#1699 On the Pen with David Knapp

Juicebox Podcast: Type 1 Diabetes – Episode #1699 “On the Pen with David Knapp”

Host: Scott Benner
Guest: Dave Knapp, founder of On the Pen
Date: December 4, 2025

Main Theme & Purpose

This episode dives into the real-world impact, science, public discourse, and future of GLP-1 medications (like Ozempic, Mounjaro, etc.) from a patient perspective. Dave Knapp shares his personal journey with type 2 diabetes, his advocacy and educational work via On the Pen, and discusses the broader implications of GLP-1s for diabetes, obesity, metabolic illness, and possibly even beyond.

The episode aims to demystify GLP-1s, debunk misconceptions about their use, and emphasize patient narratives over medical or investor perspectives.

Key Discussion Points & Insights

1. Dave’s Story: Diagnosis and Motivation

Diagnosis “out of nowhere”: Dave describes being diagnosed with type 2 diabetes in 2021 after a year of extreme fatigue and kidney stones, despite lacking the “classic” buildup and not being a stereotypical over-eater ([05:10], [08:49]).
- “I didn’t really fit the bill... I wasn’t a candy eater. I wasn’t a sugary soda drinker. Still, I was overweight.” ([08:49] - Dave)
Family history & urgency: The presence of type 2 throughout his family tree and his father’s early death from heart disease motivated him to seek solutions for longevity and quality of life.
Obesity is a disease: Dave stresses how metabolic factors, not just diet, contributed to his health. His lifetime of yo-yo dieting (especially Atkins/keto) made things worse, leading to a rapid diabetes diagnosis ([06:50], [08:49]).
Psychological toll of weight swings: Both he and Scott relate to the cycles of public praise and private shame that accompany yo-yo weight changes ([11:30]).

2. The Patient Perspective & Content Creation

Why “On the Pen”? Dave saw an information gap: “Everything that's out there is for a doctor... But nothing exists for the patients. And that's where On the Pen came in.” ([00:14], [02:40])
Transition to advocacy: Initial videos chronicling his own experience quickly shifted to sharing science, clinical trial news, pharma earnings calls, and breaking developments in GLP-1s. He became a go-to source for patient-focused updates ([15:01], [15:53]).
“Release the Vials” campaign: Dave led a viral movement pushing pharmaceutical companies to improve access and pricing, with tangible results like the release of Zepbound in direct-to-consumer vials ([17:23]).

3. GLP-1 Medications: How They Work, What They Change

Metabolic mechanisms: GLP-1s (and combo versions like Mounjaro/tirzepatide) mimic hormones in the gut that regulate satiety and insulin release. They address a root problem in people with metabolic disease, where “DPP4” enzymes destroy the body’s natural GLP-1 ([21:59]).
“The antidote to dysregulation”: Dave sees these meds as direct corrections for the hormonal chaos induced by modern life, possibly worsened by environmental/lifestyle exposures ([25:54]).
- “These medications...are the antidote to whatever the culprit is...creating a hormonally dysregulated body.” ([25:54] - Dave)
Side effects, fear, and public debate: The stigma of “cheating” by taking medication is dissected. Real patient benefit—weight loss, normalized A1C, improved energy—takes precedence, even if the mechanism isn’t fully clear ([18:34]–[25:54]).
- “I don’t know why my body doesn’t work the way it’s supposed to, but it clearly doesn’t. And you add this GLP to me and I’m better off.” ([18:34] - Scott)
Unexpected improvements: Beyond weight and blood sugar, users report benefits such as reflux and anemia improvements, possibly due to altered gut hormones ([25:54]–[28:29]).

4. Broader Applications & the Future Pipeline

Inflammation and beyond: There’s mounting evidence that GLP-1s reduce systemic inflammation, potentially helping with autoimmune conditions and even slowing Alzheimer’s progression ([29:17]).
GLP-1 plus GIP (Tirzepatide): New drug combinations target a broader range of metabolic/immune pathways.
Muscle loss & “quality weight loss”: Research is increasing on optimizing GLP-1s for fat loss without muscle wasting ([29:17]).
Heart-protective effects: Even without weight loss, GLP-1s have been shown to lower cardiovascular events by ~20% ([29:17]).
- "There's something specifically protective in the heart about the GLP-1 molecule." ([29:17] - Dave)
Historical/scientific anecdotes: The original GLP-1 drugs were derived from Gila monster venom, which mimicked the human hormone ([29:17]).

