Podcast Summary: "A Groundbreaking Therapy with Tzield Ft. Special Guest Sierra Werling"

Taking Control Of Your Diabetes® – The Podcast
Hosts: Dr. Steve Edelman & Dr. Jeremy Pettus
Guest: Sierra Werling
Release Date: March 24, 2025

Overview

This episode dives into the revolutionary potential of Tzield, the first approved therapy to delay the onset of Type 1 diabetes (T1D). Drs. Steve Edelman and Jeremy Pettus, both practicing endocrinologists with personal experience managing their own T1D, interview Sierra Werling, the first patient at their center (and one of the first in the country) to receive Tzield outside of a clinical trial. Sierra shares her unique journey through gestational diabetes, cancer, a strong family history of T1D, and finally, her experience with Tzield and the hope it offers for at-risk individuals.

Key Discussion Points & Insights

The Hosts' Diagnosis Stories: Then vs. Now

[00:20 – 03:07]

• Drs. Edelman and Pettus reflect humorously but poignantly on their abrupt and sometimes traumatic T1D diagnoses as teenagers, which occurred without warning or family history. Both ended up hospitalized with diabetic ketoacidosis.
  • Quote (Dr. Edelman, 01:16):
    “I was officially diagnosed at age 15, but for about six months beforehand, I was thirsty, urinating a lot, lost tons of weight...the next thing I know, they drew some blood and they threw me in a wheelchair, put me in the ICU, and I was there for four or five days with diabetic ketoacidosis.”
• Contrasts are made between these experiences and the opportunity for modern patients like Sierra to be screened, educated, and, thanks to Tzield, possibly delay or lessen the impact of T1D.

Sierra's Story: Family Risk, Cancer, and Two Diabetes Diagnoses

[04:09 – 10:59]

• Family History:
  Sierra has multiple relatives with T1D, including two aunts and two cousins, making her more aware but not certain of her own risk.
  • Quote (Sierra, 05:13):
    “I have two aunts with type 1 diabetes... and two cousins, one with juvenile diabetes and one just diagnosed at 43.”
• Gestational Diabetes:
  Both pregnancies involved severe gestational diabetes, requiring her to start insulin early. After each pregnancy, her blood sugars remained high for weeks but then normalized, and follow-up on diabetes was dropped.
• Cancer Diagnosis:
  Six months after her first child, Sierra was diagnosed with bone cancer (osteosarcoma). Intensive chemotherapy and steroid treatments led to additional high blood sugars and need for insulin.
• Healthcare Navigation:
  Following her second pregnancy and transition from the Navy, she was misdiagnosed with type 2 diabetes before advocating for further T1D screening and being properly referred to endocrinology.

Recognizing Early (Preclinical) Type 1 Diabetes & Staging

[11:00 – 14:28]

• Sierra explains her screening process, revealing initially elevated GAD antibodies then, on repeat, elevated zinc transporter antibodies.
• The hosts detail the current staging of T1D:

  • Stage 1: Two+ positive antibodies, normal blood sugar; 50% will progress in 5 years.

  • Stage 2: Two+ antibodies + mild blood sugar abnormalities (“dysglycemia”); 75% will progress.

  • Stage 3: Full onset, often with DKA, requiring insulin.

  • Quote (Dr. Pettus, 12:11):
    “Once two or more of these [antibodies] become positive, we actually call that now type 1 diabetes... Once you get two of these antibodies positive and you had some abnormal blood sugars... that’s what we call stage two.”

Enter Tzield: The Decision and Process

[15:02 – 18:29]

• After her A1C was borderline (6.6, then 6.4), Sierra was offered Tzield: a 14-day, daily IV immunotherapy which calms immune T cells attacking pancreatic beta cells.
• Preparation & Logistics:
  The procedure required daily blood tests and monitoring for side effects, especially for first-time patients and new staff.
  • Quote (Sierra, 17:06):
    “It was a time commitment for sure. Going into a hospital for 14 days in a row. And it’s not just the infusion itself... blood draws would take about two hours, and then the infusion... But my initial questions were just: how new is this? What’s the realistic outcome?”

