Type 1 Diabetes and Addison’s Disease: When the Diagnosis Is Suggested by the Continuous Glucose Monitoring System

Abstract

Our objective is to emphasize the important role of continuous glucose monitoring (CGM) in suggesting adrenal insufficiency in patients affected by type 1 diabetes. We describe an adolescent girl with type 1 diabetes and subsequent latent Addison’s disease diagnosed based on a recurrent hypoglycemic trend detected by CGM. In patients with type 1 diabetes, persistent unexplained hypoglycemic episodes at dawn together with reduced insulin requirement arouse souspicionof adrenal insufficiency. Adrenal insufficiency secondary to autoimmune Addison’s disease, even if rarely encountered among young patients, may be initially symptomless and characterized by slow progression up to acute adrenal crisis, which represents a potentially life-threatening condition. Besides glycometabolic assessment and adequate insulin dosage adjustment, type 1 diabetes needs prompt recognition of potentially associated autoimmune conditions. Among these, Addison’s disease can be suspected, although latent or paucisymptomatic, through periodic and careful evaluation of CGM data.

Diabetes Insipidus Complicating Diabetes Mellitus Type 1: A Pituitary Abscess Diagnosis

“…Moreover, hypoglycemia caused by low cortisol levels could have been disguised as iatrogenic hypoglycemia, which is frequent in patients with T1DM. Although the patient did not use continuous glucose monitoring (CGM) at the time of disease presentation, it may have helped to accelerate the diagnosis: In 2021 a case reported the diagnosis of adrenal insufficiency suggested by glycemic instabilities observed through CGM [ 10 ].…”

Type 1 Diabetes and Other Autoimmune Disorders in Children

“…Since, no screening procedures for AD are routinely recommended for patients with T1D, physicians need to be aware of the risk of developing such a condition, especially if the patient's history is positive for thyroid disease or severe infections [166]. An unexplained change in the glycemic trend, such as persistent hypoglycemic levels, may also be a reason to suspect the onset of AD [169].…”

Current Screening Strategies for the Diagnosis of Adrenal Insufficiency in Children

“…Aside from typical symptoms of AI including fatigue, weight loss, salt craving, and hyperpigmentation of skin, unique symptoms to look for in patients with type 1 DM are unexplained recurrent hypoglycemia or decreased insulin dose requirement. 42 Cortisol deficiency results in enhanced insulin sensitivity which leads to an increased peripheral glucose utilization, and reduced glycogenesis and gluconeogenesis. 39 Baseline morning cortisol and ACTH should be obtained as a screening test.…”