[The usage of the personal insulin pump for treatment of a 7 week infant with neonatal diabetes mellitus].

Abstract

Unlabelled: Etiology and the course of diabetes mellitus type 1 diagnosed in infancy remains the subject of intensive investigations, nonetheless the diagnosis of hyperglycemia in this period obliges prompt start of the insulin therapy. The treatment of newborns and infants is challenging because of the necessity to use very low doses of insulin.

Case report: A boy was transferred from the neonatal ward on the 8th day of life with the diagnosis of diabetes mellitus. He was born of young healthy parents (mother: 27, father: 30 years old), with no family history of diabetes or other autoimmune disorders. The course of the pregnancy remained normal until 37th week of gestation when due to alterations in the fetal heart rate the cesarean section was done. In spite of precise i.v. insulin therapy fluctuations in glucose levels persisted. Additionally the achievement of the metabolic compliance was complicated by generalized infections caused by hospital pathogens that required broad-spectrum i. v. antibiotic therapy. At the age of 7 weeks personal insulin pump Pradigm 712 for the delivery of NovoRapid insulin was introduced. Already on the 3rd day of such treatment, the daily insulin dose could be decreased from 0.7 unit/kg/24 hrs down to 0.5 unit/kg/24 hrs, and glucose levels normalized. In the course of this treatment the patient weighed 6300 g at the age of 6 months, and his psychomotoric development reached the milestones adequate for the age. The biochemical examinations revealed C-peptide levels both fasting and after glucagon stimulation <0.5 ng/ml. Additionally, the analyzed immunologic markers of type 1 diabetes are negative. The genetic testing for Kir6.2 mutation gave negative results.

Conclusions: The presented case shows that the insulin therapy carried out via personal insulin pump is the possible and effective treatment in children diagnosed with diabetes mellitus during infancy.