Podcast Summary: GLP-1s for Type 1 Diabetes — Are We There Yet?

Podcast: Diabetes Connections | Type 1 Diabetes
Host: Stacey Simms
Guest: Dr. Cecilia Low Wang, University of Colorado
Date: January 6, 2026

Overview

This episode explores the emerging topic of GLP-1 medications (such as Ozempic, Mounjaro, and upcoming compounds like Retatrutide) for people with Type 1 diabetes. Host Stacey Simms interviews Dr. Cecilia Low Wang, an endocrinologist and diabetologist deeply involved in clinical care, research, and FDA advisory roles. Their conversation covers the promise of GLP-1s in Type 1 diabetes, current research, access and approval issues, challenges with diabetes management in older adults and hospital settings, evolving kidney and cardiovascular guidelines, and professional resources for patients and providers.

Key Discussion Points & Insights

Dr. Low Wang’s Role & Perspective

• Academic endocrinologist at the University of Colorado.
  • Mix of clinical care (Type 1 diabetes, transplant patients), teaching, and FDA drug advisory roles.
  • Experience with diabetes technology, inpatient glucose management, and research administration.
  • Quote: “Diabetes is my absolute main focus and, you know, passion. So that's why [I made time for the podcast].” (08:29)

Current Status of GLP-1s for Type 1 Diabetes

[09:12]

• GLP-1s were first used in 2005, but recent drugs (like semaglutide) are much more potent, changing the field.
• Initial skepticism about GLP-1s in Type 1 because they stimulate insulin production, but new evidence suggests benefits beyond this, especially regarding weight loss and insulin resistance.
• Type 1 patients often struggle with weight management—GLP-1s may reduce insulin requirements and lower health risks associated with excess weight.
• Clinical trials (still limited) show promising data for weight loss and potential benefits in Type 1 diabetes.
  • Quote: “It can be incredibly difficult— a thousand times more difficult— to manage difficulty losing weight when you have type 1 diabetes… So maybe this class of medicines could be helpful.” (10:40)
• The field is progressing rapidly, with new combination peptides and triple agonists on the horizon.

Spotlight: Retatrutide — The “Triple” Agonist

[12:30]

• Retatrutide combines GLP-1, GIP, and glucagon agonism.
• Mechanism not fully understood; uniquely, it stimulates glucagon, a counter-regulatory hormone.
• In clinical trials, “100% of the people… were able to lose at least 5% of their weight. Never seen that before.” (13:05)
• Dr. Low Wang notes need to verify the methodology (possible run-in periods) but is excited by the result.

Real-World Use and Patient Advice

[14:01]

• Diverse patient experiences: Some with Type 1 report significant benefits (weight loss, lower insulin use), others struggle (nausea, blood sugar swings, intolerance).
• Key Advice: Always work with a diabetes provider, take dosing slow, and don’t be afraid to stay at lower doses.
• 15-25% experience significant GI side effects; in rare cases, can require ER visits.
• Individual results may vary—a reminder that clinical trial averages often mask this.
  • Quote: “…Some people may not see the effects you might be expecting… Some people may even gain some weight.” (15:29)
  • Quote: “You can possibly start to see effects within, you know, a week or two. So knowing to down titrate your insulin doses is important.” (17:52)

Insurance, FDA Approval, & Access for Type 1

[19:06]

• FDA approval for Type 1 would require solid safety data, more than efficacy alone.
• Companies need to invest in large, costly studies. The FDA’s main focus will be safety for this new population.
• Without formal approval, insurance coverage is limited, creating access barriers.
  • Quote: “If the companies can demonstrate that it can be used safely in people with Type 1, then I feel like it's… got a really good chance [for approval].” (19:41)
• Exclusion of Type 1 people from many pivotal trials (particularly for cardiovascular and kidney benefits) limits available evidence.

The Power of Patient Advocacy

[22:14]

• Dr. Low Wang shares the story of Richard Bernstein, whose quest for glucose monitoring helped push self-testing into standard care.
  • “…He started to monitor his glucoses. He started to dose his insulin based on his glucoses… and worked to, to get self monitoring of glucoses into kind of standard practice.” (23:00)
• Type 1 diabetes community advocacy often drives change and innovation in care.

