A 32-year-old with newly discovered diabetes is brought to the emergency department with polyuria and lethargy. They have been sleeping more than usual.

Initial labs show:

• Plasma glucose: 680 mg/dL
• Potassium 3.7 mEq/L
• Serum osmolality: 335 mOsm/kg

Based on the following labs, which feature most strongly supports a diagnosis of hyperosmolar hyperglycemic state (HHS) rather than diabetes ketoacidosis (DKA)?

KC has type 2 diabetes, diagnosed 5 years ago. They report low physical activity, frequent sugar-sweetened beverage intake, and high stress related to work. Last A1c was 8.2%. KC reports previous advice to “exercise more and drink less soda,” but reports making minimal changes. They express interest in improving health but feels overwhelmed by where to start.

Which of the following responses best aligns with the 2026 ADA Standards of Care recommendations for facilitating positive health behavior change?

J.C. is a ten-year-old female with a family history of type 1 diabetes. Her 7-year-old brother was diagnosed with type 1 diabetes two years ago. J.C. has no complaints and reports feeling well. She enjoys playing sports, including basketball and soccer. Her current BMI is 22.1 (93rd percentile for age). She denies any polydipsia, polyuria, or polyphagia. Her lab work demonstrates a fasting blood sugar of 71 mg/dL, an A1c of 5.0%, normal kidney function, and normal electrolytes. Her diabetes autoantibody panel shows positive glutamic acid decarboxylase (GAD) and islet antigen 2 (IA-2) antibodies, negative zinc transporter 8 (ZnT8) antibodies, and negative insulin antibodies.

What does her lab work reveal?

Peripheral Artery Disease (PAD) is significantly underdiagnosed. While PAD affects around 8.5 million Americans and prevalence rises with age (up to 20% over 60), only 10-20% are clinically diagnosed, highlighting a major gap in awareness and screening. 

According to the ADA Standards, what needs to be included in the initial screening for PAD?

CS is a 42-year-old with type 1 diabetes for just over 18 years. In the past year, their A1C changed from 7.4% to 9.1%, and weight increased by 20 pounds. Review of CGM data suggests missed insulin boluses more than 7 times per week, and discussion with CS reveals missed clinic visits due to feeling “burned out”. They score in the moderate range on the Diabetes Distress Scale.

Based on the ADA 2026 Standards of Care, which of the following is the most appropriate next step?

Katie is a 14-year-old living with type 1 diabetes since age 10. She uses multiple daily insulin injections (MDI) therapy to manage her diabetes and started using a continuous glucose monitor (CGM) 3 months ago at the recommendation of her endocrinology team. Her A1c has increased to 9.2% since starting CCM technology. 

Her mother reports that Katie has episodes of prolonged hyperglycemia when she is away from home. When at home, her mother will remind Katie to bolus based on the alerts she gets on the CGM share app. Katie reports she mutes alarms and alerts because she doesn’t want her classmates to hear them, afraid they will judge her. When you ask if she has uploaded her data to the school nurse or her endocrinology team she says, “The app is really confusing.” Her mother is frustrated with Katie for not paying attention to the CGM, saying, “She can text her friends without any problem; I don’t know why she struggles with the CGM”.

JR has been diligently studying to take their CDCES exam at the end of January 2026.  They are wondering if they should study the 2025 or 2026 ADA Standards of Care.

As a mentor to healthcare professionals entering the field of diabetes, what do you recommend?