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

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.

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Nocturnal Hypoglycemia Identified by a Continuous Glucose Monitoring System in Patients with Primary Adrenal Insufficiency (Addison's Disease)

Diabetes Technology & Therapeutics ◽

10.1089/dia.2011.0158 ◽

2012 ◽

Vol 14 (5) ◽

pp. 386-388 ◽

Cited By ~ 26

Author(s):

Gesine Meyer ◽

Annika Hackemann ◽

Juergen Reusch ◽

Klaus Badenhoop

Keyword(s):

Adrenal Insufficiency ◽

Monitoring System ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Addison’S Disease ◽

Continuous Glucose Monitoring System ◽

Addison's Disease ◽

Primary Adrenal Insufficiency ◽

Nocturnal Hypoglycemia

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21-hydroxylase Autoantibody-negative Addison's Disease in a 5-year-old Boy with Adrenal Crisis and Type 1 Diabetes Mellitus

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem.2010.189 ◽

2010 ◽

Vol 23 (11) ◽

Author(s):

Jenn-Tzong Chang ◽

Ying-Yao Chen ◽

Pao-Chin Chiu

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Addison’S Disease ◽

Adrenal Crisis ◽

Addison's Disease

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An Unusual Presentation of New Onset Type 1 Diabetes Mellitus With Concurrent Addison’s Disease in an Adolescent Male

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.932 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A456-A457

Author(s):

Ethel G Clemente ◽

Nina Mathew ◽

Berrin Ergun-Longmire

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Adrenal Insufficiency ◽

Addison’S Disease ◽

Adolescent Male ◽

Addison's Disease ◽

New Onset

Abstract Introduction: Majority of children and adolescents diagnosed with Type 1 Diabetes Mellitus (T1D) present with the classic symptoms of polyuria, polydipsia and polyphagia, associated with hyperglycemia. Concurrent conditions at the time of T1D diagnosis may alter its presentation and potentially lead to challenges in diagnosis and management. Clinical Case: We present a 17-year-old male with worsening fatigue and unintentional weight loss for two months, then one week of emesis and abdominal pain. Initial work-up by his primary care provider showed sodium 125 mmol/L (133–145), potassium 5.7 mmol/L (3.5–5.1), HCO3 20 mmol/L (21–31), anion gap 13 mmol/L (9–18), random glucose 141 mg/dL (70–199). Due to hyponatremia and dehydration, he was sent to a local emergency room where he was found to be mildly hypotensive at 87/57 mmHg. He received intravenous fluids for hydration and was sent home. On out-patient follow up, he appeared well despite being hypotensive. His additional labs revealed a random glucose of 330 mg/dl and elevated HbA1C of 8.3% (4.4–5.6). His urine was positive for glucose but negative for ketones. He was admitted for further management of new onset diabetes. On admission, he was well appearing and in no acute distress. Blood pressure was 86/57 mmHg, heart rate was 109 bpm, and other physical exam findings were unremarkable. Although his hyperglycemia improved after initiation of insulin therapy, his electrolyte abnormalities persisted, raising suspicion for adrenal insufficiency. An ACTH stimulation test was performed, with both baseline and 60-minute cortisol levels low at 1 ug/dl and 0.9 ug/dl, respectively, confirming adrenal insufficiency. He responded well to glucocorticoid and mineralocorticoid replacement. His electrolytes and blood pressure normalized. Further testing confirmed elevated levels of Glutamic Acid Decarboxylase antibodies 0.19 nmol/L (less than 0.02), Islet Antigen 2 Antibodies: 3.38 nmol/L (less than 0.02), and 21-Hydroxylase antibodies, consistent with T1D with concomitant Addison’s disease (AD). Conclusion: About 0.5% of patients with T1D have AD, but the diagnosis of T1D typically precedes AD for several years, thus the coexistence of both autoimmune conditions at diagnosis is rare.

