A Research Guide for
Type 1 Diabetes

When evaluating any treatment claim, ask these questions:

• Is the evidence from a peer-reviewed medical journal and established guidelines, or from an individual testimonial?
• Has it been tested specifically in type 1 diabetes (not type 2) in a randomized clinical trial?
• Could it interfere with insulin therapy or affect blood sugar control?
• Does anyone without a financial interest in the product recommend it?
• Are endocrinologists at major diabetes centers using it?

Be especially cautious of anyone who claims T1D can be cured with diet, supplements, or alternative protocols, or who suggests that insulin is harmful or unnecessary. Stopping insulin in type 1 diabetes is life-threatening. This advice has caused deaths. Build on standard evidence-based care — never replace it.

Some complementary approaches — such as mindfulness meditation, yoga, and structured exercise programs — have evidence supporting their use for stress management and overall well-being alongside standard T1D care. However:

• Always tell your endocrinologist about every supplement before starting it. Some can affect blood sugar levels or interact with other medications.
• Chromium, cinnamon, and other “blood sugar” supplements have been studied primarily in type 2 diabetes and have no established role in T1D management.
• No supplement replaces insulin in T1D. Period.
• Complementary means “in addition to,” not “instead of.” Any provider who tells you to stop insulin or reduce it based on a supplement protocol is putting your life at risk.

T1D is diagnosed based on a combination of symptoms, blood sugar levels, and autoantibody testing:

• Symptoms: Excessive thirst, frequent urination, unexplained weight loss, fatigue, blurred vision, and sometimes nausea or vomiting (signs of DKA).
• Blood glucose: Random blood glucose above 200 mg/dL with symptoms, fasting glucose above 126 mg/dL, or HbA1c of 6.5% or higher.
• Autoantibody testing: Blood tests for diabetes-related autoantibodies confirm the autoimmune nature of the disease. The four key autoantibodies are GAD65 (GADA), insulin autoantibodies (IAA), IA-2 antibodies, and ZnT8 antibodies. Having two or more positive autoantibodies strongly confirms T1D.
• C-peptide: This test measures how much insulin your pancreas is still producing. In T1D, C-peptide is low or undetectable, especially as the disease progresses.

In adults over 30, T1D is misclassified as type 2 diabetes roughly 40% of the time. If you have been diagnosed with type 2 but are lean, losing weight rapidly, not responding to oral medications, or have a family history of autoimmune disease, ask your doctor about autoantibody testing.

If you or your child has been diagnosed with T1D, first-degree relatives (parents, siblings, children) have a significantly higher risk of developing it. Autoantibody screening can identify at-risk family members years before symptoms appear:

• TrialNet offers free autoantibody screening for first-degree relatives ages 2.5 to 45 at over 200 sites worldwide, including the University of Utah.
• If one autoantibody is positive, the person is monitored regularly.
• If two or more autoantibodies are positive with normal blood sugar (Stage 1), close monitoring begins.
• If two or more autoantibodies are positive with abnormal blood sugar (Stage 2), teplizumab treatment can be considered to delay Stage 3.

Early detection through screening prevents the dangerous scenario of a child presenting in DKA as their first sign of diabetes. DKA awareness campaigns at diagnosis have been shown to reduce DKA rates by 50–70% in at-risk populations.

The first weeks after a T1D diagnosis are a steep learning curve. Here is what typically happens and what to focus on:

• Week 1–2: Starting insulin therapy (usually basal-bolus with injections), learning to check blood sugar, beginning to understand carb counting basics, and meeting your diabetes care team (endocrinologist, diabetes educator, dietitian).
• Week 2–4: Adjusting insulin doses based on blood sugar patterns, starting CGM if available, learning sick day rules, and beginning to develop a routine.
• Month 1–3: Fine-tuning insulin-to-carb ratios and correction factors, discussing pump and AID options, first follow-up HbA1c, and connecting with support resources.
• The “honeymoon period”: Many newly diagnosed people experience a temporary improvement where the pancreas still produces some insulin. Blood sugars may be easier to manage, and insulin doses may decrease. This is normal and does not mean the diagnosis was wrong. The honeymoon typically lasts weeks to months (sometimes up to a year or longer) before beta-cell destruction becomes complete.

Do not expect to master everything immediately. T1D management is a skill that develops over months and years. Give yourself grace during this period.

Not all diabetes fits neatly into Type 1 or Type 2. Understanding these variants matters for getting the right treatment:

• LADA (Latent Autoimmune Diabetes in Adults): An autoimmune form of diabetes diagnosed in adults, often initially mistaken for T2D. Positive for GAD65 antibodies. May respond briefly to oral medications but eventually requires insulin, typically within months to a few years.
• MODY (Maturity-Onset Diabetes of the Young): A group of monogenic (single gene) forms of diabetes. Autoantibody-negative with strong family history. Some forms respond to sulfonylurea pills rather than insulin. Requires genetic testing to diagnose.
• Neonatal diabetes: Diagnosed before 6 months of age. Often caused by specific gene mutations. Many cases can be treated with sulfonylurea pills instead of insulin.

If your diabetes does not behave as expected for T1D or T2D, discuss these possibilities with your endocrinologist. Correct classification can change your treatment entirely.

Many people with T1D are diagnosed after presenting to the emergency room with diabetic ketoacidosis (DKA) — a dangerous condition where the body, starved of insulin, breaks down fat for energy and produces toxic ketones. If this happened to you or your child, it is important to understand:

• DKA at diagnosis is common and does not mean anyone failed — it means the disease was not yet recognized.
• Going forward, DKA is preventable with proper education, ketone monitoring during illness, and never stopping basal insulin.
• Know the warning signs: nausea, vomiting, abdominal pain, fruity-smelling breath, rapid deep breathing, confusion.
• When to check ketones: blood glucose above 250 mg/dL, during any illness, or if you feel unwell with no clear cause.
• Blood ketone (BHB) testing is preferred over urine ketone strips — it is faster and more accurate.
• Seek emergency care if blood ketones exceed 1.5 mmol/L, if vomiting persists, or if there is any change in consciousness.

