ABSTRACT
One of the best-recognized patterns of glycaemic instability in
severely unstable or ‘brittle’ type 1 diabetes is the syndrome of recur-
rent diabetic ketoacidosis (DKA). These patients contribute about two-
thirds of the total burden of brittle diabetes, and are almost always
young (in their teens and twenties) and female.1,2 They have recur-
rent admissions with DKA, which persist despite all therapeutic inter-
ventions, and, not surprisingly, they have significant mortality and an
increased later burden of diabetic complications. Their ‘brittleness’,
however, may resolve with the passage of time, and they can resume
acceptable glycaemic stability.3 This chapter will trace the history of
the syndrome of recurrent DKA, critically examine causative theories,
and review management and outcome.
