Case report about treatment of the patient with DM Type 2 on multiple injections of insulin who with the help of continuous glucose monitoring (CGM) improved and was controlled only on anti-diabetic pills and GLP1 - RAG

We would like to describe a patient who was treated for decompensated Diabetes Mellitus Type 2(DM type 2) with Multiple Injections of Insulin per day. His HbA1c while when he visited our clinic was above 14 %. He was self-monitoring his Blood sugar at home (SMBG) 4- times a day. He was treated only with Metformin ER in the past. The CGM was started in Internal Medicine Residency Clinic. The patient start sharing his CGM data with the clinic through Dexcom G6 CGM and compatible I phone. The patient was educated on diet, how to adjust his insulin at home based on written instruction material. Moreover, the patient was called at least once a week by the Medicine Clinic professional how to adjust his insulin and to counsel him about his diet and physical activity. The patient had scheduled appointment to the clinic at least once a month.

After the glucotoxicity from the initial high blood sugar was managed by using the appropriate dose of insulin, the insulin dosages started to decrease in our patient. DM type 2 was well controlled with GMI less than 7% after starting the CGM. During the clinic visits, the morning fasting C- peptide of the patient was increased which we attribute due to his morbid obesity. These gave us the opportunity to start the patients on per oral antidiabetic medications and injectable GLP-1 receptor agonists (GLP-1-RAG).

The patient’s DM type 2 control was maintained 3-6 months after stopping the insulin with Glucose management index (GMI) which approximates HbA1c less than 7%.

Our experience with this patient showed that introduction of CGM instead of SMBG in the General Internal Medicine Residency Clinic can help patients with DM type 2 to improve their blood sugar control with Insulin and eventually stop the Insulin and start therapy with oral antidiabetic agents and or injectable GLP-1 -RAG. Also, we showed that this can be done safely in General Internal Medicine Residency clinic and not only in specialized clinics.