T1D comes with a lot of numbers. Knowing what each one actually tells you helps you focus on what matters and not get overwhelmed:

• HbA1c (“A1c”) is your average blood sugar over the past 2–3 months, reported as a percentage. Most adults aim for below 7%, and children for below 7.5%, but targets are individualized. A1c is useful but has a blind spot: it is an average, so it cannot tell the difference between steady, in-range days and a rollercoaster of highs and lows that happen to average out to the same number.
• Time in range (TIR) fills that gap. Measured by your CGM, it is the percentage of the day your glucose sits between 70 and 180 mg/dL. A common goal is more than 70% (about 17 hours a day) in range, with less than 4% of the day below 70. Many people find TIR more motivating than A1c because they can see it change day to day and connect it to what they did.
• Time below range is the safety number — the percentage of time under 70 mg/dL. Keeping this low (under 4%, and very little under 54) matters as much as the time in range, because lows are the immediate danger.
• C-peptide measures how much insulin your own pancreas is still making. It is mainly used around diagnosis to confirm T1D and, sometimes, to track how much of your own insulin production remains. A very low or undetectable C-peptide is typical of established T1D.

One healthy reframe: aim for “good,” not “perfect.” No person and no device keeps blood sugar perfectly flat. A day that is 70% in range with few lows is an excellent day. Chasing a flawless line tends to cause more lows and more stress, not better health.

• Which autoantibodies were tested, and which were positive?
• What is my C-peptide level, and what does it tell us about my remaining beta-cell function?
• Should my family members be screened through TrialNet?
• Could this be LADA, MODY, or another form of diabetes rather than classic T1D?
• What is my HbA1c at diagnosis, and when should we recheck it?
• Was I in DKA at diagnosis, and what do I need to know to prevent it from happening again?
• Can you connect me with a diabetes educator and a dietitian experienced with T1D?

People with T1D typically use a combination of background (basal) and mealtime (bolus) insulin:

• Rapid-acting (bolus): Insulin lispro (Humalog), insulin aspart (NovoLog), insulin glulisine (Apidra). Onset in 10–20 minutes, peak 1–2 hours. Taken before meals and to correct high blood sugar.
• Ultra-rapid-acting: Faster aspart (Fiasp), lispro-aabc (Lyumjev). Onset in 2–5 minutes. Can improve postmeal glucose spikes, especially in pump users.
• Long-acting (basal): Insulin glargine (Lantus, Basaglar, Toujeo), insulin detemir (Levemir). Provides steady background insulin over 20–24 hours. Taken once or twice daily.
• Ultra-long-acting (basal): Insulin degludec (Tresiba). Duration exceeds 42 hours, providing very stable basal coverage with flexible dosing timing.

A note on insulin icodec (Awiqli): This once-weekly basal insulin was FDA-approved in March 2026, but only for type 2 diabetes. It is not approved for T1D due to higher rates of hypoglycemia in clinical trials. Its long half-life makes low blood sugar episodes harder to manage in T1D. Off-label use in T1D would be inappropriate.

There are two main ways to deliver insulin:

• Multiple daily injections (MDI): One or two injections of long-acting insulin per day for background coverage, plus rapid-acting insulin injections before each meal and for corrections. Requires 4–6+ injections per day. Flexible and does not require wearing a device.
• Insulin pump (CSII): A small device worn on the body that delivers rapid-acting insulin continuously in tiny amounts (basal rate), with additional doses (boluses) at mealtimes. Allows fine-tuned adjustments, multiple basal rate patterns, and extended boluses for complex meals.

ADA 2026 guidelines now state that there is no requirement for C-peptide levels, autoantibody results, or a minimum duration of insulin use before starting pump therapy. If you or your child wants a pump, the conversation should begin at diagnosis.

The everyday mechanics of insulin matter more than people expect — poor technique or storage is a common, fixable reason blood sugars are harder to control than they should be.

Storing insulin:

• Keep unopened insulin in the refrigerator (not the freezer — frozen insulin is ruined and must be discarded).
• The pen or vial you are currently using can be kept at room temperature (generally up to ~30 days, but check the specific product) — room-temperature injections are more comfortable.
• Protect insulin from heat and direct sunlight. In hot weather or travel, use an insulated case. Insulin left in a hot car can lose potency, which shows up as unexplained high blood sugars.
• Inspect before use: most insulins should be clear; discard if cloudy, discolored, or containing particles (except the intentionally cloudy NPH/premixed types).

Injection and site technique:

• Rotate your sites. Injecting or wearing a pump site in the same spot repeatedly causes lipohypertrophy — lumpy, scarred tissue under the skin. Insulin absorbed from these lumps is erratic and unpredictable, a leading hidden cause of swings. Rotate systematically across the abdomen, thighs, upper buttocks, and backs of the arms.
• Use a fresh needle each time. Reusing needles dulls them, hurts more, and contributes to site problems.
• Change pump infusion sets on schedule (typically every 2–3 days). Leaving a set in too long risks poor absorption, irritation, and the kind of silent insulin failure that can lead to DKA.
• Feel for lumps. If you notice firm or rubbery areas, stop using them until they heal, and tell your care team — switching to fresh tissue can noticeably improve control.

If your blood sugars suddenly become erratic for no clear reason, check these basics first: insulin that may have overheated, a needle or set that has been used too long, and overused injection sites. These simple causes are easy to overlook and easy to fix.

Pumps and automated systems get most of the attention, but many people with T1D manage excellently on multiple daily injections (MDI) — by choice, because of cost or coverage, or while deciding about a pump. MDI is a completely valid approach, and a CGM plus good technique closes much of the gap with automation.

• Pair MDI with a CGM. This is the single biggest upgrade for injection users — real-time readings, trend arrows, and low alerts give you most of the safety benefits of technology without a pump. ADA 2026 recommends CGM for everyone on insulin, however it is delivered.
• Consider a smart insulin pen or pen cap. These record the dose and timing of every injection and connect to an app, so you can see your insulin alongside your CGM data. They quietly solve the most common MDI problem — “did I already take that dose?” — and help you and your team spot missed boluses.
• Use a long-acting basal that fits your life. Ultra-long options like degludec offer flexible timing and fewer overnight lows, which can make MDI more forgiving.
• Pre-bolus your meals. The 10–15-minute pre-meal timing trick matters even more on MDI than on a pump, because there is no algorithm catching the post-meal rise for you.
• Keep correction doses sensible. Avoid “stacking” corrections — giving another dose before the last one has finished working (usually 3–4 hours) — which is a common cause of lows on MDI. Let your CGM trend, not just the current number, guide whether to correct.

If you are happy and well-controlled on injections, you do not have to switch to a pump. And if you ever want to, the door is open at any time — there are no prerequisites to qualify.

