What are the guidelines and goals for a 24-year-old male with Type 1 Diabetes Mellitus (T1DM)?

From the Guidelines

For a 24-year-old man with Type 1 diabetes, I strongly recommend treating him with continuous subcutaneous insulin infusion or multiple daily doses of prandial and basal insulin, as well as early use of continuous glucose monitoring to improve glycemic outcomes and quality of life. This approach is supported by the most recent guidelines, including the 2025 standards of care in diabetes 1. The treatment plan should include:

• Continuous subcutaneous insulin infusion or multiple daily doses of prandial (injected or inhaled) and basal insulin
• Early use of continuous glucose monitoring to improve glycemic outcomes and quality of life
• Automated insulin delivery systems to minimize hypoglycemia risk
• Education on how to match mealtime insulin doses to carbohydrate intake and fat and protein intake
• Regular physical activity, such as 150 minutes weekly of moderate exercise, to improve blood glucose control and reduce cardiovascular risk factors 1
• A balanced diet with consistent carbohydrate counting and adequate sleep (7-9 hours nightly)
• Avoidance of smoking and limited alcohol consumption
• Regular medical follow-ups, including quarterly endocrinologist visits, annual eye exams, and regular kidney function tests

It is also important to note that the treatment plan should be individualized and reassessed over time, taking into account the patient's specific needs and goals. The use of continuous glucose monitoring metrics, such as time in ranges, can help inform treatment decisions and improve glycemic control 1. By following these guidelines, the patient can achieve stable blood glucose levels, prevent short-term complications like hypoglycemia, and reduce the risk of long-term issues such as cardiovascular disease, neuropathy, and retinopathy.

From the FDA Drug Label

Individualize the dosage of MERILOG based on the patient's metabolic needs, blood glucose monitoring results and glycemic control goal. Dosage adjustments may be needed with changes in physical activity, changes in meal patterns (i.e., macronutrient content or timing of food intake), changes in renal or hepatic function or during acute illness The risk of hypoglycemia after an injection is related to the duration of action of the insulin and, in general, is highest when the glucose lowering effect of the insulin is maximal

For a young man with diabetes type 1, the goals for management include:

• Glycemic control: Achieving and maintaining a target HbA1c level to reduce the risk of complications
• Blood glucose monitoring: Regular monitoring to adjust insulin dosages and prevent hypoglycemia and hyperglycemia
• Insulin regimen: Individualized insulin regimen, which may include rapid-acting, intermediate-acting, and long-acting insulins
• Lifestyle management: Healthy diet, regular physical activity, and stress management to improve overall health and well-being
• Regular follow-up: Regular check-ups with a healthcare provider to monitor progress, adjust treatment plans, and prevent complications

Key considerations for this patient include:

• Hypoglycemia awareness: Educating the patient on the signs and symptoms of hypoglycemia, and how to manage it
• Insulin administration: Proper technique for injecting insulin, and how to rotate injection sites to prevent lipodystrophy
• Medication adherence: Encouraging the patient to take their insulin and other medications as prescribed
• Healthy habits: Promoting healthy habits, such as regular exercise, healthy eating, and stress management, to improve overall health and well-being 2 3 2

From the Research

Guidelines for Young Men with Type 1 Diabetes

For a 24-year-old man with type 1 diabetes, the following guidelines and goals can be considered:

• Tight glucose control is crucial to decrease the incidence of microvascular and macrovascular complications, as stated in the study 4.
• The goal for most nonpregnant adults, including young men, should be to achieve an A1C level less than 7% 4, 5.
• Intensive insulin treatment is recommended, which can include a combination of multiple mealtime bolus and basal injections or continuous insulin infusion through an insulin pump 4.
• The choice between multiple daily injections and an insulin pump should be individualized based on cost, patient preference, and lifestyle 4, 5.
• Continuous glucose monitoring can improve glycemic control and is associated with lower A1C levels 4, 5.

Insulin Therapy Options

Different insulin therapies can be considered for a young man with type 1 diabetes:

• Insulin detemir and insulin glargine are two basal insulin options that have been compared in several studies 6, 7, 8.
• Insulin detemir has been shown to be noninferior to insulin glargine in terms of glycemic control, with a lower risk of severe and nocturnal hypoglycemia in some studies 6, 8.
• Insulin glargine 300 U/mL (Gla-300) has a prolonged duration of action and a more stable glucose-lowering profile compared to insulin glargine 100 U/mL (Gla-100) 7.

Lifestyle and Education

In addition to insulin therapy, lifestyle and education play a crucial role in managing type 1 diabetes:

• Patients should participate in diabetes self-management education to develop individualized premeal insulin bolus plans and learn how to manage blood glucose levels 4.
• Frequent blood glucose measurements and patient education on insulin dosing based on carbohydrate counting, premeal blood glucose, and anticipated physical activity are essential 5.
• Patients should also be educated on the management of blood glucose under different circumstances, such as sick days, and how to identify warning signs of hypoglycemia and diabetic ketoacidosis 4.