Case Study One – 10 Year Old Girl In Need Of An Ultra-Rapid-Acting Insulin
“Diane,” a 10 year old girl, was diagnosed at age 5 with type 1 diabetes. Several months after diagnosis and initiation of insulin therapy by injection, she continued to experience high blood glucose levels (150-200 mg/dl) in the afternoon and around dinner time, so she was put on an insulin pump. However, she then began experiencing hyperglycemia mid-morning, afternoon, and early evening, likely driven by her strong preference for high-carbohydrate foods. The blood glucose levels increased 1 to 2 after hours after eating the high carbohydrate foods and then decreased to the normal or hypoglycemic range in 3 to 4 hours after the bolus was given. Despite decreasing insulin doses and giving the bolus 10-15 minutes prior to eating, the patient still had elevated post-prandial blood glucose levels with worsening hypoglycemia within two to three hours of a bolus...
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Case Study Two – 68 year-old male in need of a rapid-acting U-500 insulin
DW is a 68 year old white male who developed type 2 diabetes 20 years ago. At the time of his diagnosis his weight was 275 lbs, height 73 inches (BMI 36.4). His initial HbA1c was 9.8%. For 15 years DW battled his weight and achieved variable glycemic control, with fluctuating HbA1c levels ranging from 7.2 to 9.2%. Various approaches were employed, including oral agents, MDI injections of insulin aspart and glargine, and eventually continuous subcutaneous insulin infusion in combination with rosiglitazone and metformin. When rosiglitazone was discontinued due to cardiovascular concerns, DW’s insulin requirements jumped to nearly 200 units total of basal and bolus insulin daily. It was decided to initiate U-500 R insulin via CSII, which had the immediate benefit of reducing DW’s insulin volumes, but introduced new problems with glycemic control due to the long-acting nature of U-500 R...
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