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The US healthcare system makes it difficult, expensive, and often impossible for people with T1D to access the care, education, and support they need to live. Around the Circle: Living Well with T1D brings together voices from across the type 1 diabetes community to share real stories, expert insight, and practical support for living well with T1D.
Hosted by the team at Blue Circle Health, a U.S.-based program transforming type 1 care, this podcast helps people go from just surviving to truly living well with type 1 diabetes.
Learn more at BlueCircleHealth.org
Every June, the diabetes world explodes
with headlines from the American Diabetes
Association's Scientific Sessions.
It's a big conference that happens
every year, and it's exactly what
it sounds like, scientific sessions.
For many of us living with T1D, it's
maybe a little bit easy to tune that out.
It, it feels like it's more for
scientists and not people actually
managing blood sugars in the real world.
But what if you knew which of these
breakthroughs were actually gonna
make your life easier, and which ones
were maybe a little bit farther out?
Well, today we're doing exactly that.
I'm sitting down with Natalie Bellini
and Diana Isaacs to translate some of
the biggest diabetes event of the year
into practical, human-centered takeaways.
So if you've ever felt overwhelmed by
diabetes medical news, consider this your
invitation to talk it out among friends.
But before we continue, I do need to
remind you that we're not providing
medical advice or endorsing any
specific product brands here.
We'll always encourage you to consult your
healthcare team for personalized guidance.
Natalie, Diana, thank you
both for joining me today.
Thank you so much for having us.
We're excited.
Absolutely.
Now, before we get started, can you
please tell our listeners a little
bit more about your background and
role in diabetes management today?
And Diana, let's start with you.
Oh, I get to go first.
All right, great.
So my name is Diana Isaacs.
I am an endocrine pharmacist
and also a certified diabetes
care and education specialist.
I am at the Cleveland Clinic, where
I've been the last 10 years, and prior
to that, I was in a primary care,
uh, within the VA. And in my role at
Cleveland Clinic, I'm the director
of education and training in diabetes
technology and also co-director of
endocrine disorders in pregnancy.
So basically, I work with lots of people
with diabetes to really help them get
connected to technology, and then I
have a special love for diabetes in
pregnancy, really supporting people in
pregnancy to have the best pregnancy
possible and, and best outcomes.
That's amazing.
And you won the 2026 ADA Outstanding
Educator Award this year.
Congratulations on that.
Thank you very much.
It was a, yeah, a huge, huge honor
and, um, yeah, I'm very grateful.
And actually, I gave a talk at ADA
about really the importance of diabetes
technology and the human connection.
Behind every number is a story.
Yes.
It's not just throwing tech at people.
It's also, like, listening to their
story and really individualizing,
um, the care that we provide.
So yeah, thanks for calling that out.
Yeah, absolutely, and,
and so well-deserved.
Natalie, how about you?
Hi, everyone.
My name is Natalie Bolini.
I'm an assistant professor of medicine at
Case Western Reserve University and the
program director of diabetes technology at
University Hospitals in Cleveland, Ohio.
I am a nurse practitioner, and I see
patients, uh, three to four days a
week, depending on the week, and so I
am super… I've helped our, our entire
health system unite under usernames
and codes so that we can make care
more universal across different, um,
from cardiology back to endo, over
to inpatient, back to orthopedics if
someone needs a treatment there, where
we can share data across the system,
and it's made a huge difference,
hopefully, in patient care in the end.
And you've also lived with type 1
diabetes for a little while, yeah?
I've lived with type 1
diabetes for a little while.
After you hit 50 years, you
stop counting, and I've stopped
counting, uh, five years ago.
Yeah.
That's, uh, makes me smile.
I love that.
Well, we're talking today because
I need help understanding what I
should care about coming out of the
recent ADA Sci Sessions conference.
It's widely recognized as the largest
diabetes conference in the world, but it
can also feel very overwhelming to a lot
of us, especially if we're not medical
professionals or working in the space.
Can we start with a very high
level explanation of just kinda
what is this conference all about?
Absolutely.
So why don't I take part of it,
and Diana, you take part of it.
So, so i- it's called the American
Diabetes, um, A- Association
Scientific Sessions, so this is
where people present their research.
Some of the research is what
we call bench research, where
people aren't even involved.
It might be mice, it might be cells,
it might be all kinds of other things.
And then part of the research is
human-based research, where there are
new drugs and new technologies and
advancements in those technologies, and
those things are what we call read out,
where a new study might be published, or
early data where an abstract or very early
data might be discussed at that meeting.
Um, Diana, do you wanna talk about
the different tracks there are at ADA?
Yeah, so there's different
tracks based on interest.
So, like, as Natalie said, there's
definitely the bench research, scientific
things, like, happening in animal
models that are kind of early, early on.
And I think Natalie and I are especially
very interested in, uh, clinical tracks.
Um, and within the clinical, there's
also so many differences in terms of, you
know, specializing, for example, in type
1 diabetes or nutrition or pregnancy,
for example, uh, diabetes complications.
So there's all these different tracks.
Um, and actually, when they plan the
meeting, they get a group of people
together and have people design for
these different tracks, and really try
to think of what is going to be the best,
the things people want to hear the most
about, like, the most cutting edge, and
they try to seek out the best speakers.
In addition to that, people
can submit their research.
So there's a call for abstracts,
and people submit the research that
they're working on, and then that
gets accepted after it's reviewed,
and all those types of things are
read out at the meeting as well.
So it really is the biggest gathering
of people in the diabetes space, and I
mean, I think it is the best meeting,
just because there's so much cutting edge
research that ends up being simultaneously
published, like, right there- Mm-hmm
in that.
There's a behavioral track.
There's a pediatric track.
There's a, there's a, you know,
there's a, um, MASLD track, right?
This, this fatty liver track, right?
There's all these different tracks, and
so you can actually… There's an app that
you get when you register, and you can
look at… You could just go to behavioral
medicine, and there'd be something
every session for four full days.
And then there's another track
about pedes and, like, different
things about different pediatric.
And there's sessions every time for
four full days of, of, of education.
So it's not like, okay, you're
gonna hear one or two things.
You can… I mean, the hardest part for
me, when I go through the schedule, is
I mark everything that I think I wanna
go to, that interests me, and then I
open it up, and it's like there's six
competing things at any given time
because there's so much going on, that
I think that's the biggest part of it.
I mean, you know, Diana, do you
remember the numbers this year?
Somewhere between, depending on
the year, um, between 10 and 14,000
attendees at any given year for ADA.
Yeah, and the other thing
is the exhibit hall.
So I mean, that is one
of my favorite things.
It's basically you've got every
and any company in diabetes
all in one large, large space.
I mean, you could spend hours
and hours walking around, and
even still not talk to everyone.
But this is where you really get
to see, like, all of the latest
and greatest products that are
coming out, like new services.
And then they also have product
theaters where that's where a specific
company may have a dedicated session
just on the latest and greatest.
So, like, for example, updates with
Dexcom or updates with the MiniMed pumps.
Um, but many of them will do this.
So those are some of the additional
sessions also that happen at ADA.
Embedded into it all, right.
Yeah.
And then one final thing I
would say about the exhibit
hall is all the nonprofits come.
So Blue Circle Health, for example,
had a booth there to talk about their
programming, but so does, um, you know,
the American College of Diabetology
and all kinds of other, you know,
nonprofits that are out there helping
people succeed and, and, and, and
thrive with whatever kind of support
they're giving, um, with diabetes or
with, you know, foot challenges or
neuropathy, all kinds of different…
Um, so it's really interesting.
