← Diabetes Connections | Type 1 Diabetes
Diabetes Connections | Type 1 Diabetes
GLP-1s for Type 1 Diabetes: Are We There Yet? With Dr. Cecilia Low Wang
00:38:06
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- [00:01]
A
Support for this episode comes from Dexcom. I know it's hard for some of you to believe, but we had no CGM when Benny was diagnosed at age 2 and we didn't have one until he was 9. And that's just the way it was back in the day. We were doing something like ten finger sticks a day and still missing a lot of highs and lows. I was so happy to start him on a Dexcom CGM and it just keeps improving. Dexcom G7 is their best system yet. It is discreet, accurate and delivers real time glucose numbers right to your smartphone or smart watch. No finger sticks required. Warms up in just 30 minutes and the alerts amazing. The urgent Low soon alert gives us up to 20 minutes warning before a low hits and Benny can personalize all his settings. It's an easier way to manage diabetes and gives us both more peace of mind. Learn more@dexcom.com. This week on Diabetes Connections, one of the sure thing top stories of 2026 will be GLP1s, but will we see more studies and even approval for treating Type one with these medications like Ozempic, Mounjiorno and the next versions like Retratritide that are just around the corner? I'm talking to Dr. Cecilia Lo Wang, a diabetologist at the University of Colorado who's been on the front lines of this conversation for years. This is a wide ranging interview. We also talk about the growing needs of older adults with type 1, how kidney risk guidelines are evolving, and why managing diabetes in the hospital can still be such a challenge. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your healthcare provider. Welcome to another week of the show and Happy New Year everybody. I'm always so glad to have you here. You know. We aim to educate and inspire about diabetes with a focus on people who use insulin. I'm your host Stacey Sims and this is my 10th January with diabetes Connections. We started the show in June of 2015 so we are coming up on 11 years and you know I don't make resolutions but I have set some intentions for this year. I'm doubling down on in person connections. I'm organizing more events than ever in 2026 and you can find everything about Mom's Night out and Club 1921 on the website and I'm probably going to start up my local group meetups again because we just had a friend whose little three year old was diagnosed with Type one and well, you know that stinks. There's no way around it, but I'm just so glad they could call us up and we could just go over there and talk to them in person. Stuff is the best. Please try to get to something in person, even if it is just once this year. Of course, I'm also planning on bringing you great information, compelling interviews, fun stuff, and kind of keeping the community in your ears every single week because we can't get together all the time. But you do not have to be alone. It might sound cheesy to some of you, but but I have learned Diabetes Connections is some people's only connection to diabetes. I may be the only person that they hear talking about Type one this week, this month, and I take that responsibility pretty seriously. So please reach out, let me know what you would like to hear more about and I will do my best. On the podcast this week, My guest is Dr. Cecilia Lo Wang. I wanted to talk to somebody about GLP1s for type 1 because one of my predictions for this year is FDA approval for one of these. But the industry is just zooming ahead with more options, including a pill. And we're going to start hearing more about Retratrutide. Retatrutide. I never pronounced that correctly. I'm sure when they give it the brand name it'll be something much more simple like Zepbound for Tirzepatide. But we are going to talk about that, that newest one and how it is really interesting and different because it has a glucagon component to it and we'll talk about that with Dr. Lo Wang. I've also added something new this year. I am asking guests what diabetes organization has made a difference for them. I am really interested to see how this goes throughout the year. I'm hoping to learn about what and who has moved the needle in real life and I think this is going to be fun to look back on at the end of the year. Lots more in this conversation with Dr. Cecilia Lo Wang right after this. At one of our recent Moms Night out events, the Omnipod team was on site asking moms about their experience with the OmniPod 5 automated insulin delivery system. It was so much fun and it was great to hear what the moms have to say. Here's what Angela, mom to Dominic, told us.
