Type of publication:
Conference abstract
Author(s):
*Jones A.M.; *Basavaraju N.; *Moulik P.
Citation:
Diabetic Medicine. Conference: Diabetes UK Professional Conference 2024. London . 41(Supplement 1) (no pagination), 2024. Date of Publication: 01 Apr 2024.
Abstract:
A 42-year-old lady with complex diabetes was diagnosed age 19 years. She went on an insulin pump (Medtronic Minimed), Hba1c was 56 mmol/mol which crept up to 72 mmol/mol. She developed hypertension, nephropathy and laser treated retinopathy. Starting Freestyle Libre with Medtronic640 improved Hba1c down to 52 mmol/mol. Her social and financial circumstances, including being a single mum, deteriorated leading to diabetes distress and burnout. Healthcare and diabetes management became a burden. Ambulatory glucose profile (AGP) showed time in range (TIR) 28%, high (H) 23%, very high (VH) 42% and Hba1c71 mmol/mol. Counselling and motivational interviewing with regular support was provided. She had stopped all medications and insisted on a pump break. Hba1c increased to 118 mmol/mol, TIR14%, H5%, VH81%, mean glucose (MG) 23.3 mmol/L. She wanted to restart the pump and it was felt on previous pump therapy she had safer glucose levels and no ketoacidosis. AGP improved with TIR29%, H18%, VH52%, MG15.4 mmol/L in 2 weeks. After 3 months, TIR was 33%, H20% VH42%, Hba1c76 mmol/mol. Weight was increasing with associated diabulimia. Dulaglutide was started after counselling. TIR51%, H16%, VH9%, level 1 hypoglycaemia11%, level 2 hypoglycaemia13%. She started HCL (Medtronic 780G with Guardian G4) and Hba1c was 45 mmol/mol, TIR66%, H18%, VH15%, level 1 hypoglycaemia1%, level 2 hypoglycaemia0%. Her weight has come down from 99 to 82 kg with BMI 31.4 kg/m2. Renal function has improved (eGFR 33 to 42 mL/min). Quality of life (QOL) assessments show great improvement. This case highlights a life plan is as important as a health plan. A motivational and supportive approach, advanced technologies and some off-license medication reduced diabetes burden and improved patient engagement.
DOI: 10.1111/dme.15296
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