The Continuous subcutaneous insulin infusion treatment with continous glucose monitoring system affects to poor diabetes control: a case report

Abstract

Background and Aims: Diabetes can pose a risk to both mother and child and therefore requires careful management. Methods: In this case, we present the benefits of advanced medical technologies for better diabetes control. Results: A 35-year-old female patient, who was diagnosed at age 5 with insulin-dependent diabetes mellitus, is referred to an endocrinologist for poor glycemic control while attempting to conceive. She was treated with multiple insulin injections, but despite the diabetes education diabetes control was poor with frequent severe unnoticeable hypoglycemia followed by hyperglycemia (HbA1c 8.0%). Diabetic nephropathy (albumin excretion rate 49.5 mg per 24 h), proliferative retinopathy and polyneuropathy were observed. In 2014-2016 (when she was pregnant for the first time), CSII treatment was used and diabetes control improved (HbA1c6.4%). However, due to skin reactions (rash at the site of the patches and pain at the site of the needle stick), the patient stopped using the insulin pump and continued treatment with multiple insulin injections. In 2022, a panel of physicians decided that in the presence of very poor disease control (TIR31%, readings below target 10%, HbA1c 12.4%), treatment with an insulin pump with CGM and stopping insulin in the presence of hypoglycemia was appropriate. As a result, the patient became pregnant at 2 months and disease control improved: HbA1c at baseline was 7,8%, TIR 56%. When she was 5 months pregnant, her subtarget values dropped to 0%,HbA1c to 5.6% and TIR 70%. Conclusions: It is important to start the use of advanced technologies in order to avoid at serious health complications during pregnancy and childbirth.