Podcasts about dka

Misdiagnosed with Type 2 in her 40s, Claire went into DKA while taking Mounjaro and discovered she actually has Type 1 (LADA). Hear her UK healthcare journey. ABLEnow save for today's needs or invest for tomorrow Eversense CGM Medtronic Diabetes Tandem Mobi ** Use code JUICEBOX to save 20% at Cozy Earth  CONTOUR NextGen smart meter and CONTOUR DIABETES app Dexcom G7 Go tubeless with Omnipod 5 or Omnipod DASH * Get your supplies from US MED  or call 888-721-1514 Touched By Type 1 Take the T1DExchange survey Apple Podcasts> Subscribe to the podcast today! The podcast is available on Spotify, Google Play, iHeartRadio, Radio Public, Amazon Music and all Android devices The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here or buy me a coffee. Thank you! *The Pod has an IP28 rating for up to 25 feet for 60 minutes. The Omnipod 5 Controller is not waterproof.  ** t:slim X2 or Tandem Mobi w/ Control-IQ+ technology (7.9 or newer). RX ONLY. Indicated for patients with type 1 diabetes, 2 years and older. BOXED WARNING:Control-IQ+ technology should not be used by people under age 2, or who use less than 5 units of insulin/day, or who weigh less than 20 lbs. Safety info: tandemdiabetes.com/safetyinfo Disclaimer - Nothing you hear on the Juicebox Podcast or read on Arden's Day is intended as medical advice. You should always consult a physician before making changes to your health plan.  If the podcast has helped you to live better with type 1 please tell someone else how to find it!  

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss several major developments in diabetes technology and obesity therapeutics, beginning with Abbott's announcement that its dual glucose-ketone monitoring systems, Libre Duo and Libre Duo 10 Day, have received CE mark approval in Europe. The hosts describe the devices as the first continuous glucose-ketone monitors capable of simultaneously measuring glucose and ketone levels through a single wearable sensor, with real-time ketone monitoring intended to identify rising risk for diabetic ketoacidosis (DKA). Bellini explains the rationale for separate 15-day adult and 10-day pediatric sensors, noting higher sensor failure rates and greater activity levels in children. Both hosts emphasize the potential clinical significance of continuous ketone monitoring, particularly for individuals with type 1 diabetes (T1D) using insulin pumps, where interruptions in insulin delivery can rapidly precipitate DKA.The discussion further explores how continuous ketone monitoring may expand the safe use of SGLT2 inhibitors in people with T1D and other high-risk populations. Bellini highlights concerns surrounding euglycemic DKA associated with SGLT2 inhibitor therapy and suggests that continuous ketone data could help clinicians identify susceptible individuals earlier, potentially enabling safer and more individualized dosing strategies. Isaacs underscores the limitations of current ketone testing methods, particularly urine ketone testing, which she characterizes as outdated and insufficient for modern diabetes management. The hosts also review additional patient populations that may benefit from continuous ketone monitoring, including individuals with recurrent DKA, pediatric patients with highly variable glycemic patterns, and hospitalized patients at elevated risk for ketosis due to prolonged fasting or treatment interruptions.Isaacs and Bellini also consider practical questions surrounding implementation, including reimbursement, cost, workflow integration, and compatibility with automated insulin delivery systems. They discuss whether continuous ketone monitoring could eventually become standard of care in T1D and debate the broader implications of widespread ketone data availability, including potential consumer interest outside traditional diabetes populations. Both hosts stress the importance of prioritizing access for patients at highest risk for DKA while acknowledging that broader adoption could reshape diabetes monitoring paradigms similarly to the evolution of continuous glucose monitoring.The episode then turns to recent reports involving Dexcom sensors that were reportedly stolen after being removed from the manufacturing process for quality concerns. Bellini explains that some of the affected sensors may not have completed sterility and quality assurance procedures before entering secondary markets. The hosts caution clinicians to review affected lot numbers and encourage ongoing vigilance until additional information becomes available. They also discuss the challenges of communicating recalls and safety alerts directly to patients, particularly for users relying on standalone receivers that may not connect to cloud-based notification systems.Finally, Isaacs and Bellini review newly released topline results from the phase 3 TRIUMPH-1 trial evaluating retatrutide, Lilly's investigational triple agonist targeting GLP-1, GIP, and glucagon receptors. Bellini summarizes findings demonstrating substantial weight reduction among adults with obesity or overweight without diabetes, including mean weight loss exceeding 28% at 80 weeks and continued weight reduction through 104 weeks without evidence of plateau. The hosts note that nearly half of participants achieved at least 30% weight loss, approaching outcomes historically associated with bariatric surgery. They also highlight low discontinuation rates and discuss the implications of future TRIUMPH studies evaluating retatrutide in patients with type 2 diabetes and cardiovascular disease. Isaacs concludes that the emerging data signal a transformative shift in obesity treatment, with pharmacologic therapies increasingly approaching surgical efficacy and potentially reshaping long-term obesity management strategies.Editors' Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others.

What diabetes technology is actually helping people right now—and how do you figure out what fits best into your life?In this 100th episode of the TCOYD Podcast, Dr. E and Dr. P are joined by diabetes nurse practitioner and educator Rachael Sood, founder of The Diabetes Collective, to talk through the latest updates in diabetes technology and what they're seeing in real-world diabetes care.The conversation focuses on how much diabetes technology has changed over the past few years, from hybrid closed loop systems and CGMs to new developments in sensing and automation. Rather than focusing on one “best” device, the discussion centers around finding the right fit for each person's lifestyle, preferences, and goals.Dr. E, Dr. P, and Rachael also talk about where technology may be headed next, including dual glucose and ketone sensors, more compatibility between pumps and CGMs, and the possibility of systems that require less hands-on work from people living with diabetes. The takeaway is encouraging: there are more tools and options than ever before, and diabetes technology continues to move toward making daily management simpler, safer, and more flexible.Key Topics• Choosing the right insulin pump and CGM• Tubed vs. tubeless pump systems• How lifestyle and personal preference shape technology choices• The latest updates in automated insulin delivery systems• Dexcom G7 10-day vs. 15-day sensors• Abbott's dual glucose and ketone sensor technology• Medtronic's newest technology developments• Real-world conversations patients have about wearing devices• Continuous ketone monitoring and DKA prevention• The future of fully closed loop systems• Why compatibility between pumps and CGMs matters• Technology options for people with type 2 diabetes• Where diabetes technology may be headed next✨ Subscribe for practical diabetes management tips, technology updates, and treatment breakthroughs that help people with diabetes live healthier, more flexible lives.More diabetes resources:Website: tcoyd.orgBlog: tcoyd.org/blogPodcast: tcoydthepodcast.transistor.fmInstagram:   / tcoydFacebook:   / tcoydStay connected! Sign up for our monthly newsletter here!Support TCOYD's educational programs: tcoyd.org/donate ★ Support this podcast ★

Date: May 20, 2026 Guest Skeptic: Dr. Matt McArthur is an ED Physician working primarily in Guelph and Kitchener with occasional rural locums in the small town of Walkerton, where he grew up. His clinical interests include POCUS, emergency cardiology, QI, knowledge translation, motivational interviewing, and vertigo. He is very active in medical education, including […] The post SGEM#511: I'd Like To Treat, DKA with the SQuID Protocol first appeared on The Skeptics Guide to Emergency Medicine.

Diabetic ketoacidosis is a familiar ED diagnosis, but the best fluid strategy is still up for debate. Many of us default to the traditional one‑bag system, even though it can be slow to adjust and prone to glucose swings. This new meta‑analysis compares one‑bag versus two‑bag DKA management across adults and children, examining hypoglycemia rates, time to resolution, and operational impact. Join Dr. Knudsen-Robbins as she breaks down what the evidence shows — and whether the two‑bag fluid system truly offers a clinical edge for treatment.

This episode will review the management of diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS) and euglycemic diabetic ketoacidosis (eDKA). Listeners will review the most current DKA/HHS guidelines and will be able to effective identify patients receiving insulin and fluid therapy that require changes in treatment to improve safety and disease resolution.  The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

Scott and Shannon Boggs discuss her daughter's traumatic DKA diagnosis, managing Hashimoto's, the hidden burdens of diabetes service dogs, and navigating social media fame while protecting your peace. ABLEnow save for today's needs or invest for tomorrow Eversense CGM Medtronic Diabetes Tandem Mobi ** Use code JUICEBOX to save 20% at Cozy Earth  CONTOUR NextGen smart meter and CONTOUR DIABETES app Dexcom G7 Go tubeless with Omnipod 5 or Omnipod DASH * Get your supplies from US MED  or call 888-721-1514 Touched By Type 1 Take the T1DExchange survey Apple Podcasts> Subscribe to the podcast today! The podcast is available on Spotify, Google Play, iHeartRadio, Radio Public, Amazon Music and all Android devices The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here or buy me a coffee. Thank you! *The Pod has an IP28 rating for up to 25 feet for 60 minutes. The Omnipod 5 Controller is not waterproof.  ** t:slim X2 or Tandem Mobi w/ Control-IQ+ technology (7.9 or newer). RX ONLY. Indicated for patients with type 1 diabetes, 2 years and older. BOXED WARNING:Control-IQ+ technology should not be used by people under age 2, or who use less than 5 units of insulin/day, or who weigh less than 20 lbs. Safety info: tandemdiabetes.com/safetyinfo Disclaimer - Nothing you hear on the Juicebox Podcast or read on Arden's Day is intended as medical advice. You should always consult a physician before making changes to your health plan.  If the podcast has helped you to live better with type 1 please tell someone else how to find it!  

Join Mawi, David, and Shelly for discussions on antagonistic patients, ridiculous DKA, E-Bike trauma in the ER, and Shelly's nerve pain after a skin biopsy.  Listener mail includes discussion on preoxygenation with the circuit in clasutrophobic patients, compliance sedation, and a discussion on modifications of DNR in the OR. 

