TRANSIENT NEONATAL DIABETES MELLITUS TREATED WITH INSULIN INFUSION PUMPS AND PANCREATIC BETA CELL FUNCTION FOLLOWED BY URINARY C-PEPTIDE EXCRETION

Abstract

JM was a 1928 gram, 36-week small for gestation age male infant born to a Grav.-III, Para-0 mother. Hyperglycemia of 340 mg % was identified on arrival to the nursery. Conventional approach changing from regular to NPH insulin proved unsatisfactory. Thus regular S.C. insulin (U20) was administered every 3 hrs pre-formula feeding based on Glucometer blood heel stick glucose using a sliding scale insulin dosage of 0.1 to 0.5 units. Pen-Pump (U20 regular insulin) was utilized with manual administered pre-meal doses. Insulin syringes were refilled every 12 to 24 hrs and needle sites changed every 2 to 3 days. A trial on CPI Model 9100 ambulatory infusion pump was shown feasible with continuous insulin of 3 units/24 hr rate (U10 insulin). JM was discharged at 1 month of age on a Pen-Pump with home glucose monitoring pre-meals and sliding dose regular insulin. An infusion site staph aureus cellulitis resulted in rehospitalization. A new trial of NPH (U10) b.i.d. proved effective in management by six weeks of age in the range of 2.2 units b.i.d. As the NPH insulin dose decreased from 2.2 U b.i.d. to 0.3 U b.i.d. from 3 to 6 mos. of life, home glucose monitoring, hemoglobin A₁C and urine C-peptide were helpful guidelines. Urine C-peptide proved an effective means of following residual pancreatic beta cell function with recovery of diabetes by 6 mos. of age. Timed measured urine samples every 2 weeks showed a rise from nil C-peptide to 4.0 ng/ml with return of pancreatic beta cell function.

Urine C-Peptide measured by Immunex Tek-Pharma, Sorrento Valley,CA

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