It's really, really… By the end, you're
just, you don't even know your own name.
You've been to so many things, right?
I mean, that's a good
way to put it, right?
Yeah, absolutely.
And, and one thing that I also think is
important that, that I haven't heard you
mention yet is, um, the posters, right?
There's a, there's a space next to the
exhibit hall that is just lined with
aisles and aisles and aisles of research
posters that maybe aren't doing a,
an oral presentation or a session on
the calendar, but they're all there.
And there will be dedicated times where
the researchers will stand there and
explain the research that they're, that
they're publishing through their posters.
Tell me a little about that.
Yeah, so that is a great call-out.
And so when they have this call for
abstracts, people can submit them, and
they can actually request if they'd
rather do a poster or do an oral or,
I mean, there's limited spots for
oral, so if it doesn't get accepted
as an oral, then it's a poster.
But yeah, there are several sessions
where the authors stand by their
poster, and so it's this opportunity
to really learn about all of these
different research initiatives,
projects, things that are happening.
And similar to the platform
presentations, the-- also,
there's different tracks, right?
Based on, you know, is it nutrition?
Is it pregnancy?
Um, and so this is a great
way for people to share the
research that they're working on.
Also, these get published as well.
These abstracts do get published.
And I also want to highlight because
there's so many sessions happening
concurrently, and there's no way we
can be in all the places at the same
time, although I'm working on it.
I'm trying to see if there's a way,
but So they, there is an on-demand.
So I'm actually still even going back
right now and watching some of the
things on demand that I didn't get to
watch, uh, while I was at the meeting
One of the things I think that
is important to understand
about the posters is that it's
early research typically, right?
So this is where I might submit, you
know, let's say I had 10 patients that
had all a certain condition, and I put
them all on an insulin pump, and then, and
what that outcome looked like, you know.
Or I did, you know, someone,
whatever it was, right?
So we're, we… A- And, and
it doesn't have to be people
based, it can be bench, right?
So we call it, um, bench research.
What does that mean?
That, you know, there's a,
there used to be a bench, right,
in all these research labs.
There, a lot of people
don't have a bench anymore.
It's a computer, right?
So, um, so they're not actually standing
at a bench all day at all, but that's
what we call bench research, right?
So there is some of the, some molecular
science, some animal model science,
some modeling, some AI science even now.
Um, and so what this is, is it's kind of
like this, "Okay, we did this. We thought
this great new idea, and this is what we
did." We might have done it with a handful
of people, or might have done it with, um,
you know, a- a- a s- it's, they're always
smaller is basically what it is, right?
Yeah.
And what, what is happening during
that time is other people are
looking at it going, "Huh, could
I repeat that? Could we get the
same results?" So that's one thing.
"Wow, that's really creative. Let
me go try it in my own clinical
practice." Um, or, you know, because
in order to get something to take
off, we can't just have it happen,
let's say, in Diana Isaac's office.
Right.
'
Cause if it only happens at Diana
Isaac's office, she can only have
so many people in there, right?
So if we can have it at Diana's office,
and Natalie's office, and Scott's
office, and our friend Lisa's office,
and then across in New Mexico's office,
and we can repeat the data, it becomes
more and more important that the…
And more and more where we might
say, "Okay, now this has been
repeated. Now let's create a bigger
study. Let's do this." Mm-hmm.
"Let's do that." And
that's how science grows.
These abstracts, which are, you know,
uh, is like the beginning science,
and then we all kind of go and share
information, and we take it to the next
step and go, "All right, I'm gonna take
this and do exactly what you did in
my lab or with some of my patients."
Um, and that doesn't mean I get
to go home on Monday and start.
Yeah.
That means I still have to go through, you
know, a board review and get permission.
It's not like we can just
start doing things on people.
So I don't want any listener to think,
"Oh, Tuesday, Natalie's gonna come
in and say, 'This is nifty,'" right?
That's not how it works.
We actually have to go through a
full review to, to do a trial or
an experiment with people, with
patients, um, in a, in our practices.
So but it does help stir, um, new
understanding and new curiosity-
Mm-hmm … between clinicians, and that's
what we're looking for with science.
Yeah, I love that.
You know, Diana, you mentioned a couple
of time, and, and I wanna come back to,
to what you just mentioned, Natalie,
um, because that's part of what feels a
little bit disconnected for me is some
of this research that's shared feels so
far out, so, so early, I feel like I'll
never see it in my life with diabetes.
But before we get into that, Diana, when
you mentioned, um, things being published,
right, like that's something that it's
an import- That's how, that's how this
research reaches the rest of the clinical
world that maybe didn't attend the
conference, and that's how it, it spreads.
Can you talk a little bit
more about the importance of
this research being published?
Yeah.
So, you know, often the first step is
to present it as a poster, and kind of,
it's, it's also a great opportunity to
get some feedback and even present some
early results on what you're doing.
Um, but the nice thing at ADA is when
you get it accepted, that abstract does
end up being published, and so people
can then see what you're working on.
The next step is to have the full
project published in a journal.
Um, and typically when the full project is
published, it's gonna be a longer article
that really gives all of the details
about how the project was conducted, what
type of people were included, what type
of people were excluded, how did they
evaluate the results, the statistics they
used, the clinical meaning of it all.
And the other great thing about something
being published is that there is a
peer review process as well, where
someone reviews it and asks questions
and asks for additional clarity.
Mm-hmm.
And this way, we can really ensure
the quality of the research.
Um, because the last thing you want,
and unfortunately this has happened,
where people make things up or, you
know, or people cut corners, and we
really wanna make sure the research
is quality because ultimately, if
it's something that works well, we
want to be able to replicate that.
And so some of the big research, I mean,
has led to expansion of, for example,
like CGMs and insulin pumps to more
people when we've done well-conducted
research studies showing, "Oh, look, there
is a huge benefit in this population."
So the impacts of this research and
getting published can really be huge.
Yeah.
It also plays a role in
securing reimbursement, right?
Like, the, the payers are not going
to, uh, agree very willingly to
fund something that doesn't have
some solid research behind it.
So when I, I mentioned feeling sometimes
a little bit disconnected from a lot
of these things that we're seeing
at these big conferences, uh, should
I maybe be thinking about these big
research-focused conferences differently?
They certainly hold an important
place in improving diabetes care.
What would you suggest as far as how
the average person on the streets
with T1D thinks about scientific
sessions, uh, specifically?
So I think Scott, you, you've had
diabetes for a bit now, right?
Mm-hmm.
Um, I want you to think back to 1997.
Did you have type 1 then?
I did, yeah.
You did.
So the DCCT was in 1997, and
that was research, right?
That was research that said, "You know
what? Doing this a couple of times a
day and not really checking that often,"
and for people with type 1, right?
This was the biggest NIH sponsored type 1
study at the time that had ever happened,
and they said, "Wow, if we are, if we do
intensive management, we can reduce eye
disease, kidney disease, right, by 2/3."
And so that was research in
1997, and you and I have been
following that research since then.
So things that are published today,
published or read out or discussed at
ADA today are, are part of what you and I
might live with 10 or 15 years from now.
Yeah.
So I would say some of it feels
like it's so far off, you're like…
But all of a sudden you and I, 1997,
I felt like it was 10 years ago.
It wasn't.
Right, yeah.
Yes, right?
But, like, all of a sudden, what that,
what that research ha- what… When
that research was read out, we were
like, "Oh, okay," and think about
everything that's happened since, right?
Right?