What It Felt Like: The Infusion Experience & Side Effects

[19:43 – 20:47]

• Most side effects were minor — some flu-like symptoms, joint and bone aches, especially around days 6-7, which resolved quickly.
  • Quote (Sierra, 20:05):
    “I didn't really have any symptoms... around day six or seven I started getting those flu-like symptoms... joint pain, bone achy feeling...It passed overnight and I was good to go in the morning.”

Results, Monitoring, and Ongoing Life Post-Tzield

[22:39 – 26:36]

• Monitoring:
  Sierra now uses a CGM (Continuous Glucose Monitor), even though she doesn’t need insulin, to track and manage her blood sugars with diet and exercise.
  • Quote (Sierra, 24:13):
    “So if I can take control of my health, I really like that option. I've not been able to before in the past... I'm able to manage my blood sugars right now with diet and exercise and I monitor it so I know it works for me.”
• Results & Realism:
  Despite spikes (occasionally up to 250 mg/dL post-meal), she can control her blood sugars. Nine months post-infusion, she has avoided needing insulin.
• Hope, but No Guarantees:
  She is aware that T1D may still develop eventually, but the goal is to delay full onset as long as possible. The hosts point out that delaying the need for insulin, even by months or years, is “priceless.”
  • Quote (Dr. Edelman, 21:06):
    “When Jeremy mentioned delaying type 1 by 3 years... some people have not gotten type one after seven or eight years...”

Screening for Relatives & Barriers

[27:01 – 30:48]

• Sierra is encouraging siblings and considering screening her own children, but highlights barriers like busy schedules, motivation, and (for children) finger-stick challenges and the emotional burden.
• The hosts recommend home testing from type1tested.com and note that even if there’s nothing “to do” for a young child, awareness can prevent severe presentations.
• Tzield is currently approved for use in those age 8+, though these rules may change in the future.

The Cost and Accessibility of Tzield

[30:10 – 31:17]

• Tzield’s cost is high ($150–200k), but often covered by insurance. The hosts emphasize the benefit–cost ratio compared to lifelong expenses of T1D management or ICU visits for DKA.

Notable Quotes & Memorable Moments

• On the Trauma of Old-School Diagnosis:
  • Dr. Pettus [02:19]:
    “You go from maybe thinking you’re a little sick...to ‘guess what, you have this for the rest of your life.’”
• On Delaying T1D:
  • Dr. Edelman [14:28]:
    “We tell our patients all the time, there’s never been a better time to live with diabetes... but you know what? I’d rather not have it.”
• On the Value of Modern Advances:
  • Sierra [31:53]:
    “It’s convenient to not have type 1 diabetes, while it’s inconvenient to go into the hospital for 14 days straight for a few hours. I mean, to not have it for a few more years, that is priceless.”
• On Family Barriers to Screening:
  • Sierra [27:49]:
    “My sister plans to. ...My older brother, if he listens to this, he’s just a bit on the lazy side, I think. Love him. I just need to bug him a little bit more about it, I think…”
• On How Screening Helps Even When There’s No Immediate Treatment:
  • Dr. Pettus [26:04]:
    “You’re just so aware of it...That’s just not going to happen to you. You’re going to notice when you have these little blips, maybe go on insulin. So there’s multiple reasons to…”

Highlighted Timestamps for Key Segments

• 00:20 – 03:07: Lived experiences of host diagnosis
• 05:13 – 06:55: Sierra’s family history and first pregnancy
• 06:55 – 09:28: Cancer diagnosis and impact on diabetes
• 10:35 – 11:42: How primary care missed type 1; self-advocacy
• 12:11 – 14:28: Staging system for type 1 diabetes
• 15:02 – 18:29: Learning of Tzield, qualifying, and therapy logistics
• 20:05 – 20:47: Side effects of infusion
• 22:39 – 26:36: Life, monitoring, and mindset post-Tzield
• 27:01 – 28:10: Discussion on family screening adoption
• 30:10 – 31:17: Discussion of costs and insurance
• 31:26 – 31:53: Would Sierra do it all again? (She would)

Tone and Final Thoughts

The episode is deeply personal, educational, and laced with the hosts’ trademark humor and candor. It demystifies a breakthrough therapy through Sierra’s story, provides actionable insights on early screening and current barriers, and underscores the psychological complexities of living at risk for T1D. The hosts stress the value of education, proactivity, and hope, all while remaining realistic.

Final words (Sierra, 31:53):
“To not have [type 1 diabetes] for a few more years, that is priceless.”