Endocrine Abstracts

HCL insulin pumps represent a major advancement in diabetes management. However, their use in residential settings remains underexplored. This case describes a 27-year-old woman who is unable to self-care diabetes. She has Trisomy 21, type 1 diabetes for five years, total hypoglycaemia unawareness, primary hypothyroidism, coeliac disease, and oesophageal achalasia. She resides in residential care, has limited vocabulary and experiences sensory issues with insulin injections. Progression of achalasia necessitated a percutaneous endoscopic gastrostomy (PEG) tube for nutrition. Despite basal-bolus insulin therapy and real-time CGM, her glycaemic parameters were suboptimal (average glucose 14.5mmol/l, GMI 9.6%, Time-in-Range 15%, Very High-Above-Range 57%, High-Above-Range 28%, HbA1c; 61mmol/mol), with frequent hospitalizations for hypo- and hyperglycaemia, weight gain (BMI 43 kg/m2), and reduced quality of life. The Diabetes MDT explored the Metronic MiniMedTM 780G HCL insulin pump with her family and caregivers. Twenty-two residential staff were trained via virtual/in-person sessions covering pump functions, set changes and SmartGuard technology. The Diabetes MDT provided close in-person/virtual follow-ups, adjusting the PEG feeding plan and HCL settings. Over 13 months on the pump, she achieved improved and sustained glycaemic ranges (GMI 7.1%, Time-in-Range >70%, Time-below-Range 0-1%, HbA1c 53 mmol/mol), and enhanced quality of life with only two brief hospital admissions. She became energetic, engaged in daily activities and lost 5 kg. Her caregivers reported markedly reduced diabetes-related distress. This case suggests HCL technology, combined with a skilled MDT support, offer substantial and sustained benefits in residential care. Further research is warranted to optimize HCL use for individuals unable to self-manage diabetes.