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A case of an elderly patient with insulin-dependent diabetes and dementia receiving one basal insulin plus one bolus insulin injections a day for 6 months

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Abstract

Multiple daily injections of insulin, referred to basal–bolus regimen, are generally essential in achieving glycemic control and preventing ketosis in insulin-dependent diabetes, such as type 1 diabetes (T1D). A 75-year-old man with T1D receiving basal–bolus insulin therapy exhibited symptoms of dementia after hospitalization due to pyelonephritis and failed to continue insulin self-injection. Given that his social and familial circumstances allowed insulin injection once a day during the morning, bolus insulin injections needed to be discontinued. Ketonuria was observed the day following discontinuation of bolus insulin. Although increasing the basal insulin dose (degludec) from 10 to 15 units improved ketonuria, his preprandial glucose levels increased to ≥ 500 mg/dL before lunch and ≥ 400 mg/dL before dinner. Hence, another bolus insulin injection was simultaneously added to the basal insulin dose before breakfast, which, subsequently, decreased his preprandial glucose levels to ≤ 220 mg/dL before lunch and ≤ 350 mg/dL before dinner. For half a year after discharge, ketonuria or hypoglycemia had not been detected. After 6 months, he was able to restart intensive insulin therapy with familial support. Hence, in cases where elderly patients with diabetes exhibit symptoms of dementia and can receive insulin injection once a day due to their social circumstances, short-term one basal plus one bolus insulin injections a day might be considered to prevent life-threatening diabetes complications among those who are insulin-dependent.

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Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Odawara Municipal Hospital, 46 Kuno, Odawara, Japan

    Taichi Minami & Yoichi Suzuki

  2. Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan

    Taichi Minami, Jun Shirakawa & Yasuo Terauchi

  3. Department of Endocrinology and Metabolism, Saiseikai Yokohama-Shi Nanbu Hospital, Yokohama, Japan

    Taichi Minami, Akiko Kameda, Kaoru Watanabe, Taku Yamada, Hiroko Hiiragi, Soichiro Takeda & Mayuko Takahashi

Authors
  1. Taichi Minami
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  2. Jun Shirakawa
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  3. Akiko Kameda
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  4. Yoichi Suzuki
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  5. Kaoru Watanabe
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  6. Taku Yamada
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  7. Hiroko Hiiragi
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  8. Soichiro Takeda
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  9. Mayuko Takahashi
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  10. Yasuo Terauchi
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Corresponding author

Correspondence to Yasuo Terauchi.

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Conflict of interest

YT has received honoraria for lectures from MSD K.K.; Ono Pharmaceutical Co., Ltd; Nippon Boehringer Ingelheim Co., Ltd; Takeda Pharmaceutical Co., Ltd; Mitsubishi Tanabe Pharma Corp.; Daiichi Sankyo Co., Ltd; Sanwa Kagaku Kenkyusho Co., Ltd; Eli Lilly Japan K.K.; Sanofi K.K.; Dainippon Sumitomo Pharma Co., Ltd; Novo Nordisk Pharma Ltd; and Astellas Pharma, Inc., and has obtained research support from MSD K.K.; Ono Pharmaceutical Co., Ltd; Nippon Boehringer Ingelheim Co., Ltd; Takeda Pharmaceutical Co., Ltd; Daiichi Sankyo Co., Ltd; Novo Nordisk Pharma Ltd; Eli Lilly Japan K.K.; Sanofi K.K.; and Dainippon Sumitomo Pharma Co., Ltd.

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Informed consent was obtained from him and his wife for the case report.

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Minami, T., Shirakawa, J., Kameda, A. et al. A case of an elderly patient with insulin-dependent diabetes and dementia receiving one basal insulin plus one bolus insulin injections a day for 6 months. Diabetol Int 12, 135–139 (2021). https://doi.org/10.1007/s13340-020-00452-8

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  • DOI: https://doi.org/10.1007/s13340-020-00452-8

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