A CGM is a small sensor worn on the body (usually the arm or abdomen) that measures glucose levels every 1–5 minutes and sends the data to your phone or a receiver. Key CGM systems available today:

• Dexcom G7 / G7 15-Day: Highly accurate (MARD ~8%), 10- or 15-day sensor wear, no calibration needed, customizable high and low alerts, integrates with Omnipod 5 and Tandem Control-IQ pumps.
• FreeStyle Libre 3 / 3 Plus: Very small sensor, 14- or 15-day wear, accurate (MARD ~8–9%), lower cost option, real-time glucose alerts.
• Medtronic Guardian 4 / Simplera: 7-day wear, integrates with the Medtronic 780G pump system.

ADA 2026 recommends CGM from the point of T1D diagnosis for everyone using insulin. CGM is also now recommended for monitoring presymptomatic T1D (Stage 1–2) to track progression. Most commercial insurance plans and Medicare now cover CGM for people with T1D.

AID systems (sometimes called “closed-loop” or “artificial pancreas” systems) combine an insulin pump with a CGM and a control algorithm that automatically adjusts insulin delivery based on glucose readings. Three FDA-cleared systems dominate:

• Omnipod 5 (Insulet): Tubeless, waterproof pod worn on the body. Integrates with Dexcom G7. SmartAdjust algorithm automatically increases, decreases, or suspends insulin. No tubing — popular with children and active individuals.
• Tandem Control-IQ (t:slim X2 / Mobi): Tubed pump with the Control-IQ algorithm. Integrates with Dexcom G7. Predicts glucose levels 30 minutes ahead and adjusts basal delivery. Mobi is a smaller, more discreet pump option.
• Medtronic 780G (MiniMed): Tubed pump with SmartGuard algorithm and Guardian 4 CGM. Auto-corrects with micro-boluses every 5 minutes. Adjustable glucose target as low as 100 mg/dL.

Real-world studies show all three systems significantly improve time in range compared to standard pump or injection therapy. ADA 2026 guidelines now recommend AID systems as the preferred insulin delivery method for all people with T1D — adults and children. There is no longer a requirement for C-peptide testing, autoantibodies, or a minimum time on insulin before starting an AID system.

With multiple CGM and AID options available, the choice can feel overwhelming. Factors to consider:

• Lifestyle and body type: Omnipod 5 is tubeless and waterproof, making it popular for children, athletes, and people who prefer no tubing. Tandem and Medtronic pumps use tubing but offer different algorithm behaviors and reservoir sizes.
• CGM preference: If you strongly prefer Dexcom, your AID options are Omnipod 5 or Tandem Control-IQ. If you prefer the Medtronic ecosystem, the 780G pairs with Guardian 4 / Simplera sensors.
• Insurance coverage: Coverage varies by plan. Some insurers have preferred devices. Your endocrinologist’s office can help navigate prior authorizations.
• Comfort with technology: All AID systems require initial setup and learning, but they become routine within 1–2 weeks. Ask your diabetes educator for hands-on training.
• No wrong choice: Real-world studies show that all three FDA-cleared AID systems significantly improve outcomes. The best system is the one you will use consistently.

Remember: ADA 2026 guidelines removed all barriers to starting AID. You do not need to “prove” anything first. If you want an AID system, the conversation starts now.

Regardless of how insulin is delivered, understanding how food affects blood sugar is essential:

• Carb counting: Most people with T1D count grams of carbohydrate at each meal and dose rapid-acting insulin accordingly, using an insulin-to-carb ratio (e.g., 1 unit per 10g carbs). A registered dietitian experienced with T1D is invaluable for learning this skill.
• Correction factor: An additional insulin dose to bring high blood sugar back into range (e.g., 1 unit drops glucose by 40 mg/dL).
• Fat and protein effects: High-fat and high-protein meals can cause delayed glucose rises over 3–5 hours. AID systems handle this better than MDI alone, but awareness helps.
• Pattern recognition: Reviewing CGM data weekly with your care team helps identify trends (e.g., consistent morning highs, post-lunch spikes) and adjust settings.

AID systems reduce but do not eliminate the need for carb counting. You still need to enter carbs for meal boluses, but the system handles the fine-tuning in between.

Automated insulin delivery is the biggest advance in daily T1D management in a generation, but it works best when you understand what it actually does. The most important thing to know: AID is not autopilot. The system automatically manages your background insulin and quietly corrects highs between meals — but every current system still needs you to count carbs and give a meal dose (bolus) at each meal. People who expect the system to “handle everything” are often disappointed by post-meal spikes; people who understand the division of labor get excellent results.

Here is how to get the most out of it:

• Always bolus for meals. The algorithm cannot see food coming. Skipping or forgetting meal doses is the single most common reason blood sugar runs high on an AID system.
• Count carbs as accurately as you can. The system fine-tunes around your meal dose, but it cannot fix a meal dose that was far too small. If carb counting feels hard, ask for a refresher with a dietitian — it is the highest-value skill in T1D.
• Stay “in automation” as much as possible. Sensor warm-ups, lost signal, or frequently overriding the system all reduce the benefit. Keeping the sensor working and trusting the algorithm is what drives the improvement in time in range.
• Use the activity/exercise mode. Turning it on an hour or two before exercise raises the target and helps prevent lows.
• Give it a few weeks. Most people reach their improved steady state within 2–4 weeks. Early on, it is normal to feel unsure; resist the urge to over-correct every reading.

Remember the research finding that there is no single “best” system — the best one is the one you will wear consistently and use well. Your starting glucose control and your engagement matter more than which brand you choose.

Two simple habits often make the biggest difference in smoothing out blood sugars — and neither requires new technology.

Pre-bolusing (dosing before you eat). Rapid-acting insulin takes about 15 minutes to start working, but food — especially carbohydrates — can raise blood sugar much faster. If you dose at the first bite, the food wins the race and you get a spike before the insulin catches up. Giving your meal dose 10–15 minutes before eating (when blood sugar is in range and not dropping) lets the insulin and the food peak together, flattening the after-meal rise. This one change frequently improves post-meal numbers more than any dose adjustment. (Skip pre-bolusing if you are already low, if the meal is uncertain, or for young children who may not finish eating — ask your team about timing in those situations.)

