November 22, 2008: RSSDI, Hyderabad

At National Diabetes meeting held at Novotel, Hyderabad, Dr.Arun Shankar of JDC presented the paper on "Serious symptomatic hypoglycemia in a patient on insulin pump".More than 2500 doctors from all over India participated in the 3 day event.

Seen in the pictures are Jothydev Kesavadev, Arun Shankar, Sunitha etc.,

"Serious symptomatic hypoglycemia in a patient on insulin pump" Jothydev Kesavadev, Arun Shankar, Sunitha Jothydev. Jothydev's Diabetes and Research Center, Trivandrum.

In T1DM, high A1c and recurrent low sugars poses a treatment challenge. Use of Insulin pumps reduces hypos enabling patients maintain near normal sugars. This report of serious symptomatic hypoglycemia, requiring hospitalization, cautions us in taking into account multiple factors in determining basal profiles and bolus insulin dosages in patients with wide glycemic excursions, while on pump.

Here we document the case report of 26 y.o T1DM, 16 years duration, on MDI
from our center. He used to experience frequent hypoglycemias which easily got corrected by oral ingestion of glucose. His A1c remained >10% and was switched over to CSII. Initial insulin in pump was <20% previous dose. He was on daily follow up by our diabetes team.(Diabetes Tele-Management System-DTMS). One month later, ½ an hour after lunch, waiting for bus, he recalls symptoms of hypoglycemia, suspended pump but immediately fell down unconscious. He completely recovered in hospital. Later he underwent a series of educational sessions with diabetes team on carb counting, insulin
sensitivity factor, using bolus wizard, temporary basal at times of exercise and walking etc. He has now completed >2 years on pump with no further hypo but acceptable A1c.

Close follow up is mandatory during the initial 3-6 weeks so as to optimize insulin delivery. Smart pumps when combined with intellectual and mathematical skills of patients and care givers offers the best benefit of an advanced insulin delivery mechanism mimicking a normal pancreas only in motivated subjects.

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