ABSTRACT
The classical picture of brittle diabetes is of hugely disruptive individ-
uals who demand considerable professional time due to repeated
hospital admissions for diabetic ketoacidosis and uncontrolled hyper-
glycaemia. However, severe unstable diabetes due to hypoglycaemia
is probably a greater overall burden both to individuals with diabetes
and their family as well as their professional carers. The causes of
unstable glycaemic control caused by hypoglycaemia include an
obsessive drive to maintain a perfect blood glucose, factitious
hypoglycaemia, organic problems such as hypoadrenalism as well as
temporary instability following a cluster of hypoglycaemic episodes.
