Worldwide, nearly 40% of adults are overweight and 13% are obese. Health consequences of excess weight include cardiovascular diseases, type 2 diabetes, dyslipidemia, and increased mortality. Treating obesity is challenging and calorie restriction often leads to rebound weight gain. Treatments such as bariatric surgery create hesitancy among patients due to their invasiveness. GLP-1 medications have revolutionized weight loss and can reduce body weight in obese patients by between 15% and 25% on average after about 1 year. Their mode of action is to mimic the endogenous GLP-1, an intestinal hormone that regulates glucose metabolism and satiety. However, GLP-1 drugs carry known risks and, since their use for weight loss is recent, may carry unforeseen risks as well. They carry a boxed warning for people with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. Gastrointestinal adverse events (nausea, vomiting, diarrhea) are fairly common while pancreatitis and intestinal obstruction are rarer. There may be a loss of lean body mass as well as premature facial aging. A significant disadvantage of using these medications is the high rate of weight regain when they are discontinued. Achieving success with pharmacologic treatment and then weaning to avoid future negative effects would be ideal.

We report a case series of 4 patients with type 1 diabetes who used hybrid closed-loop insulin pumps (Medtronic MiniMed 670 G) during hospitalization. Clinical data and point-of-care glucose values are presented for each patient. Glucose values are shown graphically while in manual mode as well as in auto mode. The first case was a 30-year-old man admitted for pancreatitis. Mean point-of-care blood glucose was 165.7 mg/dL while in auto mode, without hypoglycemia, compared with 221 mg/dL while in manual mode. The second case was a 28-year-old woman who was admitted for a laparoscopic cholecystectomy. Mean point-of-care blood glucose in auto mode was 131.3 mg/dL, without hypoglycemia, compared with 117.6 mg/dL while in manual mode. The third case was a 46-year-old man admitted to the intensive care unit for influenzal pneumonia. Mean point-of-care blood glucose in auto mode was 159.1 mg/dL without hypoglycemia, compared with 218.5 mg/dL while in manual mode. The fourth case was a 60-year-old man who remained in auto mode throughout his hospitalization except for a period when he removed his pump for an endoscopic retrograde cholangiopancreatography and endoscopic ultrasound. His mean point-of-care blood glucose while in auto mode was 156.8 mg/dL without hypoglycemia. These case reports support the use of hybrid closed-loop insulin-pump therapy in the inpatient setting to maintain inpatient glycemic targets and avoid hypoglycemia when part of an institution-sanctioned strategy for safe use of insulin pumps that includes point-of-care blood glucose monitoring.

Capiversatib is a pan-Ak strain transforming inhibitor used in combination with fulvestrant for the treatment of hormone receptor-positive advanced breast cancer and has a known adverse effect of hyperglycemia. We present 3 cases of severe hyperglycemia, 2 of which presented as diabetic ketoacidosis, in patients being treated with capivasertib. These cases demonstrate the severity of hyperglycemia that can result from capivasertib use, as well as highlight treatment regimens and patient outcomes.

Objective: The ideal inpatient insulin regimen efficiently attains the target blood glucose range, effectively treats hyperglycemia, and minimizes the risk of hypoglycemia. The objective of this study was to compare glycemic targets achieved by using correctional monotherapy (CM) and basal-bolus therapy (BBT) in insulin-naive patients in the inpatient setting to determine optimal blood glucose management for these patients. Design: This was a retrospective observational cohort study of 792 patients with diabetes not on home insulin therapy who were admitted to an academic hospital over a 5.5-month period. The percentages of hyperglycemic and hypoglycemic values in each group were compared. Results: Among the 3,112 measured blood glucose values obtained from 792 patients within the first 24 hours of insulin administration, 28.5% were hyperglycemic in the BBT group compared with 23.5% in the CM group. When adjusted for covariates, there was a 23% decrease in hyperglycemia in the BBT group (incidence rate ratio = 0.77, 95% CI 0.64–0.95, P = 0.006). Increases in A1C and admission blood glucose, as well as decreases in admission creatinine and inpatient steroid use, were independently associated with higher rates of hyperglycemia, adjusted for all other covariates. There was no significant difference between the groups in the rate of hypoglycemia in the first 24 hours, which was 1.9% in the BBT group and 1.4% in the CM group (P = 0.301). Conclusion: Utilizing BBT in insulin-naive patients admitted to the hospital within the first 24 hours of insulin administration results in lower rates of hyperglycemia without higher rates of hypoglycemia when compared with CM.

We describe a patient with acromegaly presenting in diabetic ketoacidosis who was able to achieve euglycemia despite discontinuation of all antihyperglycemic therapy prior to surgical or medical treatment for his acromegaly. No previous cases of acromegaly presenting in diabetic ketoacidosis have reported glycemic normalization without antihyperglycemic therapy prior to acromegaly treatment. Our case highlights this unique outcome and postulates that pancreatic β-cell resiliency may be influential on insulin resistance since our patient achieved euglycemia despite a persistent state of excess growth hormone and insulin-like growth factor-1. Our case further emphasizes that consideration for acromegaly should be given in patients presenting with severe insulin resistance and pertinent medical history and physical examination features, and it emphasizes the dramatic range of insulin requirements in patients with acromegaly.