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CPE-002 · synthetic case CPE002-FX-013

Possible T1D or LADA

Random glucose 380 mg/dL, weight loss, thirst and positive ketones.

Synthetic · no real patientReviewed acceptance scenarioMetabolic engine v1.0.0

Purpose: Possible type 1 diabetes or LADA suppresses insulin-resistance framing.

Inputs the engine received

Patient

Age
24 years

Context

Sex for threshold application
female
Active medication list available
Yes
Classic hyperglycemia symptoms or crisis
Yes
Rapid unintentional weight loss
Yes
Ketones
positive

Laboratory

Random plasma glucose
380 mg/dL

What the engine reports

Priority

Symptomatic diabetes-range glucose

SAFE-GLY-002

Random glucose ≥200 mg/dL with classic hyperglycemia symptoms meets a diabetes-range criterion. Physician review is required.

Detected clinical pattern

Urgent Review Finding

A safety rule requires urgent physician review. See the priority safety findings first; pattern rules that could mislead were suppressed.

  • Glycemic: Diabetes-Range Finding — Physician Review
  • Validity: Interpretation valid
  • Metabolic syndrome: Metabolic syndrome: incomplete assessment
  • IR-associated pattern: IR-associated pattern: not assessable
  • Safety: Urgent review

Why this pattern was identified

  • Glycemic criteria met. Random glucose ≥200 mg/dL with classic symptoms.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Urgent physician review of diabetes type and ketone status (consider autoimmune markers and C-peptide at the physician's discretion).
  2. 2Confirm the diabetes-range finding per standards of care and review diabetes type.Diabetes-range criterion met.

Differentials, pitfalls and contradicting signals

  • Diabetes type (type 2, type 1/LADA, monogenic, secondary) is a physician determination.

Missing information

  • Metabolic syndrome components not entered: Elevated waist circumference; Triglycerides ≥150 mg/dL (or treated); Low HDL-C (men <40, women <50 mg/dL); BP ≥130/85 mmHg (or treated); Fasting glucose ≥100 mg/dL (or treated).
  • Fasting insulin (supporting pattern only; fasting and same-collection glucose required).
Evidence and rule trace · 8 rules

SAFE-GLY-002Symptomatic Random Glucose Finding

Inputs: random glucose 380 mg/dL · classic hyperglycemia symptoms or crisis

SYMPTOMATIC_DIABETES_RANGE_FINDING

SAFE-DM-TYPE-001Possible T1D or LADA Review

Inputs: rapid unintentional weight loss · ketones positive · classic hyperglycemia symptoms or crisis

POSSIBLE_T1D_OR_LADA_REVIEW

MISS-002Metabolic Syndrome Incomplete Data

Inputs: 0 of 5 components met · missing: Elevated waist circumference; Triglycerides ≥150 mg/dL (or treated); Low HDL-C (men <40, women <50 mg/dL); BP ≥130/85 mmHg (or treated); Fasting glucose ≥100 mg/dL (or treated)

METABOLIC_SYNDROME_ASSESSMENT_INCOMPLETE

MISS-001Insulin Pattern Missing Data

Inputs: fasting insulin not provided

IR_PATTERN_NOT_FULLY_ASSESSABLE_WITH_CURRENT_DATA

IRP-002Hyperinsulinemic Supporting Patternsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

IRP-003Elevated HOMA-IR Supporting Findingsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

IRP-004Convergent IR-Associated Patternsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

TREND-MET-001Composite Metabolic Deterioration Warningsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

INSULIN_RESISTANCE_PRIMARY_FRAMINGinsulin resistance primary framingsuppressed

Suppressed by a validity or safety rule.

Evidence

  • EV-ADA-2026-DIAG · American Diabetes Association Professional Practice Committee for Diabetes. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1):S27-S49.

Physician adjudication required. Clinical decision support only. This output identifies guideline-based glycemic and metabolic findings and risk context. It does not diagnose insulin resistance, select treatment or recommend medication. Physician adjudication is required.

Change the values

The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.

Glycemic testsDrag the sliders to cross a threshold
  • <100
  • 100–125 prediabetes
  • ≥126 diabetes range
  • <5.7
  • 5.7–6.4 prediabetes
  • ≥6.5 diabetes range

75-g protocol

Lipids, body and blood pressure
  • <150
  • 150–499
  • ≥500 priority
  • ≥1000 urgent

Metabolic syndrome components0 of 5

  • ○ Waist not entered
  • ○ Triglycerides not entered
  • ○ Low HDL-C not entered
  • ○ Blood pressure not entered
  • ○ Fasting glucose not entered

● met · ◌ not met · ○ not entered. Three or more meet the criteria; that does not confirm insulin resistance.

