Managing Type 1 Diabetes With Obesity: What One Case Study Showed

Type 1 diabetes is an autoimmune condition where the body can't make insulin. But some people with Type 1 diabetes also develop features more commonly seen in Type 2 diabetes—like excess weight, insulin resistance (when the body doesn't respond well to insulin), and acanthosis nigricans (dark, velvety skin patches).

When both conditions occur together, doctors sometimes call it 'double diabetes.' This creates a difficult cycle: as insulin resistance grows, patients need higher insulin doses, which can lead to more weight gain, which worsens insulin resistance further.

Researchers reported on an 11-year-old girl with antibody-positive Type 1 diabetes who was using an insulin pump. Over time, her insulin needs grew so large that she was running out of pump capacity—a sign of severe insulin resistance alongside her Type 1 diabetes.

To address both her insulin deficiency and her insulin resistance, doctors tried an experimental approach: adding a once-daily injection combining basal insulin (degludec) and a GLP-1 receptor agonist (liraglutide) to her existing insulin pump therapy. This is an off-label use—meaning the combination is not officially approved for this purpose.

The girl continued using her insulin pump for mealtime insulin, while the combined medication provided basal (background) insulin plus the GLP-1 medication's effects on appetite, weight, and insulin sensitivity.

Over the eight-month follow-up, the patient showed several improvements. Her weight decreased by 2.2 kilograms, and her BMI z-score (a measure that accounts for age and height) improved.

Her blood sugar control also strengthened. Her average glucose level fell from 196 mg/dL to 139 mg/dL, and her glucose management indicator—a measure similar to A1C—improved from 8.0% to 6.6%. The time she spent in severe hyperglycemia (above 250 mg/dL) dropped from 26% to 15%.

The adjunctive therapy also reduced the total daily insulin dose she needed to deliver through her pump, suggesting the GLP-1 component was helping her body use insulin more effectively.

This is a single case report—one patient's story. It shows what happened in one situation but does not prove the approach is safe or effective for other children with double diabetes.

The medication combination used is not currently approved for pediatric Type 1 diabetes. Any use of it in children would be experimental and off-label, decided on a case-by-case basis by a diabetes care team.

To understand whether this strategy could help more young people, larger, controlled research studies would be needed. This case illustrates a potential therapeutic avenue but is not evidence of standard practice or a treatment that families should expect or pursue without specialist guidance.

Source: Cureus. Evidence type: PubMed indexed literature. Type1Cure is an information and intelligence hub, not a medical advice service. This article summarizes published research and does not provide diagnosis, treatment, or personal medical guidance. Always talk to your own care team before changing anything about your Type 1 diabetes management.