Successful Termination of Insulin Therapy in Transient Neonatal Diabetes Mellitus

A report describes a case of a 29-day-old baby boy with fetal growth restriction and born by induction at 40 weeks. He was small for his gestational age and showed hyperglycemia of 413 mg/dL at four days of age. Blood analysis revealed glucose at 377 mg/dL and insulin at 1.0 μU/mL, prompting a diagnosis of Neonatal Diabetes Mellitus (NDM). 

He received a continuous intravenous insulin infusion, and his C-peptide was recorded as 0.08 ng/mL within 15 days.

At 29 days of age, the patient showed macroglossia and an umbilical hernia, thus directing 6q24-related diabetes mellitus. He received SAP therapy on the 39th day of life. The patient weighed 3,355 g on the first day of SAP therapy and received 0.075 U/h insulin dose for the following reasons: (i) High blood glucose levels for several days and (ii) Slower onset of insulin activity when administered subcutaneously. 

The patient showed improvement in blood glucose level, lowering from 170 mg/dL to 70 mg/dL in 2 h. His dose was then reduced to 0.05 U/h, resulting in no hypoglycemia and improved blood glucose control.  

The baby received a discharge at 58 days of age, with no hyperglycemia reported after that. Genetic analysis confirmed hypomethylation within 6q24 on one of the alleles, backing the diagnosis of 6q24-related diabetes mellitus.

Sakai R, Kikuchi N, Nishi D, et al. Successful Termination of Insulin Therapy in Transient Neonatal Diabetes Mellitus. Case Reports in Pediatrics. 2023;2023. https://doi.org/10.1155/2023/6667330