Like right now, a big
discussion in research is all
of these, these GLP-1s, right?
GLP, GIP, right, these, these
glutides and Type 2 diabetes.
Well, now we're starting to see some
research with people with Type 1 diabetes,
that we can reduce insulin, that we
can help with weight loss, that we
help with the fluctuations of glucose.
Has it been FDA approved yet?
Not one of them.
But part of it is just
saying, "Hey, look at this."
And now we've got people in clinical
practice using them, and now we're going,
we're pushing to get studies done to get
FDA approval so that every person walking
around could have a GLP-1 if it would
help them manage their Type 1 diabetes.
And I think when we think about research,
where you go, "Well, this isn't gonna
happen for 20 more years," but 20 more
years is gonna happen for a lot of us.
Yes.
And when it does, it's the research
that happened, that's happening now,
that take, it just takes a while, right?
So although some of it seems very
far-fetched, some of it seems… I would
never have thought in 1997, when we
were still injecting with no CGM, by the
way, with, you know, NPH, with, uh, w-
were we still using Lent- lente, right?
That we would be where we are now,
where my pump talks to my sensor,
and it makes decisions, and I can
set a target higher if I'm gonna go
for a long walk, and I can set it,
you know, more aggressive overnight.
Yeah.
And I can… You know, I mean, think about
that all of that has been science since
the DCCT, uh- protocol was, was discussed,
it was stopped actually early, right?
It was an NIH study that was stopped
early because they couldn't expose the
people to the standard of care any longer.
Mm-hmm.
Wow.
Because we knew it was
detrimental to your health.
Yeah.
Yeah.
Yeah, you're right.
That, that does shift the
way that, uh, the way that we
might think about things a bit.
So I feel like that- So I look at
it as, like, I'm looking for these pearls.
Like, okay- Yeah … what could we do now?
What can I take back, right?
That rather than- Yeah … this
is all too far off, this is
for my grandchildren, right?
Yeah.
Yeah.
Totally.
And that's a, that's a really good
reframe and, and way to think about it.
So let's, I feel like we've
set a good foundation of what
the conference is all about.
Let's talk about some of the,
the pearls that, that you
two kind of found this year.
Is there anything that, that jumped out
at you, especially relative to type 1
diabetes, that you wanna talk about?
Well, I can start.
There was a readout with the ELIDON trial.
So that's where they've done these
islet cell transplants, and they
have 12 people in that study that are
actually living insulin-free, so kind
of the closest thing we have to a cure.
Um, but what's really unique about that
study is that, so typically when you do
any kind of islet cell transplant, uh,
transplant, you need immunosuppression,
and these immunosuppressive
drugs can be pretty damaging.
Um, you know, they can have
negative impacts on the kidneys,
for example, and they can just be
kind of harsh to take long term.
So they've developed a drug called
TEGOPRUBART, which is actually
a different type of mechanism.
It's not kind of our typical
drug that we use, which is
usually a calcineurin inhibitor.
They used this drug instead of
immunosuppression and showed that
people were able to tolerate it very
well and stay off of insulin, and some
of them all the way out to two years.
Wow.
So to me, it's like, wow.
When you think about, like, actual
cures, that's really exciting.
Now, there's, of course, it's gonna be
some time before everyone is getting it
because right now the TEGOPRUBART is an IV
that's done every three weeks, and so they
need to work on maybe reformulating that
so it's a little easier to take, either
oral or a kind of a simple subQ injection.
And also with these islet cells,
they need to kind of come up with
a way to mass produce them just so
everyone- Yeah … that could benefit,
you know, would be able to get them.
And so they're looking at
different type of stem cell
to t- to create more of these.
But anyway, I think that's really
exciting, and there were several
sessions kind of related to type 1
diabetes cure and where we're going.
And so I think to see the science
advancing in that way, even though,
yes, it's still definitely several
years out, that is really exciting.
Well, and it's a good reminder
too that it's every, uh, often
these advances are stepwise.
You know, it's not, it's not gonna go
from today to a full-blown, you know,
cure with no additional medicines.
There's, it's, it's a stepwise approach.
I think that's a very good reminder.
Yeah.
And I think that we have to
remember a couple of things that
did get as part of this discussion.
People who have a larger body mass, a
couple of those people needed a second
transplant So they've learned a lot.
So part of presenting science
at ADA is this, right?
That those people had to go
back and get more pancreatic
cells, more beta cells, right?
So that was number one.
So now they know that.
So now in, as they do more of these
in this trial, because it's still a
trial, you can't go and get in line.
It, they don't open at 9:00 AM.
You have to, right, you have
to be part of this trial.
Um, that will they now write into
their new protocol, we're gonna do
islet cells based on body weight so
that they don't have to go back in for
people who have a larger body habitus.
So that's number one.
Number two, two of the patients
out of 12 are now on GLP-1.
So that's a whole other thing, right?
Um, it, i- in that it's, it…
Are they… We don't, and we don't
really know why they're using that.
Are they using it to help with
weight loss at this point?
Are they using it for cardiovascular risk?
But it certainly does bring
down your insulin needs.
So is that clouding the… Would they
need, would they be off of insulin
entirely if they weren't on that GLP-1?
Sure.
And that answer is we don't know.
So it's 12 out of 12 with
some caveats in it, right?
Yeah.
Um, not that I'm not saying that
it's not the best thing that I've
heard about in a really long time.
I just want people to be careful
with, let's see where this goes.
Let's try to get more people.
And remember in the background, we have
this whole issue with these are cadavers.
These are cadaver pancreas,
pancreai that we use.
Um, be- and, and, and there's this
whole debate, um, so it, it's the
pancreas isn't considered an organ,
and so we, there's a whole push to
try to get the pancreas considered
an organ so that when we have cadaver
donations, we can harvest more of them.
Um, so that came up in
the discussion as well.
How do we get enough?
How do we get enough pancreas
to get enough transplant if
we're really gonna do this?
Because long-term, when we transplant
a kidney and pancreas together,
which is typically when you can get a
pancreas transplant, they don't last
as long as the kidneys do, right?
Mm-hmm.
We actually tell people
that ahead of time.
"Be prepared that this won't work
as long as your kidney will," right?
Um, because it just hasn't
been very successful.
But maybe with this new drug, maybe with
this new method, but then we gotta look at
every three weeks, can you afford to leave
your office every three weeks and go get
an infusion, and how far out will it be?
Right.
And who's gonna pay for it?
And there's a lot of ifs, but what
science does, what ADA does, is bring
this to fruition and say, "Now what?"
So now the University of Florida
is gonna start doing them, right?
So this is the next step in science
is we've done them in one place,
at the University of Chicago.
Now let's get it replicated at
the next place, and then let's…
And as every step in this research
as it happens brings my hope up.
How's that?
Yeah, absolutely.
Great.
So that's one exciting
pearl out of there One,
yeah
What else, what else
caught your attention?
I think the next one would be
continuous ketone monitoring Right?
Diana, let's talk about that.
Yeah.
Talk about that.
So Diana and I did a little
bit of this on our podcast.
Um, and so our, um…
We're excited about this.
I just saw… I was doing my charts while
I was waiting for this, for our recording
to start, and I just had a patient in
DKA- Ooh … ooh, on a pump, right?
And so had they had a k- ketone
monitor on, would they have been
told ahead of time and said, "Uh-oh,
my ketone monitor is beeping.
What do I need to do?
Let me pull out my-" Right … "ketone
monitor sheet or open up my chart
and look in my chart for my plan"?
And could we have, you know, um,
could we have, uh, d- made it that
he, he had didn't end up in the ER?