Reading your patterns instead of single numbers. A single glucose reading is a snapshot; the real insight comes from patterns over days. When you review your CGM data (ideally with your care team every few weeks), look in this order:

• Lows first. Are there lows clustering at a particular time (overnight, before lunch, after exercise)? Fixing lows is the priority — both for safety and because the rebound highs that follow lows distort everything else.
• Then variability. Are your lines all over the place, or fairly consistent day to day? Erratic patterns usually point to timing, missed doses, or carb-counting issues — worth solving before chasing tighter targets.
• Then the highs. A consistent spike after the same meal suggests that meal needs more insulin or earlier pre-bolusing; a steady overnight climb usually means background insulin needs adjusting.

This “lows, then variability, then highs” order keeps you from the common trap of simply adding insulin to lower an average that is actually being pushed up by rebounds from unrecognized lows.

Time in range (TIR) is increasingly used alongside HbA1c as the primary measure of glucose management:

• Target range: 70–180 mg/dL (3.9–10.0 mmol/L)
• Goal: More than 70% of the day in range (roughly 17 hours)
• Below range (<70 mg/dL): Less than 4% of the day (roughly 1 hour)
• Significantly below range (<54 mg/dL): Less than 1% of the day
• HbA1c target: Less than 7% for most adults; less than 7.5% for children and adolescents (individualized)

Perfection is not the goal. Glucose variability is inherent to T1D, and no human — and no technology — can keep blood sugar perfectly flat. A day that is 70% in range is an excellent day. Do not let perfect be the enemy of good.

There is no “diabetic diet” you must follow with T1D — you can eat the foods you enjoy, as long as you dose insulin to match. That said, a few practical insights make eating smoother:

• Carbohydrates drive the biggest, fastest glucose rise, which is why carb counting is the foundation of meal dosing. But fat and protein matter too.
• High-fat, high-protein meals (pizza, creamy pasta, large steaks) cause a slower, later glucose rise that can show up 3–5 hours after eating. Some people use an “extended” or “dual-wave” bolus on a pump, or a small follow-up dose, to cover this — ask your team about strategies.
• The order and form of food changes the spike. Eating vegetables and protein before carbs, choosing whole grains over refined, and avoiding sugary drinks (which spike glucose almost instantly) all blunt the rise. Liquids hit faster than solids.
• Pre-bolusing helps most with carb-heavy meals — dosing 10–15 minutes ahead gives insulin a head start.
• Treat lows with fast carbs, not a feast. The “Rule of 15” (15g fast carbs, wait 15 minutes, recheck) prevents the common cycle of over-treating a low and then rebounding high.

A dietitian experienced with T1D is genuinely worth seeing — not to put you on a restrictive plan, but to help you dose accurately for the way you actually like to eat. Flexibility, not deprivation, is the modern approach.

Hypoglycemia (blood glucose below 70 mg/dL) is the most common acute complication of insulin therapy and one of the greatest fears of people with T1D and their families:

• Mild to moderate (54–70 mg/dL): Symptoms include shakiness, sweating, hunger, rapid heartbeat, irritability, and difficulty concentrating. Treat with the “Rule of 15”: consume 15 grams of fast-acting carbohydrate (4 glucose tablets, 4 oz juice, or regular soda), wait 15 minutes, recheck, and repeat if still below 70.
• Severe (<54 mg/dL): May involve confusion, slurred speech, loss of coordination, seizure, or unconsciousness. The person may not be able to self-treat. Administer glucagon immediately (nasal glucagon such as Baqsimi is easiest for bystanders) and call 911 if there is no response within 15 minutes.
• Hypoglycemia unawareness: Some people with long-standing T1D lose the ability to feel early warning symptoms of low blood sugar. CGM with predictive low alerts is critical for these individuals. AID systems that suspend insulin before lows occur can be transformative.
• Fear of hypoglycemia: This is a recognized clinical issue that can lead people to run blood sugars chronically high to avoid lows. Address this with your care team — modern technology (CGM and AID) can reduce hypoglycemia frequency dramatically.

Every household and school where someone with T1D lives should have glucagon available, and the people around them should know how to use it. Practice with a training device before an emergency happens.

Illness can cause blood sugar to spike dramatically and increase the risk of DKA. These rules are essential:

• Never stop basal insulin — even if you cannot eat. Your body needs basal insulin to prevent DKA, regardless of food intake.
• Check blood sugar more frequently — every 2–3 hours, or rely on CGM alerts set to tight ranges.
• Check blood ketones when glucose is above 250 mg/dL or if you feel unwell. Blood BHB testing is more reliable than urine strips.
• Stay hydrated — drink water or sugar-free fluids consistently. If unable to keep fluids down, seek medical care.
• Adjust insulin: You may need more insulin during illness, not less. Follow your sick day plan from your endocrinologist.
• Emergency thresholds: Seek immediate medical care if blood ketones exceed 1.5 mmol/L, vomiting persists and you cannot keep fluids down, blood glucose stays above 300 mg/dL despite correction insulin, or there is any confusion or altered consciousness.

AID systems can help during illness by increasing automated insulin delivery, but they are not a substitute for active monitoring. Preliminary 2025 data shows improved glycemic stability during illness with AID vs. standard pump therapy, but vigilance remains essential.

Technology failures happen. Knowing how to respond prevents dangerous situations:

• CGM signal loss: If your CGM loses signal, do not panic. Check that the transmitter is properly seated on the sensor and that your phone or receiver is within range. You can always fingerstick to check blood sugar while troubleshooting.
• Pump occlusion alarm: This means insulin is not flowing properly. Change the infusion site immediately. Check blood sugar and correct with an injection if it is high. Check for air bubbles in the tubing, kinked tubing, or a bent cannula at the site.
• Unexplained high blood sugar on a pump: If glucose is above 250 mg/dL and not responding to pump corrections, suspect a site problem. Give a correction dose by injection (pen or syringe), change the infusion site, and check ketones. This is the most common cause of DKA in pump users.
• AID system exit: If your AID system drops out of auto mode (due to sensor loss, calibration, etc.), it reverts to your pre-set basal rates. Make sure your backup basal settings are current.
• Always carry backup supplies: Insulin pen or syringe, extra CGM sensor, extra pump site, glucose meter and strips, and a phone charger. Technology is powerful but not infallible.

• Am I a candidate for an automated insulin delivery system? If not now, what needs to happen first?
• Which CGM system is best suited for my situation and insurance coverage?
• What are my insulin-to-carb ratios and correction factor, and when should they be adjusted?
• What is my current time in range, and how does it compare to the recommended targets?
• What is my sick day plan? Can I have written instructions to keep at home?
• Are there newer insulin formulations that might work better for me?
• How do I handle insulin and pump management during exercise?

