A 25-year-old graduate student presented to the endocrine clinic with insidious onset of recurrent hypoglycemia. She was diagnosed with type 1 diabetes 7 months prior, following an episode of mild diabetic ketoacidosis (DKA) successfully treated in the emergency department (ED).

She initiated basal bolus insulin therapy with dramatic improvement in her HbA1c from 13.4% at diagnosis to 6.1% within a few months after starting insulin therapy. Her initial labs confirmed type 1a diabetes with a markedly elevated glutamic acid decarboxylase-65 antibody titer and a low, but not entirely undetectable, C-peptide level of 0.32 ng/mL. She is otherwise healthy without other medications or comorbidities, except for a daily oral contraceptive pill. Her BMI is 22 and her total daily insulin dose was 0.4 units/kg at the time of follow-up 3 months after her initial diagnosis.

Within a few months after diagnosis, a personal continuous glucose monitoring device (CGM) was prescribed, which measures glucose changes in the interstitial fluid in the subcutaneous tissue. CGM is often a useful adjunct for close glucose monitoring in an active young individual with type 1 diabetes.

This article originally appeared on Endocrinology Advisor