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B
My son is 10 years old and he uses an Omnipod 5. It's the only pump he has used since he was diagnosed. It's been a life changing piece of equipment for him to have. He's a competitive swimmer. He is able to keep it on in the pool and we don't have to worry about disconnecting. So we absolutely love Omnipod and it has really just made a big difference in his life.
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A
Want to try Omnipod 5 for yourself? Request a free Omnipod 5 starter kit today by visiting omnipod.com diabetesconnections. Terms and conditions apply. Eligibility may vary. Dr. Cecilia Lowang, welcome to Diabetes Connections. I'm excited to talk to you today. How are you doing?
- [05:20]
C
Um, I'm doing great. Thank you so much for having me.
- [05:23]
A
You got it. Before we jump in, tell me a little bit about what you do currently in diabetes. Are you seeing patients? Are you in research? What does your day to day look like?
- [05:31]
C
Oh, my gosh. I'm at the University of Colorado, so I'm at an academic medical center. Just like many other people who work at an academic medical center. I do lots of different things. And so currently kind of the mix of things that I do are that I see patients. And so I see patients, but not a ton. So I would say half a day a week in my endocrine clinic, the Endocrine diabetes clinic, and I also see patients in the transplant metabolic clinic. So within six months of a solid organ transplant, people who have either a history of diabetes or elevated blood sugars after their transplant, why, we'll see them in our clinic. So we have a shared program that we started a few years ago, and I was the director of the inpatient glucose management team at the University of Colorado Hospital for 11 years. I just stepped down a few months ago. It's basically a consultative service in the kind of the main hospital, the one on the Anschutz campus, for anyone who has a history of diabetes who needs specialized care. So the primary teams feel like they need some help, either because the person is on an insulin pump or because they are having a lot of low blood sugars or a history of low blood sugars, or there's just a history of, you know, just really difficult to control diabetes. And oftentimes actually we'll see people who are on high dose steroids for various reasons. We'll see people who are receiving tube feeding or tpn, you know, nutrition through their vein, or really some very, very sick people who are in the hospital and have very high blood sugars. So that's kind of what our team does. So that's my team for 11 years. And I. I'm still on the team, but I'm not the director anymore. So that's kind of the clinical part. I also supervise Our endocrine fellows on the Endocrine Consultative Service in the hospital. So people where the primary teams need kind of help with any kind of endocrine question. So thyroid pituitary, you know, just all sorts adrenal things like that. And I also teach, so I teach lots of different settings. Medical students. I'm actually an associate director of a longitudinal course for medical students for their mentored scholarly activity. So I help guide, I think it's about 100, 120 medical students across the four years. I'm not their mentor, but I'm their associate director for that course. And then I have another role. So that's kind of all the teaching. And then I teach some different seminars for fellows, residents, faculty and in different topics. And then I also have a research administration role. So I'm a medical director for what we call our IND IDE office. And so we have some CAR T trials and other cell therapies on campus. So I'm kind of the. I'm the face of the campus for the FDA for those trials where the university is sponsoring them. And I also help with some of the medical side of some of these trials.
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A
Wow. How did you make time to come on this podcast? It's a busy, busy schedule.
- [08:30]
C
Diabetes is my absolute main focus and, you know, passion. So that's why, and because I really respect what you do.
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A
Oh, thank you so much. I have a ton of questions just from what you have told me, but let's stick to the first things that we. We're going to talk about and we'll see where it goes from there. One of the stories that we're following in the diabetes community, I think very closely, you know, both people like me who are caregivers and people with diabetes is GLP1s. I mean, this went from kind of, oh, something big is coming a couple years ago to basically taking over every headline, diabetes or no. Can we focus on what's going on for people with type 1? We heard a lot about this last year in terms of a lot of research studies coming. You know, no news about submissions or anything. But from your perspective, where do we stand?
