What is “fragile diabetes”? ”Fragile” means that the disease is extremely unstable and that blood glucose fluctuates from high to low and is difficult to control. “Fragile diabetes”, also known as “unstable diabetes”, is mainly seen in patients with type 1 diabetes and some advanced type 2 diabetes with near-islet failure, and is generally considered to be the result of complete islet failure. Since patients are completely dependent on exogenous insulin for blood glucose control, the latter is significantly different from physiological insulin secretion in terms of pharmacogenetic characteristics and regulation, and lacks effective auxiliary regulation, it is easy to have high and low blood glucose fluctuations. ”Patients with brittle diabetes have poor pancreatic islet function, and the body is more sensitive to insulin, which makes clinical management very difficult, and extra caution is needed in both daily diet and medication adjustment. It is impossible to achieve the same blood glucose stability and standards as a normal diabetic patient, and it can be dangerous and harmful. ”Brittle diabetes” mainly relies on intensive insulin treatment, which can be done by insulin pump or multiple subcutaneous insulin injections a day, i.e. short-acting insulin (or ultra-short-acting insulin analogues) before three meals and medium-acting insulin (or ultra-long-acting insulin analogues) at bedtime, compared with 1-2 daily insulin injections. Compared with 1-2 daily insulin injections, this way of administering insulin by subcutaneous injection several times a day is closer to the physiological mode of action of insulin and is more effective in reducing blood glucose fluctuations. If necessary, the addition of certain oral hypoglycemic drugs (such as metformin and bactrim) can also be considered, which may also be helpful in reducing blood glucose fluctuations. In addition to insulin therapy, attention should also be paid to maintaining emotional stability and relatively regular diet and exercise, with emphasis on eating less and more meals, which is very important to reduce hypoglycemic episodes and keep blood sugar stable. Three considerations for treatment 1. Blood sugar control should not be too strict. As the islets of brittle diabetic patients are severely destroyed, both insulin and insulin antagonist hormone (such as glucagon) are severely deficient, blood sugar is extremely unstable and the risk of hypoglycemia is very high. And hypoglycemia may be fatal. Therefore, the blood glucose control standard for such patients should not be too strict, and fasting blood glucose should be controlled at about 8.0-10.0mmol/L, and 2 hours after meal blood glucose should not exceed 10.0-14.0mmol/L to avoid serious hypoglycemia. 2. Insulin adjustment should not be too large. Fragile diabetic patients are very sensitive to insulin, and a small change in insulin blood concentration can cause significant changes in blood glucose. Therefore, the adjustment of insulin dose should be very careful to prevent hypoglycemia or large fluctuations in blood sugar. 3. Try to use insulin analogues. When implementing intensive treatment, replacing medium and long-acting insulin with long-acting insulin analogues and replacing short-acting insulin with ultra-short-acting insulin analogues can better simulate physiological insulin secretion, which is beneficial to the smooth control of blood glucose.