It's In The News - where we bring you the top diabetes stories and headlines happening now. This week, Tzield approved down to age one and over, Omnipod trials for fully closed loop, Tandem approved for pregnancy, Eversense 365 launches in Europe, generic Ozempic in Canada, an award for the T1D Barbie and more.  Announcing Community Commericals! Learn how to get your message on the show here. Don't miss our in-person events: www.diabetes-connections.com/events  Learn more about studies and research at Thrivable here Please visit our Sponsors & Partners - they help make the show possible! Omnipod - Simplify Life All about Dexcom  All about VIVI Cap to protect your insulin from extreme temperatures The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Okay.. our top story this week: XX The U.S. Food and Drug Administration (FDA) approved Tzield (teplizumab-mzwv) for use in children in stage 2 type 1 diabetes (T1D) ages one and older. The approval expands the previous indication from those aged eight and above and was granted under a priority review process. This decision is supported by one-year data from the PETITE-T1D Phase IV study, which evaluated the safety and pharmacokinetics of Tzield in children under eight years old. Tzield was approved for use in individuals 8+ in stage 2 T1D in 2022. Since then, we have been working to expand the eligible population. This expansion effort includes individuals in stage 3 T1D, who can preserve endogenous insulin production for longer when they take Tzield and, most notably today, children in stage 2. https://www.breakthrought1d.org/news-and-updates/tzield-approved-for-children-ages-one-and-older-in-stage-2-t1d/   XX Big write up in the journal Pediatrics about screening for type 1. Citing the 2025 ADA Standards of Care in Diabetes, the opinion piece talks about how to engage the greater healthcare community.  It says: We aim to encourage the development of strategies to emphasize the importance of T1D early detection, integrate screening into routine health care encounters, and support implementation of T1D screening. Pediatricians and other primary care clinicians are well positioned for greater collaboration with the multidisciplinary team, ensuring early detection, timely intervention, and improved outcomes. https://publications.aap.org/pediatricsopenscience/article/2/2/1/207272/Type-1-Diabetes-Screening-in-Pediatrics-Putting?autologincheck=redirected   XX More info about GLP-1 drugs and people with type 1. New study shows off label use did not lead to DKA or pancreatitis in a large 1-year single-center study. Moreover, GLP-1 agonist use in people with T1D was associated with lower overall rates of hospitalization, as has occurred in type 2 diabetes Although GLP-1 agonists are not approved by the FDA for T1D management, off-label adjunctive use has risen for those with obesity. Semaglutide was the most commonly-used GLP-1 (65.5% of GLP-1 users) followed by tirzepatide (23.5%). The rest were using the older-generation drugs: liraglutide or dulaglutide. Lots more information to come on type 1 and glp 1-s in upcoming studies. https://www.medscape.com/viewarticle/use-glp-1s-type-1-diabetes-not-linked-increased-dka-2026a1000d56 XX Health Canada ‌​has approved the first generic ​version of ​Danish ⁠drugmaker ⁠Novo ‌Nordisk's Ozempic drug. In January 2026, the Canadian patent for Ozempic will expire, paving the way for cheap generic versions of the semaglutide injections that help regulate blood sugar levels and appetite. Health Canada said this generic, like existing products, is indicated to be used for the "once-weekly treatment of adult patients with Type 2 diabetes to manage blood sugar levels." With three generics on the market, Tadrous said the price could drop to about $100 or less, depending on their dose. Health Canada said it's currently reviewing eight other generic submissions by different companies and expects to make a decision on these in the next few weeks and months. https://www.cbc.ca/news/health/ozempic-generic-health-canada-9.7180566 XX  Insulet has enrolled the first participant in a pivotal study for its fully closed-loop (FCL)A automated insulin delivery (AID) system for type 2 diabetes (T2D  The participants are between 18 – 75 years of age, living with T2D and using insulin (basal-bolus or basal-only). The Company received Investigational Device Exemption (IDE) approval in March 2026 from the U.S. Food and Drug Administration (FDA). The Company plans to submit a 510(k) filing to the FDA in 2027 and launch its FCL AID system for T2D in 2028.   XX insulet Corporation (PODD) has initiated a voluntary recall of certain lots of its Omnipod 5 insulin delivery Pods in the U.S. after detecting that some devices had a manufacturing defect that causes insulin leakage.   Patients using the affected devices could risk experiencing high blood glucose levels due to insufficient insulin delivery, the Acton, Massachusetts-based MedTech disclosed in a statement late Thursday. The company has already notified the FDA about the recall, which it said will affect nearly 1.5% of Omnipod 5 pod units it manufactures annually. The customers were advised to immediately seek a product replacement at no cost if a Pod from a defective lot is currently in use. https://www.msn.com/en-us/money/companies/insulet-recalling-certain-defective-omnipod-insulin-delivery-devices/ar-AA1YyslT?apiversion=v2&domshim=1&noservercache=1&noservertelemetry=1&batchservertelemetry=1&renderwebcomponents=1&wcseo=1&bundles=feat-es2020-c XX Tandem Diabetes Care (Nasdaq:TNDM) gets FDA clearance for its automated insulin delivery (AID) technology for use in pregnancy. The FDA cleared the company's Control-IQ AID technology for use in what they call: pregnancy complicated by type 1 diabetes mellitus. Tandem says t:slim X2 and Mobi are the first and only commercially available AID systems cleared for use during pregnancy in the U.S. https://www.drugdeliverybusiness.com/tandem-fda-clearance-aid-pregnancy-t1d/ XX Tandem also issued an urgent medical device correction for a software problem with its Mobi insulin pumps. The malfunction may cause insulin delivery to stop, causing high blood sugar if not addressed, the Food and Drug Administration said in a Wednesday recall notice. We told you about this back in October when Tandem sent a letter to customers notifying them of the fault and instructing them to update their pump software as soon as possible. The FDA now issued a class one recall, the most serious type. We just released a bonus episode all about Tanem – tubeless mobi and what else is in the pipeline. You can listen to that wherever you are listening to this.. it's the episode just before this one. https://www.medtechdive.com/news/tandem-recalls-mobi-insulin-pumps-over-software-malfunction/818260/   XX Switching CGMs didn't make a measurable difference for adults using MiniMed's pump system. In a real-world analysis presented at the International Conference on Advanced Technologies & Treatments for Diabetes, researchers found that CGM metrics for patients who switched from the Guardian 4 sensor (MiniMed) to Instinct by Abbott were able to maintain a time in range of greater than 75%. "When it comes to the automated insulin delivery system ... I think the sensor matters less and the system matters more," Viral N. Shah, MD, professor of medicine in the division of endocrinology and metabolism and director of diabetes clinical research at Indiana University Center for Diabetes and Metabolic Diseases, said during a presentation. "Having a different sensor with the system, I think the [glycemic] outcomes will still be what you want." I'm including this because the headline here seemed to indicate no CGM makes a difference, but this study only looked at two. https://www.healio.com/news/endocrinology/20260401/switching-cgm-sensors-does-not-impact-glycemic-outcomes-with-automated-insulin-delivery   XX Vitamin D supplementation may help delay or prevent disease progression in people with prediabetes.. in people who have specific variants in their vitamin D receptor gene. This was found after a second look at large study where researchers found vitamin d really did make a difference.. a second look with people who had a specific gene variation had much better results. "More research is needed to see if there are other factors that are associated with risk reduction." https://www.medicalnewstoday.com/articles/vitamin-d-supplements-help-prevent-type-2-diabetes-right-gene-variants   XX Senseonics (Nasdaq:SENS) announced today that it initiated the first European launch of its Eversense 365 continuous glucose monitor (CGM). The launch comes a few months after the company picked up CE mark for the long-term, implantable CGM in January. Eversense 365 is the world's first 365-day CGM system. It also holds clearance as an integrated CGM (iCGM) system, meaning it can work with compatible medical devices. Those include insulin pumps as part of automated insulin delivery systems, like the Sequel Med Tech twiist system. The company said it made Eversense 365 available to the first patients in Sweden. It plans to bring the sensor to Germany, Spain and Italy in the coming weeks https://www.drugdeliverybusiness.com/senseonics-launches-eversense-365-europe/ XX A machine learning model can improve genetic prediction of type 1 diabetes by as much as 10%, show results from a University of California, San Diego study.   The researchers used the machine‑learning model T1GRS to improve on a gold standard polygenic genetic risk score used to predict who is likely to develop the condition called GRS2. The GRS2 polygenic risk score has been widely tested and can be used to predict newborns who are at high risk of developing type 1 diabetes. While early prediction can't necessarily stop the disease it can help to prevent emergencies like diabetic ketoacidosis at diagnosis, allow families time to prepare and could allow use of therapies to delay onset of the condition. In this study, Gaulton and colleagues carried out a genome‑wide association study in 20,355 people with type 1 diabetes and 797,363 non‑diabetic Europeans, as well as a further analysis around the MHC region in 10,107 diabetic and 19,639 nondiabetic individuals. https://www.insideprecisionmedicine.com/topics/molecular-dx/machine-learning-tool-helps-improve-type-1-diabetes-prediction/ XX Sen. Mark Warner (D-Va.) said Monday that he will return to the upper chamber this week after taking time off for the death of his daughter, Madison.   The Virginia senator wrote on the social platform X, "As we remember our incredible daughter, Maddy, my family has been deeply touched by the outpouring of support we've received. Thank you to everyone for your kind words." Madison Warner, 36, died earlier this month after a decades-long battle with juvenile diabetes and other health issues. Mark Warner and his wife, Lisa Collis, wrote in a statement last Monday that they were "heartbroken beyond words" by their daughter's passing.   On Monday, the former Virginia governor said his daughter "was a deeply empathetic and engaged person" and that "as recently as the day she passed, she was full of ideas and suggestions" for him, including how he could improve his social media presence.   "She used to say to me: 'Dad, you have the power — you have to use it.' She pushed me to make the most of my position, to use my seat in the Senate to help people in meaningful ways," he added.       "If I can find any solace during this time, it's that I have the enormous privilege to serve Virginians and the responsibility to keep working for a better, more just world in Maddy's name."   Warner concluded, "I look forward to returning to the Senate this week and continuing that essential work."   Madison Warner is survived by two younger sisters.     An estimated than 2.1 million Americans, including about 314,000 children and adolescents younger than age 20, have diagnosed type 1 diabetes as of March — which is what juvenile diabetes is commonly called — according to the CDC's National Diabetes Statistics Report.   An estimated 11 million U.S. adults have undiagnosed diabetes, the report notes.   Symptoms of type 1 diabetes include feeling more thirsty than usual, urinating a lot, bed-wetting in children who have never done so, feeling very hungry and losing weight without trying, according to the Mayo Clinic. https://thehill.com/homenews/senate/5851605-mark-warner-diabetes-death/ XX Mattel, Inc. and Breakthrough T1D just won a Gold Halo Award for Best Cause Product Initiative for the launch of the first Barbie with T1D.  The Halo Awards recognize the most outstanding corporate social impact efforts over the past year.

