Type 1 diabetes mellitus‑common cases Assignment Paper.

Type 1 diabetes mellitus‑common cases Assignment Paper.

Tight glycemic control in type 1 diabetes mellitus (T1DM)
patients is not possible because of hypoglycemia. Diabetic
patients are forced to change their lifestyle to adjust to the
disease condition and survive it. The best way to manage
diabetes would be to develop a therapy, which could adjust
to the patient’s conditions.[1] Type 1 diabetes mellitus‑common cases Assignment Paper.
A 6‑year‑old boy presented with classic features of
diabetic ketoacidosis, that is, weight loss and extreme
weakness and osmotic features. Type 1 diabetes mellitus‑common cases Assignment Paper.The fasting blood sugar
level was 300 mg/dL, postprandial glucose level was
467 mg/dL and hemoglobin A1c (HbA1c) was 7.2%.

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He was administered with standard intravenous insulin
and fluid, which finally brought down the fasting blood
glucose level to around 120 mg/dL. He was administered
basal‑bolus therapy and was discharged. Patient had
two episodes of severe hypoglycemia. His parents were
worried due to frequent checking of blood glucose levels
many times in a day. The challenge was also to avoid
urination in bed at night by the child. Otherwise he would
get a common cold.Type 1 diabetes mellitus‑common cases Assignment Paper. The patient remained unconscious
in the middle of the night and was fed up with the
frequent monitoring of blood sugar. The patient and the
parents had severe anxiety, depression, frustration, and
disgust. The parents considered diabetes as a curse on
their family.Type 1 diabetes mellitus‑common cases Assignment Paper. He was informed about degludec/injection
tresiba, which is not yet approved in children because
of lack of experience. The physician explained to them
that there was nothing wrong in administering it and is
not contra‑indicated in T1DM.[2] The parents were also
explained that insulin degludec may even help the child
to convert from four injections to one injection a day,
and from very frequent monitoring to once in a day. After
reviewing the literature about insulin degludec, the parents
were finally convinced about it. The patient was then
put from basal‑bolus to 2 bolus plus 1 basal and finally
degludec at 16 U. Type 1 diabetes mellitus‑common cases Assignment Paper.Over the period of time, blood sugar
level came to normal at around 110 mg/dL‑pre meal. The
patient was trained very well that if he wanted to reduce
the frequency of monitoring of blood sugar level, then
he had to follow small frequent meals. This made him
felt happy because once the sugar was controlled then
small amount of sweets was also given. Type 1 diabetes mellitus‑common cases Assignment Paper.The techniques
resulted in good compliance from the patient. The patient
did not report any hypoglycemic event over a period of
3 months. This was a big relief for the patient and his
parents. Later parents were told that the child may require
basal‑bolus therapy. The outcomes of this case study were
that in case of T1DM the physician should not be very
aggressive except during the first 2 weeks of admission.
Corresponding Author: Dr. Surender Kumar, Department of Endocrinology, Sir Ganga Ram Hospital, New Delhi ‑ 110 060, India.
E‑mail: doctorsuren@yahoo.co.uk
Brief Communication
Type 1 diabetes mellitus‑common cases
Surender Kumar
Department of Endocrinology, Sir Ganga Ram Hospital, New Delhi, India
ABSTRACT
Tight glycemic control in type 1 diabetes mellitus patients is associated with the risk of hypoglycemia. Diabetic patients are forced
to change their lifestyle to adjust to the disease condition and survive it. The best way to manage diabetes would be to develop a
therapy, which could adjust to the patient’s conditions. Here, I present few cases wherein switching to a long‑acting basal insulin
analog helped combat recurrent hypoglycemic episodes experienced by the patients.
Key words: Basal insulin analog, hypoglycemia, type 1 diabetes mellitus
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DOI:
10.4103/2230-8210.155409
Kumar: Common cases of diabetes
Indian Journal of Endocrinology and Metabolism / 2015 / Vol 19 | Supplement 1 S77
