Endocrine Abstracts

Introduction: Hemolytic-uremic syndrome (HUS) is a clinical condition characterized by nonimmune hemolytic anemia, thrombocytopenia and progressive kidney failure mediated by E.Coli Shiga-like toxin. In rare cases the inflammatory process may lead to beta-cell necrosis and, hence, overt diabetes mellitus. Post-HUS DM is characterized by severe insulin depletion and very high insulin sensitivity, making its therapeutic management particularly challenging.

Case report: We report the case of a 3 years old female admitted to her town emergency department for fever (39°C) associated with diarrhea, generalized oedema, oliguria and drowsiness. Blood test revealed metabolic acidosis, leucocytosis, increased inflammatory markers, anemia, thrombocytopenia and acute kidney failure. Based on the diagnosis of Haemolytic-uremic syndrome the patient was referred to a third level children hospital. Assisted ventilation, haemodialysis and parenteral nutrition was instituted. Blood glucose levels increased above 200 mg/dl with peaks at 500 mg/dl. GAD-Ab and ICA were negative and C-peptide below normal values. Therefore, multiple daily injections (MDI) insulin therapy was instituted with the following regimen: detemir 2U daily, aspart 0.5U for BG>200 mg/dl. Despite very low amount of insulin, the patient experienced frequent and severe hypoglycaemia in the following 24h. MDI was replaced with Sensor-Augmented Pump (SAP) therapy set at 0.025U/h basal rate and 0,05U/g Insulin:Carbohydrates ratio for meal boli. Optimal glucose control was achieved without hypoglycaemia. Moreover, excellent glucose control was maintained after enteral and oral nutrition introduction.

Discussion: This case illustrates the potential role for SAP therapy in the management of a severe insulin deficient post-HUS diabetes in a 3 years old child. Although glucose control is challenging due to the high insulin sensitivity, low insulin requirement and consequent high risk of hypoglycaemia, SAP therapy optimization offers an effective and versatile treatment option. Furthermore, early SAP therapy initiation might be beneficial in terms of infection resolution and timely recovery.