Endocrine Abstracts

On reviewing patients who are on Mixtard 30, We came across a 17-year-old Asian boy who was diagnosed to have type 1 DM and learning difficulties. We noted that his HbA1c was 5.5. According to notes he was on 16 and 8 units of Mixtard 30. We discovered that he has not been taking his evening insulin (other than a short period after diagnosis) because he was having low BM. His diet consist of burgers, orange juice, takeaways and some coke.

We have been gradually working on his diet and reducing his morning insulin.

On 29/10, We have stopped his insulin completely. He is under close follow up and remains Insulin free to date.

His story goes: Since the 2nd day of his life, he was found to be unduly sleepy with low blood sugars despite treatment with dextrose, hourly feeds and glucagon injection 6 h.

Blood taken during a hypo episode: insulin levels 305 C-peptide 1565.

U/S scan of the pancreas– cystic mass in the tail of pancreas.

– Subtotal pancreatectomy (Tail, body, head of pancreas removed).

Pathology report – Features consistent with nesidoblastosis

July 2005 – HbA1c – 6.0. Feb 06 – School nurse did some BM incluiding ones up to 20. In the clinic, HBAIC – 8.6.Patient had no symptoms of thirst, polyuria or nocturnal enuresis. Ketone testing was negative. Mix 30 – 22-morning/11-evening was started.

April 06 – HbA1c – 7.6 Nov 06 – BM ranged between 5–9.

Since then Hbaic – Aug 08 – 5.2, Aug 09 – 5.4, Jan 10 – 5.5, Sept 10 – 5.5.