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Regulation of glycaemia with the insulin pump in a patient with diabetes mellitus type 1 and celiac disease - a case report

Introdnetion: Diabetes mellitus type 1 (DM1) occurs because of autoimmune destruction of pancreatic B-cells in the islets of Langerhans, leading to the complete absence of insulin secretion. These patients are prone to other autoimmune disorders. Case report: We present a 52-year-old patient with DM1 and celiac disease who has been hospitalized 11 times for glucoregulation and insight into the progression of chronic complications (stationary nonproliferative retinopathy, sensorimotor neuropathy). The therapy included insulin degludec 20 units basally and insulin aspart with three main meals, but oscillating glycaemic values were often present. The patient was administrated insulin pump Paradigma Veo 754: basal insulin aspart on average 0.7 units/h, with bolus doses with three main meals. Five weeks after insulin pump administrition, a decrease in the frequency of hyperglycaemia was observed from 24 % to 11 %, the average blood glucose levels value decreased from 8.4 to 6.9 mmol/L. There were increases in the target range (4.4 - 12 mmol/L) from 71 % to 76 % and the estimated HbAlc was 6.5 %. However, the incidence of hypoglycaemia increased from 4 % to 13 %. Since the patient has DM1 and celiac disease, glycemic oscillations are expected, and better regulation could be achieved with the MiniMed 780G insulin pump. Conclusion: The use of an insulin pump in DM1 reduces fasting glycaemia, postprandial hyperglycaemia, hypoglycaemia, and average HbA1C. Part of the goals has been achieved, but for better glycaemic regulation, an insulin pump that predicts high and low glycaemic values and adjusts insulin doses according to measured glycaemic values is planned.

autoimmune diseases ; diabetes mellitus type 1 ; insulin

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