Ultralente insulin treatment of transient neonatal diabetes mellitus☆,☆☆,★
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).
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
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Cited by (19)
Insulin therapy in neonatal diabetes mellitus: a review of the literature
2017, Diabetes Research and Clinical PracticeCitation Excerpt :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].
Long-term follow-up of permanent neonatal diabetes in Tunisian infant
2010, Annales d'EndocrinologieNeonatal hyperglycaemia and abnormal development of the pancreas
2008, Best Practice and Research in Clinical Endocrinology and MetabolismCitation Excerpt :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.
Neonatal diabetes: a disease linked to multiple mechanisms
2007, Archives de PediatrieNeonatal and very-early-onset diabetes mellitus
2004, Seminars in NeonatologyMolecular basis of neonatal diabetes in Japanese patients
2007, Journal of Clinical Endocrinology and Metabolism
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From the Department of Pediatrics, Asahikawa Medical College, Asahikawa, Japan
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Reprint requests: Ryo Mitamura, MD, Department of Pediatrics, Asahikawa Medical College, 4-5-3-11 Nishikagura, Asahikawa 078, Japan.
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0022-3476/96/$5.00 + 0 9/24/69311