An elderly type 1 diabetic patient with life event-related brittle diabetes

The case is presented of a 74-year-old lady with type 1 diabetes of 42 years' duration, who had recurrent diabetes-related hospitalisations. These were due to both hypo- and hyperglycaemic emergencies and, over the last 20 years, 41 such, admissions (2.0 per year) had occurred - 56% hypoglycaemic, 27% diabetic ketoacidosis (DKA), and 17% with non-ketotic hyperglycaemia. There was a close relationship between social and family crises and admissions. This patient demonstrates the unusual syndrome of 'elderly brittle diabetes'. The mixed metabolic picture is typical of this syndrome, but the psychosocial impact on hospital admission is more commonly seen in younger female brittle patients with recurrent DKA.