Amal M Khan and Khaled A Alswat
Taif University, Saudi Arabia
Objective: Type I diabetes (T1DM) is the most common type of diabetes during childhood. Insulin therapy is the mainstay of T1DM treatment and Glargine is long-acting insulin that is most commonly prescribed as a basal insulin therapy. Although Glargine is typically administered once daily in the evening, alternative dosing frequencies and timings have been associated with promising results. Our aim is to optimize glycemic control in a complicated T1DM patient without increased risk of hypoglycemia. In addition to, decrease the number of insulin injections by using a new dosing frequency for Glargine. Methods: A 23-year-old girl with a 16-year history of T1DM who was initially started on regular and NPH insulin; she had a poorly controlled HbA1c of 9.8% at that time. She was switched to glargine and glulisine and her HbA1c improved to 8.5% with frequent high blood-glucose readings at 12 pm. Her case was later complicated with gastroparesis and she was switched to an insulin pump. However, she suffered from two unexplained diabetic ketoacidosis episodes, so she opted to discontinue the pump therapy. Next, she was switched back to the glargine and glulisine but with the glargine insulin given as BID. Her HbA1c improved to 7.6% but with frequent episodes of hypoglycemia prior to the BID glargine scheduled doses. For the last four months, her glargine was dosed every 16 hours. Results: After dosing insulin glargine every 16 hours her glycemic control dramatically improved. Her HbA1c improved to 5.5%, decreased hypoglycemic episodes and her gastroparesis symptoms improved. Conclusion: Clinicians should individualize the care and consider different dosing and timing methods for glargine when managing complicated T1DM cases. An additional larger study is needed to evaluate T1DM patients with complicated cases to confirm our findings.
Amal M Khan has completed her Bachelor of Medicine, Bachelor of Surgery (MBBS) at College of Medicine, Taif University, Taif, KSA. She is a Medical intern. She was a Speaker in two conferences and has published one research and one case report in AACE. She has attended a lot of conferences and workshops in Endocrinology and Medical field.
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