GLUCOSE CONTROL DURING CORONAVIRUS DISEASE IN TYPE 1 DIABETES PATIENT ON SENSOR AUGMENTED PUMP

Abstract

Introduction:Since the outbreak of novel coronavirus Sars-CoV-2 pandemic, much attention has focused on patients with diabetes due to increased risk of infection. This increased risk of infection is due to hyperglycemia induced immune dysfunction (damage to the neutrophil function, depression of the antioxidant system, and humoral immunity), micro- and macro-angiopathies, and greater requirement of medical interventions in these patients. Since it is well established that uncontrolled hyperglycemia impairs immune function in all forms of diabetes, it would be logical to presume that T1D, particularly if not well controlled, could have an increased risk of infection and intensifying glycemic control could serve as a means of primary prevention. We present the case of a patient with type 1 diabetes and mild clinical presentation of Sars-CoV-2 infection during June 2020, successfully managed with SAP (Sensor Augmented Pump Therapy, Medtronic Minimed Veo Enlite sensor). Case report: A 33 year old patient with history of type 1 diabetes for the last 14 years and primary hypothyroidism for 8 years, presented with fever, cough, muscle aches, headache and new loss of smell. RT-PCR smear confirmed the presence of a SARS-CoV-2. The last 8 years patient was on insulin pump therapy with intermittent use of glucose sensor. Her last A1c was 7.7% and she doesn’t have any diabetes complications. As it was a mild clinical presentation of COVID-19 (with absence of viral pneumonia and hypoxia) she did not require hospitalization and was able to manage her illness at home. Patient contacted our clinic and underwent online reeducation about “sick day rules”, upload of insulin pump data using CareLink Therapy Management Personal Software (Medtronic, Northridge, CA) and was advised to insert glucose sensor. We made daily online follow up of glucose profile and adjustments in insulin requirements. Basal dose of insulin was adjusted using temporary basal rate (70-80% of basal rate) which allowed stable glycemic control with Avg BG 8.9 ± 3.4mmol/L, GMI-6,2% (43,9 mmol/mol) during 14 days following confirmation of SarsCoV-2 infection. Conclusion: SAP is helpful in monitoring glucose during viral infections allowing prompt action and prevention of further complications like DKA. In settings of COVID-19 pandemic, remote monitoring enables physicians and other health-care professionals to intervene timely in patients and improve clinical outcomes.