**2.4 Case report Daniel**

**Focus:** long-term inadequate compensation during therapy by insulin pump with an improvement after switching to a hybrid pump with CGM and SmartGuard.

**History:** Daniel (today 51 y/o) was diagnosed with T1D in 2000. Primarily, he experienced polydipsia (drinking almost ten liters per day). Upon examination, glycemia was 30 mmol/l. Insulin therapy was initiated, however, glycated hemoglobin HbA1c (70 mmol/mol) and unexpected hypoglycemia (twice a month) persisted. After 13 years (December 3, 2013), Daniel was given the Paradigm Veo 554 insulin pump (without CGM). Despite this, glycated hemoglobin showed no improvement. He was diagnosed with retinopathy in his left eye in 2015. It was recommended to regularly measure glycemia and learn to recognize hypoglycemia. The implementation of continuous monitoring with a new hybrid insulin pump MiniMed 780G made this easier and showed immediate improvement in glycated hemoglobin and a decrease in INS/d (**Figures 9** and **10**).

When asked to compare Paradigm Veo to the latest MiniMed 780G, which he started using in September of 2022, he stated that it is easy to work with especially thanks to its ability to connect to a mobile phone. Besides T1D, Daniel is also treated for hypertension (ramipril), nephropathy with interstitial and glomerular damage, hypercholesterolemia (rosuvastatin), and neuropathy (**Table 4**). In 2021, he developed a dental defect. Daniel received a glucometer Galileo Glu/Ket, in order to use it in circumstances such as vomiting, nausea, fever, etc. Namely, some of these symptoms were recently present without apparent explanation. Current TIR: 87% (January 5, 2023).


### **Table 4.**

*Daniel's clinical and laboratory parameters over 9 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*

## **Figure 9.**

*Daniel's absolute values of HbA1c, BM, and INS/d over 9 years. Since he has been diagnosed with T1D in 2000, he has been treated with insulin by delivering it* via *an insulin pen. His first insulin pump, Paradigm Veo 554, was implemented on December 3, 2013. Laboratory values were constant until the application of a sensor-augmented insulin pump in September 2022, when the HbA1c concentration decreased alongside a lower insulin dosage is needed (red box).*