Fred Nova in the mix, 30 years behind the decks: for(ever)... "it all comes together" A journey through trance, progressive, melodic house, memories, passion, and evolution. Deep, melancholic & melodic house: 16 tracks and remixes from artists like Because of Art, Jim Rivers, Ivory (IT), Dave Seaman, Igor Vicente & DKA, Ferry Corsten & Marsh, Dino Lenny, Quivver, Ewerseen, Ramiro Drisdale, Sander Kleinenberg, Helsloot, Mike Koglin, Matt Darey,... Released on great labels like Anjunadeep, Rhythm Cult, ICONYC, Selador, VOD, Move, Watergate, Anjunabeats, Strictly Rhythm, All Day I Dream, Armada and many more. Memories and music are forever. Enjoy the moment… and dance like nobody's watching. Fred xxx

The belief that IV dextrose is necessary to clear ketones in hyperemesis gravidarum originated from a logical, and now known to be outdated, extrapolation of basic starvation ketosis physiology and the treatment paradigm for diabetic ketoacidosis (DKA). The original experiments that led to this conclusion go back to the 1960s (Foster data). Not only is this outdated, but it is also physiologically incorrect. We've learned a lot about IV fluid replacement about hyperemesis gravidarum in the last several years- in the last data review was in January 2026 in Lancet. Even the correction of hyponatremia has evolved. Should we be following urine ketones for patients being treated for HG? Is Dextrose needed? Listen in for details.1. Nana M, Painter R, Williamson C et al. Hyperemesis gravidarum. The Lancet, Jan 2026; 407, 78-892. Clark SM, Zhang X, Goncharov DA. Inpatient Management of Hyperemesis Gravidarum. Obstet Gynecol. 2024 Jun 1;143(6):745-758. doi: 10.1097/AOG.0000000000005518. Epub 2024 Feb 1. PMID: 38301258.3. Ayus JC, et al.Correction rates and clinical outcomes in hospitalized adults with severe hyponatremia: a systematic review and meta-analysis. JAMA Intern Med. 2025;185(1):38-51. 4. ACOG Clinical Epert Series: Inpatient Management of Hyperemesis Gravidarium. Obstet Gynecol; 2024

Chris shares his 38-year type 1 diabetes journey , overcoming a 1980s diagnosis , family abandonment , severe drug addiction , and near-fatal DKA to build a professional auto racing career. ABLEnow save for today's needs or invest for tomorrow Eversense CGM Medtronic Diabetes Tandem Mobi ** Use code JUICEBOX to save 20% at Cozy Earth  CONTOUR NextGen smart meter and CONTOUR DIABETES app Dexcom G7 Go tubeless with Omnipod 5 or Omnipod DASH * Get your supplies from US MED  or call 888-721-1514 Touched By Type 1 Take the T1DExchange survey Apple Podcasts> Subscribe to the podcast today! The podcast is available on Spotify, Google Play, iHeartRadio, Radio Public, Amazon Music and all Android devices The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here or buy me a coffee. Thank you! *The Pod has an IP28 rating for up to 25 feet for 60 minutes. The Omnipod 5 Controller is not waterproof.  ** t:slim X2 or Tandem Mobi w/ Control-IQ+ technology (7.9 or newer). RX ONLY. Indicated for patients with type 1 diabetes, 2 years and older. BOXED WARNING:Control-IQ+ technology should not be used by people under age 2, or who use less than 5 units of insulin/day, or who weigh less than 20 lbs. Safety info: tandemdiabetes.com/safetyinfo Disclaimer - Nothing you hear on the Juicebox Podcast or read on Arden's Day is intended as medical advice. You should always consult a physician before making changes to your health plan.  If the podcast has helped you to live better with type 1 please tell someone else how to find it!  

Chris shares his 38-year type 1 diabetes journey , overcoming a 1980s diagnosis , family abandonment , severe drug addiction , and near-fatal DKA to build a professional auto racing career. ABLEnow save for today's needs or invest for tomorrow Eversense CGM Medtronic Diabetes Tandem Mobi ** Use code JUICEBOX to save 20% at Cozy Earth  CONTOUR NextGen smart meter and CONTOUR DIABETES app Dexcom G7 Go tubeless with Omnipod 5 or Omnipod DASH * Get your supplies from US MED  or call 888-721-1514 Touched By Type 1 Take the T1DExchange survey Apple Podcasts> Subscribe to the podcast today! The podcast is available on Spotify, Google Play, iHeartRadio, Radio Public, Amazon Music and all Android devices The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here or buy me a coffee. Thank you! *The Pod has an IP28 rating for up to 25 feet for 60 minutes. The Omnipod 5 Controller is not waterproof.  ** t:slim X2 or Tandem Mobi w/ Control-IQ+ technology (7.9 or newer). RX ONLY. Indicated for patients with type 1 diabetes, 2 years and older. BOXED WARNING:Control-IQ+ technology should not be used by people under age 2, or who use less than 5 units of insulin/day, or who weigh less than 20 lbs. Safety info: tandemdiabetes.com/safetyinfo Disclaimer - Nothing you hear on the Juicebox Podcast or read on Arden's Day is intended as medical advice. You should always consult a physician before making changes to your health plan.  If the podcast has helped you to live better with type 1 please tell someone else how to find it!  

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!In this episode of Diabetes Dialogue, recorded on-site at the American Association of Clinical Endocrinology (AACE) Annual Meeting 2026 in Las Vegas, Nevada, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, welcome Viral Shah, MD, professor of endocrinology at Indiana University, for a discussion centered on the evolving role of GLP-1 receptor agonists and broader diabetes classification in type 1 diabetes care. Shah challenges the traditional distinction between type 1 and type 2 diabetes, emphasizing that type 2 diabetes lacks a definitive diagnostic test and is instead a diagnosis of exclusion based on phenotypic characteristics. He explains that patients with type 1 diabetes can also exhibit features of type 2 diabetes, making these categories non–mutually exclusive and supporting the rationale for dual diagnoses when clinically appropriate.The group explores how this framework informs the use of GLP-1 receptor agonists in type 1 diabetes, particularly for patients with obesity, cardiovascular disease, heart failure, or chronic kidney disease. Shah notes that while obesity provides a clear indication for GLP-1 therapy, he is also comfortable using these agents in patients with lower BMI when cardiovascular or renal protection is the primary goal, with careful attention to dose adjustment and avoidance of excessive weight loss or muscle mass reduction. He adds that SGLT2 inhibitors may be preferable in some leaner patients, particularly when renal indications predominate, and highlights recent clarification that SGLT2 inhibitor use for CKD in type 1 diabetes is not considered off-label when prescribed for kidney protection rather than glycemic control.The conversation then shifts to Shah's broader view that type 1 and type 2 diabetes differ more in pathophysiology than in long-term disease course. He argues that both conditions share progressive beta cell dysfunction and overlapping complication risks, suggesting the field should move away from rigid separation and toward a more unified understanding of diabetes progression.This perspective leads into a discussion of “prediabetes,” a term Shah critiques as outdated and insufficient. He reviews its historical origins as a label for intermediate hyperglycemia and argues that it has unintentionally minimized urgency by framing the condition as merely a risk factor rather than part of the disease continuum. Citing evidence of significantly elevated cardiovascular, kidney, and mortality risk in people with prediabetes, he advocates for staging type 2 diabetes similarly to type 1 diabetes, rather than maintaining an artificial threshold between “no disease” and diabetes. He notes that while therapies such as metformin, semaglutide, and tirzepatide have demonstrated benefit in delaying progression, regulatory limitations persist because prediabetes is not formally recognized as a disease state.The episode concludes with a discussion of autoantibody screening in adults labeled with prediabetes. Shah supports broader antibody testing, particularly in younger adults, to identify individuals with early-stage type 1 diabetes who may otherwise be misclassified and present later with DKA. He emphasizes that accessible antibody testing and therapies such as teplizumab make earlier identification increasingly meaningful, while also acknowledging the importance of patient preference and individualized decision-making. Across the discussion, Shah calls for greater flexibility in diabetes classification, earlier intervention across the disease spectrum, and a more proactive approach to preventing complications rather than waiting for traditional diagnostic thresholds to be crossed.