Diabetes distress is a well-recognized clinical condition — not a character flaw and not the same as depression (though they can overlap):

• What it is: The emotional burden of living with a demanding chronic condition. Frustration, exhaustion, feeling overwhelmed by the relentlessness of daily management, guilt about glucose numbers, and fear of complications.
• How common it is: Studies suggest 20–40% of people with T1D experience significant diabetes distress at any given time.
• Why it matters: Untreated distress leads to reduced self-management, higher HbA1c, avoidance of glucose checks, and increased risk of complications.
• Screening: The ADA recommends annual screening for diabetes distress, depression, anxiety, fear of hypoglycemia, and disordered eating. The T1-DDS-7 is a validated 7-item screening tool. Only about 16% of diabetes centers currently screen more than half their patients — if your clinic does not screen, bring it up yourself.

You are allowed to be tired of this disease. That does not make you a bad patient. It makes you human. The goal is to recognize when the burden is affecting your care and to ask for support before it becomes a crisis.

The intersection of T1D and eating disorders is a serious and under-recognized issue:

• The constant focus on food, carb counting, and weight that T1D requires can create an unhealthy relationship with eating.
• Insulin omission (“diabulimia”): Deliberately reducing or skipping insulin to lose weight. This is extremely dangerous and leads to DKA, accelerated complications, and death. It is more common in young women with T1D.
• If you or someone you care about is restricting insulin for weight control, this is a medical emergency that requires specialized treatment from a team experienced with both diabetes and eating disorders.

There is no shame in this. Eating disorders in T1D are driven by the disease itself and the psychological demands it creates. Treatment exists and recovery is possible.

Exercise is strongly recommended for everyone with T1D — it improves cardiovascular health, insulin sensitivity, mental well-being, and overall quality of life. However, it requires planning:

• Aerobic exercise (running, cycling, swimming) typically lowers blood sugar. You may need to reduce insulin or consume carbs before and during activity.
• Anaerobic and high-intensity exercise (weightlifting, sprinting, competitive sports) can temporarily raise blood sugar due to adrenaline and cortisol release.
• CGM is essential during exercise — set low alerts at a higher threshold (e.g., 100 mg/dL) and start activity with glucose trending flat or slightly rising.
• AID systems during exercise: Most systems have an exercise or activity mode that raises the glucose target. Activate it 1–2 hours before exercise for best results.
• Post-exercise lows: Blood sugar can drop hours after exercise, especially overnight. Reduced basal insulin or a bedtime snack may be needed.

Many elite athletes have T1D. Exercise is not something you do despite diabetes — it is one of the most powerful tools for managing it.

T1D is managed not just with insulin but with attention — and attention is a limited resource. Two often-overlooked factors, sleep and stress, affect both your blood sugar and your capacity to keep managing it well.

Sleep and blood sugar work both ways. Poor or short sleep increases insulin resistance, so glucose tends to run higher and be harder to control the next day. In the other direction, overnight lows, frequent CGM alarms, and worry about going low can wreck sleep — for both people with T1D and the parents of children with T1D. Some practical levers: use your CGM’s predictive low alerts and (if you use AID) its overnight automation, which is specifically good at preventing nocturnal lows; set alarm thresholds thoughtfully so you are warned about genuine danger without being woken constantly; and talk to your team about adjusting evening insulin if lows or highs cluster overnight. Better overnight control and better sleep reinforce each other.

Stress raises blood sugar directly. Stress hormones (cortisol, adrenaline) push glucose up, so a stressful week can show up on your CGM even if nothing else changed. Beyond the physiology, chronic stress drains the mental energy that good diabetes management requires — making it easy to skip checks, miss boluses, or stop reviewing data. This is not a willpower failure; it is the predictable result of a relentless condition.

Strategies that protect your energy:

• Automate what you can. AID systems, CGM sharing, pharmacy auto-refills, and supply subscriptions reduce the number of decisions and tasks you carry.
• Aim for “good enough” on hard days. Safety first (avoid severe lows and DKA); perfection can wait. Diabetes does not require an A-plus every day.
• Take real breaks from the data. You do not have to look at every reading. Reviewing patterns a few times a week, rather than reacting to every number, is both effective and sustainable.
• Ask for help early. Diabetes distress and burnout are common and treatable. A counselor experienced with chronic illness, a peer-support group, or simply telling your care team “I’m exhausted by this” can change things. The ADA recommends yearly screening for distress and depression — if your clinic does not ask, bring it up.

Managing the mental load is not separate from managing diabetes — it is part of it. Protecting your energy is what makes good control sustainable over years, not just weeks.

Type 1 diabetes is largely invisible, which means the people around you only understand it if you tell them. How much you share is entirely your choice, and it can vary by setting — but there is one practical floor worth meeting: the people you spend the most time with should know enough to help you in an emergency. A severe low can leave you unable to help yourself, and in that moment a friend, partner, coworker, or teammate who knows what to do is genuinely lifesaving.

At a minimum, make sure a few key people know three things: that you have type 1 diabetes; what a low blood sugar looks like in you (which might be confusion, shakiness, irritability, sweating, or slurred speech that can resemble intoxication); and what to do about it — give you fast sugar if you are awake and able to swallow, and, if you cannot, use your glucagon and call emergency services. Glucagon today is simple: nasal sprays and pre-filled auto-injectors require no mixing, and a 60-second walkthrough is enough to teach someone. Keep it somewhere findable and tell people where it is.

Beyond emergencies, deciding how openly to live with T1D is personal. Many people find that being matter-of-fact about it — checking glucose or dosing insulin without hiding — reduces their own stress and quietly educates those around them. Others prefer to keep it private in some settings. Both are valid. A few situations are worth thinking through in advance:

• Work: You are not obligated to disclose to an employer, but doing so allows formal accommodations (under the Americans with Disabilities Act in the US) such as breaks to check glucose, eat, or treat a low. At minimum, consider telling one trusted colleague who could recognize and respond to a low.
• Dating and relationships: There is no “right” time to mention T1D — share when it feels comfortable. A partner who understands your lows and your routine becomes an important part of your safety net.
• Friends and social settings: Letting friends know the basics — especially around alcohol, late nights, and exercise, when lows are more likely — means you can relax and enjoy yourself rather than manage alone.
• Medical identification: A bracelet, necklace, or phone medical ID speaks for you when you cannot, telling first responders you have T1D and use insulin.