5. Access, Dosing Innovation, and Compounded Forms

Early widespread availability: At first, Mounjaro was available via coupon for $25/month to anyone, sparking huge demand and shortages ([17:23]).
Micro-dosing and compounding: The injectable pen doses aren’t ideal for all; some need much less, but current products don’t cater to that. Compounding pharmacies (legally allowed during shortages) are making custom doses and even oral forms ([48:17]).
- “You have now millions of people who have gotten benefits...of getting on an individualized dose of these medications and finding that 2.5 mg of tirzepatide is the starting dose commercially. But I...took 10% of that a week and got similar benefits.” ([48:17] - Dave)
Weekly vs. more frequent dosing: There's no science to support weekly being "ideal," but rather a convenience for pharma, payers, and pharmacy logistics ([55:33]).
Oral and sublingual forms: For those needle-averse, compounded oral versions are emerging, though with less regulatory oversight ([53:52]).

6. Barriers, Biases, and the Need for Patient Advocacy

Medical resistance and outdated ideas: Some providers still default to old objections (e.g., “muscle wasting") without nuanced understanding ([28:29]).
- “That guy doesn’t understand this functionally at all and he’s out there giving advice.” ([28:29] - Scott)
Complexity in Type 1 diabetes: The conversation shifts to off-label use among Type 1s, who sometimes see insulin needs plummet (sometimes almost to zero) on GLP-1s, but this is not universally true, and carries certain health risks ([37:22]–[64:15]).
Insulin resistance & functional application: For some, especially those with co-existing insulin resistance, a tailored approach (microdosing, off-label use) can be transformative ([51:08]–[53:52]).
Caveats about safety: Strong warnings not to attempt self-treatment or stop insulin without careful management ([62:55]–[64:15]).

7. Social Consequences, Economics, and Hope

Impact on US healthcare: Dave predicts GLP-1s could “save the healthcare system” if made accessible and affordable ([41:33]).
- “Almost everyone who lives in this country should be considering the idea of talking to their doctor about whether...these medications could benefit them in some way.” ([44:16] - Dave)
Upcoming price reductions: Recent policy moves will bring prices down substantially, especially for Medicare and Medicaid recipients. Cash-pay prices expected to drop to $250/month ([60:05]).
Societal mindset shifts: Scott highlights decades of “weight loss at any cost” culture morphing into new criticisms of “cheating” with meds, underlining human inconsistency ([37:00]).
Big Pharma’s role: Skepticism, hope, and the business realities of pharma are discussed openly ([58:40]).

Notable Quotes & Memorable Moments

On the patient mindset:
- Scott: “I tell people I have a GLP deficiency. That’s what I tell them, because it shuts them up.” [28:42]
On transformative results:
- Scott: “My brother...lost, like, 70 pounds. His A1C’s dropped way down...and still, he was with a doctor the other day who said...‘I wouldn’t be using this GLP medication.’ ...That guy doesn’t understand this functionally at all and he’s out there giving advice.” [28:29]
On stigma & public response:
- Scott: “I’m not a person who’s like, put everybody on medication. I’m really not. But, like, now that I've seen what it’s done for me, I'm not down with just yelling like, ‘you’re cheating if you’re doing this thing.’” [18:34]
On med innovation and compounding:
- Dave: “Clinical trials are designed for regulators and they’re designed for investors. They’re not really designed for patients...We're starting to see a shift in that.” [48:17]
On expanding indications and hope:
- Dave: “I really believe these medicines...have the power to save our healthcare system in the United States.” [41:33]

Important Timestamps

[05:10] Dave’s diagnosis story
[08:49] Metabolic effects, yo-yo dieting, and family consequences
[15:01] Genesis of On the Pen; learning the science as a patient
[17:23] Viral “Release the Vials” campaign and Mounjaro coupon heyday
[21:59] GLP-1 mechanisms, DPP4, and metabolic dysfunction explained
[25:54] The “antidote” theory and broad relevance beyond weight loss
[28:29] Provider misconceptions and frustration
[29:17] Inflammation, autoimmune, heart protection – GLP-1’s next frontier
[37:00] Society’s double standard on weight loss solutions
[41:33] Policy change and hope for access; “saving the healthcare system”
[48:17] Compound pharmacies and personalized GLP-1 dosing
[51:08] Microdosing, functional dosing intervals, and personal experiences
[53:52] Oral/sublingual tirzepatide, injection avoidance, and practical hurdles
[60:05] Upcoming Medicare/Medicaid/cash price changes for GLP-1s
[62:55] Warnings on insulin reduction and the need for careful management