Exercise is one of the most recommended tools for living well with diabetes and one of the most complicated to actually start. In this episode, Rob sits down with Amanda Mueller (aka @bicepsandbolus), a certified personal trainer, corrections exercise specialist, and CPA who was diagnosed with type 1 diabetes at 26. Amanda's honest about the years she spent afraid to move her body after diagnosis, the roundabout way she fell in love with strength training (spoiler: she married her trainer), and why she thinks the whole "exercise is good for your diabetes" conversation is being framed wrong. The centerpiece of this conversation is Amanda's "Movement Menu", a practical framework for building a sustainable exercise life that actually accounts for bad blood sugar days, low energy, decision fatigue, and the reality that most of us are not elite athletes trying to optimize every workout. The goal isn't the perfect workout. It's the one you come back to. They also go a little deeper and discuss why exercise shouldn't feel like punishment, how chronic stress and blood sugar are more connected than we talk about, and why going low in a Pilates class doesn't mean the class didn't count. If you've ever used a bad diabetes day as a reason to skip a workout and then felt guilty about it, this episode is for you. They close things out with a live "Exercise with Diabetes Draft", each picking three movements they'd want on their personal movement menu, and why. It's fun, it's practical, and you might find your new favorite workout buried somewhere in it. Chapters: 00:00 Introduction and Amanda's background 02:31 Adult diagnosis and the fear that followed 04:27 Losing weight in DKA and what came after 06:22 Meeting her trainer husband and rediscovering movement 08:08 Why the right people are force multipliers 09:45 Wanting to feel strong again: what that really means 13:36 Why exercise is a behavior, not a personality trait 16:04 The Movement Menu explained 18:09 The best workout is the one you actually do 20:13 Releasing judgment around imperfect workout days 24:40 The calorie math trap: why your class still counted 27:48 Exercise as a stress reset in 2026 29:32 You don't need more time, you need less friction 31:22 The Exercise with Diabetes Draft begins 40:27 Keeping it simple, sustainable, and fun Resources: Amanda Mueller on Instagram: @bicepsandbolus Movement Menu Document: Comment "MENU" on the podcast post on Instagram (@diabeticsdoingthings) and Rob will send it to you. Atomic Habits by James Clear: referenced in conversation around small, compounding habits: atomichabits.com

Exercise is one of the most recommended tools for living well with diabetes and one of the most complicated to actually start. In this episode, Rob sits down with Amanda Mueller (aka @bicepsandbolus), a certified personal trainer, corrections exercise specialist, and CPA who was diagnosed with type 1 diabetes at 26. Amanda's honest about the years she spent afraid to move her body after diagnosis, the roundabout way she fell in love with strength training (spoiler: she married her trainer), and why she thinks the whole "exercise is good for your diabetes" conversation is being framed wrong. The centerpiece of this conversation is Amanda's "Movement Menu", a practical framework for building a sustainable exercise life that actually accounts for bad blood sugar days, low energy, decision fatigue, and the reality that most of us are not elite athletes trying to optimize every workout. The goal isn't the perfect workout. It's the one you come back to. They also go a little deeper and discuss why exercise shouldn't feel like punishment, how chronic stress and blood sugar are more connected than we talk about, and why going low in a Pilates class doesn't mean the class didn't count. If you've ever used a bad diabetes day as a reason to skip a workout and then felt guilty about it, this episode is for you. They close things out with a live "Exercise with Diabetes Draft", each picking three movements they'd want on their personal movement menu, and why. It's fun, it's practical, and you might find your new favorite workout buried somewhere in it. Chapters: 00:00 Introduction and Amanda's background 02:31 Adult diagnosis and the fear that followed 04:27 Losing weight in DKA and what came after 06:22 Meeting her trainer husband and rediscovering movement 08:08 Why the right people are force multipliers 09:45 Wanting to feel strong again: what that really means 13:36 Why exercise is a behavior, not a personality trait 16:04 The Movement Menu explained 18:09 The best workout is the one you actually do 20:13 Releasing judgment around imperfect workout days 24:40 The calorie math trap: why your class still counted 27:48 Exercise as a stress reset in 2026 29:32 You don't need more time, you need less friction 31:22 The Exercise with Diabetes Draft begins 40:27 Keeping it simple, sustainable, and fun Resources: Amanda Mueller on Instagram: @bicepsandbolus Movement Menu Document: Comment "MENU" on the podcast post on Instagram (@diabeticsdoingthings) and Rob will send it to you. Atomic Habits by James Clear: referenced in conversation around small, compounding habits: atomichabits.com

On this week's episode of Critical Care Time, Cyrus & Nick go all-in on DKA and spend a little time talking about alcoholic and starvation ketosis too! In this jam-packed, clinically robust episode, the guys discuss the importance and pathophysiology of DKA before discussing all things treatment. After listening to this - and perusing the show notes - you'll be a DKA master! Check it out and let us know what you think. Special thanks to Integration Health and The Difficult Airway Course: Critical Care for supporting the production of this episode! Hosted on Acast. See acast.com/privacy for more information.

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!In this episode of Diabetes Dialogue, host Diana Isaacs, PharmD, is joined by Jessica Castle, MD, vice president of medical affairs at Dexcom, to discuss the company's recent innovations in continuous glucose monitoring (CGM) and their clinical implications.To open the episode, Castle outlines the launch of the Dexcom G7 15-day system, highlighting its extended wear duration, improved accuracy (MARD ~8%), and strong early adoption among adults. She notes ongoing efforts to optimize sensor longevity, particularly through adhesive enhancements, while acknowledging that pediatric expansion remains under evaluation due to unique wear challenges in children. Integration with automated insulin delivery systems continues to evolve, with further updates anticipated.The discussion then shifts to Dexcom's newly cleared Smart Basal feature, designed to address persistent clinical inertia in basal insulin titration for type 2 diabetes. Castle explains how clinician-defined parameters within the Dexcom Clarity platform enable automated daily dose adjustments based on CGM data, with the goal of minimizing both hyperglycemia and hypoglycemia. Early data presented at ATTD demonstrate significant improvements in mean glucose (>40 mg/dL reduction) and time in range (>20 percentage point increase), without increased hypoglycemia, underscoring both the safety and efficacy of this approach.Isaacs and Castle also explore recent advancements in Dexcom's digital ecosystem, including AI-driven meal detection and nutritional analysis within the Stelo and G7 platforms. These tools facilitate real-time behavioral insights, reinforcing CGM's role as a powerful driver of lifestyle modification. Castle emphasizes the growing integration of artificial intelligence to deliver actionable, personalized feedback while maintaining clinical reliability.Expanding beyond glycemic metrics, Castle reviews emerging real-world evidence supporting CGM use across diverse populations. Retrospective analyses presented at ATTD demonstrate substantial reductions in diabetic ketoacidosis (DKA), including >90% risk reduction in pediatric type 1 diabetes following CGM initiation. Additional registry data in non-insulin-treated type 2 diabetes show meaningful A1C reductions (~0.6%) and associated weight loss, reinforcing the value of CGM beyond insulin-dependent populations. The conversation also highlights complementary benefits when CGM is used alongside newer pharmacotherapies, including GLP-1 receptor agonists and dual incretin agents.The episode further addresses gaps in evidence, particularly in pregnancy. While CGM adoption is increasing and supported by growing data in gestational diabetes, Castle acknowledges limited evidence in preexisting type 2 diabetes during pregnancy. Ongoing studies, including the IMAGINE trial, aim to evaluate earlier CGM implementation and its potential to improve maternal and fetal outcomes, potentially reshaping current screening paradigms.The discussion concludes with a forward-looking perspective on Dexcom's innovation pipeline. Castle highlights Smart Basal and the G7 15-day system as near-term practice-changing tools, alongside continued advancements in sensor design, accuracy, and usability. Both speakers emphasize the expanding role of CGM as a foundational technology in diabetes management, supporting a more proactive, data-driven, and patient-centered approach to care across clinical settings.Editor's Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others.

Rob Howe has lived with type 1 diabetes for 21 years. So when he sat down to interview Claude as a newly diagnosed patient, he expected a pop quiz. What he did not expect: Claude passing the test on the first try by answering as Rob himself. Because Claude thought it been hosting this show all along. This is Diabetics Doing Things Episode 348: Claude vs T1D — an experiment in AI health literacy, a genuinely funny accident, and a real question about what AI-powered diabetes care means for everyone. Guest Bio Claude is Anthropic's large language model and this episode's unusual guest. Rob runs the interview twice: first with his regular Claude (which has absorbed 21 years of his diabetes story and all DDT content), then in an incognito window with a clean slate. The contrast is the episode. Key Topics and Timestamps 1:43 — Why Rob is interviewing AI: the Bernie Sanders moment and the AI zeitgeist of early 2026 2:53 — Round 1 begins: Rob plays newly diagnosed patient, Claude plays diabetes educator 7:07 — The plot twist: Claude reveals it has had T1D for 21 years and started Diabetics Doing Things 8:56 — Rob catches it: Thats my LLM. Resets to incognito mode. 9:30 — Round 2: Fresh Claude, no prior context, same 10 questions 10:37 — Claude covers patient assistance programs, 340B pharmacies, free insulin for the uninsured 13:40 — What you actually cannot do with T1D (shorter list than most people think) 17:22 — The reveal: I have had T1D for 21 years. I think you passed. 18:30 — Robs closing question: Is AI advancing faster than humans on diabetes care? Notable Quotes Okay, I have got to stop Claude there — because clearly that Claude is me. — Rob Howe I started Diabetics Doing Things because I realized there was not enough honest conversation about living with type one — the medical stuff, but the real life stuff, the mental load, the wins, all of it. — Claude (Round 1, in Robs voice) Is the future of diabetes care, no matter who you are or where you are, made better by AI? Really something to think about. — Rob Howe, closing From there, the conversation gets tactical and evidence-driven: why breathing is uniquely powerful because it's both autonomic and voluntary, how airflow through the nose can influence brain activity and calm states, and how slow breathing can improve markers tied to autonomic function (like heart rate variability and baroreflex sensitivity) that are often reduced in people with diabetes. Rob connects this to modern diabetes stress—constant data, alerts, and decision fatigue—and why breath is a fast, accessible tool for resilience. Nick addresses the “woo vs. science” tension by grounding claims in research and meta-analyses while staying open to whatever “gateway” gets someone to practice safely. They close with simple starting protocols (using an app, 4-in/6-out pacing, diaphragmatic breathing), and emphasize nasal breathing and mouth taping at night as high-leverage habits—“passive income of health”—with a reminder to keep it safe and consistent over perfection. Chapters: 00:15 Insulin Sensitivity Playbook + Meet “The Breathing Diabetic” 01:27 Diagnosis Story: Age 11, DKA, and the “Diet Coke” Moment 02:48 The “Second Diagnosis”: Mid-20s Wake-Up and Lifestyle Control 03:58 From Air Quality Scientist to Breath Nerd: Discovering Wim Hof 04:51 The Oxygen Advantage: Nasal Breathing, CO₂, and a Breakthrough 08:52 Breath Goes Mainstream: James Nestor Validation + Confidence to Share 11:50 Why Breath Is a Superpower: Autonomic + Voluntary = A Lever 15:11 The Brain Angle: Nasal Airflow, Brainwaves, and Calm States 18:06 Diabetes Physiology: HRV, Baroreflex, and Slow Breathing Benefits 35:52 Practical Protocols: 5-Min Minimum Dose, Apps, Ratios, Mouth Tape Resources: The Breathing Diabetic Instagram The Breathing Diabetic Website