- [09:12]
C
Yeah, no, that's a really, really hot topic. And I think it's actually going to be important, increasingly important in the years to come. So one of the other roles that I had and kind of have is that I've been on the advisory committee for the FDA Anti Crime Metabolic Drugs Committee since 2016, and I was the chair of that committee from 2021 to 2025. And so one of my, actually my very first meeting back in 2016 or 17 was about a GLP one. And then I also was lucky enough to be on the committee when semaglutide was being considered for approval. It's been really, really interesting to kind of see this field grow. But of course we've had GLP1s. The first one came out in 2005, so it was 20 years ago. It's just that they weren't quite as potent as these newer ones. And really it's semaglutide that kind of changed the conversation. I know that when these first came out, I remember one of the medical science liaisons of one of the companies asking me if I thought that this class of drugs would be appropriate for people with Type one. And I thought, oh my gosh, I'm not sure that they would because of the way that they work, which is that they help stimulate insulin production. And so it didn't seem to make sense that they would be helpful for people with Type one. And then of course the other concern was that they also slow gastric emptying. So of course that's a concern because especially for people who, who have gastroparesis, like that's not something we want to worsen. I think the initial thought was maybe it's not the right medication. But I think as we learned more, this whole kind of the different mechanisms of action that the GLP1 based drugs have, um, we started to think, oh, you know, that's actually this, maybe this could be helpful. Especially as people started to see the effects on weight. And a couple of things about that kind of separate from weight. People with type 1 diabetes have insulin resistance. And so that's something that we've kind of learned over the past five or ten years or so, kind of separate from having excess weight. But unfortunately, this, this epidemic of overweight and obesity has, has affected people with type 1 diabetes too. It can be incredibly difficult, I mean, I would say a thousand times more difficult to try to manage difficulty losing weight when you have type 1 diabetes because there are so many things you're dealing with. You're trying to, first of all, besides maintaining glucoses, trying to prevent low blood sugars, on and on and on, watching your food and your activity, trying to remove excess weight, it just is so difficult. And so I think that people started to think that maybe this class of medicines could be helpful for people with type 1. I think more thinking about the weight side of things now we actually have some randomized control trials that are studying this. We've had some smaller publications that show that they're effective for weight loss and that can reduce insulin requirements. It can make it. I mean, there's so many different health risks related to excess weight that this can help with. So I think there's a lot of potential and we'll see more. And of course, the GLP1 based drugs, that's not the only thing because there are lots of other different combination peptides that are being developed as well, but the GLP1 based ones are the top. Right now, I hesitate to ask because.
- [12:31]
A
I don't want to derail us, but I was just reading about and I hope I say it right. Retretrutide.
- [12:36]
C
Yeah.
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A
Is coming next. It's the triple one because ozempic or semaglutide was 1 Manjaro tirzepatitis 2. And this one, tell me about what this means because it may be the first time a lot of people are hearing about it.
- [12:50]
C
One of the things that I think is just, it's very, very surprising because it also stimulates glucagon. That's right. So it's GLP1, GIP and glucagon. And so there's so much that we're figuring out that we don't understand about physiology of weight, I guess, weight regulation with the development of these peptides. And so retatrutide. The one little thing that I noticed with one of the trials, one of their pivotal trials, is that it is the only medication I've ever seen where 100% of the people on the trial were able to lose at least 5% of their weight. So never seen that before. And what I need to double check is like, did they have a run in period? So sometimes these weight loss trials, the companies will build in a run in period where if there's no effect or if you gain weight on a medication, then that four week run in period, you don't get to keep going. Um, so it could be that they built that in. I would need to double check that. But I've never ever seen 100% of people on a trial lose 5% or more weight. So to me that's super exciting. But it also tells us, because it stimulates glucagon, which of course is a counter regulatory hormone for insulin, we don't really understand how these drugs are working to regulate weight.
- [14:01]
A
It's incredible to hear you say that though. We don't know. I mean, you don't hear a lot of people admitting that. You just see a lot of commercials with people Dancing around saying, call your doctor. But, but back to people with type one. I mean, I have a lot of friends who have had a lot of success on the ones that are available now on semaglutide and on Tirzepatide. And I have a couple of friends who have tried it and have really not had any success. They found it too difficult. Blood sugar swings, nausea, you know, different problems that I'm sure, you know, you're familiar with with your patients. What's your advice for people with type 1 who are trying this? Whether they're doing it for weight loss as it is prescribed or they're trying it kind of off label for their type 1 diabetes? Right back to our conversation. But first a word from our community.
