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A standardized approach based on dietary and multiple daily insulin injections for the management of diabetes in infants

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Abstract

Plasma glucose control in the neonates and infants with diabetes based on dietary and multiple daily insulin injections is highly difficult. In this study, the infants were fed at 3- to 4-h intervals. All patients were started on insulin therapy with 0.6 U/kg/day divided equally into four doses. The morning, noon, and evening doses were given as premixed insulin (25% insulin lispro and 75% insulin lispro protamin sulphate), while the night insulin dose was given as premixed or neutral protamin Hagedorn (NPH) insulin according to the feeding frequency during the night. Nine-point capillary blood glucose profiles, HbA1c, and anthropometric measurements were evaluated. The study had 15 infants diagnosed with neonatal diabetes (ND) or type 1 diabetes mellitus (T1DM). The mean duration of the follow-up was 22.9 ± 8.7 months. During the follow-up, all patients had experienced sufficient weight and length gains and had experienced neither any episode of ketoacidosis nor wide fluctuations in blood glucose levels. Hypoglycemia, normoglycemia, and hyperglycemia were reported in 9.1, 79.9, and 11% of all the blood glucose measurements, respectively. Severe hypoglycemia was not experienced by any patients. The mean HbA1c levels in the patients with ND and T1DM at the last visit were 7.0 ± 0.2 and 7.6 ± 0.56%, respectively. The findings suggest that our approach is useable for plasma glucose control without wide fluctuations in infants with diabetes.

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Acknowledgements

The authors are grateful to Andrew Hattersley and Sian Ellard (Peninsula Medical School, Molecular Genetics Royal Devon & Exeter NHS Hospital, Exeter, United Kingdom), Jukka Kallijarvi (Folkhälsan Research Center, University of Helsinki, Helsinki, Finland), and Roger Colobran (Hospital University Vall d’Hebron, Barcelona, Spain) for the molecular genetic tests in cases 1–5. All genetic tests were done free of charge. They also thank Ayhan Tastekin (Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey) for the cooperation and participation in case 5.

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Authors and Affiliations

  1. Department of Pediatric Endocrinology, Faculty of Medicine, Ataturk University, Erzurum, Turkey

    Hakan Doneray & Ayse Ozden

  2. Haci Salih Efendi M. Ebu Ishak C. TEMA sitesi, A Blk. 4/15, Yenisehir, 25070, Erzurum, Turkey

    Hakan Doneray

  3. Department of Pediatrics, Faculty of Medicine, Ataturk University, Erzurum, Turkey

    Remziye Seda Yesilcibik

Authors
  1. Hakan Doneray
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  2. Ayse Ozden
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  3. Remziye Seda Yesilcibik
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Correspondence to Hakan Doneray.

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The study was approved by the Ataturk University of Medical Sciences ethics committee. Written informed consent form was signed by parents.

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The authors declare that they have no conflicts of interest.

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Doneray, H., Ozden, A. & Yesilcibik, R.S. A standardized approach based on dietary and multiple daily insulin injections for the management of diabetes in infants. Int J Diabetes Dev Ctries 38, 345–352 (2018). https://doi.org/10.1007/s13410-017-0590-1

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  • DOI: https://doi.org/10.1007/s13410-017-0590-1

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