I don't know for sure, but
Diana, do you wanna talk a little
bit about CKM as we call it?
Yeah.
So i- it's very exciting.
There was actually a really nice
debate with Jennifer Scheiner and
Jeremy Pettus kind of on, like,
debating do we need continuous
ketone monitoring for, for people.
And it was kind of funny because
Jeremy Pettus took the, the con side,
but he was like, "I'm pretending to
take the con side because I'm really
very excited about this technology."
Um, so they did a, you know, a
great job explaining the benefits.
Obviously, you know, the thing is
DKA, while it's fortunately not
super common, it's a life-threatening
emergency that kills people.
Yeah.
Uh, so I think anything we can
do to prevent that, you know, the
major hospitalizations and deaths,
even if it's not happening all
the time, it is a huge, huge win.
And actually, the Libre Duo was
approved earlier this year in
Europe, and it has been submitted
to the FDA, so we're hopeful it
will gain approval in the US soon.
But this is basically a device that
looks just like the Libre 3 Plus,
and it measures ketones at the
same time it's measuring glucose.
And it's really…
Most of the time, we, we would
expect people hopefully don't
have ketones, or it's a very
low level, so it won't… Great.
They don't have to worry about it.
But if something happens, if someone's
sick and they think it's just the flu,
or something happened with their infusion
set and they didn't realize they're,
they haven't been getting insulin
the last several hours, it will alert
them, and they can take action on that.
And so when you think about the
use cases, I mean, definitely
in kids, oh my goodness.
Yeah.
But also, like, a lot of adults,
like, can get sudden DKA.
And so definitely type 1 diabetes, I
mean, this is gonna be hugely beneficial.
There are some cases where we see
DKA in type 2 diabetes, and certainly
one of the areas we're also very
excited about is SGLT2 inhibitors, um,
especially in type 1 diabetes, where
we've been really- cautious about using
them even though they have tremendous
benefits on the kidney, on the heart.
We're so nervous because they cause DKA,
and often they cause DKA at glucose levels
that are in the normal range- Right … or
only slightly elevated, so it's really
difficult to detect that someone's in DKA.
So the hope is that we would be able
to use these drugs in people with
type 1 diabetes so they could get
the same benefits, and then we would
be able to lower that risk of DKA.
So let's take a quick-
Another- … step back, right?
So- Yeah,
please
…
SGLT2 inhibitors are medications, they're
pills that are FDA-approved for people
with type 2 diabetes that pull glucose out
of the urine through the kidney, and you
urinate out a little bit of extra glucose,
um, all the time, basically, right?
So when your glucose is elevated above
the target of somewhere around 100,
um, it will actually help pull some
of that glucose out of your urine.
People with diabetes have some magical
things happen that are very frustrating.
One of them is we hold onto glucose at
a much higher level than people without
diabetes, both in type 1 and in type 2.
And so when that happens, it's
like conserving it, so it's keeping
your glucose high, so this will
allow it to spill some glucose out.
After they were FDA-approved to help
reduce glucose, these other, these
other magical things were discovered.
So we tr- use them to treat heart failure,
we use them to treat diabetes, we use
them to r- to slow down kidney disease.
So, um, you know,
they're all named flozin.
So the s- um, the, the, the whole
class is called SGLT2 inhibitors.
They all start… They all end in
flozin, canagliflozin, right, like that.
And so they have a handful of letters
in the beginning with flozin at the end.
That's how you know what they are.
The challenge is that it's that, is
that we use them in, early on in people
with type 1 diabetes, and then they
end up in the hospital, like, and
they're like, "Okay, wait a minute.
Their glucose is 148.
They can't be in DKA," and
they're in full-blown DKA.
Mm-hmm.
That's called euglycemic DKA,
normal glucose, but full-blown DKA.
You guys, it's just as deadly.
We had people end up in ICU, just
as deadly as glucose of 450 DKA.
At least with a glucose of 450
when you walk in, people know
what's wrong with you, 'cause
they say, "Oh, the glucose is 450.
Let's make sure they're
not in DKA," right?
So it, the challenge is it masks
the, the glucose is not letting the
person, the clinical person think
the whole pathway through, the
science of what the numbers are.
So we've done our job as best we can to
teach emergency room, uh, providers that
this can happen, that this is part of it.
We have a flag in our chart now.
Um, we actually stop them, and that is
the ADA recommendation, that you stop
them if you're going in for, uh, surgery,
elective surgery, that you just don't
take them for those three or four days.
If you're sick, we don't take them.
If you're… So these magic
pills are really magic, and they
do work with type 1 diabetes.
The data is out, and they've been
presented in oral, um, orally
and in published papers now that
the glucose just beautifully
comes down a little bit, right?
It's pulling out glucose all the
time, but we can't always predict
who's gonna end up Just like other
challenges with other medicines,
who's gonna be allergic to something?
We can't say.
Who's-- W- Can you predict who's
gonna be allergic to peanut butter?
No.
You can't predict who's gonna
end up with euglycemic DKA.
We, we would think it would be someone
who doesn't take a lot of insulin
or who doesn't eat consistently,
who, who wants to… It's not.
You would think, okay,
someone who takes a lot of it.
No.
So the challenge has been that we're
all in clinical practice hesitant to use
them, even if we know they're beneficial,
because we're afraid that someone
might get a masked, um, euglycemic DKA.
So if we had a beeper that would beep
every, you know, with high ketones and
say, "When your beeper goes, change
your infusion set first," right?
If you have type 1 diabetes,
do the things to fix it.
Make sure your glucose… But also
eat some carbohydrates, take some
extra insulin to clear these ketones.
If they keep going up, you need to
go to the ER and say, "I think I have
euglycemic DKA. Here's your handout.
Bring it to the ER with you," right?
I would then feel way more comfortable
using these medications in, in people
with type 1 to reduce the risk of kidney
disease, to treat heart failure, uh,
to do those things that help, that
these medications are indicated for
So this is also another good
example of these two different
paths coming together, right?
We've got the drug development path,
and then you've got the, the C.K.M. path
that are, are beneficial and can offer
new paths forward to work together.
I think that's, I think
that's very exciting as well.
And it sounds like, you know, with
the C.K.M. sensor from Abbott being
approved in, in Europe already,
that that feels a little bit closer
to me than decades out, right?
Like, we're gonna see some
pretty fast progress here.
It's coming, yeah.
Yeah.
That is coming.
Yep.
Like, that really is coming soon.
Um, and it, that is exciting.
And it should be available
for adults and kids.
What they're, uh, saying is
adults will be the full 15 days.
Um, kids is 10 days, at least
based on what it is in Europe, um,
so it'll be a little bit shorter.
But also, we've heard from the pump
companies that they are planning to
integrate the dual glucose ketone
sensor within all of their pumps.
So that's great, 'cause then
people could still use that,
still use their AID system.
So, uh, that is something I'm
very much looking forward to.
Um,
another- So
l-
let's, yeah, real quick, though,
let's remind people that it won't
be that your AID system will
say, "Oh, you're getting ketones.
Let's give you more insulin." In the
beginning it will simply be, "Your ketones
are, are elevated" and a red light will
come on, or flash, or something like that.
Or you'll get a beep and a warning.
It will not be integrated, like delivering
more or less insulin in the beginning.
Uh, we need to learn more
about how this is gonna work.
So let's say I get up in the morning
and I do my two cups of black coffee on
my way to work, and I have a slamming
day, and I work through lunch, and
it's now 2:00 in the afternoon, and
I'm, I'm crabby 'cause I'm hungry.
