Background: Management of transient neonatal diabetes mellitus is complex. Conventional insulin therapy may be increase additional medical problems. From the case is presented, We suggested s.c. insulin pump therapy of neonatal diabetes is a safe and effective approach to management.
Objective and hypotheses: To evaluate the therapeutic effect of continuous s.c. insulin infusion with insulin pump in a case with transient neonatal diabetes mellitus (TNDM).
Method: A 2-month female infant patient, presented with postnatal persistent hyperglycemia, received a diagnostic workup in the newborn department of our hospital. Methylation-specific PCR showed complete loss of methylation at the TND differentially methylated region on chromosome 6q24, which was consistent with 6q24 transient neonatal diabetes. Thus a diagnosis of TNDM was confirmed genetically. This patient, previously treated with multiple daily insulin injections and glibenclamide, which proved to be ineffective, was then given continuous s.c. insulin infusion with insulin pump. Insulin dose and infusion mode were adjusted based on blood glucose profiles. The patient has been followed up for 3 years.
Results: Blood glucose levels were significantly improved within 2 weeks. Basal and bolus infusion mode had been maintained for 2 years and subsequently switched to a mode with basal insulin infusion only for 2 months, which was then discontinued and followed by a single injection of basal insulin until now. Blood glucose levels fluctuated from 4.1 to 11.2 mmol/l. Hypoglycemia was minimal. The patient thrives well, with her weight and height around the 50th percentage in her age group.
Conclusion: Continuous s.c. insulin infusion with insulin pump provided optimal and safe control of blood glucose in TNDM, and might also shorten length of hospital stay, prevent relevant complications and reduce mortality rate.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology