You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.



Beyond the Basics of Type 1 Diabetes

  • Authors: Rinku Mehra, MD, MBA
  • CME / ABIM MOC / CE Released: 4/24/2023
  • Valid for credit through: 4/24/2024
Start Activity

  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 1.00 ABIM MOC points

    Nurses - 1.00 ANCC Contact Hour(s) (0.25 contact hours are in the area of pharmacology)

    IPCE - 1.00 Interprofessional Continuing Education (IPCE) credit

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for pediatric endocrinologists, diabetologists/endocrinologists, pediatricians, primary care physicians (PCPs), nurse practitioners (NPs), physician assistants (PAs), nurses, and other clinicians who care for patients with T1D.

The goal of this activity is for learners to be better able to recognize, screen for, and stage T1D; use appropriate management with new therapeutic options; and provide patient/caregiver education for patients at risk.

Upon completion of this activity, participants will:

  • Have greater competence related to
    • Staging high-risk patients for T1D
    • Treatment for patients with high risk of clinical development of T1D
    • Team-based education of patients/caregivers about T1D risk, screening, and staging


Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.

Disclosures for additional planners can be found here.


  • Rinku Mehra, MD, MBA

    The Mehra Clinic
    Vienna, Virginia


    Rinku Mehra, MD, MBA, has no relevant financial relationships.


  • Jennifer Hakkarainen, PA-C

    Medical Education Director, Medscape, LLC


    Jennifer Hakkarainen, PA-C, has no relevant financial relationships.

  • Jason Luis Quiñones, PhD

    Associate Medical Writer, Medscape, LLC


    Jason Luis Quiñones, PhD, has no relevant financial relationships.

Compliance Reviewer/Nurse Planner

  • Stephanie Corder, ND, RN, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Stephanie Corder, ND, RN, CHCP, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.

Accreditation Statements

Developed through the strategic collaboration between the Pediatric Endocrine Society (PES) and Medscape Education.

In support of improving patient care, Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

This activity was planned by and for the healthcare team, and learners will receive 1.00 Interprofessional Continuing Education (IPCE) credit for learning and change.

    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Aggregate participant data will be shared with commercial supporters of this activity.

    The European Union of Medical Specialists (UEMS)-European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 credit™ into European CME credit (ECMEC) should contact the UEMS (

    College of Family Physicians of Canada Mainpro+® participants may claim certified credits for any AMA PRA Category 1 credit(s)™, up to a maximum of 50 credits per 5-year cycle. Any additional credits are eligible as noncertified credits. College of Family Physicians of Canada (CFPC) members must login to Mainpro+® to claim this activity.

    Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons of Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME’s “CME in Support of MOC” program in Section 3 of the Royal College’s MOC Program.

    Contact This Provider

    For Nurses

  • Awarded 1.0 contact hour(s) of nursing continuing professional development for RNs and APNs; 0.25 contact hours are in the area of pharmacology.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.


Beyond the Basics of Type 1 Diabetes

Authors: Rinku Mehra, MD, MBAFaculty and Disclosures

CME / ABIM MOC / CE Released: 4/24/2023

Valid for credit through: 4/24/2024


The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short posttest assessment based on the material presented.


Tyrese, a 5-year-old Black male, presented in his usual state of health and weight to his pediatrician's office. He was described as an active child and participated in both sports and after-school activities. His parents described him as a picky eater, but his diet was generally well balanced. His mother's concern was her child's excessive consumption of fluids with associated nausea and intermittent complaints of stomach pain. She initially interpreted his symptoms as an indication of a viral infection, comforting him with antiemetics, soups, and fluids to keep him hydrated. His symptoms progressed to vomiting and frequent urination. After 48 hours, she drove him to the pediatrician for a sick visit, on her suspicion of a worsening case of stomach virus or flu. Tyrese's pediatrician carefully examined him and properly tested him for common viral and bacterial infections. Subsequent results were negative for COVID-19, influenza, respiratory syncytial virus (RSV), and strep throat. Noting Tyrese's presentation and deteriorating condition at home, the pediatrician completed a point-of-care urine dipstick test, and the test was positive for glycosuria and ketonuria. He then recommended that Tyrese be urgently transported to the local hospital, as shortly after his physical examination and labs, his symptoms acutely progressed to rapid, deep breathing. Upon arrival to the emergency department (ED), and repeat physical exam and laboratory testing, he was transferred to pediatric intensive care unit (ICU) for close observation. The results of his physical examination and bloodwork include the findings shown in Table 1.

Table 1. Patient's Initial Workup and Laboratory Testing

Patient information
  • 5 years old
  • Height: 101.6 cm (5th percentile)
  • Weight: 15.8 kg (10th percentile) 
  • BMI: 15.4
Personal and family medical history
  • No family history of T1D or other related metabolic disorders (eg, celiac disease, autoimmune thyroid disease)
Physical exam
  • Signs and symptoms:
    • Stomach pain
    • Nausea
    • Emesis
    • Polydipsia
    • Sweet breath odor
    • Kussmaul breathing
Laboratory evaluation results
  • Pathogen testing: negative for COVID-19, RSV, flu, and strep
  • Random plasma glucose: 300 mg/dL
    • Polyuria
  • HbA1c level: 12.5%
  • Urine ketones: 4+
    • Ketonuria
  • Serum bicarbonate: 12 mEq/L

BMI, body mass index; HbA1c, glycated hemoglobin; mEq, milliequivalents; T1D, type 1 diabetes.

  • Print