Insulin Glargine Dosing Every 16 Hours for a Complicated Type I Diabetes Case

ABSTRACT: Objective: Type I diabetes mellitus (T1DM) is the most common type of diabetes during childhood. Insulin therapy is the mainstay of T1DM treatment, and glargine is long-acting insulin that is most commonly prescribed as a basal insulin therapy. Although glargine is typically administered o...

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Main Authors: Khaled A. Alswat, MBBS, CCD, FACP, Amal M. Khan
Format: Article
Language:English
Published: Elsevier 2016-01-01
Series:AACE Clinical Case Reports
Online Access:http://www.sciencedirect.com/science/article/pii/S2376060520305587
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spelling doaj-6dfe70ce4f3c493d86fbb552f2522e892021-04-30T07:25:10ZengElsevierAACE Clinical Case Reports2376-06052016-01-0124e346e350Insulin Glargine Dosing Every 16 Hours for a Complicated Type I Diabetes CaseKhaled A. Alswat, MBBS, CCD, FACP0Amal M. Khan1Department of Internal Medicine, Taif University School of Medicine, Taif, Saudi Arabia; Address correspondence to Dr. Khaled A. Alswat, Taif University School of Medicine, P.O.Box 888, Airport Rd, Al Huwaya, Taif, 21944, Saudi Arabia. E-mail:Taif University School of Medicine, Taif, Saudi Arabia.ABSTRACT: Objective: Type I diabetes mellitus (T1DM) is the most common type of diabetes during childhood. Insulin therapy is the mainstay of T1DM treatment, and glargine is long-acting insulin that is most commonly prescribed as a basal insulin therapy. Although glargine is typically administered once daily in the evening, alternative dosing frequencies and timings have been associated with promising results.Methods: A 23-year-old woman with a 16-year history of T1DM who was initially started on regular and neutral protamine Hagedorn insulin continued to have a poorly controlled glycated hemoglobin (HbA1c) level of 9.8% (84 mmol/mol). She was switched to glargine and glulisine, and her HbA1c improved to 8.5% (69 mmol/mol) with frequent high blood glucose readings at 12 PM. Her case was later complicated with gastroparesis and she was switched to an insulin pump. However, she suffered from two unexplained diabetic ketoacidosis episodes and opted to discontinue the pump therapy. Next, she was switched back to the glargine and glulisine but with the glargine insulin given twice daily.Results: The patient's HbA1c improved to 7.6% (60 mmol/mol) but with frequent episodes of hypoglycemia prior to the scheduled doses of glargine. For the next 4 months, glargine was dosed every 16 hours and her glycemic control dramatically improved. Her HbA1c improved to 5.5% (37 mmol/mol), her appetite improved, and she gained some of the weight that she had previously lost.Conclusion: Clinicians should individualize care and consider different dosing and timing methods for glargine when managing complicated T1DM cases.Abbreviations: BID = twice daily; DKA = diabetic ketoacidosis; DM = diabetes mellitus; GI = gastrointestinal; HbA1c = glycated hemoglobin; MDI = multiple daily injections; QHS = once at bedtime; T1DM = type I diabetes mellitushttp://www.sciencedirect.com/science/article/pii/S2376060520305587
collection DOAJ
language English
format Article
sources DOAJ
author Khaled A. Alswat, MBBS, CCD, FACP
Amal M. Khan
spellingShingle Khaled A. Alswat, MBBS, CCD, FACP
Amal M. Khan
Insulin Glargine Dosing Every 16 Hours for a Complicated Type I Diabetes Case
AACE Clinical Case Reports
author_facet Khaled A. Alswat, MBBS, CCD, FACP
Amal M. Khan
author_sort Khaled A. Alswat, MBBS, CCD, FACP
title Insulin Glargine Dosing Every 16 Hours for a Complicated Type I Diabetes Case
title_short Insulin Glargine Dosing Every 16 Hours for a Complicated Type I Diabetes Case
title_full Insulin Glargine Dosing Every 16 Hours for a Complicated Type I Diabetes Case
title_fullStr Insulin Glargine Dosing Every 16 Hours for a Complicated Type I Diabetes Case
title_full_unstemmed Insulin Glargine Dosing Every 16 Hours for a Complicated Type I Diabetes Case
title_sort insulin glargine dosing every 16 hours for a complicated type i diabetes case
publisher Elsevier
series AACE Clinical Case Reports
issn 2376-0605
publishDate 2016-01-01
description ABSTRACT: Objective: Type I diabetes mellitus (T1DM) is the most common type of diabetes during childhood. Insulin therapy is the mainstay of T1DM treatment, and glargine is long-acting insulin that is most commonly prescribed as a basal insulin therapy. Although glargine is typically administered once daily in the evening, alternative dosing frequencies and timings have been associated with promising results.Methods: A 23-year-old woman with a 16-year history of T1DM who was initially started on regular and neutral protamine Hagedorn insulin continued to have a poorly controlled glycated hemoglobin (HbA1c) level of 9.8% (84 mmol/mol). She was switched to glargine and glulisine, and her HbA1c improved to 8.5% (69 mmol/mol) with frequent high blood glucose readings at 12 PM. Her case was later complicated with gastroparesis and she was switched to an insulin pump. However, she suffered from two unexplained diabetic ketoacidosis episodes and opted to discontinue the pump therapy. Next, she was switched back to the glargine and glulisine but with the glargine insulin given twice daily.Results: The patient's HbA1c improved to 7.6% (60 mmol/mol) but with frequent episodes of hypoglycemia prior to the scheduled doses of glargine. For the next 4 months, glargine was dosed every 16 hours and her glycemic control dramatically improved. Her HbA1c improved to 5.5% (37 mmol/mol), her appetite improved, and she gained some of the weight that she had previously lost.Conclusion: Clinicians should individualize care and consider different dosing and timing methods for glargine when managing complicated T1DM cases.Abbreviations: BID = twice daily; DKA = diabetic ketoacidosis; DM = diabetes mellitus; GI = gastrointestinal; HbA1c = glycated hemoglobin; MDI = multiple daily injections; QHS = once at bedtime; T1DM = type I diabetes mellitus
url http://www.sciencedirect.com/science/article/pii/S2376060520305587
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