Effective substitution of CSII with glargine insulin in a patient with an unstable type 1 diabetes mellitus
Abstract
This is a case of a patient with a highly unstable LADA type of diabetes mellitus with repeated serious incidents of life-threatening night hypoglycaemia and a very speedy development of organ complications only two years after the sickness was diagnosed. Mostly the hypoglycaemia occurred at night, gradually the frequencies increased as well as the intensity which required the assistance of another person and subsequently often a few days in hospital.
In this case we noted a combined set of causes for the hypoglycaemia - irregular meals, an increase in physical strain and inadequate doses of insulin. The patient was repeatedly instructed and advised on the correct way of dealing with hypoglycaemia.
Considering the high frequency, the intensity of night hypoglycaemia we chose to apply compensation by introducing a continual subcutaneous application of insulin with an insulin pump. Unfortunately the patient was incapable of handling the pump properly and the faulty use led to life-threatening conditions.
So that this led to a reversion to the application of insulin injections and the selection of insulin analogues combined with glargine in morning doses and lispro with the main meal. The effect of this treatment was satisfactory; the long-term metabolic compensation is comparable.