ESPE Abstracts

Background: Variable rate intravenous insulin infusion (VRIII) is commonly used in unwell patients with diabetes and complex nutritional needs. However, frequent blood glucose monitoring with infusion rate adjustment gives rise to significant safety concerns and is extremely resource intensive. Fully closed-loop (FCL) systems are promising technological advancements in diabetes management. It comprises of continuous glucose monitoring and a control algorithm to automatically modulate insulin delivery via an insulin pump in response to glucose concentration. CamAPS HX is one such system that has shown to improve glycaemic control in adult inpatients receiving nutritional support, although there are no data for children. The CamAPS HX algorithm is an Android ‘app’ initialised by input of body weight and total daily insulin dose, and has an adjustable nominal glucose target of 5.8mmol/l and options for bolusing for carbohydrate intake.

Objective: We present a case of a hospitalised adolescent with diabetes secondary to acute pancreatitis managed with a FCL system.

Case Report: A 14 years-old boy (weight=63kg) was admitted to the paediatric intensive care unit with acute necrotizing pancreatitis and oesophageal perforation. Persistent hyperglycaemia with low c-peptide levels (12pmol/l with glucose level of 14.4mmol/L), suggested diabetes secondary to pancreatic beta-cell failure. He was started on VRIII from Day-2 of admission and required daily insulin doses of 0.9-1.2unit/kg while on total parental nutrition (TPN). The clinical course was complicated by near complete necrosis of pancreas and peripancreatic collections. Undulating clinical course, frequent titration of TPN and variable tolerance to nasogastric feeds resulting in frequent unscheduled changes posed significant challenges to conventional insulin pump therapy. Therefore, CamAPS HX FCL was started off-licence on Day-20 following institutional governance approval. The system allowed stable glucose levels with no adverse effects during time on and off TPN and while reintroducing enteral feeds (Table 1). The patient was switched to CamAPS FX (hybrid closed-loop system) on day 25 prior discharge home.

Conclusion: This case supports the safe and effective use of FCL systems for inpatient management of paediatric patients with complex nutritional needs. To our knowledge, this is the first reported paediatric inpatient case to use this system.