Focus on Older Adults with Type 1

[24:37]

• Increasing numbers of older adults are living with Type 1.
• Their care is extremely challenging due to co-morbidities, cognitive/functional decline, and technology management.
• Need for individualized care; current resources are scarce but growing focus on this population is welcome.
  • “Type 1 diabetes is extremely difficult in older adults… how do we do all of that safely and still maintain quality of life?” (24:37)

Evolving Guidelines — CKM Syndrome

[26:14]

• New American Heart Association “CKM Syndrome” initiative incorporates cardiovascular, kidney, and metabolic health.
• Guidelines intended to be more holistic.
• Lack of Type 1-specific data remains a significant problem, but kidney and cardiovascular risks are high for this population.
  • “CKM syndrome… tries to bring in the kidney part of things… it's hard to make solid recommendations [for Type 1]… but there are many aspects of it that'll be important, especially because the risk… is so high.” (26:14)

Diabetes Management in the Hospital — Patient Safety

[28:36]

• Hospital care for Type 1 is not standardized; expertise unevenly distributed.
• Intensive care units (ICU) usually deliver very tight control—challenge is in general floors where patients may or may not keep their technology, and meal/procedure timing is unpredictable.
• Advice: Partner closely with care teams, advocate, ask questions, and communicate preferences and concerns.
  • Quote: “Partnering with your care team is probably the main thing I would say and advocating… as much as you can.” (30:54)

Hope for Improved Expertise — American College of Diabetology

[33:24]

• Dr. Low Wang co-founded the American College of Diabetology to expand specialized training for diabetes care beyond endocrinology.
• Goal: Set training standards and create more diabetes-knowledgeable providers across the nation.
  • “We're kind of trying to do lots of other things… accreditation, training, conferences, partnering with lots of organizations to try to set that standard of excellence…” (34:16)

Notable Quotes & Memorable Moments

• On GLP-1s and uncertainty:
  “It's incredible to hear you say that though—‘We don't know.’ You don't hear a lot of people admitting that.” — Stacey (14:01)
• On FDA approval prospects:
  “So number one is safety… If the companies can demonstrate that it can be used safely in people with Type 1, then I feel like it's got a really good chance.” — Dr. Low Wang (19:41)
• On the need for inclusion:
  “They need to stop being excluded [Type 1s from trials].” — Dr. Low Wang (20:46)
• On information sources:
  “I think that the way that people are receiving information these days is things like podcasts and they want to hear voices other than me, you know?” — Dr. Low Wang (35:12)
• On patient advocacy:
  “The ingenuity of the diabetes community never ceases to amaze me. People are incredible.” — Stacey (24:04)

Timestamps for Key Segments

• Dr. Low Wang’s Background: 05:22–08:24
• GLP-1s for Type 1 – State of the Field: 09:12–12:30
• New Drugs (Retatrutide) and Mechanisms: 12:30–14:01
• Practical Patient Advice on GLP-1s: 14:54–17:32
• Insulin Dosage Reductions: 17:32–19:06
• FDA, Approval Process, and Access: 19:06–21:40
• History & Power of Patient Advocacy: 21:40–24:10
• Older Adults with Type 1 Diabetes: 24:37–26:14
• CKM Syndrome Guidelines (Kidney, Cardio): 26:14–28:36
• Hospital Management Advice: 28:36–32:44
• American College of Diabetology Spotlight: 33:24–35:12

Additional Resources & Community

• Dr. Low Wang encourages listeners to seek information from reliable sources and advocates for more provider training to close care gaps.
• The show maintains a welcoming and supportive tone, emphasizing community connection and direct communication.

Overall Tone:
The conversation is candid, compassionate, and practical—balancing optimism about new therapies with honest discussion of challenges, research gaps, and the need for advocacy and education.

For more information or questions, visit diabetes-connections.com and access resources in the show notes.