- [14:54]
D
Hi, I'm Lisa katzenberger and my 15 year old son Ryan has type 1 diabetes. I am the author of the children's picture book It Belongs to the World, Frederick Banting and the Discovery of Insulin, which is illustrated by Ms. Diabetes and published by HarperCollins. I wrote this book to share Frederick Banting's determination to help others and his selfless sale of the patent for insulin for just $1, saying, Insulin does not belong to me, it belongs to the world. You can find my book on Amazon at Barnes and Noble and everywhere books are sold.
- [15:30]
C
I think that definitely doing it with, in conjunction with your diabetes provider I think is really important. There's so much information that I think people need to know when they kind of get into this or give it a try. And I think it's important to have someone who can kind of look at all the other things that are going on with you and then tell you some of the potential pitfalls. Also talk with you about, you know, how they might suggest going up. I mean, the standard way that the label says for these weekly GLP1 based drugs is to stay on a single dose level for at least four weeks. There are some people who need to be on them for longer in order to be able to tolerate them. And what some people may do fine on the lower doses. And so I think that's one thing to kind of keep in mind is that you don't have to keep going up on the dose and sometimes you don't have to go to the maximum dose to find benefits. But also exactly as what you said, some people may not see the effects that you might be expecting. So of course when we look at these clinical trial data, all clinical trial data, they're averages and they try to parse out certain populations and try to understand It. But there are some people who don't lose very much weight on them, don't see much of an effect. And some people may even gain some weight. And so it's a small percentage, but just something to keep in mind. And then I think the other part is the adverse effects. And so 15 to 25% of people may develop these gastrointestinal adverse effects. And they could, some of them could be mild and, you know, they'll do fine if they stay at this low dose and do some other things like, you know, stop when they're feeling full or, you know, there are some different little strategies, but for some people, it's so intolerable that actually some people have needed to go to the emergency room because they are having such severe nausea and vomiting or severe diarrhea. And so. And then some people have noted, you know, a fair amount of constipation. So lots of different potential side effects that people have to be aware of and just have a game plan, you know, call their provider to kind of troubleshoot what to do next. And I think certainly you wouldn't want to wait until something super severe before you did something about it. But just being aware that sometimes it can be super severe.
- [17:33]
A
Yeah, I mean, but again, with type one, the people that I know, again, this is so anecdotal. Right. We need to look at studies. And in the wider picture here they have all the people who've had success with it, they are using so much less insulin. It's incredible. You know, you hear stories, 20%, 50% less insulin than before. Talk to me about that if you could.
- [17:53]
C
Yeah, and that's. Actually, I'm glad that you brought that up because I think that's the other thing. So one is that we're not sure how effective these medications will be in a single individual. So I think that being aware that it could have very little effect or it could be delayed or it could be extremely potent, so kind of realizing that it could be along that continuum, but being prepared for the super potent part, that's where I'll usually counsel my patients to proactively decrease their insulin doses, probably after a couple weeks after starting. Because it's a weekly medication, it takes probably what they say, five to six half lives, so five to six weeks for it to achieve a stable level in your system. But you can possibly start to see effects within, you know, a week or two. And so knowing to down titrate your insulin doses, I think is an important thing. So then depending on where your A1C is or kind of how your control is and other things, you might need to cut it more or less, you know, 25, 50% or 25%, something like that. So I think that those are all. Some things that. That's why it's a really long visit. You know, when. When a person decides that they want to try this, that there's a lot to talk about, there's a lot to consider.