In today's episode we cover Episode 12 of season 2 The Pitt as the ER hits the 12-hour shift change with three episodes left, and we preview upcoming pods on DTF St. Louis (Victor's Monday conversation with Sona), the Paradise season finale, and future coverage like Your Friends and Neighbors and Euphoria. Victor and Kim discuss how handoffs really work, why the show's single-attending setup feels unrealistic, and how end-of-shift stress and interpersonal strain (Dana vs. Robbie, Santos' self-harm, Langdon's sobriety, Robbie's alarming behavior) take center stage. We break down the “code hula hoop” assault aftermath involving Dana's pocketed Versed, the end-stage renal failure patient bizarrely treated with phlebotomy instead of emergent dialysis, a fireworks scalping case with Joy's “oops” stapling moment, a severe sunburn gag, rural hospital access issues, Duke finally going to CT, the hospital's cyber/EMR situation improving, and the uninsured DKA patient returning critically injured. mailto:needssomeintroduction@gmail.com   00:00 Welcome and Show Updates 01:37 Late Recording and Friends Visit 02:25 Medical Jargon at Home 03:18 Hour 12 Shift Handover 07:08 End of Shift Emotions 08:38 Code White and Hospital Codes 10:19 Dana Intervenes With Sedation 12:35 Violent Patient and Legal Fallout 15:06 Staff Breaking Points 18:55 ER Understaffing Reality Check 22:36 Geriatrics Comment and Metaphor 24:20 Foot Exam and Neuro Tests 26:07 Empathy for Elders 26:47 Rural Hospital Closures 28:03 Robbie's Double Standard 28:42 Dialysis Crisis Case 32:00 Fireworks Scalp Injury 33:30 Sunburn and Reenactors 35:48 Tension at shift end 39:15 Returning DKA Patient 41:27 CT Scan and Cyber Update 43:10 Wrap Up 

After a terrifying DKA diagnosis and life flight to Spokane, Cassie shares how her son's type 1 began, the pressure to "not try too hard," and navigating early control, burnout fears, and honeymoon shifts. Free Juicebox Community (non Facebook) Eversense CGM Medtronic Diabetes Tandem Mobi ** Use code JUICEBOX to save 40% at Cozy Earth  CONTOUR NextGen smart meter and CONTOUR DIABETES app Dexcom G7 Go tubeless with Omnipod 5 or Omnipod DASH * Get your supplies from US MED  or call 888-721-1514 Touched By Type 1 Take the T1DExchange survey Apple Podcasts> Subscribe to the podcast today! The podcast is available on Spotify, Google Play, iHeartRadio, Radio Public, Amazon Music and all Android devices The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here or buy me a coffee. Thank you! *The Pod has an IP28 rating for up to 25 feet for 60 minutes. The Omnipod 5 Controller is not waterproof.  ** t:slim X2 or Tandem Mobi w/ Control-IQ+ technology (7.9 or newer). RX ONLY. Indicated for patients with type 1 diabetes, 2 years and older. BOXED WARNING:Control-IQ+ technology should not be used by people under age 2, or who use less than 5 units of insulin/day, or who weigh less than 20 lbs. Safety info: tandemdiabetes.com/safetyinfo Disclaimer - Nothing you hear on the Juicebox Podcast or read on Arden's Day is intended as medical advice. You should always consult a physician before making changes to your health plan.  If the podcast has helped you to live better with type 1 please tell someone else how to find it!  

CME credits: 0.25 Valid until: 19-03-2027 Claim your CME credit at https://reachmd.com/programs/cme/dka-new-consensus-practice/50979/ If widespread use of continuous ketone monitoring (CKM) devices is to be safe and effective in reducing the occurrence of diabetic ketoacidosis (DKA), it is important to establish clear ketone thresholds which notify CKM users when action on their part is required. In preparation for availability and use in practice, and in the absence of substantial evidence that can identify appropriate ketone thresholds for CKM use, an international panel of experts in the management of DKA developed objective practical recommendations on how this novel diabetes technology could improve outcomes for individuals at risk of DKA.=

It's In the News, a look at the top headlines and stories in the diabetes community. This week's top stories: Stem Cell Islet Therapy Partnership, "Lyla's Law" Type 1 Testing Debate, Patient-Led Insulin Dosing for Gestational Diabetes, $3 Semaglutide Manufacturing, FDA GLP-1 Compounding Crackdown Announcing Community Commericals! Learn how to get your message on the show here. Learn more about studies and research at Thrivable here Please visit our Sponsors & Partners - they help make the show possible! Omnipod - Simplify Life All about Dexcom  All about VIVI Cap to protect your insulin from extreme temperatures The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  transcript with links:  Welcome! I'm your host Stacey Simms and this is an In The News episode.. where we bringing you the top diabetes stories and headlines happening now. A reminder that you can find the sources and links and a transcript and more info for every story mentioned here in the show notes. I am definitely feeling better – that lingering cold is gone – but whew still recovering from non stop travel for the past five weeks. I have a great strech of time her at home, then going to Vegas for Brekathorugh T1D at the end of the month and we have two club 1921 events in April – Atlanta and Philly. Before we jump into the news – I need your community commercials! These have been a lot of fun, I announced them late last year – your voice on the show. All the instructions it's very easy in the show notes. Okay.. our top story this week: XX A biotech company developing stem-cell treatments for type 1 diabetes has announced a new research partnership aimed at improving the survival of transplanted insulin-producing cells. NewcelX, a clinical-stage company based in Switzerland, said it will work with Eledon Pharmaceuticals to study a combination approach. The goal is to help transplanted cells survive longer in the body by reducing the immune response that often leads to transplant rejection. If successful, the strategy could support longer-lasting islet cell replacement and move the therapy closer to becoming a functional treatment for people with type 1 diabetes. However, the companies have not yet released any safety or effectiveness data on the combination treatment, and financial details of the partnership were not disclosed. The research agreement is focused on exploring whether combining stem-cell-derived islets with targeted immune therapy can lead to longer-lasting cell transplants and improved outcomes for people with type 1 diabetes. https://www.stocktitan.net/news/ELDN/newcel-x-announces-strategic-collaboration-with-eledon-d10l1vqdofls.html XX Debate this week in the UK on whether testing for type 1 diabetes should become mandatory when children present with symptoms. The Westminster Hall debate, scheduled for 9 March, will consider calls for routine testing of babies, toddlers and young children who show signs associated with the condition. It follows a petition backing the move, dubbed 'Lyla's Law', which passed 121,000 signatures in December 2025. The campaign was launched by John Story after his two-year-old daughter, Lyla, died from diabetic ketoacidosis (DKA) on 3 May 2025, 16 hours after being diagnosed with tonsillitis. https://www.nursinginpractice.com/clinical/diabetes-and-endocrinology/diabetes-community-urged-to-call-on-mps-to-attend-lylas-law-debate/ XX     A new study suggests that people with gestational diabetes who adjust their own insulin doses may reach healthy blood sugar levels faster than those whose doses are adjusted by clinicians. Half of the participants were assigned to adjust their own insulin doses using a simple rule: increase the dose by two units if fasting blood glucose was above 95 mg/dL, decrease it by two units if it dropped below 70 mg/dL, and keep the same dose if levels fell in between. The other half had their insulin adjusted by clinicians through weekly reviews. By the end of pregnancy, both groups had similar average fasting glucose levels before delivery: about 89 mg/dL in the patient-led group and 90 mg/dL in the clinician-led group. However, those adjusting their own insulin reached their blood sugar targets more quickly, averaging 1.8 weeks compared with 2.5 weeks for those managed by clinicians. The study also found lower risks of certain complications among the patient-led group. https://www.medscape.com/viewarticle/self-insulin-dosing-leads-control-gestational-diabetes-2026a1000729 XX   A blockbuster anti-obesity and diabetes drug could cost as little as $3 per month to manufacture once it goes off patent later this month, researchers said Friday, providing a major opportunity to boost health in low and middle-income countries.   Semaglutide, the active molecule in Novo Nordisk's Ozempic and Wegovy will lose patent protection in countries such as Brazil, China, and India later this month, and researchers identified 150 countries where it was never patented. These researchers estimated it will cost as little as $3 to produce a month's supply of semaglutide, which in its branded form sells for around $200 a month in the United States. Another of the study's authors, Professor Francois Venter at the University of Witwatersrand in South Africa, said drugs to treat HIV, TB, malaria, and hepatitis are now available at prices close to production costs but still sufficient for generic manufacturers to operate. https://www.sciencealert.com/weight-loss-drugs-could-cost-just-3-a-month-to-make-as-patents-end XX Here in the US the FDA is stepping up its efforts to combat widespread GLP-1 drug compounding. In its latest offensive, the agency has unleashed a fresh set of 30 warning letters targeting telehealth companies it says make "false or misleading" claims about compounded versions of popular obesity drugs. The FDA says Compounded drugs can be important for overcoming shortages or meeting unique patient needs—but compounders should not try to compound drugs in a way that circumvents FDA's approval process." https://www.fiercepharma.com/pharma/fda-ramps-crackdown-glp-1-drug-compounders-fresh-batch-30-warning-letters XX   Check your infusion sets for an issue: Unomedical, a subsidiary of Convatec and a supplier of insulin infusion sets to diabetes tech firms, has received a warning letter from the FDA. Inspectors raised concerns with leaking infusion sets, following a regulatory assessment of Unomedical's facility in Reynosa, Mexico, last summer. Unomedical supplies infusion sets to insulin pump makers including Medtronic, Tandem Diabetes Care and Beta Bionics. In a Feb. 3 statement, Convatec said the letter focuses on reporting procedures and quality protocols and does not place restrictions on producing, marketing or distributing any of Unomedical's products.  Unomedical told the FDA in its responses that it plans to conduct a retrospective review of complaints involving serious injury or death by January and conduct additional training on complaint handling by May.   https://www.medtechdive.com/news/fda-warns-insulin-infusion-set-maker-unomedical-over-leaks-mishandled-comp/813503/ XX Nearly four in ten people with type 2 diabetes do not take their medications as prescribed, according to a new research review published in Diabetologia in November 2025.   Researchers examined existing studies on medication adherence, including how often patients miss doses, why it happens, and what strategies may help. They estimated that about 38% of patients with type 2 diabetes are not fully adherent to their medications.   Adherence rates vary depending on the type of medication. About 63% to 68% of patients take oral glucose-lowering drugs as directed, while adherence drops to 43% to 54% for injectable GLP-1 medications and 41% to 64% for insulin.   Poor adherence can lead to serious consequences. One retrospective study cited in the review found that patients who consistently took their glucose-lowering medications had a 31% lower risk of hospitalization or emergency department visits.   The review also highlighted ways to improve adherence. Simplifying medication routines can help, such as using fixed-dose combination pills, which combine multiple drugs into a single tablet. Studies show these combinations are linked to better adherence and improved blood sugar control.   Pharmacists can also play an important role by providing education, reviewing medications, setting up reminders, and helping patients organize their treatment plans. The researchers noted that support should be tailored to each patient. Older adults may benefit from simpler systems and caregiver support, while younger patients may respond better to digital tools like app-based reminders.   The authors also found that measuring adherence is challenging and recommend using multiple methods, such as pharmacy records, patient interviews, and objective tests when possible.   Overall, the review concludes that personalized, multi-step approaches lasting at least three months are most effective in helping people with type 2 diabetes stay on track with their medications. https://www.pharmacytimes.com/view/type-2-diabetes-medication-adherence-rates-remain-low-and-pharmacists-can-help XX New clinical trial shows metformin does not directly reverse insulin resistance in people with type 1 diabetes. Instead, it lowers the total amount of insulin required to keep blood glucose levels within the recommended range. The findings, published in Nature Communications, challenge long-held assumptions about how metformin works in type 1 diabetes. The results may help physicians refine treatment strategies and reduce the daily demands placed on people who rely solely on insulin therapy. "Insulin resistance is a growing problem in type 1 diabetes. Not only does it make regulating blood sugar levels difficult, but it is an underappreciated risk factor for heart disease, which is one of the biggest causes of health complications and deaths in those with type 1 diabetes," says Dr. Jennifer Snaith, endocrinologist and co-lead of the study.   https://scitechdaily.com/groundbreaking-trial-reveals-unexpected-benefit-of-metformin-in-type-1-diabetes/   Tech news ahead, including updates from Sensonics, Dexcom & Tandem.. right after this…. Back ot the wnews.. XX Sensonics shares that it's secured FDA investigational device exemption (IDE) for its self-powered, battery-enabled Gemini sensor. It enrolled the first patients in the IDE trial and expects to complete that in the second half of 2026. Gemini builds on the implanted CGM to put the transmitter under the skin as well as the sensor. https://www.drugdeliverybusiness.com/senseonics-q4-2025-ide-gemini-cgm/ XX Medtronic Diabetes is now officially MiniMid, a stand alone public company. Medtronic  acquired MiniMed 25 years ago announed last May that it would spin its diabetes business off. In their statement the company points out that MiniMed is the only diabetes tech company to sell both insulin pumps and continuous glucose monitors.   https://www.investing.com/news/stock-market-news/medtronics-diabetes-unit-minimed-valued-at-53-billion-as-shares-fall-in-nasdaq-debut-4547518 XX Kevin Sayer heads back to Dexcom.. The former CEO is back in his position as executive chair of the Board, he'd stepped away for a medical leave. Dexcom (Nasdaq:DXCM) announced today in an SEC filing that former CEO Kevin Sayer has returned from his leave of absence. Sayer's return to the board comes just days after Dexcom announced a new board member. Last week, the company announced that it added Google SVP, Platforms and Devices, Rick Osterloh, to its board as well.     https://www.drugdeliverybusiness.com/kevin-sayer-returns-dexcom-board-chair/ SAN DIEGO - DexCom, Inc. (NASDAQ:DXCM) announced the appointment of Rick Osterloh to its Board of Directors, effective today, according to a press release statement.   Osterloh serves as Senior Vice President, Platforms & Devices at Google, where he oversees Android, Google Play, Chrome, and Google's hardware portfolio including Pixel phones, Google Nest devices, and Fitbit wearables. He has held this position since 2016.   https://www.investing.com/news/company-news/dexcom-appoints-google-executive-rick-osterloh-to-board-93CH-4529662 XX Sequel Med Tech announced broad national availability of its twiist™ Automated Insulin Delivery (AID) System powered by Tidepool. After U.S. FDA clearance in 2024 and a controlled launch to optimize the twiist experience, the system is now fully available nationwide. The release says: Built on Sequel's proprietary iiSure™ Technology, the system enables earlier detection of delivery issues, alerting users to blockages up to nine times faster than other AID systems1, potentially reducing the risk of unexplained high glucose and giving you time to take action before experiencing severe high blood sugar or DKA2. Designed to expand access to automated insulin delivery, twiist is available through pharmacy channels with a flexible access model, XX Tandem Diabetes Care's Mobi automated insulin delivery system is now available with Android devices. In November, Tandem announced that it received FDA approval for the Android version of its Mobi mobile app. The pump, which pairs with Tandem's Control-IQ+ algorithm, previously worked with iOS software. At the time of the clearance, it said it would commence a limited rollout before the full launch — now underway — this year.   Tandem launched Mobi in the U.S. in February 2024. It initially received FDA clearance for people with diabetes ages six and up in July 2023. The system then received expanded clearance for pediatric indications in April 2024, then later won CE mark in May 2025.   Mobi features a 200-unit insulin cartridge and an on-pump button to provide an alternative to phone control for insulin boluses. It comes in at less than half the size of the flagship Tandem pump system, the t:slim X2 pump. Mobi can fit in a coin pocket, clip to clothing or go on the body with an adhesive sleeve. https://www.drugdeliverybusiness.com/tandem-diabetes-care-launches-mobi-android/