You should never feel that T1D is something to be ashamed of or to hide. It is a condition you manage with skill every day — and letting the right people in makes that work lighter and safer.

Women with T1D can have healthy pregnancies, but planning ahead is critical:

• Preconception HbA1c target: Below 6.5% before conceiving, ideally for at least 3 months prior. This significantly reduces the risk of birth defects and pregnancy complications.
• Folic acid: 5 mg/day (higher than standard dose) recommended before conception and through the first trimester.
• Glucose targets in pregnancy: Fasting 70–95 mg/dL, 1-hour postmeal 110–140 mg/dL.
• CGM during pregnancy: Strongly recommended. The CONCEPTT trial demonstrated that CGM use during T1D pregnancy improves neonatal outcomes.
• AID systems: Increasingly used in pregnancy, though most have not been specifically validated for pregnancy. Discuss with your maternal-fetal medicine specialist.
• Medications: In pregnancy, T1D is managed with insulin only. SGLT2 inhibitors are contraindicated in pregnancy (and are not FDA-approved for T1D at all), and other non-insulin diabetes pills are not used. Review every medication with your team before and during pregnancy.
• Retinopathy screening: Essential before and during pregnancy, as retinopathy can progress rapidly during pregnancy.
• Complications risk: T1D pregnancy carries 2–4 times higher risk of maternal and fetal complications compared to non-diabetic pregnancy, but these risks are substantially reduced with good preconception glucose control.

The key message: planned pregnancies with T1D have far better outcomes than unplanned ones. Start the conversation with your endocrinologist and an obstetrician experienced with T1D well before you start trying.

Alcohol:

• Alcohol blocks the liver from releasing stored glucose, increasing the risk of delayed hypoglycemia (sometimes 12+ hours after drinking).
• Never drink on an empty stomach. Have carbs with alcohol. Reduce basal insulin overnight if needed.
• Set CGM alerts before going to sleep after drinking. Tell the people you are with that you have T1D and what low blood sugar looks like.
• Symptoms of low blood sugar can mimic intoxication — wear medical identification.

Travel:

• Carry at least twice the supplies you think you will need, split between carry-on and checked luggage.
• Insulin and supplies must go through airport security in a clear bag. Carry a letter from your doctor.
• Adjust basal insulin timing for time zone changes (>3 hours). Your endocrinologist can help plan this.
• Keep insulin out of extreme heat and cold — use an insulated travel case.
• Know the emergency number and the word for “diabetes” and “insulin” in the local language of your destination.

School and work:

• Children with T1D are entitled to a 504 Plan or IEP that ensures access to CGM, insulin, snacks, and bathroom breaks during school.
• Adults are protected by the ADA (Americans with Disabilities Act) in the workplace. Reasonable accommodations include the ability to check glucose, take insulin, and eat as needed.

Sending a child with T1D to school requires planning but should never limit their participation:

• 504 Plan or IEP: Under federal law (Section 504 of the Rehabilitation Act), children with T1D are entitled to accommodations at school. A 504 Plan should include: unrestricted access to water, bathroom, and snacks; permission to check blood sugar and administer insulin at any time; a trained staff member available to assist with diabetes care; accommodations for standardized testing.
• Diabetes Medical Management Plan (DMMP): Your endocrinologist completes this form, which tells the school exactly how to manage your child’s diabetes — including insulin doses, carb ratios, glucose targets, hypoglycemia treatment, and emergency contacts.
• CGM and school: Schools should allow CGM alarms without restriction. Parents can often follow their child’s glucose remotely via CGM sharing features. Establish clear protocols for who responds to alarms.
• Field trips and sports: Your child should participate fully. Ensure the school has a plan for off-campus care, that emergency supplies travel with the child, and that coaches understand the basics of low blood sugar treatment.
• Peer support: Children with T1D may feel different from classmates. Diabetes camp, T1D youth groups, and age-appropriate education for classmates can help normalize the condition.

The ADA (American Diabetes Association) provides template 504 Plans and school training materials. Your diabetes educator can also visit the school to train staff.

T1D management evolves as life changes. Key transitions to prepare for:

• Adolescence: Hormonal changes (puberty) cause insulin resistance, often requiring significant dose increases. Teens naturally push for independence — gradually transfer diabetes tasks while maintaining safety nets. This is one of the hardest periods for both teens and parents.
• Leaving home (college, first job): A critical transition. Ensure your young adult knows how to: order and manage their own supplies, communicate with insurance, recognize and treat DKA, and has a new endocrinologist established before the move. The College Diabetes Network is an excellent resource.
• Career and relationships: Decide how much to share with coworkers and new partners — this is a personal choice. At minimum, close colleagues should know the basics of low blood sugar treatment. Many people with T1D find that openness reduces anxiety.
• Aging with T1D: Glycemic targets may be relaxed in older adults to reduce hypoglycemia risk, especially if hypoglycemia unawareness is present. CGM and AID are particularly valuable for older adults living alone. Complication screening remains essential throughout life.

One surprising and important reality: hospitals are not always set up to manage type 1 diabetes the way you do at home. Many hospital staff are far more experienced with type 2 diabetes, and standard hospital protocols can clash with the technology and routines that keep you stable. Knowing this in advance lets you advocate for yourself or your child.

• Never let your basal insulin be stopped. The most dangerous hospital error in T1D is omitting background insulin when you are not eating — this causes DKA. You always need basal insulin, even NPO (nothing by mouth) before a procedure. If staff plan to hold all insulin, politely but firmly ask them to confirm the plan with an endocrinologist.
• Ask about keeping your pump or CGM. Many hospitals now allow patients to continue their own insulin pump and CGM if they are well enough to manage it (sometimes with a signed agreement). Bring all your supplies and a charger. For some imaging tests (MRI, CT) devices must be removed — have a backup injection plan.
• Request an endocrinology or diabetes team consult for any admission or surgery. Specialized inpatient diabetes teams improve safety.
• Plan surgery timing. For scheduled procedures, ask in advance how your insulin should be adjusted the night before and morning of, and whether you can keep your CGM for monitoring during recovery.
• Bring a one-page summary. List your diagnosis, insulin regimen (basal and ratios), devices, allergies, and your endocrinologist’s contact. Hand it to the care team on arrival.