- [19:07]
A
In your experience with the FDA using that experience, what do you think the process is going to be here for approval for people with type 1? Again, knowing that people with type 1 can use it for weight loss. Right. But for treatment with Type one, like, it's being used for treatment for type two. I don't know. This is such a layperson thing to say, Cecilia. But, like, I'm worried that it won't get Approved for type 1, which means insurance companies won't pay for it, because there are a lot of pitfalls, as we've already talked about, that people with type 2 don't dose insulin, you know, may not have to worry about.
- [19:41]
C
I think there are a few things to consider. So one is kind of, what size of trial is the FDA expecting? So are they expecting, you know, a gigantic trial or just a smaller one just to show safety, maybe some degree of efficacy? I think companies would need to commit that amount of funding because it's expensive to try to obtain an indication for a medication and to study it in a population. And so it's kind of a commitment that the company needs to make. But I think that, you know, I. And I can't predict anything about the fda, but I think some of the things that they consider, it really depends a lot on. So quote the package or the packet that the company puts together and what. What is their question? How would they make sure that it's being used safely? I feel like that would actually be their biggest concern in this new population, people with type 1 diabetes. So, number one is safety. And then they're kind of. Their next thing is efficacy. So I feel like that's. If the companies can demonstrate that it can be used safely in people with Type one, then I feel like it's. It's got a really good chance.
- [20:45]
A
Wow.
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D
Okay.
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C
There's a lot of people who could benefit. I mean, if you think about people with type 1 diabetes who. Let's say they have established heart disease and people with kidney disease, but unfortunately, people with type 1 were specifically excluded from, like, the. Some of the trials. So I think that it's. It's just been really really difficult from our side. I think both I and other people who've served on the advisory committees have felt like they, there need to be more trials that include people with type 1 diabetes. They need to stop being excluded.
- [21:18]
A
Oh, I'm glad to hear you say that. I know we're in the middle of these studies. You know, last year and the year before at ADA scientific sessions, they ended the sessions. Basically the news that at least I took away was we are doing these studies like stay tuned, Type one is being included, which is very hopeful. So without asking you about timelines or anything like that, it does sound like things are moving ahead.
- [21:41]
C
Yes, I think so. I believe that many of these are investigator initiated trials. I don't know for sure, but I think the companies want to partner on these. And so I do think that this is. I just gave a grand rounds, a medical grand rounds from my department a few weeks ago. Actually, it was World Diabetes Day, November 14, and I was talking about advanced diabetes technologies, kind of what a department of medicine might need to know. And so it's a more general audience. But one of the things that I think is really, really incredible is just how. Because I gave the story of Richard Bernstein. I don't know if you know his story.
- [22:14]
A
Sure, sure.
- [22:14]
C
Yeah. So I told that story about glucose monitoring. And I think that it's just another example of, you know, patients advocating for, for what's needed. And I feel like that's especially strong in the type 1 diabetes community.
- [22:27]
A
You know, I said sure, that I'm familiar with Richard Bernstein, but I'm sure there are many people listening who are not especially specifically what you're talking about, because I know him, he's very much a proponent of low carb eating and he lived a long time and very healthfully. But that's not what you were talking about. So could you tell me that story?
- [22:43]
C
Yeah. So the, the aspect of what he's done because he has made a huge impact. And unfortunately he passed away this past April and there was an article about him in the Wall Street Journal. The aspect that I was talking about was really more about glucose monitoring. So he was diagnosed with type 1 diabetes when he was 12. And so at that time we didn't have good ways to measure glucose, we didn't have great insulins, et cetera. And so he, I think he was in his 30s when he started to develop a lot of like really realize that he started to worry that he wouldn't be able to see his kids grow up, basically because he was developing complications from the diabetes. So he tried to get a hold of a glucometer, the Ames reflectance Spectrophotometer or something like that, the Ames Reflectance Meter. But at that time, only providers could get it, only doctors. And so he got his wife to get him one. She was a psychiatrist. And he, he had an engineering background. So he started to monitor his glucoses. He started to dose his insulin based on his glucoses. And even then, you know, he didn't have exact numbers. It was more ranges. But anyway, he was able to manage his glucoses better, prevent hypoglycemia, and worked to, to get self monitoring of glucoses into kind of standard practice. And so he ended up going back to medical school in his 40s and became a physician and opened his own clinic and taught his patients how to do this.
