Insulin Glargine Dosing Every 16 Hours for a Complicated Type I Diabetes Case

ABSTRACT Objective: Type I diabetes mellitus (T1DM) is the most common type of diabetes during childhood. Insulin therapy is the mainstay of T1DM treatment, and glargine is long-acting insulin that is most commonly prescribed as a basal insulin therapy. Although glargine is typically administered once daily in the evening, alternative dosing frequencies and timings have been associated with promising results. Methods: A 23-year-old woman with a 16-year history of T1DM who was initially started on regular and neutral protamine Hagedorn insulin continued to have a poorly controlled glycated hemoglobin (HbA1c) level of 9.8% (84 mmol/mol). She was switched to glargine and glulisine, and her HbA1c improved to 8.5% (69 mmol/mol) with frequent high blood glucose readings at 12 PM. Her case was later complicated with gastroparesis and she was switched to an insulin pump. However, she suffered from two unexplained diabetic ketoacidosis episodes and opted to discontinue the pump therapy. Next, she was switched back to the glargine and glulisine but with the glargine insulin given twice daily. Results: The patient's HbA1c improved to 7.6% (60 mmol/mol) but with frequent episodes of hypoglycemia prior to the scheduled doses of glargine. For the next 4 months, glargine was dosed every 16 hours and her glycemic control dramatically improved. Her HbA1c improved to 5.5% (37 mmol/mol), her appetite improved, and she gained some of the weight that she had previously lost. Conclusion: Clinicians should individualize care and consider different dosing and timing methods for glargine when managing complicated T1DM cases. Abbreviations: BID = twice daily; DKA = diabetic ketoacidosis; DM = diabetes mellitus; GI = gastrointestinal; HbA1c = glycated hemoglobin; MDI = multiple daily injections; QHS = once at bedtime; T1DM = type I diabetes mellitus