Will I have some ketones?
Probably, because I haven't eaten
breakfast and I delayed lunch.
That is, that is normal pathophysiology.
So what we need to do is
learn what numbers mean what,
and why I have some ketones.
It's because I just need
to eat some lunch, right?
When we do this in, when, when
people do ketogenic diets, right?
They're re- when we… People who
lose weight are, are spilling ketones
naturally as they lose weight.
So some ketones are not detrimental
and, and there's gonna be a big public
health learning curve here to learn,
and clinical curve too, to learn what
these mean and how they're going to
work, and then maybe one day they'll
be incorporated into the algorithm.
But it would be much more of a red
light versus, or a message, versus
or a beep and a message, versus
a this is part of your algorithm.
I just want to make sure people understand
that that's not coming in 2026 or '7.
It's just not.
Yeah.
We're not there yet, right?
No, that's a really good call-out, yeah,
that it's not gonna be, right, the pump
is not gonna give you more insulin.
You're gonna have to kind of
thoughtfully think through what to do.
And actually, the point you just
brought up was Jeremy Pettus in
his debate, he kind of said that.
He's like, "Oh, what are people
gonna do with the data? They're
gonna be so confused." And then
Jennifer Scheuer was, you know, kind
of funny, 'cause that's what people
said about CGM in the beginning.
They're like, "Oh, CGM's
giving me- Too many data points
too
much
info."
Right.
Right.
What are we gonna do?
Right.
Yeah.
Right.
Like it, we can't give it to everyone.
Some people will be too anxious.
There'll be too many
numbers for them, right?
So hopefully, you know, yes,
there'll be some questions.
Like, is this number, do
I need to do anything?
But I think we'll, we'll figure it out
All right.
Normally, we take a break here and share
a story from someone who's gone through
the Blue Circle Health program, but I'd
like to do something a little different
today because we have Natalie here.
Natalie, we often joke inside here that
you are our number one referring provider,
which is an amazing title to hold.
But in one minute or so, can
you tell us more about why?
Like, what, when people have
access to you, such an amazing
clinician, why is Blue Circle Health
something you're recommending?
So there's really two reasons.
The first is that we're a team, right?
I believe that every single person that
touches someone with diabetes is part
of that team, and I, as a clinician,
don't care where they get the care from.
I care that that's excellent care.
So if someone says, "I have a dietician
near my house, I have a this, I
have a that," and we're getting the
outcomes that the person is looking
for, that's part of it, whether it's
part of my health system or not.
So that's number one.
Number two, the cost of things is going
up astronomically, and so when you see an
endocrine provider, and then you wanna see
my nurse, my dietician, or a pharmacist,
or the social worker, or the psychologist,
or the exercise physiologist, or…
It's all a copay.
And so as people's- Yeah … deductibles
go up and as people's, uh, financial
challenges, you know, gas is
expensive right now, everything.
Yeah.
When I think about that and I can
say, "Look, Blue Circle Health is
here to support people with Type 1
diabetes and complete that circle and
help you do that without charging you
for it, you're part of my community.
I see you as an extension of
our practice at this point."
Well, thank you, Natalie.
That means a lot to us.
Now, you may have heard me
talk about diaTribe before, and
there's a good reason for that.
I'm a proud member of
the diaTribe fan club.
They do such a great job of taking vast
amounts of information and making it easy
to understand, and their ADA Scientific
Sessions coverage is no exception.
There are two great articles from
diaTribe that I wanna call out.
The first is titled Top Diabetes News ADA
2026, and the next one is titled Diabetes
Technology Highlights from ADA 2026.
So if you're wanting to dig a little
deeper on any of the things that you
heard today or maybe hear more from
diaTribe about some of the things that
we didn't get a chance to cover, you
can head to diatribe.org and you'll find
them in one of the latest news sections,
or you can simply type ADA 2026 into
the search bar at the top of the page,
and they should come right up for you
All right, so those were two big ones,
and I, I imagine you two probably have
Several, but let's do maybe one more
or two more if we're a little fast.
But what else comes to mind
for you?
Okay, we'll try to do faster
'cause there's so many things.
Okay.
I wanna talk about inhaled insulin.
Yes.
I think this is a big thing now,
um, the fact that inhaled insulin
got approved for ages six and over.
Um, and this, you know,
is very, very exciting.
Um, you know, there's a product theater
about this and some other sessions.
I actually did a session with
Earl Hirsch and Michael Holler.
Uh, it was a Medscape session
about inhaled insulin.
And I mean, it's really exciting to
have this as an option for kids now.
And, you know, some of it is now
we're getting clinics kind of up
and running and figuring out, okay,
like, how do we offer… Who do we
offer this to, and how do we do it?
Um, one of the things is there
is this pretty basic test.
It's called an FEV1.
Um, Natalie, you explain things so well,
so you can explain that in more detail
But it's basically, like, a very
simple test you can do in office.
Like, you blow a couple times,
and they record how fast you're
blowing, but, or how strong it is.
But anyway, it's a really
simple thing, but clinics, like,
still have to figure it out.
They have to figure out,
okay, who's gonna do it?
How am I gonna document it?
And then now I can prescribe it.
So whenever there's something new,
sometimes people are like, "Ah, how
do I do it?" But, and that was some of
the sessions, is, like, talking about,
hey, this doesn't have to be so hard.
We can offer this, and then how
do we follow up with people,
and how do we adjust the dosing?
'Cause dosing of inhaled
insulin is very, very different.
But what's really remarkable is that
what the data shows is that you can
get, in terms of, like, time and range
in A1C, you can get outcomes as good
as people on AID systems if, and the
caveat is if, you really dose at your
meals, and you kind of watch, and you
redose if you're continuing to go up.
Like, people that are, are doing that,
they can get the similar outcomes.
And why that's so important is because,
you know, there's always some reason
someone just doesn't want to be on a pump.
Sure.
Like, you know, maybe they want a break.
They've got tons of things on their body.
Like, you know, just they're having
skin sensitivities, and they just,
like, they just don't wanna be
attached to something all the time.
And so here now we have an option, at
least we can offer people, and really
be able to give them that choice.
And in fact, the ADA standards of
care, now I'm gonna break this into
something else, but there was also a
session, you know, on the updates every
year of the standards of care, but
one of the things they added was a new
kind of algorithm on Type 1 diabetes
management and insulin adjustment.
But one of the things they say is, like,
you should periodically be reassessing.
Like, is what they're doing working?
Do we need to start thinking
about offering a different
technology or switching from pump
to inhaled insulin or vice versa?
So, um, that was also presented
at, at the Sci Sessions as well.
Yeah, that's
exciting.
So one of the things that I think
is really cool is that when you
get FDA approval for anything in
children- It speaks to safety, right?
It's kind of like there's like,
we always get approval for adults
first in almost everything, right?
And it takes, like, sometimes
years and years and years and
years to get kid approval, to get
children approval, and they did it.
And this, to me, is everything
because I don't wanna hear it
anymore when someone says, "Well,
what about their lungs?" Stop.
We've had d- we've had people using,
uh, Technosphere insulin, which
is what it's technically called,
Technosphere, how cool is that, right?
Um, for years now, and they love it.
And, and Diana, you said,
"Well, maybe they don't like a
pump, and maybe they don't…"
Maybe in 2026, they simply can't
afford it because they have a $5,000
out-of-pocket, and they've got terrible,
you know, coverage at the whatever,
and we can get, we can get inhaled
insulin for them at a semi-reasonable
cost for most people, right?
