Juicebox Podcast: Type 1 Diabetes

Episode #1717 – Knowing All Your Tools (Part 1)

Date: December 23, 2025
Host: Scott Benner
Guest: Sarah (LADA, nurse, diabetes advocate)

Episode Overview

This episode kicks off a two-part deep dive into understanding all available tools for managing diabetes—focusing on the power of knowledge, patient advocacy, and real-life experiences. Host Scott Benner interviews Sarah, a nurse with seven years of lived experience with Latent Autoimmune Diabetes in Adults (LADA), who shares her evolving journey, critical turning points, and strategies for seeking personalized and advanced diabetes care. Together, they tackle common emotions, systemic challenges, and the importance of persistence when navigating the healthcare system with a chronic condition.

Key Discussion Points & Insights

Sarah’s Background and Diagnosis Journey

• Diagnosis Story:

  • Sarah has LADA, diagnosed at age 37 (now 44), with a strong family history of Type 1 and other autoimmune diseases.
  • Participated in TrialNet as a child and was GAD positive at age 11, marking elevated risk, but didn't expect the actual diagnosis to happen.
    • “My mom enrolled us in TrialNet… I was GAD positive… She told me there's a higher chance, but of course you're like, that will never happen to me.” (08:08–09:13)
  • After her third pregnancy—where gestational diabetes persisted post-delivery—her glucose did not normalize, signaling the start of LADA progression.

• Family History:

  • Brother diagnosed at 9 with Type 1.
  • Father initially diagnosed with Type 2, later reclassified as LADA.
  • Great-grandfather died from Type 1 before insulin was available.
  • Family also has Hashimoto's and MS diagnoses.

• Initial Missed Cues and Delayed Progression:

  • Sarah’s health awareness meant she noticed symptoms, but “the wash of life” (busy with children, postpartum depression, anxiety) led to delayed action.
  • Initially misdiagnosed and managed as Type 2, started on Metformin despite family history and antibodies, highlighting common misclassification in adult-onset diabetes.
    • “Somebody said type two and your feet came out of the sand and you just went out to sea with it and just were like, okay, I have type two. Just like that.” – Scott (14:23–14:37)

The Turning Point: Self-Advocacy and Seeking the Right Care

• Recognition of Symptoms and Self-Testing:

  • Weight loss and tingling fingers prompted Sarah to finally check her fasting glucose—it was dangerously high (~380 mg/dL).
  • Immediate shift to insulin therapy (Humalog + long-acting), managed almost entirely through her own initiative, leveraging family expertise as her mom was a diabetes educator.
    • “It was over the phone: ‘You’re starting Humalog, you’re starting long acting… go pick it up. This is starting today.’” (19:35–20:44)
  • Initial diabetes management was largely "trial and error," with minimal provider involvement.

• Emotional Response and Family Dynamics:

  • Experience of denial and compartmentalization—treating management as a temporary, even ‘work-like’ crisis.
  • Diagnosis eventually created a family ‘tribe’ among her, her brother, and her father, surfacing shared management experiences and fostering open communication.
  • Sarah became a tech-forward advocate, quickly adopting CGM and pump therapy, even ahead of her relatives.

Technology and Self-Education

• Rapid Adoption of Modern Tools:

  • Swift move to T-slim pump and Dexcom CGM—her self-advocacy led her to modern therapies ahead of her family members.
  • Diabetes management knowledge came “primarily from my mom… it was trial and error, managed by me, less by endocrinology.” (31:28–32:10)

• Changing Insulin Needs:

  • Experienced a gradual but continuous increase in insulin requirements, which was psychologically distressing; coined "diabetes distress."
  • “Every year I felt like I was taking more insulin, and that was the most stressful thing for me… like, this is just going to keep going for the rest of my life.” (32:18–33:28)

Game-Changer: The Empowerment from a Collaborative Endocrinologist

• Desperation & Search for Answers:

  • Reached a point of research-fueled desperation—she wanted more than "try harder" for control.
  • Sought a new endocrinologist after feeling dismissed (e.g., unhelpful response to inquiries about Amylin/GLP-1s).

