Juicebox Podcast: Type 1 Diabetes

Episode #1753 – Diabetes Spectrum, Part 2

Host: Scott Benner
Guest: Trisha
Release Date: January 29, 2026

Episode Overview

This episode continues an in-depth, no-holds-barred conversation about the full spectrum of diabetes experiences, especially focusing on the way medical systems, new therapies, and personal journeys intertwine. Host Scott Benner and guest Trisha discuss living with slowly progressive type 1 diabetes (sometimes called LADA), GLP-1 medications, challenges of medical diagnosis, the pitfalls of academic medicine, innovations in digestive health for diabetics, and the lifelong psychological impact of chronic illness. Listeners are urged to think boldly, question assumptions, and advocate for themselves.

The episode is candid, empathetic, sometimes irreverent, and aimed at empowering listeners to be "Bold With Insulin"—to take control of their own diabetes care and narratives, supported by lived experience and open dialogue.

Key Discussion Points & Insights

1. The Origin and Effects of GLP-1 Drugs (02:49–06:26)

• GLP-1 Analogs’ Origins:

  • A Canadian researcher discovered high GLP levels in the saliva of the Gila monster, a lizard that eats until satisfied and then fasts. This discovery led to today's GLP-1 medications for diabetes and weight loss.
    • “He swabbed its mouth and found that the GLP in its saliva was significantly more than humans. And that's where today's idea came from originally.” — Scott (02:51)

• GLP-1 Efficacy Beyond Type 2 Diabetes:

  • Scott and Trisha discuss dramatic weight loss and improved insulin sensitivity in both type 1 and type 2 patients, even when not pursuing weight loss.
  • Real-world examples: A teen with significant weight loss in just over a week; Scott’s personal 70-pound weight loss over two years.

• Insulin Requirements and GLP-1s:

  • Even those without extra weight see insulin needs drop after starting GLP-1s.
  • The impact is not solely due to reduced food intake, suggesting underlying metabolic mechanisms.

2. Medical Bias and Off-Label Use of Medications (05:31–06:26)

• Medical Hesitancy:

  • Scott critiques the rigid academic attitudes toward drugs like GLP-1, which are labeled type 2 drugs, thus discouraging creative, off-label use in type 1 or LADA patients.
    • “…when you get into the academia side of it, the people who sit around and congratulate themselves all the time…they get stuck in like, well, it's a type 2 diabetes drug.” — Scott (05:42)

• Personal Experience of Misdirection:

  • Trisha describes frustration when doctors dismiss her suggestions or symptoms because she doesn’t fit the “textbook” patient profile.

3. Chronic Digestive Issues and New Solutions (06:26–14:59)

• Long-Term Damage:

  • Trisha shares how poorly managed or slow-progressing type 1 diabetes led to severe nerve damage in her colon ("colonic inertia"), requiring advanced GI tests and leading to significant quality-of-life issues.

• Innovative Treatments:

  • The Vibrant Capsule: A vibrating pill-like medical device that stimulates colonic peristalsis, described as a game-changer for diabetic nerve damage.
  • “I'm on a drug—a medical device called Vibrant Capsule. It's changing things for diabetics with nerve damage…It looks like a pill. It vibrates on a certain cadence…” — Trisha (07:49)
  • Supportive meds like magnesium and motegrity; coached bladder awareness.

• Psychological and Social Impact:

  • The long diagnostic journey, misattributed symptoms (e.g., nocturia, urgency), and lack of glucose in urine with slowly progressive diabetes.

4. The Realities of Slow-Progressing Type 1 (LADA) (10:21–14:59)

• Nonlinear Symptom Profiles:
  • Trisha notes that LADA patients don't always present with classic symptoms, e.g., not extreme polyuria but excessive nighttime urination, normal fasting sugars but post-meal spikes.
  • “Doctors need to understand it can be a very different experience for LADA.” — Trisha (14:14)
• The Importance of Nuanced Diagnosis:
  • Missed red flags, delayed progression, and damage despite being a well-educated healthcare worker.

5. Frustrations with Academic Medicine & The Slow Pace of Change (17:56–25:47)

• Out-of-Touch Academia:

  • Both speakers rant against the insularity of academic medicine, which rarely translates decades of research to actionable, rapid bedside change.
  • Citing an example where a "decade-long study" concluded what patients and families discovered years before via lived experience.

• Peer Review vs. Lived Experience:

  • Scott argues the value of “learning by listening” to patients, rapid adaptation, and sharing, rather than waiting for formal, slow-moving publication.
    • “…it's hard to…it's easy to say the healthcare system doesn't work preventatively, but I think people's minds don't work preventatively.” — Scott (33:24)

6. Family History, Autoimmunity, and Medical Communication (27:38–31:15)

• Connecting Family Medical Dots:

  • How patient and physician often miss connections in family history (e.g., Raynaud’s as autoimmune).
  • The limitations of word policing and rigid definitions, limiting holistic patient understanding.

• Generational Health Patterns:

  • Stories about allergies and autoimmune issues, epigenetics, and family dynamics in disease expression.

7. Medical Myths and Changing Best Practices (35:08–39:05)

• Historical Medical Mistakes:

  • A humorous but sobering run-down of outdated treatments (bloodletting, mercury, lobotomies, early allergy avoidance advice).
  • Encourages skepticism and questioning of current “settled science” as it will inevitably change.