Flow, Tone, and Closing Thoughts

The conversation is candid, pragmatic, and passionate, reflecting both men’s lived experience and broad empathy for anyone facing metabolic illness. Dave brings focused, research-informed insights; Scott draws out the everyday frustrations, triumphs, and deeply human consequences behind the clinical headlines.

Both stress that patients must drive the conversation with their healthcare teams and push for individualized solutions—even as science, pharma, and policy slowly catch up.

Closing Reflections

“Everything that I share...I just want people to have better conversations with their doctor. And if your doctor doesn’t know about it, ask them to know about it or find somebody that does.” — Dave ([65:15])

Summary Table: Key GLP-1 Topics

| Topic | Insights from Episode | Timestamps | |---|---|---| | Patient experience | Yo-yo dieting, weight stigma, lack of patient-facing resources | 05:10, 08:49, 15:01 | | GLP-1 mechanism | Mimics gut hormones, corrects dysregulation, multi-system benefits | 21:59, 25:54, 29:17 | | Stigma & “cheating” | Public narrative lags behind science; real-world results matter | 18:34, 28:29, 37:00 | | Dosing flexibility | Microdosing, compounding, personalized intervals vs. “packaged” clinical doses | 48:17, 51:08, 53:52 | | Access & policy | Early coupon access, viral patient advocacy, coming price drops | 17:23, 41:33, 60:05 | | Type 1 diabetes | Potential but unpredictable effects, insulin reduction cases, risks of mismanagement | 37:22, 51:08, 62:55 |

For Listeners

This episode challenges popular assumptions around diabetes care, obesity, and the impact of modern medicine—using lived experience and emerging evidence to push for a more empathetic, flexible, and science-forward approach. If GLP-1 meds are new to you or you’re considering them, this is a must-listen—approachable, comprehensive, and grounded in what real patients want and need.

Reminder: Do not make changes to your medical regimen based on podcasts—bring questions and ideas from this episode to your medical provider for individualized advice.

Juicebox Podcast: Type 1 Diabetes – Episode #1699 “On the Pen with David Knapp”

Host: Scott Benner
Guest: Dave Knapp, founder of On the Pen
Date: December 4, 2025

Main Theme & Purpose

The episode aims to demystify GLP-1s, debunk misconceptions about their use, and emphasize patient narratives over medical or investor perspectives.

Key Discussion Points & Insights

1. Dave’s Story: Diagnosis and Motivation

Diagnosis “out of nowhere”: Dave describes being diagnosed with type 2 diabetes in 2021 after a year of extreme fatigue and kidney stones, despite lacking the “classic” buildup and not being a stereotypical over-eater ([05:10], [08:49]).
- “I didn’t really fit the bill... I wasn’t a candy eater. I wasn’t a sugary soda drinker. Still, I was overweight.” ([08:49] - Dave)
Family history & urgency: The presence of type 2 throughout his family tree and his father’s early death from heart disease motivated him to seek solutions for longevity and quality of life.
Obesity is a disease: Dave stresses how metabolic factors, not just diet, contributed to his health. His lifetime of yo-yo dieting (especially Atkins/keto) made things worse, leading to a rapid diabetes diagnosis ([06:50], [08:49]).
Psychological toll of weight swings: Both he and Scott relate to the cycles of public praise and private shame that accompany yo-yo weight changes ([11:30]).

2. The Patient Perspective & Content Creation

Why “On the Pen”? Dave saw an information gap: “Everything that's out there is for a doctor... But nothing exists for the patients. And that's where On the Pen came in.” ([00:14], [02:40])
Transition to advocacy: Initial videos chronicling his own experience quickly shifted to sharing science, clinical trial news, pharma earnings calls, and breaking developments in GLP-1s. He became a go-to source for patient-focused updates ([15:01], [15:53]).
“Release the Vials” campaign: Dave led a viral movement pushing pharmaceutical companies to improve access and pricing, with tangible results like the release of Zepbound in direct-to-consumer vials ([17:23]).

