Background & Aims: Brittle diabetes, associated with longstanding type 1 diabetes, is characterized by poor blood glucose control that fluctuates dramatically. Often, patients are defined as having brittle diabetes if they frequently experience episodes of hypoglycemia followed by episodes of hyperglycemia. Hypoglycemia can, in some cases, cause harmful complications such as altered levels of consciousness and seizures. In rare situations, seizures resistant to standard anti-epileptic drugs can prove difficult to manage. In this article, we examine the use of a ketogenic diet as a potential treatment for drug-resistant seizures associated with brittle diabetes.
Case Presentation: A 39-year-old female with type 1 diabetes, known to have fluctuations in her glycemic control and seizures at least weekly prior to admission to the endocrinology service. During her admission, she began having 5–6 daily seizures, which were resistant to all anti-epileptic therapies (with supervision by neurology).
Results: After consulting with the Nutrition team, a ketogenic diet was initiated. Over time, seizure frequency began to decrease and ceased entirely after 5 days. After meeting criteria for seizure freedom, we were able to gradually wean all anticonvulsant medications. The patient was discharged 30 days later on the ketogenic diet. Upon follow-up 30 days later, the patient and her family reported no further seizures.
Conclusion: The ketogenic diet may be an alternative treatment option in rare cases of drug-resistant seizures in brittle diabetes, even in the adult population. This promising approach warrants larger-scale studies to elucidate its precise mechanisms and long-term efficacy.