Case Study: 15-year-old female with Type 1 Diabetes

Dated: 8 October 2025 

Case Study: 15-year-old female with Type 1 Diabetes, managed at Sugar20 Clinics under Dr. Seelam Rajitha Reddy, Expert Diabetologist

Chief compliant: 15yr old female child came with H/O high and fluctuating blood sugars. 

H/o Present illness: She was found to be Type 1 Diabetic just 2 months back when she was investigated for recurrent boils on torso and thighs. On evaluation sugars were high with HbA1c of 15% and no urine ketones. She was the only child and Family history revealed father being diabetic for the last 25 yrs. He was on treatment and sugars were well under control.

She was managed  with iv insulin and other appropriate supportive treatment in admission. All the antibodies: IAA, ICA, GAD 65, Zn T 8 were found to be negative with low c-peptide levels. Auto immune thyroid disease was ruled out. 8AM cortisol levels were WNL. She attained menarche at 12 yrs of age and had regular cycles.

She was discharged with Tresiba 15u once daily dose. Her sugars post discharge were found to be fluctuating but no hypoglycemic episodes were encountered on CGMS. 

When the child came to Sugar 20 clinic, She was on Tresiba of 18u once daily dose at night time with a compliance of 85% but was injecting insulin alternately on right and left arms. No H/o menstrual disturbances. SMBG was done regularly showing high sugars regardless of the time and her parents were really concerned regarding the outcome for their child.

Management: Evaluation revealed high sugars,10.8 HbA1c, no urine ketones and very low c-peptide levels. She was advised to go for CGM (Continuous Glucose Monitoring) Free style libre of  2nd generation for 14 days. 

We trained her on insulin pen usage, storage, sites of administration , site rotation, dose adjustment, how to deal with hypoglycemic episodes, diet and exercise. On CGM, She was continued on Tresiba initially in escalated, divided  doses. Then was shifted to Ryzodeg before BF and dinner in divided doses as the subject was not ready to take insulin before lunch at college. That didn’t either help her like the long acting insulin. So, she was put on NPH+Reg 50/50 which brought in a paradigm shift in her log curve. She visited Sugar20 Clinic every 3rd day and was on continuous virtual follow up. The last 3 days were utilized to calculate her total dose. Only one hypoglycemic episode was encountered throughout the follow up on CGMS. After the 2 week CGMS F/U  she was discharged and was reviewed after 1 month. She was  doing well and her HbA1c was 7.3%.