- [24:04]
A
The ingenuity of the diabetes community never ceases to amaze me. People are incredible.
- [24:10]
C
Absolutely, completely agree.
- [24:12]
A
Have you heard about the groups T1D to 100 or grown up T1DS? This is something that I'm hoping to do more of a focus on this year. And I've talked about this a lot because these are older people with Type one who, you know, speaking of the ingenuity, there aren't a lot of resources for them out there. I'm curious, in your practice and in your teachings, people with Type 1, thankfully, are growing up and living longer. Is this a focus more and more?
- [24:38]
C
Yes, absolutely. And I'm, I'm so glad you mentioned this because actually this is another thing that I've been. I think I gave a talk several years ago that the American Heart association asked me to talk about diabetes management in older adults. So I've talked about this topic a few times in the past several years to different groups. And I think specifically type 1 diabetes is extremely difficult in older adults. And there, gosh, there are all sorts of challenges. I think that obviously not all older adults are the same. There's a spectrum of people, you know, who are super healthy and very active. But then there are people who are dealing with a lot of different medical challenges, comorbidities. And then there are people who actually are affected by things like dementia or just really, really limited function, or are in, you know, nursing homes and things like that, skilled nursing facilities with type 1 diabetes. And so I think this is definitely a focus. I mean, how do we manage technology? How do we manage, you know, these tight glycemic goals that people grew up with? That's another one, actually. And how do we do all of that safely and still maintain quality of life. And I mean, it's just, and trying to align everything with, with people's goals.
- [25:50]
A
Now that's something that I'm excited to dig into more. But I'm also kind of nervous because elder care is so difficult already in this country. Skilled nursing, everything else that needs to go with it. So when you throw type one in the mix, I'm a little nervous about what we're going to find out. But I'm glad to know people are talking about it. Yeah, I had said the, the, you know, the kidney monitoring guidelines. Is that something for people with type one as well?
- [26:14]
C
Yeah. So the CKM syndrome. So this is kind of an. There is a presidential advisory from the American Heart association that was published a couple of years ago on CKM syndrome. So kind of this new thing that's been coined. I think that one way to look at this is, oh, you know, is this just repurposing metabolic syndrome? But no, it's not. I think that metabolic syndrome, that whole concept, when that came out decades ago, that was really important because it kind of told us that there's a constellation of things that can show that the person is more insulin resistant and at higher risk for things like cardiovascular disease, et cetera. But this is different. So I think that CKM syndrome, it's more holistic and really tries to bring in the kidney part of things. And of course, it's still very cardiovascular focused. It's from the American Heart association, although many other professional societies have signed onto it and collaborated. But the guidelines for CKM syndrome are coming out in the spring, and I'm on the writing committee for the CKM guidelines and it's a multidisciplinary committee with cardiologists, of course, but also nephrologists, obesity specialists, endocrinologists, patient representatives. I mean, just. And also general internists. And I believe we have PharmD's. So it's a really great mix of people thinking about what to recommend, what do the data show and then how should we operationalize this in recommendations that we put into these guidelines. So I think type 1 diabetes is not specifically called out. It's. It's actually just diabetes in general. But just like so many things, I think that the data for that are specific to type one is not there. And that's, that's one of the problems, and that's actually been a huge problem with a lot of cardiovascular disease recommendations is that we don't have data specific to type 1. There are people who have done more kind of population studies and trying to pull out patients with, you know, people with type 1 to try to make recommendations, but it's extremely difficult. And of course, we don't have a lot of trials in cardiovascular risk that are specific to people with Type one. So those are all problems. And they're trying to, you know, this is very evidence based, so they're trying to use what data we have. And when you don't have it, it's hard to make solid recommendations. So I would say the CKM syndrome doesn't specifically call out type one in many, if not most places. But I do think that there are many aspects of it that'll be important for people with Type 1, especially because the risk for cardiovascular disease and kidney disease is so high. And so we need to be caring about that.
