Podcast Summary: "Aging and Type 1 Diabetes"

Podcast: Taking Control Of Your Diabetes® - The Podcast!
Host: Dr. Steve Edelman
Guests: Joanne Milo (T1D Advocate, Author) & Dr. Athena Tamikis (Endocrinologist)
Episode Date: February 24, 2026

Episode Overview

This episode dives deeply into the unique challenges—and surprising opportunities—of aging with type 1 diabetes (T1D). Dr. Steve Edelman hosts a lively and heartfelt discussion with longtime advocate Joanne Milo and esteemed endocrinologist Dr. Athena Tamikis. Together, they discuss shifting perspectives on aging, the evolving landscape of diabetes care for older adults, the power of technology, social determinants of health, emotional well-being, and practical strategies for living well into advanced years with T1D.

Key Discussion Points & Insights

1. Changing Narratives: Outliving Expectations

• Initial Diagnosis as "Death Sentence"
  • Both Steve and Joanne recount being told as teens in the 1970s that they wouldn’t live past 40. Now, both are thriving well into later life, emphasizing how drastically things have changed.
  • Quote (Joanne Milo, 01:59): "I just Sunday celebrated type 1 diabetes for 61 years... When I was diagnosed... I was told I would probably not make it past the age 40. I just turned 72."
• Creating Community and Advocacy
  • Joanne’s journey led her to found the Savvy Diabetic blog and build support communities like Loop and Learn (~14,000 members).
  • She also started the “T1D to 100” initiative, focusing on the unique experiences and needs of older adults with T1D.

2. Shifting Understanding of Type 1 Diabetes Onset

• Not Just a "Juvenile" Disease
  • Dr. Tamikis highlights recent findings that over a third of new T1D diagnoses occur in adults over 35—many of whom are initially misdiagnosed as type 2.
  • Quote (Dr. Athena Tamikis, 05:40): "Over 35% of people diagnosed with new onset type 1 diabetes today are over the age of 35, 40... They walk into the ED at 40, 45 years old and they get labeled type 2 diabetes."
• Case Examples
  • First-time diagnoses even in individuals as old as 91, illustrating the importance of appropriate recognition and tailored care.

3. Key Challenges of Aging with Type 1

• Cognitive and Physical Concerns
  • Cognitive decline (memory, organization) complicates self-management routines.
  • Physical issues (neuropathy, vision loss) increase risk of falls and hospitalizations.
  • Quote (Joanne Milo, 08:19): “This disease is... 20 hours a week, if you do it right... It’s a lot of time.”
• Social Isolation and Support Needs
  • The risk of losing care partners, the burden on family, and navigating healthcare systems.
  • Fear of being "misunderstood, unsafe, and unheard" as expressed by Joanne’s support group (30:13).

4. The "4M" Framework in Elderly Diabetes Care

• Medications, Mentation, Mobility, & What Matters
  • Dr. Tamikis outlines the ADA’s comprehensive approach, emphasizing individualized care focusing on quality of life (10:17).
  • Memorable exchange on “What Matters”
    • Steve Edelman (10:45): "What is what matters?"
    • Dr. Tamikis: "Exactly. It’s what’s important in your life... Donuts." (10:56)
    • Discussion on managing T1D to prioritize life enjoyment.

5. Individualizing Management: Cognitive & Physical Assessments

• Screening & Prevention
  • Importance of cognitive, vision, hearing screening, and fall risk assessment.
  • Barriers include fear (loss of license, independence) and denial; strategies for sensitive communication with patients (17:50–19:59).
• Social Determinants of Health (SDoH)
  • Addressing financial, living, and food insecurity often overlooked in standard care (18:05).

6. Technology & Medication Advances—For All Ages

• Modern Devices
  • CGMs, insulin pumps, and hybrid closed-loop systems remain viable—even protective—for older adults, provided they can manage the technology (21:21).
  • Quote (Dr. Tamikis, 21:25): "If the person can manage putting it on... then yes, absolutely, offer it. It’s part of that discussion."
• Medication Updates
  • GLP-1 agonists (Ozempic, Mounjaro) and SGLT2 inhibitors (Farxiga, Jardiance) show substantial benefits for heart and kidney health, though off-label for T1D (25:47–27:32).
  • Regular review of medication regimens is important (28:53).

7. Emotional and Psychological Well-being

• The Non-Stop Nature of T1D

  • Joanne describes the relentless vigilance required and the emotional toll ("24/7... six hours away from dead" — 30:13).
  • Encourages self-compassion, community, and "finding points of joy"—even invoking the “touch grass” (go outside, ground yourself) concept (31:28).
  • Quote (Joanne Milo, 31:28): "Give yourself grace. You’ve done so well, and this is an impossible task. And you’re still doing it."

• Coordination of Care

  • Navigating multiple doctors and specialists becomes a full-time job with age (30:54).

8. Reflection & Forward-Looking Advice

• What Would You Do Differently?
  • Joanne reflects on gaps in her early knowledge (33:39): "I didn’t know carb counting till I was in my 50s, so it was a guess."
  • Stresses importance of education, advocacy, and preparation for aging (34:08).
• Research & Community Involvement
  • Participation in research is growing, with more studies now including older adults (34:54–35:36).

Memorable Quotes & Moments

• On Outliving Early Prognoses:
  • Joanne: "I just turned 72." (01:59)
• On Community and Advocacy:
  • "We’re not afraid of aging. We’re afraid of being misunderstood, unsafe, and unheard." — Joanne Milo (30:13)
• On Technology in the Elderly:
  • Dr. Tamikis: "Absolutely [offer the technology]. It’s part of that discussion... those actually may be protective." (21:22)
• On Enjoying Life:
  • Dr. Tamikis: "I want you to be able to live your life the way you want to, to enjoy yourself and let me help you do that..." (36:19)
• On Emotional Toll & Self-Compassion:
  • "Give yourself grace. You’ve done so well, and this is an impossible task. And you’re still doing it." — Joanne Milo (31:28)

Notable Timestamps

• 01:59 – Joanne’s diagnosis story and motivations for advocacy
• 03:53 – Lack of research/information on aging with T1D & formation of peer support group
• 05:40 – Late adult-onset T1D: misconceptions, misdiagnosis
• 08:19 – Daily time and complexity of T1D management
• 10:17 – ADA’s 4M framework introduction
• 13:46 – Exercise and activity as lifelong habits
• 15:47 – Importance of hearing/vision & regular screening
• 18:05 – Social determinants of health: what are patients struggling with?
• 21:21 – Suitability (and benefits) of technology/devices for older adults
• 25:47 – Medication advances, approval issues, and real-world use
• 30:13 – Emotional reality: “24/7 disease,” fear of being misunderstood
• 31:28 – Importance of self-compassion and “find your point of joy”
• 33:39 – Joanne’s retrospective advice
• 36:19 – Dr. Tamikis’ closing wisdom: Focus on living and joy

Closing Thoughts & Takeaways

• Aging with T1D is not just possible—it’s increasingly common.
• Individualized, compassionate care is essential: physical, cognitive, and emotional needs shift over time.
• Modern diabetes management technologies and medications can greatly enhance safety and quality of life, but must be matched to the individual.
• Social connection, advocacy, and preparedness are crucial for thriving at every stage.
• Healthcare providers must screen, listen, and adapt interventions—and patients must be empowered to educate and advocate for themselves as they age.

Resources Mentioned:

• Joanne’s community: t1d2100.com, Facebook group: T1D to 100
• ADA’s Standards of Care & 4M Framework
• Savvy Diabetic blog

For further exploration and community: Visit tcoyd.org and t1d2100.com

End of summary.