You are the expert in your own diabetes. It is completely appropriate — and often necessary — to speak up, ask questions, and request specialist involvement. A calm, informed patient or parent is the best safeguard against avoidable errors during a hospital stay.

• Can you screen me for diabetes distress, depression, and anxiety using a validated tool?
• Can you refer me to a mental health professional who understands T1D?
• What is my plan for managing blood sugar during exercise?
• I am thinking about pregnancy — what do I need to do to prepare?
• How should I handle alcohol and blood sugar management?
• Can you help me write a diabetes management plan for my child’s school or my workplace?
• Are there peer support groups or diabetes camps you recommend?

Optimal T1D care requires a coordinated team. Knowing who should be on your team helps you advocate for comprehensive care:

• Endocrinologist: Your primary T1D physician. Ideally one who specializes in type 1 (not all endocrinologists focus on T1D). Visits typically every 3–4 months.
• Certified Diabetes Care and Education Specialist (CDCES): Formerly called diabetes educator. Provides hands-on training for insulin management, CGM, pump starts, carb counting, and sick day protocols. Essential in the first year and whenever technology changes.
• Registered Dietitian: One experienced with T1D, not just T2D. Helps with carb counting, meal planning, managing food around activity, and developing a healthy relationship with food.
• Mental health professional: A psychologist, social worker, or counselor experienced with chronic illness management. Especially valuable during diagnosis, transitions, and periods of burnout.
• Ophthalmologist: For annual dilated eye exams to screen for retinopathy.
• Primary care physician: For non-diabetes health needs, vaccinations, and coordinating care across specialists.
• Pharmacist: A knowledgeable pharmacist can help with insurance coverage questions, generic alternatives, and medication interactions.

If you do not have access to all of these specialists, your endocrinologist and CDCES are the essential core. Telemedicine has expanded access to T1D-specialized care in areas where local expertise is limited.

• University of Utah Diabetes & Metabolism Center: Academic endocrinology center with T1D expertise, including AID system initiation, CGM training, and clinical trial access. Also a TrialNet screening site for first-degree relatives.
• Primary Children’s Hospital (Intermountain): Pediatric diabetes program for children and adolescents with T1D, including newly diagnosed education, pump starts, and transition programs.
• Intermountain Health Diabetes Services: Multiple locations along the Wasatch Front offering endocrinology, diabetes education, and support services.
• JDRF Utah/Idaho Chapter: Local events, fundraising walks, family support, peer mentoring, and advocacy. Connects newly diagnosed families with experienced T1D families.
• Camp UTADA (Utah Diabetes Association): Summer camp for children with T1D. Medically supervised with 24-hour endocrinology coverage. An important experience for building confidence and community.
• TrialNet screening at University of Utah: Free autoantibody screening for relatives ages 2.5–45 of people with T1D. Early detection enables preventive treatment.

• JDRF (Breakthrough T1D): The leading global organization funding T1D research. Provides clinical trial information, advocacy, community events, and peer support. jdrf.org
• American Diabetes Association (ADA): Publishes the annual Standards of Care, offers educational resources, and advocates for diabetes-related legislation. diabetes.org
• Beyond Type 1: Online community and educational platform created by and for people with T1D. Resources, personal stories, and a mobile app for connection. beyondtype1.org
• T1D Exchange: Registry and research network that collects real-world data from thousands of people with T1D to improve care. t1dexchange.org
• Children with Diabetes: Online community and organizer of the annual Friends for Life conferences for families with T1D. childrenwithdiabetes.com
• College Diabetes Network: Support and resources for young adults with T1D navigating college life. collegediabetesnetwork.org
• DiabetesMine / Healthline: Patient-focused journalism and community for diabetes technology and daily living with T1D.

• $35 insulin copay cap: The Inflation Reduction Act (2022) caps insulin copays at $35/month for Medicare beneficiaries and many private insurance plans. Check with your insurer.
• Manufacturer assistance programs: Eli Lilly, Novo Nordisk, and Sanofi all offer insulin affordability programs with copay caps for eligible patients. Apply directly through their websites.
• Biosimilar insulins: Multiple biosimilar versions of insulin aspart and glargine are now available at lower cost. Ask your endocrinologist about switching.
• CGM and pump financial assistance: Dexcom, Insulet (Omnipod), Tandem, and Medtronic all have patient assistance and copay programs. These devices can cost $3,000–$8,000/year even with insurance, so explore all available programs.
• State programs: Many states have emergency insulin programs for uninsured or underinsured patients. Contact your state diabetes association.
• Patient advocate at your clinic: Most endocrinology practices have staff dedicated to insurance appeals, prior authorizations, and financial assistance navigation. Use them.

Insulin rationing — stretching insulin to make it last longer — still occurs in the United States, even with copay caps. If you are rationing insulin, tell your care team immediately. There are resources available, and no one should die from a lack of access to a medication that has existed for over 100 years.

• TrialNet: Free autoantibody screening and T1D prevention/intervention trials. University of Utah is a participating site. trialnet.org
• ClinicalTrials.gov: The U.S. government registry of all clinical trials. Search “type 1 diabetes” and filter by your state and enrollment status.
• JDRF Clinical Trial Finder: Curated listings of T1D-specific trials with plain-language descriptions of what each trial involves.
• T1D Exchange Clinical Network: A network of T1D centers conducting real-world research studies.

Research participation is voluntary and always maintains your standard care. It is one of the most direct ways to help accelerate progress toward better treatments and an eventual cure for T1D.

• Keep a 30-day emergency supply of insulin, syringes/pen needles, CGM sensors, pump supplies, glucose tablets, and a glucagon kit.
• Store backup insulin in the refrigerator (never freeze). Know the expiration dates.
• Have a glucagon rescue kit (nasal glucagon such as Baqsimi, or injectable glucagon) accessible to family members and close contacts. Make sure they know how to use it.
• Wear medical identification (bracelet, necklace, or digital ID on your phone) at all times.
• Carry fast-acting glucose (glucose tablets, juice boxes) whenever you leave the house.
• Keep a printed card in your wallet with your diagnosis, insulin regimen, emergency contact, and endocrinologist phone number.

• Can your office help with insurance prior authorizations for my CGM and pump supplies?
• Are there patient assistance programs that could reduce my out-of-pocket costs?
• Can you connect me with a social worker or financial counselor at the clinic?
• Do you know of local T1D support groups or family networks in Utah?
• Can you refer my child to a diabetes camp program?
• What clinical trials are currently enrolling at your center or through TrialNet?
• Can you write a letter for my child’s school or my employer to support a diabetes management plan?