- [28:37]
A
Yeah, for sure. I also wanted to ask you about your experience. You talked about managing glucose in the hospital and from a patient perspective and from a caregiver perspective as well. This is one of the scariest things because quite often you're in a hospital for something that is not quote, unquote, diabetes related, and then you have to give over your diabetes care to somebody who might not be familiar with your pump or your even your cgm, which is hard to believe these days. Do you have any advice for laypeople who are put in that position, like, what can we do to be safer in the hospital and feel safer?
- [29:11]
C
Yeah. So I think that those of us who work in academic medical centers, I think we're extremely fortunate because we do have, you know, usually our hospitals have teams, specialized teams that can help guide management in kind of that really specialized setting. And, you know, we have different standards of care that are focused on the hospital setting for people with diabetes. We have endocrine society guidelines, I mean, all sorts of things. But I think that the expertise is not evenly distributed across the country. And so I would say that the vast majority of hospitals don't have that specialized expertise to help people who have diabetes, especially type 1 diabetes, on advanced diabetes technologies in the hospital setting. And of course, the hospital setting is hard because you lose a lot of control. It's a very complex system. A lot of things can go wrong because a lot of things have to go right in order for things to work. There are so many different reasons that can make. Make things just extra challenging. And I guess you asked about advice. If I were to give advice to a family or to a person with type 1 diabetes who's in the hospital, I would say that actually the surprisingly, the intensive Care setting is probably the setting where I would not worry as much because oftentimes people are so ill. I mean, hopefully you would never need to go to the icu, but if you needed to go to the icu, the diabetes I think would be well controlled because the standard of care is to use IV insulin and that's, you know, minute to minute titration, you know, every one hour. Finger sticks. Some places are willing to use the CGMs, although there are certain ways you have to validate the CGMs and of course they're not approved for use in the hospital. But anyway, so I think the ICU setting is actually surprisingly more straightforward. I think it's actually the non ICU setting that's a little harder because do you get to stay on your automated insulin delivery system or not? What happens with meals? You never know when that procedure or that imaging study is going to happen. Sometimes you're, because you're admitted even though you're sick and you need these things. Sometimes the list is long and so it might not happen till 2 in the morning. So there's all sorts of things that happen in the hospital and then things aren't timed very well. And so I think partnering with your care team is probably the main thing I would say and advocating, but I think that's probably the single piece of advice I would use and just trying to partner as much as you can and trying to understand and asking the questions, that's going to be probably most helpful.
- [31:43]
A
It's amazing how things have changed. Like I said, my, my son was diagnosed back in 2006 and he needed a very minor surgery, but he was little and they needed to do general anesthesia for it. And he had been in a pump for probably less than a year at that point. So he was three. And everybody had never seen a pump on a kid that little. They, you know, most people hadn't seen a pump before at all. I will never forget, they, they had me come back into the recovery room like much sooner than I would have been allowed. And they all gathered around to see how I used it. And then a couple of years ago he had knee surgery. And we got to the hospital and the anesthesiologist was like, oh, do you use control iq? Like he knew everything. It was hysterical.
- [32:22]
C
That's amazing.
- [32:23]
A
It was amazing. And Benny got to use, he kept everything on the cgm, the insulin pump, they put it in his little pocket. They, they just knew enough. And I'm, I'm sure most anesthesiologists do not know the names of the aid systems. We got a really special one there. But the staff was certainly not amazed to see any of it. And I was really glad to see how much that's changed. But I know we're very lucky.
- [32:45]
C
Yes, yes. And I think that that's the ideal state. And so, you know, that's what we try to work towards. And I think from what I've seen, surgery teams like they, and anesthesiology teams like they, they want to know and they want to know how to manage. And I think there was a period of time, year, maybe five, 10 years ago, when people would just remove the pumps and that was a problem. But I think that I would say things have really improved in the last maybe five years or so.
