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?

JR was recently diagnosed with type 2 diabetes, but based on their history of pancreatitis, you suspect JR actually has Diabetes Type 3c. 

Which of the following symptoms match a diagnosis of Diabetes Type 3c?

MT is a 29-year-old with Type 1 diabetes who is currently 14 weeks pregnant. She uses a continuous glucose monitor (CGM) with concurrent fingersticks and uploads her glucose data weekly. Her CGM settings was already set to the recommended time in range and the latest CGM report shows the following: time in range (TIR): 67%, time below range: 6%, time above range: 27%.

Based on current ADA Standard of Care, which of the following statements is most accurate regarding her CGM values?

RT has type two diabetes and has been maintaining a time and range of 70% or greater. However, when they show up at the office, the last week’s time in range dropped to 30%. You ask what was different this week from the previous few months. RT tells you they went on a five day fishing trip and forgot their insulin.

Kyle is a 55-year-old man with type 2 diabetes for ten years. He was recently diagnosed with retinopathy in both eyes. His grandmother lost her eyesight due to diabetes. Due to this family history, he is very concerned about his new diagnosis. He uses a Libre continuous glucose monitor (CGM) to monitor his blood sugar levels. During your visit, he is preoccupied with checking his Libre CGM and tells you that he uses his glucometer to verify CGM readings at least four to six times per day. When you ask him about this, he reports that he can’t focus on his work or home life if he isn’t over 90% time in range.

AR lives with type 2 diabetes, and their waistline is 41 inches. Since their ALT and AST levels are elevated, you know they are at risk for steatosis (MASH). You quickly calculate their Fibrosis-4 Index (FIB-4), by plugging in AR’s Age, AST, ALT, platelet count into the FIB-4 calculator.  AR’s result is 2.83.

According to the ADA Standards, with a FIB-4 value of 2.83, which action is required?

MJ just discovered that in addition to their type 2 diabetes and a BMI of 31, they also have MASH. 

Based on this diagnosis, which FDA approved medication would help address their steatosis?

MS is a 59-year-old with type 2 diabetes who is struggling with frequent urinary tract infections. They are on metformin and empagliflozin, and their A1C is 7.3%.  MS has already received several courses of antibiotics.

Which of the following actions would you recommend?