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Metabolic control and hypoglycaemia in people with type 1 diabetes: insulin pump therapy vs. intensified insulin therapy in an unselected cohort in routine care

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-021-00700-0 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Guido Kramer ◽

Christof Kloos ◽

Ulrich A. Müller ◽

Gunter Wolf ◽

Nadine Kuniss

Keyword(s):

Type 1 Diabetes ◽

Insulin Therapy ◽

Metabolic Control ◽

Continuous Glucose Monitoring ◽

Treatment Satisfaction ◽

Severe Hypoglycaemia ◽

Glucose Monitoring ◽

Routine Care ◽

Insulin Dosage

Abstract Aims The aim of this study was to compare individuals with type 1 diabetes with continuous subcutaneous insulin infusion (CSII) and intensified insulin therapy (ICT) in routine care regarding metabolic control and treatment satisfaction. Methods Individuals with type 1 diabetes (CSII n = 74; ICT n = 163) were analysed regarding metabolic control, frequency of hypoglycaemia and treatment satisfaction (DTSQs range 0–36). Results Individuals with CSII (duration of CSII: 14.1 ± 7.2 years) were younger (51.1 ± 15.8 vs. 56.2 ± 16.2 years, p = 0.023), had longer diabetes duration (28.7 ± 12.4 vs. 24.6 ± 14.3 years, p = 0.033), lower insulin dosage (0.6 ± 0.2 vs. 0.7 ± 0.4 IU/kg, p = 0.004), used more frequently short-acting analogue insulin (90.5% vs. 48.5%, p < 0.001) and flash/continuous glucose monitoring (50.0% vs. 31.9%, p = 0.009) than people with ICT. HbA1c was similar between CSII and ICT (7.1 ± 0.8%/54.4 ± 9.1 mmol/mol vs. 7.2 ± 1.0%/55.7 ± 10.9 mmol/mol, p = 0.353). Individuals with CSII had higher frequency of non-severe hypoglycaemia per week (in people with blood glucose monitoring: 1.9 ± 1.7 vs. 1.2 ± 1.6, p = 0.014; in people with flash/continuous glucose monitoring: 3.3 ± 2.2 vs. 2.1 ± 2.0, p = 0.006). Prevalence of polyneuropathy (18.9% vs. 38.0%, p = 0.004) and systolic blood pressure (138.0 ± 16.4 vs. 143.9 ± 17.1 mmHg, p = 0.014) was lower in CSII. Satisfaction with diabetes treatment (26.7 ± 7.3 vs. 26.0 ± 6.8, p = 0.600) did not differ between CSII and ICT. Conclusions CSII and ICT yielded comparable metabolic control and treatment satisfaction but CSII was associated with higher incidence of non-severe hypoglycaemia and lower insulin dosage.

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MANAGEMENT OF ENDOCRINE DISEASE Disease burden and treatment challenges in patients with both Addison’s disease and type 1 diabetes mellitus

Acta Endocrinologica ◽

10.1530/eje-20-0052 ◽

2020 ◽

Vol 183 (1) ◽

pp. R1-R11

Author(s):

Dimitrios Chantzichristos ◽

Björn Eliasson ◽

Gudmundur Johannsson

Keyword(s):

Type 1 Diabetes ◽

Management Strategies ◽

Treatment Strategies ◽

Specific Treatment ◽

Addison’S Disease ◽

Adrenal Crisis ◽

Addison's Disease ◽

Autoimmune Thyroid ◽

Increased Risk

Concurrent type 1 diabetes (T1D) and Addison’s disease (AD) is a rare combination of diseases and, in approximately one third of these patients, it is also combined with an autoimmune thyroid disease. Recently, it was shown that patients with both T1D and AD have a higher risk of premature death compared to patients with T1D alone, the most common causes of death being due to diabetic complications and cardiovascular disease. These patients receiving replacement therapies with both insulin and glucocorticoids face an increased risk of hypo- and hyperglycemia and diabetic ketoacidosis and have a higher risk of adrenal crisis than patients with AD alone. Treatment challenges include the opposing effects of insulin and glucocorticoids on glucose homeostasis and the need to balance and synchronize these two treatments. The rarity of this disease combination may explain the paucity of data on outcome and specific treatment strategies in this patient group. Based on this review, we suggest management strategies for their insulin and glucocorticoid replacement therapies and indicate future areas of research.

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