Rob welcomes Dr. Nick Heath—an atmospheric scientist living with type 1 diabetes for 27+ years and known online as “The Breathing Diabetic”—to explore how breathing can become a practical lever for living well with diabetes. Nick shares his diagnosis at age 11 and how his “second diagnosis” moment came in his mid-20s when nutrition changes improved his control and opened his mindset to other tools within his control. That curiosity eventually led him into breathwork, first through Wim Hof and then more deeply through Patrick McKeown's The Oxygen Advantage, where the science around nasal breathing, slower breathing, and CO₂ tolerance clicked—followed by a noticeable improvement in his blood sugars after a few months of consistent practice. From there, the conversation gets tactical and evidence-driven: why breathing is uniquely powerful because it's both autonomic and voluntary, how airflow through the nose can influence brain activity and calm states, and how slow breathing can improve markers tied to autonomic function (like heart rate variability and baroreflex sensitivity) that are often reduced in people with diabetes. Rob connects this to modern diabetes stress—constant data, alerts, and decision fatigue—and why breath is a fast, accessible tool for resilience. Nick addresses the “woo vs. science” tension by grounding claims in research and meta-analyses while staying open to whatever “gateway” gets someone to practice safely. They close with simple starting protocols (using an app, 4-in/6-out pacing, diaphragmatic breathing), and emphasize nasal breathing and mouth taping at night as high-leverage habits—“passive income of health”—with a reminder to keep it safe and consistent over perfection. Chapters: 00:15 Insulin Sensitivity Playbook + Meet “The Breathing Diabetic” 01:27 Diagnosis Story: Age 11, DKA, and the “Diet Coke” Moment 02:48 The “Second Diagnosis”: Mid-20s Wake-Up and Lifestyle Control 03:58 From Air Quality Scientist to Breath Nerd: Discovering Wim Hof 04:51 The Oxygen Advantage: Nasal Breathing, CO₂, and a Breakthrough 08:52 Breath Goes Mainstream: James Nestor Validation + Confidence to Share 11:50 Why Breath Is a Superpower: Autonomic + Voluntary = A Lever 15:11 The Brain Angle: Nasal Airflow, Brainwaves, and Calm States 18:06 Diabetes Physiology: HRV, Baroreflex, and Slow Breathing Benefits 35:52 Practical Protocols: 5-Min Minimum Dose, Apps, Ratios, Mouth Tape Resources: The Breathing Diabetic Instagram The Breathing Diabetic Website

Rob welcomes Dr. Nick Heath—an atmospheric scientist living with type 1 diabetes for 27+ years and known online as “The Breathing Diabetic”—to explore how breathing can become a practical lever for living well with diabetes. Nick shares his diagnosis at age 11 and how his “second diagnosis” moment came in his mid-20s when nutrition changes improved his control and opened his mindset to other tools within his control. That curiosity eventually led him into breathwork, first through Wim Hof and then more deeply through Patrick McKeown's The Oxygen Advantage, where the science around nasal breathing, slower breathing, and CO₂ tolerance clicked—followed by a noticeable improvement in his blood sugars after a few months of consistent practice. From there, the conversation gets tactical and evidence-driven: why breathing is uniquely powerful because it's both autonomic and voluntary, how airflow through the nose can influence brain activity and calm states, and how slow breathing can improve markers tied to autonomic function (like heart rate variability and baroreflex sensitivity) that are often reduced in people with diabetes. Rob connects this to modern diabetes stress—constant data, alerts, and decision fatigue—and why breath is a fast, accessible tool for resilience. Nick addresses the “woo vs. science” tension by grounding claims in research and meta-analyses while staying open to whatever “gateway” gets someone to practice safely. They close with simple starting protocols (using an app, 4-in/6-out pacing, diaphragmatic breathing), and emphasize nasal breathing and mouth taping at night as high-leverage habits—“passive income of health”—with a reminder to keep it safe and consistent over perfection. Chapters: 00:15 Insulin Sensitivity Playbook + Meet “The Breathing Diabetic” 01:27 Diagnosis Story: Age 11, DKA, and the “Diet Coke” Moment 02:48 The “Second Diagnosis”: Mid-20s Wake-Up and Lifestyle Control 03:58 From Air Quality Scientist to Breath Nerd: Discovering Wim Hof 04:51 The Oxygen Advantage: Nasal Breathing, CO₂, and a Breakthrough 08:52 Breath Goes Mainstream: James Nestor Validation + Confidence to Share 11:50 Why Breath Is a Superpower: Autonomic + Voluntary = A Lever 15:11 The Brain Angle: Nasal Airflow, Brainwaves, and Calm States 18:06 Diabetes Physiology: HRV, Baroreflex, and Slow Breathing Benefits 35:52 Practical Protocols: 5-Min Minimum Dose, Apps, Ratios, Mouth Tape Resources: The Breathing Diabetic Instagram The Breathing Diabetic Website