Not every single person, but a
lot of people can get coverage
for it, and they like it.
It's easy.
It's simple.
Um, and, and so we have a lot of
people in our practice that wear a
pump that use it some of the time.
They use it just like r- like,
it's like the anti-glucagon.
So you went out, you said
you had 15 grams, you didn't.
You had 90, okay?
I don't know why you thought it was 15.
I've done it before, too.
I'm like, "Oh, that must've been 20."
And, like, that's just not what happened.
And now I'm going up,
double arrow up, right?
And I'm beeping, and I'm angry,
and I'm… And I can inhale
4 units, which acts like 2.
Diana said, like, it's a different dosing.
It's not that hard.
It's half of what the number says.
And say, "Okay, I weigh 115 pounds.
This is, what, 4 units
is, is, is really 2.
Here I go." And watch my numbers
stop doing this and just come right
back down again beautifully, right?
So I think that we can think about
inhaled insulin very differently.
It doesn't have to be you're not on
a pump, you're only doing it this
way, you take a once a day basal,
and now you use inhaled insulin.
It can be that you use a pump,
an AID, and some inhaled insulin.
You use it as a rescue, or you
use it at work because you don't
wanna… or at some place where
you want that insulin in and out.
I have some athletes that use it for
meals before exercise to get that
insulin because it's out in 90 minutes.
It's not that 4 or 5-hour tail
that, that we can just be so
frustrated with sometimes, right?
You're like, "My insulin's
gone." No, it's not, right?
There's this drag- Yeah … that's
just hanging around, haunting
us for a long period.
I, we use it for lots of different,
lots and lots of different things, and
I think once you start truly offering
it, people want it What I will say about
the testing for it, this FEV1, we have
this little computer that's about, I
don't know, the size of, uh, you guys
all have type 1 and Omnipod, right?
Not even.
And you put a little piece of cardboard
on top of it, and you put them in the
office, and you say, "Take the biggest
breath you've ever taken in your life
and blow as hard as you can." And so
they take this huge breath, and you
blow into the tube, and you say, "Blow,
blow, blow, blow." That's my part.
I like that part, right?
And so… And we wanna see that your
lung function is, is at goal, right?
Is, is normal.
Um, I've never had anyone fail that.
We, wh- who we don't use it for is
people with COPD or smokers, right?
You can't, we can't do that to the lungs.
Sure.
You can't add to the lungs.
They're already at a diminished rate.
So, um, we, but we can do
it right in the office.
I will tell you, the company
will mail them, um, mail adults.
I don't know if they're mailing
peds, to be honest with you.
I don't know their policy.
I bet they would.
I
wouldn't be surprised if they would.
We'd have to ask, right?
But, um, I know for adults, they will
mail you your FEV run right to your house,
and I've had people take a picture of it
and upload it through MyChart, and I have
it, and I'm done, and I can use that.
They don't even have to come in because
some of Pa- some of this is access, right?
If you live two hours from my office and
I have to get you to drive there just
to do this FEV1, 'cause you're supposed
to do it before you start and then once
a year, um, this is, um… And, and
just so you know, the lung function
data didn't change over time, right?
So the data that they have
on lung function in the
studies is, is, is impressive.
So I'm not concerned about lung
function in people that don't have
an issue with their lungs already.
Um, but those are the, those are the
other parts of, of this, you know,
this Technosphere insulin, this Afrezza
is the brand, is the only brand- Yeah
of insulin out there right now.
We love it.
Both Diana and I are huge fans.
Can I throw in one more thing-
Please … not related to inhaled
insulin- Totally … but just related
to ADA, because I wanna call out, like,
GLP-1 drugs in Type 1 diabetes is a very
hot topic, and Natalie was part of a
cons- an international consensus on the
use of GLP-1 drugs in Type 1 diabetes
that actually, I believe, was published
the Friday- It was published, yep
of the meeting.
So Natalie, you wanna talk
a little bit about that?
You guys, you need a GLP-1.
Okay?
Right?
I mean, so, so what do we know
about GLP-1's bigger than just
it, it helps with diabetes, right?
So GLP-1, when you think about
it, is gut, liver, pancreas.
That's how I teach it.
GLP, right?
It slows down the digestion in your gut.
It tells your liver to calm down.
People with diabetes, our livers
are doing this all the time.
It's, like, making extra glucose.
It's, like, it's, like, not in the,
it's not in its right mind, okay?
And it tells your
pancreas to make insulin.
And for those of you with Type 1 with
no more pancreatic function, with zero
C-peptide like me, mine's like a vortex.
It's, like, zero, zero, zero, zero.
Um, your pancreas then laughs, right?
But it still does the other two things.
So what it does is it reduces
and it sends a message to your
brain that you're not as hungry.
It helps control that
brain function of hunger.
When I talk to people who have Type
1 diabetes and I ask them questions
like, "Have you ever felt full?"
And half of them cry,
it's a terrible place.
People with diabetes, whether they
have Type 1 or Type 2, some of
them have never felt full in their
lives, and this helps with that.
It helps the hunger center of your
brain just say, "I can stop now and,
and I'm okay with it, and I don't
need more food." So it, it helps the
fluctuations, and that's the benefit
for us with diabetes who are trying
to increase our time and range without
having so many lows, without having the
greater than 250, all the numbers, right?
The other things we know about
GLP-1 now is it, it, it reduces
the risk of cardiovascular disease.
It protects kidneys.
It does all these… It's, it's indicated,
one of them is indicated for sleep apnea.
It redu- I mean, so, so these
are kind of miraculous drugs.
Yeah.
They're hormones, and what we know
about them is a lot of us are using
them to reduce those risks for people.
I can't wait for science to tell me that
it's gonna work in type 1s as well, that
it's gonna reduce the cardiovascular risk,
because we have no real data on that yet.
But what we do know is we are using
them in clinical practice, hoping
that we're helping someone protect
their kidneys and their heart
and those kinds of things, right?
Reducing those risks.
So we met in Barcelona at, um, a
technolo- an international technology
conference this year, and even before
that, started writing this guidance for
people with type 1s, specifically for GLP.
Um, and then there's of course GLP…
I'm sorry, GLP-1s, and then there's
GLP and GIP combined, and we, we…
Since it's with Scott, we're
allowed to use names here.
It's not a medical, right?
Yeah.
Mm-hmm.
So, um, Mounjaro is GLP and
another hormone called GIP.
They're hormones, just like insulin is a
hormone, and we don't make enough, guys.
So we need to get it for you.
Even people who are thin,
we will use lower doses.
There's a stacked dose.
There's a titrating dose.
Um, it does help with weight loss.
So FDA approval for tirzepatide, which
is Mounjaro, is for type 2 diabetes.
FDA approval for weight loss
of tirzepatide, same molecule,
same drug, is Zepbound.
So it's the same thing sold
under two different brands.
Ozempic is the w- same way.
Ozempic is FDA approved
for type 2, semaglutide.
Semaglutide for weight loss is Wegovy.
So that's how it works, right?
Um, and then we have Trulicity, which
is only FDA approved for diabetes.
There is no weight loss side of Trulicity.
And those are the big ones.
There is a once-a-day Victoza, um, that
we occasionally use if someone's insurance
doesn't cover some of the others.
Sure.
But we're big fans of the weekly.
We really are.
Um, and so we want more people to, to have
access to these medications, and so we
as a group of clinicians said we should
write some guidelines to help people get
access to them as quickly as possible
That's great.
