Juicebox Podcast: Type 1 Diabetes

Episode #1728: ADA Standards of Care for 2026
Date: January 5, 2026
Host: Scott Benner (A)
Guest: Jenny Smith (B)

Overview:

In this episode, Scott Benner and Jenny Smith analyze the newly released 2026 ADA Standards of Care for diabetes, specifically focusing on Type 1 Diabetes. They break down what's truly new, why these standard guidelines often lag behind community knowledge, and how people with diabetes (PWD) can advocate for themselves amid slow-moving recommendations. The episode blends practical analysis, candid critique, and personal storytelling to drive home actionable ways to live well—and boldly—despite systemic inertia in diabetes care.

Key Discussion Points & Insights

1. The Slow Pace of Change in ADA Guidelines

• General Sentiment: Both Scott and Jenny express that ADA guidelines progress slowly and often lag behind real-world diabetes management.
• Scott’s Cynicism:
  • "It feels like a lot of nothing to me, and I realize that it's something that probably moves on very slowly..." (01:50)
• Jenny’s Perspective:
  • The standards are mainly seen and used by clinicians—not by the PWD community itself.
  • "These standards are usually not even something people with diabetes look at. They really are from a clinical standpoint..." (05:06)

2. Screening and Early Prevention vs. Practical Access

• Scott: Questions the utility of massive screening efforts when the interventions are so limited and burdensome.
  • "If you find them, the answer is 13 infusions over 13 days...and if we're lucky, this might stave off diabetes for a year or so. Like, wow." (04:13)
• Jenny: Believes large organizations wait for enough momentum and data before including new interventions in the guidelines.

3. Lag with New Therapies: Example of GLP-1 Medications

• Scott: Frustrated by medications like GLP-1s moving from "off-limits" to recommended years after the community already saw benefits.
  • "Three years ago...they were busy telling us, no, no, no, it's not for type ones, it's only for type twos. What they meant was, is we don't have production ramped up yet..." (08:56)
  • Concerned people will internalize early negative advice and never revisit it:
  • "It's three years of telling people, oh, no, this thing is not for you, and those people will never think about it again." (09:33)
• Jenny: GLP-1s are now “finally” in the standards, but it’s been normative in the savvy diabetes community for years.
  • "A big highlight is absolutely the GLP1s...Now the standards say, yes, there's value to these medications." (08:29)

4. The Problem with Hard Targets and Drift in Management

• A1C Targets:
  • Kids: 7.5%; Adults: below 7% (06:42)
  • Jenny highlights the “wavy lines” and need for personalization—unlike how the numbers are often presented.
• Scott: Worries a number becomes a lifetime ceiling.
  • "Once you've established that as your standard, then that's it forever and ever..." (10:19)
  • Drift happens easily:
    • "If you tell somebody 7.5, then 8.2 doesn't seem that far from 7.5... And you just zoom." (32:57)

5. Why Slow Guidance Harms Real Lives: The Story of Mike

• Scott’s Personal Story:
  • Shares the slow tragic saga of his best friend Mike who, after bad advice and outdated care, spiraled into severe complications and early death.
  • "At some point in Mike's life, someone said, this is how you take care of your diabetes. And he believed them." (15:27)
  • Emphasizes that knowledge and access can dramatically affect outcomes.
  • Impactful Moment: “And he died the next day.” (15:27) [Mike’s story is woven from 11:42–16:00]

6. The Problem of Relying on Official Guidance Alone

• Jenny: Points out many clinicians (especially primary care) may rely too heavily on guidelines or may not stay up-to-date, increasing the gap.
• Scott:
  • Good recommendations take too long to make it to insurance coverage and real-world access.
  • "It typically takes one to three years for a new ADA recommendation to be written into insurance, medical policies..." (21:42)
  • “Your life is this long. That's a big picture thing and we should be doing that. The ADA's thank God. Right? But like for you personally, inside of your life, you don't have the 300 years that they're mapping this out over.” (21:43)

7. Progress in the 2026 Standards: What’s Actually New?

• Highlights:
  • GLP-1s are listed as recommended treatments for obesity in T1D. (34:50)
  • No more C-Peptide, antibody, or insulin duration requirements for starting pumps/AID systems. (35:04)
  • Workplace accommodations for diabetes tech stated clearly. (35:06)
  • Hospital safety: Must never stop basal insulin for T1Ds. (35:22)
• Cynicism on Timelines:
  • “It took us till 2026 to say that... We could have slipped [workplace accommodation] in 10 years ago.” (35:12)
  • On hospital policies: “Congratulations. Where the hell was that before?” (35:33)

8. DIY/Open Source AID Systems and Medical Liability

• Jenny’s Milestone: ADA now finally acknowledges open-source and DIY systems, which she’s been using and teaching for almost a decade.
  • “First time...they’re acknowledging the aid systems inclusive and their value inclusive of the open source DIY systems. The first time. How long have I been using an open source system? Since early 2017.” (22:14)
• Liability Barrier: Until something is in the standards, most clinicians won’t recommend it, even if it works—due to liability fears.