It's In the News.. a look at the top headlines and stories in the diabetes community. This week's top stories: UK looks at starting universal T1D screening, Dexcom's CEO mentions a new product, bariatric sugery vs GLP medications, FDA approves update to prescribing info for inhaled insulin, miscroplastic and diabetes link studied, and more! Announcing Community Commericals! Learn how to get your message on the show here. Learn more about studies and research at Thrivable here Please visit our Sponsors & Partners - they help make the show possible! Omnipod - Simplify Life All about Dexcom  T1D Screening info All about VIVI Cap to protect your insulin from extreme temperatures The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Episode transcription with links: (Stacey Track) Welcome! I'm your host Stacey Simms and this is an In The News episode.. where we bringing you the top diabetes stories and headlines happening now. We are less than one month from our first MNO of 2026. Please join us in Silver Spring MD Feb 20 and 21. It's going to be amazing. We're going to Nashville next March 6-7 and we're going to have a great event a Club 1921 we just added on Thursday March 5th for health care providers and patient leaders. All the info is over at diabetes-connetionss.com events/ Okay.. our top story this week: XX   All UK children could be offered screening for type 1 diabetes using a simple finger-prick blood test, say researchers who have been running a large study. This is the ELSA study - Early Surveillance for Autoimmune diabetes, a first of its kind UK study. They tested blood samples from 17,931 children aged 3-13 for autoantibodies, markers of type 1 diabetes that can appear years before symptoms. Families of children found to have early-stage type 1 diabetes received tailored education and ongoing support to prepare for the eventual onset of type 1 diabetes symptoms and to ensure insulin therapy can begin promptly when needed, reducing the chances of needing emergency treatment. Those with one autoantibody also received ongoing support and monitoring.   Some families were also offered teplizumab, the first ever immunotherapy for type 1 diabetes, which can delay the need for insulin by around three years in people with early-stage type 1 diabetes. The second phase has launched and will expand screening to all children in the UK aged 2-17 years, with a focus on younger children (2-3 years) and older teenagers (14-17 years). The research team aims to recruit 30,000 additional children across these new age groups. ELSA 2 will assess how screening can be scaled across the NHS and evaluate its cost-effectiveness. https://www.birmingham.ac.uk/news/2026/childhood-type-1-diabetes-screening-is-effective-and-could-prevent-thousands-of-emergency-diagnoses XX At the J.P. Morgan Healthcare Conference Dexcom CEO Jake Leach says they're going to launch a new product outside the US. I'll link up that interview, The full quote: "When you look at the outside the U.S., there are a lot of structures that are tiered. Patients have access to different types of products, so we've got a new one that we want to introduce that will add flexibility there. It's based on the G7 platform, just like Dexcom ONE+, but it has a unique experience that's tailored for a subset of users that, today, don't have access to Dexcom." Your guess is as good as mine, but sounds more like a pricing or ordering issue than a new bit of hardware or software. Dexcom will also bring Stelo to some international markets this year. And plans a new mobile app experience for the wearable biosensor meant for people who don't dose insulin. Leach also says G8 will be much smaller and with more capability. but is a few years away. https://www.drugdeliverybusiness.com/dexcom-ceo-jake-leach-2026-roadmap-jpm/ XX A new international consensus statement provides guidance for the use of diabetes technology during pregnancy for women with type 1 diabetes (T1D), type 2 diabetes (T2D), or gestational diabetes (GD).   Organized by the diaTribe Foundation, the document was based on evidence where available, as well as opinion from an international group of experts in endocrinology, diabetes technology, and obstetrics & gynecology, among others.   This is the first set of recommendations specifically addressing the use of diabetes technology in pregnancy – and we'll link it up. https://www.medscape.com/viewarticle/new-consensus-statement-addresses-diabetes-tech-pregnancy-2026a100020d XX Bariatric surgery beats GLP-1s for type 2 diabetes across income levels. This study was published this month, looking at nearly 300 patients are 4 medical centers. Success here is measured by lower blood glucose levels, higher weight loss (28% vs. 10%), less use of diabetes medications, remission of diabetes to the point of no longer needing to inject insulin, and reduced risk factors for cardiovascular disease.     Bariatric surgery was better than medical therapy across all social backgrounds, they found, and not just in areas of higher deprivation. The ancillary study was smaller, and some of the participants randomized in earlier stages crossed over from medical to surgical treatment, and the reverse. The authors acknowledged and accounted for these limitations, along with the rapid development of more powerful obesity drugs not fully captured in the study. This was a long term study – more than 12 years – and by the end of the study more people were choosing GLP1 medications. One dividing line: If someone hopes to lose 100 pounds, that's more likely with surgery than with medications.  "Ultimately, we need large, long-term, well-designed studies to clarify the best strategy for a given patient." https://www.statnews.com/2026/01/19/diabetes-study-bariatric-surgery-better-than-glp-1s/ XX Researchers at the University of California, Riverside have reported for the first time that a father's exposure to microplastics (MPs) can lead to metabolic problems in his children, including diabetes. This is a mouse study, but it looks at a previously unrecognized way in which environmental pollution may influence the health of future generations. MPs are extremely small plastic fragments, measuring less than 5 millimeters, that form as consumer products and industrial materials break down. Metabolic disorders describe a group of conditions that include elevated blood pressure, high blood sugar, and excess body fat, all of which raise the risk of heart disease and diabetes. The team found that female offspring of male mice exposed to MPs were far more prone to metabolic disorders than offspring of unexposed fathers, even though all offspring received the same high fat diet.     The research team hopes the findings will guide future investigation into how MPs and even smaller nanoplastics affect human development.   https://scitechdaily.com/microplastics-can-rewire-sperm-triggering-diabetes-in-the-next-generation/ XX The FDA has finalized four new recalls for certain lots of Abbott's FreeStyle Libre 3 and FreeStyle Libre 3 Plus sensors due to ongoing safety concerns. We told you about this in November when Abbott says some of its continuous glucose monitoring (CGM) sensors were providing incorrect low glucose warnings. Internal testing identified the issue—carbon building up in the sensors during the manufacturing process—and determined that approximately 3 million CGM sensors were affected. The sensors were distributed in the United States, Canada and several European countries.  When Abbott shared that announcement, the FDA was still reviewing the situation. No recalls had yet been finalized. Now, however, the agency has announced four new Class I recalls.   https://cardiovascularbusiness.com/topics/clinical/heart-health/fda-confirms-recalls-abbott-cgm-sensors-new-lawsuit-alleges-company-concealed-information XX   Insulet brings back it's U.S. Pod recycling program, now making it available to all U.S. customers. The Pod recycling program, offered at no cost to customers, enables users to request a recycling kit online. This allows them to return their used Omnipods. Insulet then decontaminates the returned Pods before transporting them to a company specializing in recycling for electronics and medical products. Insulet began recycling pilot programs in Mass and California and are rolling it out nationwide. Insulet also has "Pod takeback" programs outside the U.S. in several international markets. These programs enable customers to request a takeback kit by contacting their local customer support team.   https://www.drugdeliverybusiness.com/insulet-expands-us-pod-recycling-program/ XX Up next a new resource for a population at three times the risk for diabetes, but without a lot of access to health information. I The first diabetes information website primarily in ASL has launched. The site includes GIFs and videos on diabetes management and an ASL glossary of diabetes-related terms. This is from University of Utah Health – Called Deaf Diabetes Can Together. Deaf and hard of hearing people are at three times higher risk for diabetes, but access to health information in ASL is limited. https://healthcare.utah.edu/newsroom/news/2026/01/first-diabetes-information-website-asl-launches XX Novo Nordisk ended all work on cell therapies, including a Type 1 diabetes program, in October – and now has found a buyer. Aspect has acquired rights to the assets and giving Novo an option to reengage for later-stage development and commercialization. Novo is helping bankroll Aspect's development of the assets, investing in the company and providing research funding. The arrangement gives Novo a chance to profit from the programs down the line. Novo is eligible for royalties and milestone payments on future product sales and, having handed the reins to Aspect for now, can expand its role in later-stage development and commercialization. The integration will involve the transfer of capabilities and expertise from Novo sites in Denmark and the U.S. to Aspect's Canadian operations. https://www.fiercebiotech.com/biotech/novo-nordisk-offloads-diabetes-assets-aspect-amid-cell-therapy-retreat XX XX Lucas Escobar has carved a role by proving that healthcare marketing can be culturally resonant, commercially powerful and deeply human. As director and head of U.S. consumer marketing at Insulet, he has redefined how the Omnipod tubeless insulin pump shows up in culture, transforming a medical device into a symbol of identity, inclusion and empowerment.   Under Escobar's leadership, Insulet launched three breakthrough initiatives: Dyasonic: Sound of Strength, a Marvel comic collaboration introducing a superhero who uses Omnipod; The Pod Drop, which turned the sound of a pod change into a celebratory music track; and Omnipod Mango x Pantone, medtech's first color partnership, honoring the vibrancy of the diabetes community. Each blended creativity with purpose while driving results, helping fuel Omnipod's consistent double-digit growth and its position as the most prescribed insulin pump in the U.S.   Living with type 1 diabetes himself, Escobar brings lived experience to his work, using storytelling not just to sell, but to make people feel seen.   Click here to return to the 2026 MM+M 40 Under 40 homepage.   From the January 01, 2026 Issue of MM+M - Medical Marketing and Media https://www.mmm-online.com/40-under-40/40-under-40-lucas-escobar-insulet/ -- FDA approves an update to the prescribing info for Afrezza inhaled insulin. This is a revision to the recommendations for the starting mealtime dosage when patients switch from shots or insulin pumps. This is aimed at healthcare providers - the updated labeling was supported by results from the INHALE-3 trial. The FDA is still considering approval of Afrezza for kids – a decision there expect by summer. https://www.globenewswire.com/news-release/2026/01/26/3225442/29517/en/MannKind-Announces-FDA-Approval-of-Updated-Afrezza-Label-Providing-Starting-Dose-Guidance-when-Switching-from-Multiple-Daily-Injections-MDI-or-Insulin-Pump-Mealtime-Therapy.html   -- UK researchers have developed a calculator to predict whether someone is at risk for type 1 diabetes. They're hoping this helps in screening and in preventing DKA at diagnosis. They used the TEDDY study to create this calculator, which right now is in beta form and only for kids and teens ages 8-18. The current beta form of the calculator asks users to answer questions about four factors necessary to estimate a child's risk of developing type 1 diabetes: age, family history, number of confirmed autoantibodies, and genetic risk score. The calculator has been given regulatory approval as a diagnostic in the U.K., and he's working with a company that's hoping to bring it to the U.S. in the next few months in the form of a home genetic test kit. https://www.healthcentral.com/news/type-1-diabetes/new-calculator-might-help-predict-type-1-diabetes-before-symptoms-appear

