


Diabetes can be a very difficult disease to manage. This is particularly true when confronted with a patient who attends with recurrent episodes of hypoglycemia, diabetic ketoacidosis, or mixed glycemic instability. This chapter aims to explain the common causes of such presentations, and the suitable investigations to identify a treatable cause. Further to this, if a diagnosis cannot be reached and the problems still persist, the chapter then discusses the diagnosis and management of “brittle diabetes.” This complex and often misunderstood disease affects only a very small minority of patients with type 1 diabetes but requires a considered and careful approach to its diagnosis and treatment. Such issues are discussed within this chapter.


  • type 1 diabetes;
  • hyperglycemia;
  • recurrent diabetic ketoacidosis;
  • recurrent hypoglycemia;
  • brittle diabetes;
  • diagnosis;
  • investigation;
  • management