Can you, um, can you envision a time
where once the science sort of proves this
out, that this becomes a standard option
for people living with type 1 diabetes?
So we're waiting for… So, so this
is the hardest part about this, is
it's all, it's not all about money,
but money drives a lot, doesn't it?
Sure.
So if you were a company making, you
know, Scott's GLP-1, and you were doing a
decide who to sell it to, would you sell
it to the 34 million people with type
2 diabetes, or would you sell it to the
1.8 million of us with type 1 diabetes?
Yeah.
Where would you make your bang, right?
And you have a board, and you have to
make profit, and you have to invest
millions and millions and millions,
hundreds of millions of doll- billions,
a billion dollars for a drug, right?
And so what typically happens is,
first, we get them approved for
type 2s, and now we go backwards.
We're waiting on SGLT2 inhibitors.
Those aren't approved for
type 1s either, right?
Right.
Um, because of the DKA,
though, right, we tried.
And so I believe in my heart that the
companies will go back now because
it's the right thing to do, but we
were never gonna be first, right?
And we are getting a few through.
Um, uh, um, you know, Zepbound is
approved for, um, for people with
sleep apnea, for example, right?
Um, Ozempic has the flow study
now that, that, that helps reduce
that kidney disease progression.
So if I can slow down your kidney disease,
where you never need dialysis, and you
stay healthy, and it reduces your risk of
heart attack, even if your function isn't
perfect, as long as it's not gone, and
you don't need dialysis, I'm good, right?
Yeah.
I believe that those things will come.
We do struggle with getting approval.
I will tell you, Diana and
I were at- Where were we?
A- ACE this year, right?
The American Association of Certified
Endocrinologists have their own meeting,
a different meeting, so not just about
diabetes, but about all of endocrinology.
And Viral Shah stood on the stage and
said, "The ADA now says you can have
type 1 and type 2 at the same time."
So you can have type t- 1 diabetes
with, with type 2 characteristic-
Mm-hmm … characteristics, including
insulin resistance, including overweight
or obese, and two-thirds of my patients
have either… or the people that I see,
people with diabetes, have overweight
or obese as part of their diagnoses.
So that's easy, right?
I can call them more than one
thing diagnostically, and it's
part of the ADA guidelines now.
So that's how we're getting it approved.
Yeah.
I'm just telling you what it is.
People dance around it.
I don't.
I'm done.
I'm done dancing.
We need to help you guys.
Yeah.
Well, I wanna add, the
overweight, obesity, so that's
kind of a separate indication.
And so when people have insurance
coverage for that, then often we can
kind of just ignore their diabetes
and submit it- Mm-hmm … under that.
I think the challenge is that still
insurance is kind of limited in terms
of many aren't- Yeah … covering,
especially, like, Medicaid plans
aren't covering people with
just for, for weight management.
But Medicare now, through the
Bridge program, is now expanding
and covering obesity and offering
these drugs for $50 a month.
So I kind of talked with my team and
everything, and we figured out, like,
people with type 1, if they meet the other
criteria, like they meet the Body Max
Index and they have, you know, the other
criteria, we're gonna put them through.
We're gonna try to-
Yeah … get it for them.
So I think, you know, we are
gonna see the coverage improve.
I think some unknowns are actually,
what are the benefits and… versus
risks in people- Sure … with
normal weight with type 1 diabetes?
And the reason this is kind of an
unknown is 'cause these drugs do
cause weight loss, and obviously,
at a certain point, you don't want
someone to lose too much weight.
You don't want them to
lose their muscle mass.
And so I think that is actually
a research opportunity.
Many of the research studies in type
1 have been in type 1 with overweight
and obesity, and I'd love to see more
data in people with normal weight,
but also seeing, hey, are there these
additional cardiorenal benefits and
benefits on their, their glucose levels?
Yeah, thanks for mentioning that So,
yeah, I mean, what, what we do now is,
is we use the lowest doses available
for those people because I have to…
People who have, who are "normal
weight," um, who don't qualify because
of overweight or obese under the
Medicare or whatever guidelines end up
with heart attacks and strokes, too.
And so, um, we have to at least try.
And one of the things that we
do is we use super low dose, um,
Ozempic specifically because you
can dial that dose up and down.
It's in a pen designed exactly like,
um, Trulicity is, actually, and
so we can give microdoses of that.
I'm not talking microdoses
like once a day.
I still use it once a week, but I
will use less than even the lowest
dose possible in those people
because I don't need weight loss.
We don't want weight loss with that.
What we want is the
cardiovascular risk reduction.
The challenge is, what?
We don't know if that lower
dose helps or not, right?
Yeah.
We don't know, but what we do know
is we see for those people, a lot
of them do have less fluctuations
in glucose in spite of the fact that
they're not on an efficacious dose.
Um, so there, there is that discu-
We could just, we could spend four
hours talking about just this, Scott.
Yeah.
We
need to have another episode.
Well, I mean, I agree.
Right.
It's promising and- Yep … you know, I
agree that's a great- Yep … strategy.
We just need to know the outcomes.
Like, is that, right…
I- Is it- It's gonna be-
going to ultimately- Yeah … it
seems logical it would.
We just need
to see the data.
We have no idea, but do I wait?
Do I say to someone,
"Well, your BMI is only 24.
I am not gonna give it to you, but if
you get to 27," as my husband jokingly,
who also has type 1, jokingly says,
"Well, Natalie, we can eat up to that.
We can take care of this, right?
So if I eat up to a BMI of 27, then
you'll give me something?" That, the…
So, but it's gonna be a long time, right?
If we s- look at the s- like, we're gonna
get it approved for type 1s in general.
There's going to be
cautionary with lower BMIs.
Yeah.
I don't know how long we're gonna wait,
Scott, for someone like you and I to
say, "Well, Natalie and Scott need
a low dose to protect their hearts
because our hearts have been exposed to
way higher glucose fluctuations- Right
when we didn't even have glucose
testing as a kid," right?
So-
Just to throw in there, many people that
I see with type 1 are hesitant to take
statins, and that is an evidenced-based
therapy that we know reduces heart
attacks and strokes and is really cheap.
So yes, like, this is really interesting,
but I also wish people would look at
some of the other therapies, too, like
statins, like ACE inhibitors- Mm-hmm
or, or whatever, the other blood pressure
medicines, um, as well when we're thinking
about kind of overall heart health.
It's a good reminder that we need to be
having widespread conversations with the,
the patients that you're serving to learn
more about what are their hesitations.
Why, why do they feel maybe
uncomfortable about looking at
a, another medicine like that?
So that's a, that's a
really good reminder.
And one of my favorite phrases is,
"Time will tell," and I'm gonna
caveat that with, uh, time and good
science will tell with some of these
things that we've talked about today.
If someone's feeling maybe a bit inspired
or, or maybe just curious about something
they've heard from our podcast today,
or something else coming out of the ADA,
what do you think is the best way for
them to bring that up with their care team
without, without feeling, um, like they're
questioning their direction or maybe
putting unfair pressure on their team?
Do you have any suggestions for that?
I always tell people when they find
something… You know, all- someone
will say to me, "Well, I found
online," and they'll start talking.
"Did you print it? No, I need
you to bring it to me," right?
Put it, take a picture of it.
If it's on your phone, take a
picture of it so I can see where
it's coming from so that we can talk
about it, and I know what resource.
Because people will say things
like, "Well, I don't get a flu
shot. I heard statins give me, you
know, give me memory loss." Yeah.
"I hear whatever." Show me where you're
seeing that, because let me show you the
other side of the data that, you know.
