Sensor-augmented CSII therapy with predictive low-glucose suspend following total pancreatectomy

• Published in: Endocrinology, diabetes & metabolism case reports Vol. 2017; no. 1; pp. 1 - 5
• Main Authors: Scott, E S, Fulcher, G R, Clifton-Bligh, R J
• Format: Journal Article
• Language: English
• Published: England Bioscientifica Ltd 28.10.2017; Bioscientifica
• Subjects: Adult; Anxiety; Australia; Diabetes; Diabetes mellitus type 1; Female; Glucagon; Haemoglobin A1c; Hypercalcaemia; Hypoglycaemia; Iatrogenic disorder; Insulin; Insulin Aspart; Insulin glargine; Male; Multiple endocrine neoplasia (MEN) type 1; Neuroendocrine tumour; Novel Treatment; Oncology; Pancreas; Pancreatectomy; Pancreatic neuroendocrine tumour; Radionuclide imaging; Surgery; White; Glucagon; Oncology; Iatrogenic disorder; Diabetes mellitus type 1; Continuous glucose monitoring; October; Surgery; Novel treatment; Adult; Anxiety; Pancreas; Radionuclide imaging; Neuroendocrine tumour; Hypoglycaemia; Haemoglobin A1c; Multiple endocrine neoplasia (MEN) type 1; Pancreatectomy; Hypocalcaemia; Insulin; White; Insulin glargine; Insulin Aspart; 2017; Female; Male; Pancreatic neuroendocrine tumour; Hypercalcaemia; Diabetes; Australia; Continuous subcutaneous insulin infusion
• ISSN: 2052-0573; 2052-0573
• DOI: 10.1530/EDM-17-0093

Pancreatogenic diabetes is characterised by recurrent severe hypoglycaemia due to changes in both endocrine and exocrine functions. There are no guidelines to manage these individuals. Herein, we describe the post-operative management of two people who developed pancreatogenic diabetes following total pancreatectomy for neuroendocrine malignancy. In both individuals, diabetes was managed using sensor-augmented predictive low-glucose suspend continuous subcutaneous insulin infusion (CSII). We demonstrate the benefit of sensor-augmented CSII in averting hypoglycaemia whilst optimising glycaemic control. Expected rates of severe hypoglycaemia in individuals with pancreatogenic diabetes can be averted with the use of continuous glucose monitoring (CGM) technology, optimising quality of life and reducing the risk of diabetes-related complications. Learning points: There are no clear guidelines to manage people with pancreatogenic diabetes. We describe the use of CGM with predictive low-glucose suspend continuous subcutaneous insulin infusion (CSII) in the management of two individuals post-pancreatectomy. Predictive low-glucose suspend technology can achieve excellent glycaemic control whilst avoiding recurrent and severe hypoglycaemia in people with pancreatogenic diabetes. Predictive low-glucose suspend CGM should be considered as an effective therapeutic option for the management of pancreatogenic diabetes.