Endocrine Abstracts

Basal insulin secretion is essential for the maintenance of fasting glucose levels, especially through inhibition of excessive hepatic glucose output. Insulin glargine U300 is a novel long acting basal insulin formulation that provides more stable effect than glargine U100. Because of the pharmacokinetic properties of glargine U300, the expected plasma insulin concentration is not achieved during the first 4 days of treatment. We report a case of diabetic ketoacidosis in the first day of glargine U300 treatment due to low plasma insulin concentration. A 62 year old female patient with diagnosis of type 2 diabetes mellitus (DM) for 25 years. Her medications include insulin aspart 12 unit three times daily, insulin detemir 22 unit once daily, metformin 1000 mg twice daily, linagliptin 5 mg. According to the patient’s anamnesis, it has been noticed that in addition to the especially night hypoglycemia, the blood glucose levels of fasting and postprandial in the evening were high and she said that did not adhere to her diet. Physical examination revealed that her BMI is 33 kg/m². Laboratory findings were as follows; HbA1c: 10.3%, c-peptide: 0.07 μg/L, Hb: 9.2 g/L, MCV: 89 fL, ferritin: 7.93 μg/L. The patient was hospitalized to regulate her blood glucose and to investigate anemia etiology. Insulin detemir, used by the patient were replaced by insulin glargine U300 U/mL, 30 units once daily because of the hypoglycemia at night and the high blood sugar levels in the evening. On the second day of treatment, abdominal ultrasound examination is demanded from the patient to research anemia etiology in the morning and as fasting. Blood glucose was measured 450 mg/dL after returning from the ultrasound when she had not eaten breakfast. It was detected that the ketone in the urine and pH: 7.29, hCO3: 14 mmol/L in the blood gas of the patient with complaints of nausea and fatigue. Insulin infusion was initiated by considering mild diabetic ketoacidosis in the patient. For treatment of insulin glargine U300 U/mL to be stable, 4 days must pass. For the first 4 days, it may be seen the diabetic ketoacidosis on the patients who have type 1 DM and, as in this case, long-term type 2 DM with decreased insulin reserve, that are treated with newly started insulin glargine U300 due to inadequate plasma basal insulin.