I mean, and that's, people
will think their own way.
I mean, people will think, you
know, when we start GLP-1s,
we don't typically stop them.
We might reduce the dose at some point in
the future, but we're not really stopping
them very often, um, at all, just like we
don't stop insulin in someone with Type 1.
That's how I talk about that.
It's the same kind of thing.
If you find something or you hear
something, sh- help me by helping to
help you by getting me the source- Yeah
so that I know where you're
getting your information from.
There's a lot on the American Diabetes
Association website, um, about diabetes in
general, and I think they've done a really
good job sourcing their information.
Another great place is
Beyond, uh, Type 1, right?
The Beyond Type 1 website
is very, very well done.
Um, both Diana and I are on their
medical advisory board, so, um, we try
really hard to help them really set
the standard of care of guidance of,
you know, what we, what should we be
doing to, to thrive with Type 1 diabetes
and live our forever life, right?
Live as long as everyone
else that I grew up with.
Um, so, so I think if you, if, if people
are, who are listening or watching can
find the source or take a picture of
it with the website listed so that I
can open it with them and help them
w- figure out where it's coming from
and who wrote it, um, and, and where
their clinical expertise is coming
from, it will help us help you make a
good decision, I think is the best way.
Yeah,
I completely agree with that.
I love the idea of, like, print it
so we're all looking at the same
thing, 'cause sometimes when you
try to say something over, it gets,
like, it jumbled a little bit.
Yeah.
Um, and I think just bring it up
in, like, a questioning manner.
You know, just say, "I heard this."
Like, "I would love to hear your
thoughts about this," or, "Where
could I learn more about this?"
Or, "Is there someone I could meet?
Could I have a referral for Blue Circle
Health?" So I think bringing it up
in that way can be really helpful.
Yeah.
That's great.
That's very helpful.
Well, you've both been extremely
generous with your time today.
Um, is there anything that
maybe I haven't asked about that
you wanna be sure to mention?
I think the only other thing that
is coming that is consistently
changing is th- the world of,
um, automated insulin delivery.
Mm.
Right?
Yeah.
Like, there were so many great
things that were… You know, so the
islet insulin pump company, right,
Beta Bionics, did a presentation
on every single patient's data.
This has never happened before, you
guys, where a company didn't say, "Let
me show you a study where everyone
stood on their left foot and only ate
fava beans on Tuesdays, and then they
had these perfect glucoses," right?
Like, we see a lot of studies that
are kind of hand-selected like that.
And Beta Bionics, um, said, "Well,
let's just look at all our data.
Like, we're proud of our data.
We're proud of our product.
Let us show you everything." And
so that was really impressive, that
they actually, you know, said that.
Um, Omnipo- a- and, and their data's
impressive, too, by the way, right?
Mm. Um, Omnipod announced their
new target of 100, as well as their
enhancement to their algorithm, where
for those people that are high for a
while and then they get kicked out of
automated mode and have to wait that
five minutes to restart automated mode,
and then people go back to sleep- Right
and they don't do it, and they- then
they're out for three or four days
of automated mode, that's all gone.
It's going to alarm and say, "Hey, you're
supposed to check your pod and make sure
it's not leaking, and do those things,"
but it won't kick you out anymore.
Um, that's a big thing.
Uh, there was, there was talk on, on
Tandem and, and their algorithm and
using that, um, sensitivity, their
correction factor, and making it strong
to make the, the algorithm even stronger.
Uh, MiniMed has a brand-new pump.
I mean, like, you guys, it was just…
And that's just the, the, the top of
the iceberg of, um- Yeah … you know,
there's new Dexcom data on people just
taking, not even taking insulin at all.
There's new… Like, it's just like,
whoosh, you just can't even, right?
So- Yeah,
and Twist, yeah, I agree.
And Twist, too.
And Twist also presented more of their
real world data, 'cause, like, now
they've been out over a year, they have
more people on their pump and stuff,
and so we continue to kind of see
that and impressive outcomes as well.
Yeah.
All, every single brand had something
pretty amazing to talk about at this
p- at this sess- at these sessions.
So, I, I mean, I think as a person
with type 1, if you're out there,
g- when you go, when your pump is
either out of warranty or if you're
interested, if you have a pharmacy
benefit pump, to look at something else.
There are, there are others going through
pharmacy now, both, um, uh… Tandem
is going through pharmacy for some now.
Um- Betabionics is going through pharmacy
for some now, which is the islet.
Um, you know, uh, Sequel Twist
is only going through pharmacy.
So you don't have to wait your
four or five years anymore.
You don't have to be that… And you can
go in and just say, "What's available
if I went through pharmacy? I know I
have a pump that's in warranty right
now, but what are my other options?"
I would ask that every
time I walked in the door.
You say- Yeah … "I wanna know what's
new with you," but I want you to ask
me, "What i- what… Give me some hope.
What's new?
What's, what should I be looking
forward to?" You know, at every visit.
That's, that, I think the technology
is, is running in the right direction.
I agree.
As someone who's generally kind of
an early adopter and kind of a nerd
about some of these things, I love
that they're, i- it's moving faster and
faster all the time, so, so that's great.
Like you say, we could talk for a long
time about all of these things, but,
uh, I wanna be respectful of your time.
I really am appreciative of, of both
of you sharing so much of your time.
Uh, your Diabetes Dialogue podcast,
is it fair to say that it's designed
mostly for clinicians, but there's
still a lot of value for the
average everyday person, right?
Yes.
We, Natalie and I have been doing a
podcast for over four years together.
Wow.
We have over 200 episodes, and it's
called Diabetes Dialogue: Technology,
Therapeutics, and Real World Perspectives
because we give… Like, we see patients.
Like, we give our real world-
Yeah … take on all of this.
And yes, while it's like it was initially
really geared to healthcare professionals,
I think a lot of our listeners and viewers
are also people with diabetes, people
just interested and want to learn more.
Um, and so some of it, some of the
terminology might be more advanced, but
I feel confident people can still, you
know, benefit, so we encourage you to
tune into that if you're interested.
Yeah, absolutely.
We're a smart bunch.
We can, we can- Yeah, I think so.
We can learn.
We're quick learners, so I love that.
So, uh, to find that, they can search
for Diabetes Dialogue in their podcast
player or on YouTube and find you.
Um, those are probably the best places.
Is there anywhere else they should look?
Yeah, just put Diabetes Dialogue and
either Diana Isaacs or Natalie Bellini,
and you should be able to find it.
Yeah.
Amazing.
Yeah, I love that.
Well, thank you both so much for,
again, your time and just also helping
us make sense of this big conference.
So this conference happens every
year, so it's, it's sometimes as
us living with diabetes might feel
like things are progressing slowly,
things are moving along at a steady
clip, and that's pretty encouraging.
Awesome.
Thanks for having us, Scott.
What a great conversation.
Thanks so much for listening today,
and a huge thank you to Natalie and
Diana for helping us turn that fire
hose of medical information into
something that feels much more useful.
So if you're leaving this conversation
feeling like you don't need to stress
over every single research headline
you see, then we've done our job.
Remember, medical breakthroughs
are important, but your day-to-day
life is what matters most.
You don't have to keep up with
every study or every conference
to manage your diabetes well.
So find ways to filter out the noise,
focus on the tools that help you, and
if you're curious about something new,
just bring it up with your care team.
Again, you're the expert on your own life.
If this conversation helped you breathe
a little easier, consider sharing it
with someone who might need to hear it,
and we'll see you in the next episode.
Until then, keep living well with T1D