Elsevier

The Journal of Pediatrics

Volume 128, Issue 2, February 1996, Pages 268-270
The Journal of Pediatrics

Ultralente insulin treatment of transient neonatal diabetes mellitus,☆☆,

https://doi.org/10.1016/S0022-3476(96)70406-7Get rights and content

Abstract

In an infant with transient neonatal diabetes mellitus, control of the blood glucose concentration was attained with ultralente insulin treatment, without any episodes of hypoglycemia. We recommend subcutaneous injection of ultralente insulin, rather than lente or isophane (NPH) insulin, to avoid hypoglycemia during the treatment of transient neonatal diabetes mellitus. (J PEDIATR 1996;128:268-70)

Section snippets

CASE REPORT

A female infant was born spontaneously at 39 weeks of gestation at Asahikawa Medical College Hospital. Birth weight was 1978 gm (–2.3 SD for gestational age). Apgar scores at 1 and 5 minutes were 7 and 9, respectively, and her subcutaneous tissue was reduced. Her mother, aged 31 years, had asymptomatic thyroiditis, and her great-grandfather and great-grandmother on her father's side had adult-onset diabetes mellitus.

Although the infant's blood glucose concentration was 5.9 mmol/L (106 mg/dl) 10

RESULTS

Blood glucose levels before subcutaneous injection of lente insulin and NPH insulin were 19.2 ± 2.6 mmol/L (mean ± SD, 346 ± 46 mg/dl) and 17.3 ± 2.9 mmol/L (311 ± 52 mg/dl), respectively, and decreased to 11.0 ± 4.6 mmol/L (199 ± 83 mg/dl) and 7.0 ± 3.3 mmol/L (126 ± 60 mg/dl) 2 hours after subcutaneous injection. Blood glucose levels before and 2, 4, 6, and 12 hours after subcutaneous injection of ultralente insulin were stable (Figure).

Figure. Changes in blood glucose levels (mean ± SD)

DISCUSSION

Gentz et al.1 indicated that giving small intermittent doses of regular insulin, while frequently measuring blood glucose levels, is the only safe way to avoid hypoglycemia during treatment of TNDM with insulin. However, previous reports have not described details of changing blood glucose levels after subcutaneous injection of regular insulin, intermediate-acting insulin, or long-acting insulin. In some patients treated with an intermediate-acting insulin or regular insulin, hypoglycemia has

References (8)

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  • Insulin therapy in neonatal diabetes mellitus: a review of the literature

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    One report did not specify the type of subcutaneous insulin used [53]. Another frequently described strategy involved subcutaneous administration of insulin from the beginning of therapy (nine cases), using short-acting insulin (followed by intermediate-acting insulin) [54], intermediate-acting insulin [17,21,55–58], or ultralente insulin [59]. Other reports did not specify the route and/or type of insulin used [7,55,60,61].

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    Although paediatricians face numerous difficulties in managing insulin therapy in the newborn period, very few data are available on the methods of insulin delivery in neonatal diabetes. In infants with transient neonatal diabetes mellitus, control of the blood glucose concentration was attained with ultralente insulin treatment, without any episodes of hypoglycaemia.95 These authors recommended subcutaneous injection of ultralente insulin, rather than lente or isophane (NPH) insulin, to avoid hypoglycaemia during the treatment of transient neonatal diabetes mellitus.

  • Molecular basis of neonatal diabetes in Japanese patients

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From the Department of Pediatrics, Asahikawa Medical College, Asahikawa, Japan

☆☆

Reprint requests: Ryo Mitamura, MD, Department of Pediatrics, Asahikawa Medical College, 4-5-3-11 Nishikagura, Asahikawa 078, Japan.

0022-3476/96/$5.00 + 0 9/24/69311

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