P-501: Insulin pump therapy improves glycemic control in an adolescent with exocrine pancreatic insufficiency and unstable carbohydrate absorption
D Alencar de Menezes Athayde, H Hamad Timeny de Carvalho, J Cavalcanti de Oliveira, P Fiacadori, J Cavalcanti de Oliveira, B Sannicola Bernardi, B Semer Kann, C Gouveia Buff PassoneAbstract
Introduction
Diabetes associated with exocrine pancreatic insufficiency is challenging to manage, especially when intestinal absorption is irregular. In such cases, multiple daily injections may fail to match insulin delivery to unpredictable carbohydrate absorption, leading to marked glycemic variability.
Objectives
To describe the clinical course and glycemic response to insulin pump therapy in an adolescent with exocrine pancreatic insufficiency and difficult-to-control diabetes.
Methods
We report the case of a 15-year-old boy with Down syndrome, celiac disease, immune deficiency on immunoglobulin replacement, exocrine pancreatic insufficiency due to pancreatic atrophy/lipomatosis, and insulin-dependent diabetes for 6 years. He was followed with continuous glucose monitoring (CGM) and serial HbA1c assessment. Despite pancreatic enzyme replacement, dietary counseling, CGM use, and intensified insulin therapy, glycemic control remained poor. An automated insulin delivery system was initiated in September 2025.
Results
The patient had persistent hyperglycemia, high glycemic variability, and baseline time in range (TIR) of 22%, partly due to erratic carbohydrate absorption. Anti-GAD antibodies were >2000 IU/mL, C-peptide was low (0.4 ng/mL), and HbA1c reached 10.0%. He also had difficulty gaining weight. After pump initiation, TIR improved to 80–83%, and HbA1c decreased to 6.8%. There was marked clinical and nutritional improvement, with a 6-kg weight gain over four months (BMI z-score -0.27). Some nocturnal hypoglycemia persisted, requiring basal adjustments. Some nocturnal hypoglycemia persisted, requiring ongoing basal adjustments.
Conclusions
This case highlights the complexity of diabetes management with exocrine pancreatic insufficiency. Insulin pump therapy improved glycemic control and flexibility, representing an important strategy in pediatric patients with unstable absorption.