• Transformative Clinical Experience:

  • New endocrinologist did a comprehensive battery of labs—C-peptide, full antibody panels—leading to a nuanced diagnosis of LADA with some retained beta cell function.
  • “It was life changing for me… He really started at the beginning and said, I'm not going to write a diagnosis on your chart. We're going to see what the labs tell us and go from there.” (34:09–36:26)

• Impact on Patient Agency:

  • Validation of Sarah’s experience (“He was looking at me truly inside of who I was…” – 36:33–37:14), led to tears and a renewed sense of empowerment.
  • Discovery: C-peptide had moved from 0.4 (at diagnosis) to 1.5 (normal range), changing treatment options.
  • New approach: Recognizing the “fluid” nature of C-peptide, leading to recommendations for broader use of medication options (GLP-1s) beyond traditional Type 1 paradigms.
  • “If you're going to be managed like type 2, the repertoire of available medications just explodes.” (45:41–46:42)

New Treatment Tools: GLP-1 Receptor Agonists

• Why and How:

  • Sarah started Mounjaro (tirzepatide), a GLP-1/GIP dual agonist, to preserve remaining beta cell function, reduce insulin need, and possibly provide additional neuro/cardiovascular benefits.
  • “Your beta cell or whatever is producing insulin are like raisins. We need to help those be grapes…” (45:04–45:41)
  • Saw marked reduction in insulin-to-carb ratio (from 8:1 to 11:1), dramatic improvement in glucose control, and rapid, desired weight loss.

• Barriers and Provider Communication:

  • Old clinicians frequently dismissed newer adjunct therapies with, “I don’t prescribe that, and I don’t know who I would recommend you to,” intensifying her sense of isolation and frustration (38:54–40:24).
  • Sarah underscores systemic access issues—advocating for more regular C-peptide reassessment and for patients to proactively seek collaborative, up-to-date care.

Notable Quotes & Memorable Moments

• On Misdiagnosis and Overwhelm:
  “It’s really easy not to see it… When you’re beating yourself up—when you have no context for this—and you end up in the hospital, is it really easy not to see it.”
  — Scott (14:28–14:37)

• On Emotional Impact of Progressive Insulin Dependence:
  “That was the most stressful thing for me… every year I’m going to be taking more insulin every single day. Like, that’s terrible. And it just, it felt like that was the journey that I was on.”
  — Sarah (32:18–33:01)

• On Finding the Right Doctor:
  “It was life changing for me. He really started at the beginning and said, I’m not going to write a diagnosis on your chart. We’re going to see what the labs tell us and we’ll go from there.”
  — Sarah (34:09–36:26)
  “It felt like this endocrinologist was looking at me truly… instead of just ‘your A1C looks great, keep up the good work’… It was so validating.”
  — Sarah (36:26–37:14)

• On Patient Empowerment and the Right to Explore All Tools:
  “I want every single tool to be available to me, not just what the endocrinology team thinks is best for me… I want all the research, I want all the potentials.”
  — Sarah (34:41–34:58)

• On GLP-1 Therapy:
  “It was like immediate proof to me that this was working and that those beta cells were plumping up like grapes…”
  — Sarah (48:13–49:06)

• On the Importance of Repeat C-Peptide Testing:
  “You shouldn’t just get your C-peptide checked once… You should be checking it regularly to ensure you have the right diagnosis.”
  — Sarah (46:50–47:26)

Timestamps for Major Segments

• 00:17 – 06:58: Sarah’s diagnosis, family history, and early life context
• 07:03 – 09:33: Participating in TrialNet and psychological response to “at risk” status
• 10:38 – 13:40: From gestational diabetes to LADA—missed cues and misdiagnosis
• 14:13 – 15:37: Mental health context, postpartum difficulties
• 18:05 – 20:58: Initial self-initiated insulin therapy, navigation without substantial clinical guidance
• 21:12 – 25:11: Family response, forming a “diabetes tribe”, early tech adoption
• 29:13 – 33:28: Gradual increase in insulin needs, psychological coping
• 34:09 – 37:14: The transformational endocrinology appointment—holistic review, repeat labs, new insights
• 38:54 – 41:45: Frustrations with dismissive providers, desperation leading to seeking new care
• 42:06 – 47:26: GLP-1 (Mounjaro) as a LADA treatment—mechanisms, personal results, shifting treatment paradigms
• 48:13 – 49:06: Tangible results from GLP-1 therapy, rationale for regular re-testing
• 49:06 – End: Teaser for Part 2

Overall Tone & Style

This conversation is open, candid, and relatable—mixing supportive humor with constructive detail. Scott is empathetic, a bit scattered (as he jokes), and draws out real-life nuance, while Sarah is analytical, methodical, and reflective. Together, their exchange is highly informative, grounded in both evidence and emotion, and deeply encouraging for listeners seeking self-advocacy in diabetes care.

For Listeners

This episode offers critical lessons in:

• The realities of delayed LADA diagnosis and why persistent self-advocacy matters.
• The need for repeat, comprehensive labs to obtain an accurate diagnosis and explore the best available therapies.
• The importance of finding a clinician who is willing to take a collaborative, individualized approach.
• How emerging therapies—like GLP-1 agonists—may be game changers when leveraged appropriately.

If you or a loved one is navigating an adult-onset diabetes diagnosis, this is a must-listen episode for strategies, hope, and validation.

Next: Listen to Part 2 for continued exploration of advanced management strategies and more practical “Bold With Insulin” wisdom!