A Therapeutic Approach in A Patient with Neonatal Diabetes

Abstract

We describe a case of neonatal diabetes mellitus treated with insulin. The patient was a female with a birth weight of 1590 g, which was small for her gestational age. Although intravenous insulin infusion was started at 48 hours after birth, it was difficult to achieve a good glycemic control, which resulted in poor physical growth in spite of insulin infusion. Continuous subcutaneous insulin infusion (CSII) was started at 86 days after birth. Insulin requirement began to decrease after she reached 1 year of age, and insulin therapy was terminated at 14 months of age. When a VSD patch closure operation was performed at 2 years of age, insulin treatment by CSII was needed for only 10 days. Intrinsic insulin secretion provoked by glucagon was poor at 4 months, but had improved to some extent at 4 years. The patient's physical and neurological development has been normal until now without any diabetic complications. Recently hyperglycemia sometimes has occurred after meals, and her glycosylated hemoglobin has risen to 6.0%. Neonatal diabetes is very rare and most cases are reported to be of a transient type. Careful follow up of the clinical course for a long time and appropriate treatment, including CSII, will be necessary for individual cases.