ESPE Abstracts

Handling diabetes at a very early age is difficult, even more when a complementary diet has not yet started. There is increasing evidence supporting the use of CSII in infants but some tricks could be useful.

Infant 1: 10 mo, admitted in cardiac arrest. ROSC after 3 minutes, severe DKA (pH 6,95). Transferred to PICU, received also plasma transfusions. Day 2: CGM Dexcom G6 was started and tests for pancreatic autoimmunity and genetic of neonatal diabetes were performed. Day 7: CSII (Tandem t:slim X2 Basal IQ) was started. Genetic and pancreatic autoimmunity tests gave negative results. Day 14: Control IQ started: TDI 0,9 U/kg/die, bolus for milk meals in extended mode. Control IQ automatically managed meals up to 40 g of CHO. No hypoglycaemia. TIR 52%, TAR 48%, TBR 0%. Day 90: Considering an interference due to plasma transfusion, autoimmunity was repeated and T1D was confirmed. Day 180: TIR 85%, TAR 12%, TBR 4% (1% <54 mg/dl). Neurocognitive tests resulted equal to peers.

Infant 2: born at 37 w. Normal pregnancy, SGA. Normal glucose check and metabolic screening. Day 1: At 34 days of life admitted to ED for fever and hypovalid feeding. At the sepsis workup finding of glycemia 500 mg/dl, ketons 0,3 mmol/L, no acidosis. Rhino-Enterovirus at nasal swab. IV Insulin was started at 0,005-0,01 U/kg/h. Day 2: C peptide 0,7 mg/L, pancreatic autoimmunity tests and genetic of neonatal diabetes were performed, rtCGM Libre 3 applied, insulin modulated up to 0,07 U/kg/h. Day 9: CSII was started (Tandem Basal, then Control IQ) using oblique set in high gluteal area. Aspart diluited 1:1, then 1:2, basal rate 0,24 U/h, FSI 1/600, I/CHO 1/180, always-on sleep mode to avoid automatic boluses with stable control. Days 10-20: the mother was taught how to stop insulin for glycemia 180 in rapid decline and to use oral glucose to manage hypoglycemia. No pancreatic autoimmunity was found. Day 30: de novo heterozygosis variant in KCNJ11: glibenclamide was started, insulin progressively stopped. The actual dose is 0,25 mg/kg/die in 6 administrations, TIR 86%, TAR 12%, TBR 2% (<54 mg/dl 0%). The neurological evaluation is normal.

Conclusion: HCL, in an experienced centre, might be useful to manage diabetes also for infants. As regards to neonatal diabetes, it appears fundamental to shift to sulphonylureas as soon as there is the genetic confirmation.