Glycemic Control in Diabetic Patient with Pancreatic Head Tumor

Abstract

There has been a rapid growth in the number of diabetes patients using insulin pump therapy (IPT) in most developed countries around the world. In the period between 2004 and 2010, new pump users increased by over 30%, while the IPT discontinuation rate is low, at approximately 2%. The United States has the highest level of IPT use worldwide, with an estimated 350 000 to 370 000 IPT users, including those with type 2 diabetes. Of patients with T1D in the United States, 40% are on IPT. Other European countries, such as Germany and Norway, have over 15% of T1D patients treated with IPT. The main motivating factors relate to improved quality of life, reduction in hypoglycemia and a strong desire to improve glycemic control. 78 years old female came to our hospital with a complain of jaundice of the skin, pain in the epigastric region, poor appetite. The patient had an RFA due to livercell cancinoma. The patient was diagnosed with diabetes since 2005 used insulin novomix. Glycemic control 8,5-9,0%. On physical examination, jaundice of the skin, pain in the epigastric region. CECT: pancreatic head tumor, HCC in SIV of the liver , calculus cholecystitis. The ERCP was performed for management of mechanical jaundice. Selective deep cannulation of bile duct was done successfully. When the patient was contraindicated to eat insulin therapy was performed using a syringe pump. According to the recommendations of AACE for diabetic patients , the introduction of continuous subcutaneous insulin infusion into clinical practice reduces the risk of hypoglycemia, improves glycemic control and thereby the quality of life of patients. Glucose levels were monitored using a syringe pump for 4 days when the patient is contraindicated to eat. During these days there was no high fluctuation in glucose levels.