• United States (FDA) — All major insulin analogs, CGM systems (Dexcom G7, Libre 3, Guardian 4), and AID systems (Omnipod 5, Control-IQ, 780G) are approved. Teplizumab (Tzield) approved for Stage 2 T1D (age 1+). Lantidra (islet transplant) approved. Insulin icodec (Awiqli) approved only for T2D. SGLT2 inhibitors NOT approved for T1D.
• European Union (EMA) — All major insulin analogs and CGM/AID systems approved and widely available. Teplizumab is NOT EMA-approved as of 2026 — European patients do not yet have access to disease-modifying therapy outside of clinical trials. Dapagliflozin was temporarily licensed as adjunct to insulin in T1D (BMI ≥27) with restrictions. Insulin icodec approved for T2D.
• United Kingdom (NICE/MHRA) — NICE NG17 (updated) guides T1D management. CGM and AID systems are available but access varies by NHS trust. Libre sensors widely funded by the NHS. DAFNE structured education program is standard of care. Teplizumab not yet available.
• Japan (PMDA) — All major insulin analogs available. CGM and pump systems available with increasing adoption. SGLT2 inhibitors are approved for T1D with specific restrictions and mandatory DKA education — a unique regulatory position. Teplizumab not yet approved.
• Canada (Health Canada) — All major insulin analogs, CGM systems, and AID systems available. Provincial formulary coverage varies. The Edmonton Protocol for islet transplantation was developed in Canada. Teplizumab regulatory review ongoing.
• Australia (TGA) — Insulin analogs and diabetes technology widely available. CGM fully subsidized under the National Diabetes Services Scheme (NDSS) for all people with T1D. AID systems available with private insurance or partial NDSS subsidy. Teplizumab not yet TGA-approved.

Most standard T1D treatments — insulin analogs, CGM, and AID systems — are available in all high-income countries, though coverage and out-of-pocket costs vary significantly. Key regional differences:

• SGLT2 inhibitors for T1D: Available in Japan and some EU countries with restrictions. Not available in the US, Canada, or Australia for T1D.
• Teplizumab: Currently US-only. European patients seeking access must enroll in clinical trials or explore compassionate use pathways.
• Islet transplantation: Available in the US (Lantidra), Canada (Edmonton Protocol sites), UK (selected NHS centers), and Australia (selected research centers). Most programs are limited to adults with severe hypoglycemia unawareness.
• Insulin cost: The United States historically has the highest insulin costs globally. In most other high-income countries, insulin is heavily subsidized or free. The $35/month copay cap (Inflation Reduction Act) has narrowed but not eliminated this gap.
• CGM cost and access: Australia subsidizes CGM for all people with T1D through the NDSS. In the UK, the NHS increasingly funds CGM. In many lower-income countries, CGM remains inaccessible due to cost.

• If I travel internationally, how do I ensure I can access insulin and diabetes supplies?
• Are there clinical trials for new T1D treatments available in other countries that I might be eligible for?
• Is teplizumab available through any clinical trial or compassionate use program in my country?
• How does my CGM or pump warranty work if I need a replacement while abroad?

• Oral insulin for T1D prevention (TrialNet Oral Insulin Study / DPT-1) — Multiple large clinical trials tested whether oral insulin could induce immune tolerance and prevent T1D in at-risk individuals with positive autoantibodies. The DPT-1 Oral Insulin trial and subsequent TrialNet Oral Insulin study failed to show significant delay in T1D onset in the primary analysis. Post-hoc subgroup analyses suggested possible benefit in specific autoantibody profiles, but this was not confirmed prospectively. FAILED
• Anti-CD20 (rituximab) for new-onset T1D — Rituximab, an anti-CD20 B-cell depleting antibody, showed temporary C-peptide preservation in the TrialNet rituximab trial for new-onset T1D. However, the benefit was transient (lasting approximately 6–12 months), and the therapy did not produce lasting disease modification. The risk-benefit profile did not support clinical use. FAILED
• VX-264 (encapsulated stem cell device, Vertex) — Designed to deliver stem cell-derived islet cells (same as VX-880) inside an immunoprotective encapsulation device, eliminating the need for immunosuppression. Phase 1/2 trial initiated in 2023 with 17 planned patients. Vertex discontinued the program in March 2025. The company is pivoting to alternative immunoprotection strategies for its stem cell-derived islets. WITHDRAWN
• Sotagliflozin (Zynquista) for T1D — A dual SGLT1/SGLT2 inhibitor that demonstrated improved A1c and time in range as an adjunct to insulin in the inTandem clinical trial program. However, the FDA denied the T1D indication twice (2019 and again in December 2024) due to a 3–4 times higher rate of diabetic ketoacidosis. Lexicon Pharmaceuticals halted commercial activities for the T1D indication (and in 2025 submitted additional data toward a possible future resubmission). SGLT2 inhibitors remain not approved for T1D in the US. FAILED
• Insulin icodec (Awiqli) for T1D — This once-weekly basal insulin was evaluated in the ONWARDS 6 trial for T1D. The FDA advisory committee voted 7–4 against the T1D indication in May 2024 due to higher rates of clinically significant and severe hypoglycemia compared to daily insulin degludec. The long half-life makes hypoglycemia episodes harder to manage in T1D. Approved only for T2D (March 2026). FAILED
• Intranasal insulin for T1D prevention (INIT II) — The Intranasal Insulin Trial II tested whether nasal delivery of insulin could prevent T1D in at-risk first-degree relatives. The trial did not meet its primary endpoint — intranasal insulin did not delay or prevent the onset of T1D. FAILED
• Nicotinamide (vitamin B3) for T1D prevention (ENDIT) — The European Nicotinamide Diabetes Intervention Trial (ENDIT) tested high-dose nicotinamide in first-degree relatives of T1D patients with positive autoantibodies. The trial showed no effect on T1D prevention or delay, despite promising preclinical data. FAILED
• Mixed meal tolerance test-based monitoring (replacing CGM) — While mixed meal tolerance testing remains valuable as a research tool for measuring C-peptide secretion, it was once proposed as a practical monitoring tool for disease progression. CGM monitoring has proven far more practical for real-world staging and progression tracking, and the ADA now recommends CGM for presymptomatic T1D monitoring. DE-ADOPTED