Insulin pump therapy in transient neonatal diabetes mellitus

Abstract

Neonatal diabetes mellitus (NDM) is a rare disease requiring insulin treatment. Its treatment is primarily focused on maintaining adequate glycemic control and avoiding hypoglycemia. Although insulin pump therapy is frequently administered to adults and children, there is no consensus on the use of insulin pumps in NDM. A 10 day-old female infant was referred to us with intrauterine growth retardation and poor weight gain. Hyperglycemia was noted, and continuous intravenous insulin infusion was initiated. However, the patient's serum glucose levels fluctuated widely, and maintaining the intravenous route became difficult within the following weeks. Continuous subcutaneous insulin infusion with an insulin pump was introduced on the twenty-fifth day of life, and good glycemic control was achieved without any notable adverse effects including hypoglycemia. We suggest that the insulin pump is a safe and effective mode for treating NDM and its early adoption may shorten the length of hospital stays in patients with NDM.

A Novel KCNJ11 Mutation Associated with Transient Neonatal Diabetes

“…Managing infants with NDM presents many problems, arising from the very small insulin doses required, the high risk of hypoglycemia, the lack of subcutaneous fat and the coordination of insulin therapy with the frequent and uncontrolled feeding schedule of the newborn period. Continuous subcutaneous insulin infusion (CSII) has been recommended as the treatment of choice in the initial management of infants with NDM ( 19 , 20 , 21 ). Rapid acting insulin preparations (Lispro, Aspart and Regular) may cause severe hypoglycemia and should be avoided, with the exception of CSII ( 1 ), while long acting or intermediate acting insulin has been successfully used in these patients ( 22 , 23 , 24 ).…”

Neonatal diabetes mellitus due to a novel variant in the INS gene

“…Early on, a combination of intermediate- and short-acting insulin (with transition to typical basal-bolus regimen later in infancy) was effective in avoiding hypoglycemia and reducing (although certainly not eliminating) glycemic variability; early availability of a continuous glucose sensor was crucial in allowing for frequent adjustments to the patient's insulin regimen. The successful use of insulin pump therapy (continuous subcutaneous insulin infusion [CSII]) has been well described in cases of NDM (Tubiana-Tufi 2007), even being introduced during initial hospital stay in a case of transient NDM (Park et al 2013). Challenges common to both injection and pump therapy include frequent feedings, limited subcutaneous fat stores, and need for minute doses of insulin in patients with NDM.…”