The physician should also try to convince the parents
about line of treatment, and educate both the patients and
the child. The dose may be gradually stabilized without
being aggressive, and this also prevents frequent episodes
of hypoglycemia. Hence, gradual tightening of glycemic
control is very important. The doctor should analyze the
psyche of the patient and his parents.Type 1 diabetes mellitus‑common cases Assignment Paper.
A 57‑year‑old female presented with a 13 year history
of diabetes. Due to the failure of oral hypoglycemic
agents (OHAs) in controlling her sugar levels, for the last
3 years, she was treated with biphasic insulin aspart 30/70.
She was a very frequent flier, a regular swimmer and socially
very active, and this led her to have irregular meals. Hence,
she often go into frequent hypoglycemia and during the last
6 months the patient’s average blood glucose level during
fasting were 170 mg/dL and postprandial glucose levels
varied from 230 to 280 mg/dL. Even after high sugar levels,
she fortunately had normal kidney functions. Patient was
able to afford an insulin pump, so she was put on one. With
the pump, her blood glucose was in control and patient was
happy.Type 1 diabetes mellitus‑common cases Assignment Paper. However she soon realized the limitation of carrying
it everywhere she went. These were the true feelings of a
patient who was very active while she was on an insulin pump.
The physician, after discussing with the patient, started her
on insulin degludec and lifestyle modification, especially the
diet component. Patient understood these problems and
followed the diet. Type 1 diabetes mellitus‑common cases Assignment Paper.She followed the dietary modification
and over 2 months of time, fasting blood glucose was
110 mg/dL, post meals values were around 180 mg/dL. She
had only one episode of minor hypoglycemia which was due
to delayed meal. The doctor later reduced degludec from 44
U to 40 U and blood glucose was still improving without any
episode of hypoglycemia in the last 3 months. The outcome
of this case is that with this therapy and dietary modification,
a desired level of blood glucose can be achieved, without
hypoglycemic risk. Type 1 diabetes mellitus‑common cases Assignment Paper.
An 80‑year‑old retired army officer, staying alone, has
type 2 diabetes for the last 12 years and renal function
test was normal and patient was on insulin along with
other OHAs. Despite this, the patient was getting
attacks of hypoglycemia, which scared the patient of
unconsciousness and even death. The limiting factors were
that the patient was staying alone and was dependent upon
an attendant to get injections. During the weekends or
holidays, the attendant was not on a regular time, and this
led to irregular insulin injections, causing hypoglycemic
episode to patient. This patient as well was put on insulin
degludec and over a period the dose of degludec was also
increased. His HbA1c and fasting blood glucose level
improved without any episode of hypoglycemia. The
outcomes of this case are that degludec along with dietary
modifications gave desired diabetes control without any
hypoglycemia.Type 1 diabetes mellitus‑common cases Assignment Paper.
Summary
The main barrier to tight glycemic control is hypoglycemia.
This can be adjusted with slight dietary modification
without changing the therapy.[3]
References
1. Kalra S, Sahay R, Unnikrishnan AG. Concerns about hypoglycemia
in India: The Diabetes Attitudes Wishes and Needs (DAWN2) study.
J Soc Health Diabetes 2014;2:48‑9.
2. Kalra S, Unnikrishnan AG, Sahay R. Pediatric diabetes: Potential for
insulin degludec. Indian J Endocrinol Metab 2014;18:S6‑8. Type 1 diabetes mellitus‑common cases Assignment Paper.
3. Kalra S, Baruah MP, Sahay R. Person centered care in the Second
Diabetes Attitudes, Wishes and Needs (DAWN2) study: Inspiration
from India. Indian J Endocrinol Metab 2014;18:4‑6.
Cite this article as: Kumar S. Type 1 diabetes mellitus-common cases. Indian
J Endocr Metab 2015;19:76-7.Type 1 diabetes mellitus‑common cases Assignment Paper.
Source of Support: Nil, Conflict of Interest: None declared.
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