• Reversal on Hormone Replacement for Women:

  • Highlighting newly accepted findings that contradict years of hormone replacement risk.

8. The Value—and Limits—of Self-Experimentation (39:23–41:24)

• Anecdotal Interventions:
  • Scott describes his wife’s relief from long COVID symptoms using nicotine patches, based on a podcast tip.
  • The speakers discuss weighing risk-benefit and the difference between cautious, open-minded trying and recklessness.
    • “…I am here to tell you that her long COVID symptoms have not been a problem for the last 14 days.” — Scott (39:56)

9. Psychological Trauma and Growth from Living with Diabetes (18:23–19:11, 58:24–58:56)

• Post-Traumatic Stress & Growth:
  • Trisha details the trauma of late diagnosis and medical dismissal, using EMDR and CBT therapy for healing.
    • “…to convince the areas of my brain that associated with the medical misdiagnosis...if I didn't do it, it wouldn't have calmed...[now] I've had what they call post-traumatic growth.” — Trisha (19:11)
  • Importance of mental health/self-advocacy for chronic illness patients.

10. AI, Critical Thinking, and Medicine’s Future (45:49–48:29)

• AI for Medical Diagnosis:

  • Discussion about whether AI—using patient history and symptoms—could surpass human physicians’ ability to connect the dots faster and more efficiently.
    • “…opened up your ChatGPT app…laid out your history…what do you think is wrong?...I think that in about 20 seconds it would have figured out your problem.” — Scott (46:06)

• Doctors’ Limitations:

  • The impossibility of any single doctor holding both the vast medical database and a complete picture of a complex patient, and how AI could serve as a powerful tool.

11. The Importance of Community & Storytelling (52:53–56:15)

• Podcast Impact:

  • Listeners (including Trisha) are reassured by the podcast and community, helping them realize their experiences are valid and shared.
  • The importance of sharing lived knowledge and refusing to let “word police” or “perfectionism” hinder conversation.

• Advocacy for Recognizing Diabetes as a Spectrum:

  • Trisha passionately calls on organizations like the ADA to accurately communicate that diabetes is a spectrum—supported by modern data.
    • “…stop. Start telling the truth about diabetes being a spectrum, okay? Like, we have the data with the CGMs. Like, there's so much we know…” — Trisha (56:15)

Notable Quotes & Memorable Moments

“It doesn't matter the words I use. I appear to have a GLP deficiency, because once you give it to me, I'm okay… In a couple of hours, her insulin needs are going to start to go down.”
— Scott (03:10)

“You can't get into a room and congratulate yourself after having spent, like, half your career to figure out a thing that some jackass with a microphone figured out 10 years before.”
— Scott (24:45)

“Doctors need to understand it can be a very different experience for LADA.”
— Trisha (14:14)

“We just don't understand it a lot and we think we do.”
— Scott (30:35)

“I learned through my whole experience, learned helplessness. So you’ve got an intelligent, educated person…who, if you taught her things…she’s gonna listen.”
— Trisha (32:30)

“You just can't…expect a human being to [keep all patient and medical knowledge straight]. This is where…if you sat down…with AI…20 seconds it would have figured out your problem.”
— Scott (46:06)

“If I helped one person who has this kind of family history go get all the screening and all the appropriate tests…I think some of the root cause for me started very young, where I stopped going to an endocrinologist…So if I save one person, man, it’s worth it.”
— Trisha (56:15)

“We need those people within this field.”
— Trisha (60:33, referencing compassionate diabetes educators)

Segment Timeline

• Origin of GLP-1s and Impact on Insulin, Appetite: 02:49–05:31
• Systemic Academic Limitations, Medical Bias: 05:31–06:26
• GI Complications, Vibrant Capsule, Colon Motility: 06:40–14:59
• Untypical Symptom Profiles, Slow-Progressing Type 1 (LADA): 14:00–16:51
• Living with Chronic Complications, Emotional Toll: 17:56–19:11
• Medical Academia vs. Patient Experience: 21:21–25:47
• Connecting Family History, Importance of Storytelling: 27:38–31:15
• Critique of Historical and Current Medical Practices: 35:08–39:05
• Self-Experimentation, Nicotine Patch for Long COVID: 39:23–41:24
• AI, Critical Thinking in Medical Diagnosis: 45:49–48:29
• Podcast as Support, Empowerment: 52:53–56:15
• Advocacy for Truth in Diabetes Spectrum: 56:15–57:12

Tone & Language

The conversation is warm, direct, unfiltered, and compassionate. Both Scott and Trisha frequently use humor and candor to address uncomfortable truths and frustrations, making the episode accessible and real. They empower listeners to trust their intuition, push for better care, and utilize both lived experience and evolving science—including AI tools—while also remembering the importance of community and mental health.

Takeaways for Listeners

• Diabetes, especially type 1 and LADA, often presents in unexpected ways and requires nuanced, individualized care.
• Don't accept easy labels or dismissals—be bold, question, self-advocate, and leverage new tools from GLP-1s to AI.
• Medical systems are slow to change; lived experience and patient community can provide faster, sometimes more accurate insights.
• Chronic illness comes with invisible emotional challenges—seek support, mental health care, and recognize post-traumatic growth.
• There is immense value in sharing stories, connecting clinical dots, and speaking openly—even if the “official line” in medicine hasn’t caught up yet.

[End of summary – for detailed understanding, listeners are encouraged to check out the full episode, especially the segments referenced above.]