9. How to Self-Advocate and Use Standards as Leverage

• Jenny: PWDs should review standards annually—not to adopt everything, but to bring proof to clinicians and press for what’s available.
  • "If the doctor's still giving you pushback, you can bring it and kind of say, hey, look. This is part of the standards." (27:32)
• Scott: Standards are helpful ammunition for pushing back against outdated or poorly informed medical advice.
  • “That thing where you tell me the GLP is going to make me go into DKA. We can stop saying that now, right? The paper says you don't have to say it to me anymore.” (27:36)

10. Systemic Risk Aversion and the Harm of “Common Denominator” Teaching

• Scott:
  • Frustrated by how the system teaches to the slowest, most risk-averse denominator, rather than empowering everyone to aim higher.
  • "I'm tired of common denominator teaching for people..." (31:30)
• Jenny:
  • Wishes standards would focus on enabling and teaching PWD how to actually improve, not just maintain "safe" numbers.

11. The Emotional and Physical Impact of "Guideline Lag"

• Scott & Jenny:
  • Cite concrete consequences of the slow machinery of care—lost opportunities, systemic inertia, and even preventable tragedy.
  • “Don't limit yourself to me...everyone gets to know what happens when the island burns down. It's up to them what they do with it. It's not up to you as to whether or not they die without ever having fought for themselves.” (49:24)

Notable Quotes & Memorable Moments

• On GLP-1 Slow Adoption:
  • Scott (08:56): "Isn't it possible...when they were busy telling us, no, no, no, it's not for type ones, it's only for type twos. What they meant was, is we don't have production ramped up yet, so let's not everybody be dipping their toe into this pond yet."
• On Setting and Drifting Targets:
  • Scott (32:57): "If you tell somebody 7.5, then 8.2 doesn't seem that far from 7.5... And then next week, you know, or next month or three months from now, we come back again and into eight. Five, you go, that's not bad. It only went up 0.2, 0.3. You're doing great. We'll try again. Like, you know, and you just zoom."
• On Tragedy of Out-of-Date Care:
  • Scott (15:27): "I see that story as completely connected to this because at some point in Mike's life, someone said, this is how you take care of your diabetes. And he believed them."
• On Empowerment and Self-Advocacy:
  • Jenny (27:32): "If the doctor's still giving you pushback, you can bring it and kind of say, hey, look. This is part of the standards. Why are we not discussing this? I've brought it up for two years already."
• On Uptake of DIY Systems:
  • Jenny (22:14): "I've been using one since early 2017. Yes, that is a long time. I have worked with person after person after person. I have talked to doctors..."
• On Responsibility to Share Knowledge:
  • Scott (48:03): "I don't know how I was supposed to know all this and then just not tell anybody about it."
• On the Incremental Harm of Complacency:
  • Scott (34:27): "It works the same way in your mind as gaining weight, not cutting the weeds around your house or something. You just accept more and more of something that on day one, you weren't excited to accept."
• On Agency:
  • Scott (44:02): "If your argument is, well, everyone's not going to understand, everyone's not going to have the bandwidth, everyone's not going to have access. So we just won't tell anybody. That's a terrible perspective to have."
  • Jenny (44:09): "It's also judging somebody from what you think you've gathered out of a 10 or 15 minute office conversation..."

Timestamps for Important Segments

• [03:46] – Significance (or not) of new ADA updates; slow progress and organizational inertia.
• [08:29] – The (belated) inclusion of GLP-1s and their value for T1D.
• [11:42–16:00] – Scott tells the story of his friend Mike: a case study in outdated guidance with tragic results.
• [21:42] – Barriers: medical necessity, insurance lag, and the critical importance of acting sooner.
• [22:14] – ADA’s first-time acknowledgment of open-source AID systems; medical liability hurdles.
• [27:32] – How to use updated Standards as leverage during clinical visits.
• [32:57] – The insidiousness of “drift” in A1C numbers and treatment goals.
• [34:50–35:33] – What’s actually new in the 2026 guidelines, including GLP-1s, pump access, workplace and hospital policies.
• [43:25] – Incremental, “invisible” complications and the necessity for daily vigilance.
• [48:03] – Ethical motivation for public education and sharing best practices.
• [49:24] – Universal right to know about risks and self-advocate, regardless of ability or access.

Conclusion & Takeaways

1. The ADA Standards matter—but they’re always behind the lived experience.
Scott and Jenny urge listeners not to rely solely on official guidelines for timely, optimal care. The system is built for safety and liability, but that means progress is slow and the cutting edge is always somewhere else.

2. Tools and knowledge are power—seek them out, use them for advocacy.
Review updates to help argue for the resources and approaches you need; use standards as leverage, but pursue learning and self-experimentation as well.

3. The cost of waiting or complacency is often hidden, incremental…and very real.
Scott’s story of Mike is a haunting illustration: the hidden toll of poor guidance may not be felt until it’s far too late.

4. Everyone deserves the opportunity to fight for better outcomes—don’t let the system limit your ceiling.
Empowerment, curiosity, and self-advocacy are recurring themes. Neither host believes in waiting for the system to catch up.

Memorable Sign-off:
"Go fight for yourselves. Stop it." – Scott Benner (51:44)

For further action and support, listeners are encouraged to explore the Diabetes Pro Tip Series (episodes 1000–1025) and join the Juicebox Podcast’s private online community.

Juicebox Podcast: Type 1 Diabetes. Bold With Insulin.