MON-614 Management of glucose variability in a person with Diabetic gastroparesis with hybrid closed loop system.

Abstract Disclosure: A. Ramachandran: None. S.K. Azad: None. V. Perugu: None. S. Agarwal: None. We present a 69-year-old male with Type 2 Diabetes with Gastroparesis on a T:Slim X2 insulin pump with U-200 insulin for two years. He has occasional nausea and vomiting managed by diet modification. Continuous Glucose Monitoring (CGM) showed a Time in range (TIR) (70-180) of 61%, high(>180) of 36.5%, low(<70) of 2.4. Interpretation revealed variable blood sugars with post prandial hyperglycemia followed by hypoglycemia. He was administering meal bolus 2 hours after the meal and entered extra carbohydrates to manage hyperglycemia. However, due to variable absorption he receives auto-boluses from the pump prior to meal bolus causing insulin stacking. We used ‘sleep mode’ to turn off auto-bolus with the advice to bolus 30 minutes in an extended bolus form, post prandially. Discussion: Patients with gastroparesis often have inadequate glycemic control (GC). Management is challenging as delayed absorption complicates timing and dosing of insulin which exacerbates glycemic variability. Although no clear guidelines have been established for management of glycemia in diabetic gastroparesis, ADA recommends automated insulin delivery (AID) as it can dynamically adjust insulin delivery based on real-time CGM which improves TIR and reduces HbA1c without increasing hypoglycemia. Our case highlights that insulin stacking could occur with background auto-bolus use with AID in such cases and the importance of tailoring management. Presentation: Monday, July 14, 2025