Background and Aims

CASE-REPORT

DIABELOOP IN LONG STANDING TYPE 1 DIABETES WITH DEMENTIA

Menzen M¹, Ostrowski-Krause M¹, Otten F², Mohr S¹

1 Gemeinschaftskrankenhaus Bonn, Department of Endocrinology

2 Gemeinschaftskrankenhaus Bonn, Department of Geriatrics

85 years old woman with type 1 diabetes, diagnosed 1946. Now treated with multiple dose injection of insulin lispro to mealtime 1IU at morning, 0,5 IU at lunch and dinner per 10g carbohydrate and 6 Units of detemir once daily. HbA1c 60 mmol/mol, stimulated c-Peptid: 0,046ng/ml.

Concomitant diseases: Heart failure with preserved ejection fraction, pulmonary arterial hypertension. Frailty with severe sarcopenia (Frailty Share FI 75), incipient dementia (MMST 23/30) with dominant deficits in visuoconstructive skills.

2021 she suffered from two severe hypoglycemia stage III with falls and fracture of os pubis and cranial brain trauma. Both situations caused by unintentional double injection of bolus insulin. Even CGMS with Dexcom G6 supervised by social worker was not able to prevent the rapide drop of blood sugar.

Methods

We decided to switch therapy to automated insulin delivery with AccuChek insight, Dexcom G6 combined with Diabeloop DBLG1 with insulin aspart. No meal annoncement was done. She ate 40g of carbohydrates to each meal.

Results

Tissue glucose in mean was ~180mg/dl with no hypoglycemia and rise after meal up to a maximum of 284 mg/dl for a few minutes with rapid drop to upper range targets. Betahydroxybutrate measured in this situations has been in normal ranges.

Conclusions

This is the first case report of AID use in long standing type 1 diabetes with dementia to our knowledge.