Glycemic Control during Gender-Affirming Therapy in a Patient with Type 1 Diabetes

• Authors: Sarah H. Campbell, Geisel School of Medicine at Dartmouth; Kristin L. Flint, Emory University; J. Sonya Haw, Emory University; Georgia Davis, Emory University; Priyathama Vellanki, Emory University
• Journal Title: Clinical Diabetes
• Volume: Volume 37, Number 4
• Publisher: American Diebetes Association | 2019-10-01, Pages 398-400
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.2337/CD19-0016
• Subjects: Health Sciences, Public Health; Gender Studies

Abstract

A 20-year-old transgender woman (natal male with feminine gender identity) with a 15-year history of type 1 diabetes presented to the clinic to begin gender-affirming hormone therapy. The patient was diagnosed with type 1 diabetes at the age of 5 years. Around the time of diagnosis of type 1 diabetes, she experienced two episodes of diabetic ketoacidosis but has had no additional episodes since adolescence. At initial presentation to the endocrinology clinic, her A1C was 6.8% (51 mmol/mol) on therapy with insulin detemir 33 units each night and mealtime insulin lispro at a 1:8 insulin-to-carbohydrate ratio. At this time, she was experiencing approximately one episode of hypoglycemia per week.