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CONFIRMATION

POSITIVE for ≥ 2 Ab

 Patient may have early-stage T1D 
 

Evaluate for E10.A0:
Type 1 diabetes mellitus, presymptomatic, unspecified

Obtain Random Blood Glucose (RBG) and HbA1c

Follow-up to monitor for medical safety and progression to T1D

Normal RBG <140 mg/dL

and HbA1c ≤ 5.6%
 

  Patient may have Stage 1 T1D 


Evaluate for
E10.A1
:Type 1 diabetes mellitus, presymptomatic, Stage 1 

RBG 140-199 mg/dL

OR HbA1c 5.7-6.4%


 Patient may have Stage 2 T1D 
(consider Teplizumab if ≥ 8 yrs)


Evaluate for

E10.A2: Type 1 diabetes mellitus, presymptomatic, Stage 2 

Age > 18y

Lower Intensity Follow-up

Assess/Educate for symptoms

• Instruct on Self-Monitored Blood
   Glucose testing: Test 2 hours after
   largest meal of day once monthly

• In 12 months: RBG, HbA1c, OGTT
   and CGM

b

Age 5–18y

Medium Intensity Follow-up

Assess/Educate for symptoms

• Instruct on Self-Monitored Blood
   Glucose testing: Test 2 hours after
   largest meal of day once weekly

• In 6 months: RBG, HbA1c, OGTT
   and CGM

b

Age < 5y

Higher Intensity Follow-up

• Assess/Educate for symptoms

• Instruct on Self-Monitored Blood
   Glucose testing:
   –Test 2 hours after largest meal of
     day for 5 days and send in
     numbers.
   –After initial assessment, test 2 hours
     after largest meal of day once
     weekly.

• In 3 months: RBG, HbA1c and CGM

• In 6 months: OGTT

• In patients ≥18y, follow-up every
   6-months may be efficient.

b

RBG ≥ 200 mg/dL

OR HbA1c ≥ 6.5


 Patient may have Stage 3 T1D 
(needs insulin)


Evaluate for

E10.65: Type 1 diabetes mellitus
with hyperglycemia

•  Evaluate for symptoms    
   of 
hyperglycemia and
   ketosis

 

•  Verbal consult with and
   urgent referral to pediatric /
   adult diabetologist

a

    Ask the Experts can provide confirmation testing. Please contact us for additional information.

 

Ketosis symptoms: vomiting, nausea, abdominal pain, Kussmaul breathing, altered mental
    status. If concern for ketosis, check urine or blood ketones if able, if positive or unable to test
    refer for urgent evaluation at ED.

​

b  Patient/family should be given educational support by experienced provider on normal CGM
    excursions, normal hypoglycemia ranges, and signficance of prolonged glucose peaks.
    All CGM wear should include support for 
issues with adhesion and skin irritation as needed.

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