What do patients want?

disease?Even if we accept that then the psychosocial stresses of adolescence contribute at least as much as physiology to poor control.Brittle became a convenient word for parents, nurses, and doctors struggling to cope with difficult metabolic control in their charges.Brittle diabetes does exist-in the sense that some young (and some not so young) patients with poorly controlled diabetes do experience very unstable glycaemic control.And specific abnormalities-for example, of insulin absorption-have been found.7But the term has become inextricably associated with cases of manipulative behaviour and carries pejorative overtones.Our increased understanding of the metabolic causes of diabetic instability and the con- tribution of psychological stress to erratic glycaemic control gives us new, more specific, diagnostic labels.The follow up studies lead to the conclusion that brittle diabetes may be self limiting and not intrinsically different from non-brittle diabetes in the long term.The main risk to life is recurrent hypoglycaemia, which may be a separate syndrome.Any psychosocial difficulties need treatment.Deciding how to use expensive and potentially dangerous treatments is not easy.Indeed, the effect of the intensive regimens used for brittleness has not been examined- outcome might have been different without them.Regardless of their label, patients with unstable diabetes need expert multidisciplinary care.