Abstract
A 72-year-old man was diagnosed as having diabetes mellitus at the age of 60 years. At the age of 64 years, he started talking gliclazide. At the age of 69 years, insulin therapy with the insulin analog aspart and isophane insulin was started because of poor glycemic control. At that time, his glycosylated hemoglobin (HbA1c) level was 9.7%. Following insulin therapy, his glycemic control improved. At the age of 71 years, his glycemic control began to worsen again, with his HbA1c level increasing to 8.6%. An examination at an other hospital revealed insulin antibodies and an allergic reaction to insulin. Although the insulin therapy was changed from lispro (which produced a slight allergic reaction to insulin on a skin test) to miglitol, the poor glycemic control persisted and continuous subcutaneous insulin infusion (CSII) was started. Fasting hypoglycemia and daytime hyperglycemia persisted, and he was admitted to our hospital for 24-hour glucose monitoring using continuous glucose monitoring (CGM) . As detailed glucose variations were confirmed, we changed the patient's treatment to lispro taken three times a day after stopping CSII. This change in the patient's therapy enabled the insulin dose to be lowered from 67.3 to 40 units. We concluded that CGM is beneficial for the treatment of brittle diabetes in patients with insulin antibodies and who are unaware of their hypoglycemia, as in the present case.
