**2.3 Case report Clark**

**Focus**: continuously increased INS/d, and body mass along with near-optimal HbA1c concentration and hypoglycaemia when using insulin pump without CGM and followed by hybrid pump with SmartGuard.

**History:** At 20 years of age, Clark (today 46 y/o) was diagnosed with T1D. Education and treatment by means of insulin pen and multiple daily injections resulted in improvement in clinical and laboratory findings. Clark was compliant and had no problem adjusting to the insulin boluses according to meals and physical exercise at that time. In 2009, Clark received his first insulin pump. In 2013, insulin pump Paradigm Veo (without CGM) was implemented and, in 2017, replaced with MiniMed 640G. INS/d was high (routinely adopted according to intake of saccharides), but otherwise no other issues, in clinical and laboratory parameters (**Table 3** and **Figures 7** and **8**). In 2022 a hybrid insulin pump MiniMed 780G was introduced. Since that time Clark had troubles with his adaptation to the new algorithms dealing with saccharide ratio and insulin boluses. For example: after eating a roll for breakfast that contains 25 g of saccharides and noticing that the pump gives him only one unit of insulin, he would enter additional saccharides that he did not consume, until it would give him 2.5 units of insulin as he was used to. (Essentially ignoring that the pump gives him exactly what he needs at that moment.) This approach resulted in reoccurring hypoglycemia followed by increased food intake and growing body mass. Therefore, lower insulin doses resulting in reduced risk of hypoglycemia, lower body mass, and lower HbA1c may be reached provided Clark creates a deeper understanding of the algorithm behind MiniMed 780G. At the time he is able to manage MiniMed 780G. Current TIR: 87% (January 5, 2023).


Besides T1D, Clark also has hyperlipoproteinemia (diagnosed in 2014), treated with rosuvastatin, and unstable hypertension.

### **Table 3.**

*Clark's clinical and laboratory parameters from the diagnosis of T1D over the last 8 years.*

*Benefits of Implementation of Insulin Pump in People with Type 1 Diabetes: 10 Case Reports DOI: http://dx.doi.org/10.5772/intechopen.110073*
