Background Transient neonatal hyperglycemia is a common metabolic complication encountered in premature infants, particularly those born at extremely low gestational ages. Neonatologists typically express concern regarding hyperglycemia when the plasma glucose concentration, as measured by the standard laboratory test, exceeds 180 to 200 mg/dL (10 to 11.1 mmol/L). The delicate balance of glucose regulation in these vulnerable neonates is often disrupted due to immature pancreatic function and other physiological factors. Hyperglycemia in this population is associated with an increased risk of adverse outcomes, including long-term neurodevelopmental and metabolic issues. As a result, effective management strategies are imperative to mitigate these risks and promote optimal growth and development.

In this case, we present our experience with using subcutaneous insulin Degludeg in managing temporary neonatal hyperglycemia.

Case Report(s) We present a case of a 24-week gestation premature female baby with extreme low birth weight 780 grams and neonatal hyperglycemia since birth. Despite initial attempts to manage blood glucose levels through non-insulin therapies and reducing glucose infusion rate (GIR), the baby exhibited persistent significant hyperglycemia that was refractory to usual treatment but demonstrated a favorable response to long-acting subcutaneous insulin Degludeg.

Subcutaneous insulin Degludeg therapy was started at the age of 21 days when baby’s weight was 860 grams at a dose of 0.5 units on first day and increased next day to 1 unit daily. Blood glucose was monitored every 4 hours. Flash glucose sensor was also applied to the thigh for continuous glucose monitoring. Degludeg was used daily for 2 weeks and then stopped as blood glucose readings remained less than 150 mg/dL thereafter.

Conclusion(s) Managing transient neonatal hyperglycemia/transient neonatal diabetes in extreme premature infants poses unique challenges, requiring a careful balance between glycemic control and the delicate nature of their underdeveloped physiology. While management strategies for transient neonatal diabetes exist, there is limited literature detailing the management in the context of extreme prematurity, particularly involving the use of novel therapeutic agents such as subcutaneous insulin degludec.

Insulin degludec offers a longer duration of action, allowing for once-daily dosing and reducing the risk of hypoglycemia. Its ultra-long half-life and stable pharmacokinetic profile make it an ideal option for maintaining stable blood glucose levels in this vulnerable population of extreme preterm infants.

By sharing this case report, we aim to contribute to the existing knowledge on managing transient neonatal hyperglycemia in extreme premature infants. The utilization of subcutaneous insulin degludec in this context highlights an alternative therapeutic approach that can potentially optimize glycemic control, minimize treatment burden, and improve long-term outcomes.