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?

SJ is 52 years old with a 10-year history of type 2 diabetes. They recently started on insulin degludec U-100 Flex Touch pen 15 units per day. At a follow-up visit, SJ brings their insulin pen and mentions they have been keeping it in their work bag since starting therapy. They are unsure how long they can continue to use this same pen.

What is the best advice for SJ for insulin storage in this situation?

Grace is a 38-year-old female who has lived with type 1 diabetes for 20 years. She is a nurse and works variable shifts. She voices concern today about her hemoglobin A1c being elevated at 8.4% over the past 6 months. She is doing everything she can to manage her diet, daily exercise routine, and reports rarely missing insulin doses. She is currently using a Dexcom G7 CGM.

She has never pursued insulin pump therapy because she was fearful that she would no longer be in control of her diabetes if she used a pump. She is now interested in an automated insulin delivery system and asks you which pump is “best” for controlling blood sugar.

What is the best way to answer this question?