Abstract
Adolescents and young adults (youth) with type 1 diabetes (T1D) often face a significant diabetes burden, and optimizing glycemia presents a particular challenge. These challenges are compounded by physiological and psychosocial complexities, which can create barriers to accessing advanced diabetes technologies, which are the current gold standard of care. This case report highlights a young individual who, to our knowledge, represents the highest HbA1c level ever published at the initiation of automated insulin delivery. It explores his experiences with automation, safety, and multiple hospitalizations related to intoxication.