Patient and scope
Sex for thresholds
Ketones
Symptoms and safety
Risk context
Liver context
Medications
Outside the standard adult runtime
Fasting insulin (supporting only)Calculation and sandbox

Shown with HOMA-IR when fasting and same-collection are confirmed. It does not classify anything.

Research sandbox (unvalidated)

In production the insulin and HOMA-IR rules are off: no validated threshold profile exists. Here you can supply your own threshold to see how the sandbox rules would behave. The output is labeled a sandbox candidate and is never a diagnosis.

Live result · computed in your browser

Priority

Symptomatic diabetes-range glucose

SAFE-GLY-002

Random glucose ≥200 mg/dL with classic hyperglycemia symptoms meets a diabetes-range criterion. Physician review is required.

Detected clinical pattern

Urgent Review Finding

A safety rule requires urgent physician review. See the priority safety findings first; pattern rules that could mislead were suppressed.

  • Glycemic: Diabetes-Range Finding — Physician Review
  • Validity: Interpretation valid
  • Metabolic syndrome: Metabolic syndrome: incomplete assessment
  • IR-associated pattern: IR-associated pattern: not assessable
  • Safety: Urgent review

Why this pattern was identified

  • Glycemic criteria met. Random glucose ≥200 mg/dL with classic symptoms.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Urgent physician review of diabetes type and ketone status (consider autoimmune markers and C-peptide at the physician's discretion).
  2. 2Confirm the diabetes-range finding per standards of care and review diabetes type.Diabetes-range criterion met.

Differentials, pitfalls and contradicting signals

  • Diabetes type (type 2, type 1/LADA, monogenic, secondary) is a physician determination.

Missing information

  • Metabolic syndrome components not entered: Elevated waist circumference; Triglycerides ≥150 mg/dL (or treated); Low HDL-C (men <40, women <50 mg/dL); BP ≥130/85 mmHg (or treated); Fasting glucose ≥100 mg/dL (or treated).
  • Fasting insulin (supporting pattern only; fasting and same-collection glucose required).
Evidence and rule trace · 8 rules

SAFE-GLY-002Symptomatic Random Glucose Finding

Inputs: random glucose 380 mg/dL · classic hyperglycemia symptoms or crisis

SYMPTOMATIC_DIABETES_RANGE_FINDING

SAFE-DM-TYPE-001Possible T1D or LADA Review

Inputs: rapid unintentional weight loss · ketones positive · classic hyperglycemia symptoms or crisis

POSSIBLE_T1D_OR_LADA_REVIEW

MISS-002Metabolic Syndrome Incomplete Data

Inputs: 0 of 5 components met · missing: Elevated waist circumference; Triglycerides ≥150 mg/dL (or treated); Low HDL-C (men <40, women <50 mg/dL); BP ≥130/85 mmHg (or treated); Fasting glucose ≥100 mg/dL (or treated)

METABOLIC_SYNDROME_ASSESSMENT_INCOMPLETE

MISS-001Insulin Pattern Missing Data

Inputs: fasting insulin not provided

IR_PATTERN_NOT_FULLY_ASSESSABLE_WITH_CURRENT_DATA

IRP-002Hyperinsulinemic Supporting Patternsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

IRP-003Elevated HOMA-IR Supporting Findingsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

IRP-004Convergent IR-Associated Patternsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

TREND-MET-001Composite Metabolic Deterioration Warningsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

INSULIN_RESISTANCE_PRIMARY_FRAMINGinsulin resistance primary framingsuppressed

Suppressed by a validity or safety rule.

Evidence

  • EV-ADA-2026-DIAG · American Diabetes Association Professional Practice Committee for Diabetes. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1):S27-S49.

Physician adjudication required. Clinical decision support only. This output identifies guideline-based glycemic and metabolic findings and risk context. It does not diagnose insulin resistance, select treatment or recommend medication. Physician adjudication is required.

More metabolic cases

CPE002-FX-001

Healthy Metabolic Baseline

A 35-year-old with normal glucose, lipids, waist and blood pressure.

CPE002-FX-002

Prediabetes by HbA1c

HbA1c of 6.0% and nothing else.

CPE002-FX-003

Prediabetes by FPG

Confirmed-fasting glucose of 108 mg/dL.

CPE002-FX-004

OGTT-Only Prediabetes

Only a 75-g OGTT: 2-hour glucose 165 mg/dL.

CPE002-FX-005

Diabetes-Range Finding

HbA1c 6.8% and fasting glucose 134 mg/dL.

CPE002-FX-006

Metabolic Syndrome with Normal Glucose

Normal glucose, but waist 108 cm, TG 190, HDL 36 and BP 138/88.

All metabolic cases

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