- [33:10]
A
Before I let you go, something new I'm doing in 2026 is asking my guests about a diabetes organization they would like to spotlight. You know, something that's made a difference for them or something that they just want other people to know about. Is there any organization you'd like to mention?
- [33:25]
C
Of course. So thank you for asking that. And of course, I have to say the organization that I helped co found, it's called the American College of Diabetology. It's more provider facing, so really trying to improve the situation of more evenly distribute kind of specialized diabetes expertise across the entire country. So right now we don't have enough endocrinologists and diabetes specialists across the entire country. So what we're trying to do is kind of set the standard for training for of primary care physicians to take care of people with diabetes. And so that's the whole goal of American College of Diabetology. So we actually have probably over 60 diabetology trained fellows across the country. So we've had diabetes fellowships for, since 2002, but they've been few, they've been small, they're expanding. I kind of started ours along with my colleague Sarit Polsky about five years ago, five, six years ago. And the American College of Diapatology developed a board exam for diabetology. And we have been supported by the Helmsley Charitable Trust and been able to help give seed funding to programs that are trying to establish new fellowship programs. And we're kind of trying to do lots of other things, accreditation, training, kind of conferences, things like that, and partnering with, with lots of different organizations to try to set that standard of excellence for people who are. For clinicians and diabetes. And yeah, we, we need more people who can help especially we just don't have enough people right now.
- [35:00]
A
It is incredible the lack of endocrinologists. I mean, we are so lucky in Charlotte. We have a great group. But I know people drive two, three hours just to get here. And I'm sure that's the case all over the country. There's just not enough.
- [35:13]
C
I think that one of the most important things that my patients are looking for is reliable sources. And the thing is I can refer them to various, like the 88 website and things like that, but 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 what I mean? So other than kind of your. Your standard, I guess, institutional sources or other things. And so I think it's really important what you're doing and what I said before about why I thought it was important to make time for this, that's exactly why. So I think it's important to everything that you're doing with trying to get information out there, interviewing people. My goal is to improve lives and hopefully improve lives of everyone affected by diabetes. And you know, I think type 1 diabetes is one of those things that, you know, we haven't seen enough research from companies and things like that. We need more, especially from the cardiovascular and other kind of a non insulin side of things. So I'm really excited about being here with you today.
- [36:15]
A
Well, that means a lot. Thank you. That means a lot coming from somebody like yourself. Thank you so much for saying that. And I hope that I can talk to you again maybe later this year if we get more information about everything we talked about. It would be great to follow up. So thanks for being here.
- [36:29]
C
Yeah, awesome. Thank you.
- [36:36]
A
This might sound like a humble brag or whatever, but I mean this sincerely. I am still amazed and humbled when healthcare professionals are familiar with the show and say nice things like that. How cool was that? Oh my goodness. More information on a few of the.
- [36:50]
D
Things we talked about.
- [36:51]
A
I will put that in the show notes for you and we will follow up because we are just at the beginning of what's going on here, especially with GLP1s. So stay tuned. Right. And did you hear the community commercial? Send me yours. How to do that and all the guidelines that is in the show notes. You can always find the show notes wherever you're listening. Every podcast app has them. If you're having any trouble, just head on over to diabetes-connections.com every episode has its own homepage and I've got all the information about the community commercials and how to submit in every episode's notes for this year. Reminder change for this year. We are doing these interview episodes every other week. So next week will be in the news. We'll be here every Tuesday. But we're doing it a little differently this year. We'll see how that goes. Thanks to my editor, John Buchenis, from Audio Editing Solutions. Thank you so much for listening. Listening. I'm Stacey Sims. I'll see you back here soon. Until then, be kind to yourself. Diabetes Connections is a production of Stacy Sims Media. All rights reserved.
- [37:57]
C
All wrongs avenged.