3. GLP-1 Medications: How They Work, What They Change

Metabolic mechanisms: GLP-1s (and combo versions like Mounjaro/tirzepatide) mimic hormones in the gut that regulate satiety and insulin release. They address a root problem in people with metabolic disease, where “DPP4” enzymes destroy the body’s natural GLP-1 ([21:59]).
“The antidote to dysregulation”: Dave sees these meds as direct corrections for the hormonal chaos induced by modern life, possibly worsened by environmental/lifestyle exposures ([25:54]).
- “These medications...are the antidote to whatever the culprit is...creating a hormonally dysregulated body.” ([25:54] - Dave)
Side effects, fear, and public debate: The stigma of “cheating” by taking medication is dissected. Real patient benefit—weight loss, normalized A1C, improved energy—takes precedence, even if the mechanism isn’t fully clear ([18:34]–[25:54]).
- “I don’t know why my body doesn’t work the way it’s supposed to, but it clearly doesn’t. And you add this GLP to me and I’m better off.” ([18:34] - Scott)
Unexpected improvements: Beyond weight and blood sugar, users report benefits such as reflux and anemia improvements, possibly due to altered gut hormones ([25:54]–[28:29]).

4. Broader Applications & the Future Pipeline

Inflammation and beyond: There’s mounting evidence that GLP-1s reduce systemic inflammation, potentially helping with autoimmune conditions and even slowing Alzheimer’s progression ([29:17]).
GLP-1 plus GIP (Tirzepatide): New drug combinations target a broader range of metabolic/immune pathways.
Muscle loss & “quality weight loss”: Research is increasing on optimizing GLP-1s for fat loss without muscle wasting ([29:17]).
Heart-protective effects: Even without weight loss, GLP-1s have been shown to lower cardiovascular events by ~20% ([29:17]).
- "There's something specifically protective in the heart about the GLP-1 molecule." ([29:17] - Dave)
Historical/scientific anecdotes: The original GLP-1 drugs were derived from Gila monster venom, which mimicked the human hormone ([29:17]).

5. Access, Dosing Innovation, and Compounded Forms

Early widespread availability: At first, Mounjaro was available via coupon for $25/month to anyone, sparking huge demand and shortages ([17:23]).
Micro-dosing and compounding: The injectable pen doses aren’t ideal for all; some need much less, but current products don’t cater to that. Compounding pharmacies (legally allowed during shortages) are making custom doses and even oral forms ([48:17]).
- “You have now millions of people who have gotten benefits...of getting on an individualized dose of these medications and finding that 2.5 mg of tirzepatide is the starting dose commercially. But I...took 10% of that a week and got similar benefits.” ([48:17] - Dave)
Weekly vs. more frequent dosing: There's no science to support weekly being "ideal," but rather a convenience for pharma, payers, and pharmacy logistics ([55:33]).
Oral and sublingual forms: For those needle-averse, compounded oral versions are emerging, though with less regulatory oversight ([53:52]).

6. Barriers, Biases, and the Need for Patient Advocacy

Medical resistance and outdated ideas: Some providers still default to old objections (e.g., “muscle wasting") without nuanced understanding ([28:29]).
- “That guy doesn’t understand this functionally at all and he’s out there giving advice.” ([28:29] - Scott)
Complexity in Type 1 diabetes: The conversation shifts to off-label use among Type 1s, who sometimes see insulin needs plummet (sometimes almost to zero) on GLP-1s, but this is not universally true, and carries certain health risks ([37:22]–[64:15]).
Insulin resistance & functional application: For some, especially those with co-existing insulin resistance, a tailored approach (microdosing, off-label use) can be transformative ([51:08]–[53:52]).
Caveats about safety: Strong warnings not to attempt self-treatment or stop insulin without careful management ([62:55]–[64:15]).

7. Social Consequences, Economics, and Hope

Impact on US healthcare: Dave predicts GLP-1s could “save the healthcare system” if made accessible and affordable ([41:33]).
- “Almost everyone who lives in this country should be considering the idea of talking to their doctor about whether...these medications could benefit them in some way.” ([44:16] - Dave)
Upcoming price reductions: Recent policy moves will bring prices down substantially, especially for Medicare and Medicaid recipients. Cash-pay prices expected to drop to $250/month ([60:05]).
Societal mindset shifts: Scott highlights decades of “weight loss at any cost” culture morphing into new criticisms of “cheating” with meds, underlining human inconsistency ([37:00]).
Big Pharma’s role: Skepticism, hope, and the business realities of pharma are discussed openly ([58:40]).

