Suspension of basal insulin to avoid hypoglycemia in type 1 diabetes treated with insulin pump

Endocrinology, Diabetes & Metabolism Case Reports

article

Mauro Boronat¹  Rosa M Sánchez-Hernández¹  Julia Rodríguez-Cordero¹  Angelines Jiménez-Ortega¹  Francisco J Nóvoa¹ 

[1] Section of Endocrinology and Nutrition, Hospital Universitario Insular;Department of Medical and Surgical Sciences, University of Las Palmas de Gran Canaria

关键词: Adult;    Female;    White;    Spain;    Pancreas;    Diabetes;    Insulin;    Diabetes mellitus type 1;    Hypoglycaemia;    Hypoglycaemia;    Glucose (blood;    fasting);    Haemoglobin A1c;    Glutamic acid decarboxylase antibodies;    Insulin;    Insulin glargine;    Continuous subcutaneous insulin infusion;    Nursing;    Unusual effects of medical treatment;    January;    2015;   

DOI  :  10.1530/EDM-14-0081

学科分类：血液学

来源: Bioscientifica Ltd.

【 摘 要 】

Treatment with continuous s.c. insulin infusion (CSII) provides better glycemic control and lower risk of hypoglycemia thanconventional therapy with multiple daily insulin injections. These benefits have been related to a more reliable absorptionand an improved pharmacokinetic profile of insulin delivered through CSII therapy. However, even for patients treated withCSII, exaggerated postmeal hyperglycemic excursions and late postabsorptive hypoglycemia can still constitute a therapeuticchallenge. Two female patients with type 1 diabetes who began treatment with CSII required to increase their previousbreakfast insulin-to-carbohydrate ratio in order to achieve postprandial glycemic goals. However, they simultaneouslypresented recurrent episodes of late hypoglycemia several hours after breakfast bolus. Advancing the timing of the bolus wasineffective and bothersome for patients. In both cases, the best therapeutic option was to set a basal insulin rate of zero unitsper hour during 6 h after breakfast. Even so, they need to routinely take a midmorning snack with 10–20 g of carbohydrates toavoid late postabsorptive hypoglycemia. They have been using this insulin schedule for about 3 years without complications.The action of prandial insulin delivered through insulin pumps can be inappropriately delayed for the requirements of somepatients. Although suspension of basal rate can be an acceptable therapeutic alternative for them, these cases demonstratethat new strategies to improve the bioavailability of prandial insulin infused through CSII are still needed.

【 授权许可】

CC BY-NC-ND