PMC10211331_01
PMC10211331_02
CGM profile of infant 2 during treatment with insulin and/or glibenclamide. (A). Only CSII therapy (both basal and bolus delivered by CSII). (B). CSII (only basal insulin) and glibenclamide therapy divided into three meals. (C). Only glibenclamide therapy divided in three meals. (D). Only glibenclamide therapy divided into six meals. The arrows indicate the administration of glibenclamide during meals. Abbreviations: CSII, continuous subcutaneous insulin infusion pumps.
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Using CSII therapy, insulin administration was easier, given the small accounts of insulin needed, but glucose variability was still high ( Figure 1A ). Glibenclamide was started after nine days of hospitalization with a dose of 0.08 mg/kg/day till a maximum of 0.31 mg/kg/day, divided into three oral doses per day ( Figure 1B ). At home, glibenclamide treatment was modulated according to the boy's meal requests, choosing to administer the therapy, in a smaller amount, at every meal ( Figure 1C ). Glibenclamide was administered with a dose of 0.20 mg/kg/day, divided into six meals, showing a good glycemic profile ( Figure 1D ).
Insulin and Glibenclamide tiltration of infant 2. Modulation of insulin and glibenclamide doses (mg/kg) during hospitalization. The figure shows a progressive reduction of insulin doses during glibenclamide tiltration, till insulin was discontinued.
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Insulin therapy was discontinued 16 days after the hospital admission, seven days after glibenclamide's first administration.  Figure 2  shows the modulation of insulin and glibenclamide doses during hospitalization.
Glycemic profile of infant 2 during the follow-up. The figure describes the glycemic profile of the boy after the CGM was positioned. The timing of the follow-up is expressed in weeks from the first CGM positioning. In the first two weeks insulin therapy was gradually switched to glibenclamide therapy. In the following weeks, when the boy was only on glibenclamide treatment, an increased TIR was observed in his glucose profile. Abbreviations: CGM, continuous glucose monitoring; TIR, Time in Range.
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The patient's glycemic control during the follow-up is reported in  Figure 3 .