Notable Quotes & Memorable Moments

On the patient mindset:
- Scott: “I tell people I have a GLP deficiency. That’s what I tell them, because it shuts them up.” [28:42]
On transformative results:
- Scott: “My brother...lost, like, 70 pounds. His A1C’s dropped way down...and still, he was with a doctor the other day who said...‘I wouldn’t be using this GLP medication.’ ...That guy doesn’t understand this functionally at all and he’s out there giving advice.” [28:29]
On stigma & public response:
- Scott: “I’m not a person who’s like, put everybody on medication. I’m really not. But, like, now that I've seen what it’s done for me, I'm not down with just yelling like, ‘you’re cheating if you’re doing this thing.’” [18:34]
On med innovation and compounding:
- Dave: “Clinical trials are designed for regulators and they’re designed for investors. They’re not really designed for patients...We're starting to see a shift in that.” [48:17]
On expanding indications and hope:
- Dave: “I really believe these medicines...have the power to save our healthcare system in the United States.” [41:33]

Important Timestamps

[05:10] Dave’s diagnosis story
[08:49] Metabolic effects, yo-yo dieting, and family consequences
[15:01] Genesis of On the Pen; learning the science as a patient
[17:23] Viral “Release the Vials” campaign and Mounjaro coupon heyday
[21:59] GLP-1 mechanisms, DPP4, and metabolic dysfunction explained
[25:54] The “antidote” theory and broad relevance beyond weight loss
[28:29] Provider misconceptions and frustration
[29:17] Inflammation, autoimmune, heart protection – GLP-1’s next frontier
[37:00] Society’s double standard on weight loss solutions
[41:33] Policy change and hope for access; “saving the healthcare system”
[48:17] Compound pharmacies and personalized GLP-1 dosing
[51:08] Microdosing, functional dosing intervals, and personal experiences
[53:52] Oral/sublingual tirzepatide, injection avoidance, and practical hurdles
[60:05] Upcoming Medicare/Medicaid/cash price changes for GLP-1s
[62:55] Warnings on insulin reduction and the need for careful management

Flow, Tone, and Closing Thoughts

Both stress that patients must drive the conversation with their healthcare teams and push for individualized solutions—even as science, pharma, and policy slowly catch up.

Closing Reflections

“Everything that I share...I just want people to have better conversations with their doctor. And if your doctor doesn’t know about it, ask them to know about it or find somebody that does.” — Dave ([65:15])

Summary Table: Key GLP-1 Topics

For Listeners

Reminder: Do not make changes to your medical regimen based on podcasts—bring questions and ideas from this episode to your medical provider for individualized advice.

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Summary

Juicebox Podcast: Type 1 Diabetes – Episode #1699 “On the Pen with David Knapp”

Main Theme & Purpose

Key Discussion Points & Insights

1. Dave’s Story: Diagnosis and Motivation

2. The Patient Perspective & Content Creation

3. GLP-1 Medications: How They Work, What They Change

4. Broader Applications & the Future Pipeline

5. Access, Dosing Innovation, and Compounded Forms

6. Barriers, Biases, and the Need for Patient Advocacy

7. Social Consequences, Economics, and Hope

Notable Quotes & Memorable Moments

Important Timestamps

Flow, Tone, and Closing Thoughts

Closing Reflections

Summary Table: Key GLP-1 Topics

For Listeners

Summary

Juicebox Podcast: Type 1 Diabetes – Episode #1699 “On the Pen with David Knapp”

Main Theme & Purpose

Key Discussion Points & Insights

1. Dave’s Story: Diagnosis and Motivation

2. The Patient Perspective & Content Creation

3. GLP-1 Medications: How They Work, What They Change

4. Broader Applications & the Future Pipeline

5. Access, Dosing Innovation, and Compounded Forms

6. Barriers, Biases, and the Need for Patient Advocacy

7. Social Consequences, Economics, and Hope

Notable Quotes & Memorable Moments

Important Timestamps

Flow, Tone, and Closing Thoughts

Closing Reflections

Summary Table: Key GLP-1 Topics

For Listeners