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A 66-year-old woman with pre-diabetes and hormone receptor-positive, human epidermal growth factor receptor 2-negative metastatic breast cancer was started on fulvestrant, and referred to endocrinology prior to initiation of alpelisib. Because of anticipated possible hyperglycaemia, and the woman's reluctance to start fingerstick glucose monitoring, a continuous glucose monitor (CGM) was prescribed for safety. CGM data revealed the rapid onset of hyperglycaemia over the first 2 weeks of alpelisib treatment with nocturnal hyperglycaemia (Fig. 1). Hyperglycaemia occurred in the first 6 h after each dose was administered, and after 2 weeks average daily glucose levels were three times higher than baseline.Questions 1. What is alpelisib? Why does alpelisib cause hyperglycaemia?3. How is alpelisib-induced hyperglycaemia treated? FIGURE 1 Two-week continuous glucose monitoring data from woman with breast cancer the day after initiating alpelisib. The woman took alpelisib daily at 6pm. Daily average (Avg) glucose readings are shown.ª 2020 Diabetes UK

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