We report on an 11-year-old female patient diagnosed as T1DM without ketoacidosis and treated with multiple daily injections (MDI). Because of confirmed positivity for celiac disease markers (EMA, IgA antitTG), after intestinal biopsy, a gluten-free diet (GFD) was started. During the first 3 years after T1DM diagnosis, the girl showed multiple glycemic fluctuations, with HbA1c mean values: 7.9% (HbA1c target values, according to ISPAD guidelines,3 ≤7.5%). Moreover, her body weight increased: BMI (kg/m2) was 19 (BMI-SDS= +0.8) 2 months after diabetes onset; 3 years later, it increased to 26.6 (BMI-SDS= +2). At the age of 14, she was introduced to the CSII pump (Roche Accu-Chek Combo®).
Her insulin requirement was 48 U/day (0.7 U/kg/day), specifically, 19.2 U as basal dosage and 28 U as pre-meal boluses. At the first control check after CSII beginning, three pre-meal boluses were reported in the logbook, as prescribed. With the use of the Accu-Chek Smartpix system®, the glucose data and the pump's data were transferred to the electronic record (Accu-Chek 360°®). The summing-up chart showed a clear imbalance between basal insulin and boluses: 22% versus 78%. The electronic diary showed data quite different from the personal logbook. The patient confirmed the intake of frequent and improper additional boluses, very close to each other (Figure 1). Every additional bolus was followed by food intake. The patient started weekly psychotherapeutic support, and a problematic relationship with food was identified. Binge-eating was diagnosed according to DSM-IV staging criteria.4
FIGURE 1.The Electronic Diary