P-299: Challenges in glycemic management of a 1-year-old infant with type 1 diabetes using insulin pen therapy: a case report from a public health system setting
B de Melo Nunes, T Leão de Oliveira, D Lérco FlygareAbstract
Introduction
Type 1 diabetes (T1D) is an autoimmune disease causing absolute insulin deficiency and lifelong need for exogenous insulin. Standard therapy is a basal–bolus regimen with long-acting insulin for basal needs and rapid-acting insulin for prandial and correction doses. Dose adjustment must be individualized according to age, weight, and glycemic variability. In infants, management is challenging due to very low insulin requirements and high sensitivity to small dose changes.
Objectives
To report challenges in managing T1D in an infant treated with insulin pen therapy.
Methods
A 1-year-old infant with T1D presented with severe diabetic ketoacidosis requiring hospitalization. Treatment included NPH and regular insulin, later transitioned to insulin glargine and insulin lispro after endocrinology follow-up. The patient had positive anti-GAD and anti-insulin antibodies. Insulin pump therapy was unavailable within the public health system.
Results
The patient used 3 units of basal insulin daily (1 morning, 2 night). The main difficulty was correction dosing, as 1 unit of rapid insulin frequently caused hypoglycemia, indicating marked insulin sensitivity and requiring frequent fast-acting carbohydrate intake. Hypoglycemia accounted for ∼1% of readings. The insulin sensitivity factor was adjusted and carbohydrate counting initiated. Higher glycemic targets were temporarily accepted. Continuous glucose monitoring showed 42% time in range, 26% hyperglycemia (180–240 mg/dL), and 30% severe hyperglycemia (>240 mg/dL).
Conclusions
This case highlights the difficulty of glycemic control in infants with T1D due to extreme insulin sensitivity and limited dosing precision with pen devices. Individualized insulin adjustment and caregiver education are essential. Insulin pump therapy may improve outcomes, with evidence of better control and reduced hypoglycemia versus multiple daily injections (Pickup JC et al., Diabetologia, 2014; Phillip M et al., Diabetes Care, 2007).