Scott and Jenny review the newly released 2026 ADA Standards of Care, praising key updates like hospital safety protocols while critiquing the "slow drift" of official guidance compared to real-world management. Topics Discussed: The "Slow Drift" of Guidance: Scott analyzes how standards often lag behind effective real-world management, comparing current advice to guidelines from 2018 and 2022. GLP-1s for Type 1: The new guidance explicitly lists GLP-1 receptor agonists as a treatment option for obesity in people with Type 1 diabetes. Technology Access: The requirement for C-Peptide levels or antibody presence has been removed for initiating insulin pumps or AID systems. Hospital Safety: A crucial new standard mandates that basal insulin should never be held for patients with Type 1 diabetes in the hospital. Workplace Advocacy: New language supports reasonable accommodations for adults using diabetes technology (pumps/CGMs) in the workplace. Cannabis Warning: The standards include a new specific warning against cannabis use for those at risk of DKA due to concerns about "cannabis hyperemesis syndrome".

Episode 210: Heat Stroke BasicsWritten by Jacob Dunn, MS4, American University of the Caribbean. Edits and comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice. Definition:Heat stroke represents the most severe form of heat-related illness, characterized by a core body temperature exceeding 40°C (104°F) accompanied by central nervous system (CNS) dysfunction. Arreaza: Key element is the body temperature and altered mental status. Jacob: This life-threatening condition arises from the body's failure to dissipate heat effectively, often in the context of excessive environmental heat load or strenuous physical activity. Arreaza: You mentioned, it is a spectrum. What is the difference between heat exhaustion and heat stroke? Jacob: Unlike milder heat illnesses such as heat exhaustion, heat stroke involves multisystem organ dysfunction driven by direct thermal injury, systemic inflammation, and cytokine release. You can think of it as the body's thermostat breaking under extreme stress — leading to rapid, cascading failures if not addressed immediately. Arreaza: Tell us what you found out about the pathophysiology of heat stroke?Jacob: Pathophysiology: Under normal conditions, the body keeps its core temperature tightly controlled through sweating, vasodilation of skin blood vessels, and behavioral responses like seeking shade or drinking water. But in extreme heat or prolonged exertion, those mechanisms get overwhelmed.Once core temperature rises above about 40°C (104°F), the hypothalamus—the brain's thermostat—can't keep up. The body shifts from controlled thermoregulation to uncontrolled, passive heating. Heat stroke isn't just someone getting too hot—it's a full-blown failure of the body's heat-regulating system. Arreaza: So, it's interesting. the cell functions get affected at this point, several dangerous processes start happening at the same time.Jacob: Yes: Cellular Heat InjuryHigh temperatures disrupt proteins, enzymes, and cell membranes. Mitochondria start to fail, ATP production drops, and cells become leaky. This leads to direct tissue injury in vital organs like the brain, liver, kidneys, and heart.Arreaza: Yikes. Cytokines play a big role in the pathophysiology of heat stroke too. Jacob: Systemic Inflammatory ResponseHeat damages the gut barrier, allowing endotoxins to enter the bloodstream. This triggers a massive cytokine release—similar to sepsis. The result is widespread inflammation, endothelial injury, and microvascular collapse.Arreaza: What other systems are affected?Coagulation AbnormalitiesEndothelial damage activates the clotting cascade. Patients may develop a DIC-like picture: microthrombi forming in some areas while clotting factors get consumed in others. This contributes to organ dysfunction and bleeding.Circulatory CollapseAs the body shunts blood to the skin for cooling, perfusion to vital organs drops. Combine that with dehydration from sweating and fluid loss, and you get hypotension, decreased cardiac output, and worsening ischemia.Arreaza: And one of the key features is neurologic dysfunction.Jacob: Neurologic DysfunctionThe brain is extremely sensitive to heat. Encephalopathy, confusion, seizures, and coma occur because neurons malfunction at high temperatures. This is why altered mental status is the hallmark of true heat stroke.Arreaza: Cell injury, inflammation, coagulopathy, circulatory collapse and neurologic dysfunction. Jacob: Ultimately, heat stroke is a multisystem catastrophic event—a combination of thermal injury, inflammatory storm, coagulopathy, and circulatory collapse. Without rapid cooling and aggressive supportive care, these processes spiral into irreversible organ failure.Background and Types:Arreaza: Heat stroke is part of a spectrum of heat-related disorders—it is a true medical emergency. Mortality rate reaches 30%, even with optimal treatment. This mortality correlates directly with the duration of core hyperthermia. I'm reminded of the first time I heard about heat stroke in a baby who was left inside a car in the summer 2005. Jacob: There are two primary types: -nonexertional (classic) heat stroke, which develops insidiously over days and predominantly affects vulnerable populations like children, the elderly, and those with chronic illnesses during heat waves; -exertional heat stroke, which strikes rapidly in young, otherwise healthy individuals, often during intense exercise in hot, humid conditions. Arreaza: In our community, farm workers are especially at risk of heat stroke, but any person living in the Central Valley is basically at risk.Jacob: Risk factors amplify vulnerability across both types, including dehydration, cardiovascular disease, medications that impair sweating (e.g., anticholinergics), and acclimatization deficits. Notably, anhidrosis (lack of sweating) is common but not required for diagnosis. Hot, dry skin can signal the shift from heat exhaustion to stroke. Arreaza: What other conditions look like heat stroke?Differential Diagnosis:Jacob: Presenting with altered mental status and hyperthermia, heat stroke demands a broad differential to avoid missing mimics. -Environmental: heat exhaustion, syncope, or cramps. -Infectious etiologies like sepsis or meningitis must be ruled out. -Endocrine emergencies such as thyroid storm, pheochromocytoma, or diabetic ketoacidosis (DKA) can overlap. -Neurologic insults include cerebrovascular accident (CVA), hypothalamic lesions (bleeding or infarct), or status epilepticus. -Toxicologic culprits are plentiful—sympathomimetic or anticholinergic toxidromes, salicylate poisoning, serotonin syndrome, malignant hyperthermia, neuroleptic malignant syndrome (NMS), or even alcohol/benzodiazepine withdrawal. When it comes to differentials, it is always best to cast a wide net and think about what we could be missing if this is not heat stroke. Arreaza: Let's say we have a patient with hyperthermia and we have to assess him in the ER. What should we do to diagnose it?Jacob: Workup:Diagnosis is primarily clinical, hinging on documented hyperthermia (>40°C) plus CNS changes (e.g., confusion, delirium, seizures, coma) in a hot environment. Arreaza: No single lab confirms it, but targeted testing allows us to detect complications and rule out alternative diagnosis. Jacob: -Start with ECG to assess for dysrhythmias or ischemic changes (sinus tachycardia is classic; ST depressions or T-wave inversions may hint at myocardial strain). -Labs include complete blood count (CBC), comprehensive metabolic panel (electrolytes, renal function, liver enzymes), glucose, arterial blood gas, lactate (elevated in shock), coagulation studies (for disseminated intravascular coagulation, or DIC), creatine kinase (CK) and myoglobin (for rhabdomyolysis), and urinalysis. Toxicology screen if history suggests. Arreaza: I can imagine doing all this while trying to cool down the patient. What about imaging?-Imaging: chest X-ray for pulmonary issues, non-contrast head CT if neurologic concerns suggest edema or bleed (consider lumbar puncture if infection suspected). It is important to note that continuous core temperature monitoring—via rectal, esophageal, or bladder probe—is essential, not just peripheral skin checks. Arreaza: TreatmentManagement:Time is tissue here—initiate cooling en route, if possible, as delays skyrocket morbidity. ABCs first: secure airway (intubate if needed, favoring rocuronium over succinylcholine to avoid hyperkalemia risk), support breathing, and stabilize circulation. -Remove the patient from the heat source, strip clothing, and launch aggressive cooling to target 38-39°C (102-102°F) before halting to prevent rebound hypothermia. -For exertional cases, ice-water immersion reigns supreme—it's the fastest method, with immersion in cold water resulting in near-100% survival if started within 30 minutes. -Nonexertional benefits from evaporative cooling: mist with tepid water (15-25°C) plus fans for convective airflow. -Adjuncts include ice packs to neck, axillae, and groin; -room-temperature IV fluids (avoid cold initially to prevent shivering); -refractory cases, invasive options like peritoneal lavage, endovascular cooling catheters, or even ECMO. -Fluid resuscitation with lactated Ringer's or normal saline (250-500 mL boluses) protects kidneys and counters rhabdomyolysis—aim for urine output of 2-3 mL/kg/hour. Arreaza: What about medications?Jacob: Benzodiazepines (e.g., lorazepam) control agitation, seizures, or shivering; propofol or fentanyl if intubated. Avoid antipyretics like acetaminophen. For intubation, etomidate or ketamine as induction agents. Hypotension often resolves with cooling and fluids; if not, use dopamine or dobutamine over norepinephrine to avoid vasoconstriction. Jacob: What IV fluid is recommended/best for patients with heat stroke?Both lactated Ringer's solution and normal saline are recommended as initial IV fluids for rehydration, but balanced crystalloids such as LR are increasingly favored due to their lower risk of hyperchloremic metabolic acidosis and AKI. However, direct evidence comparing the two specifically in the setting of heat stroke is limited. Arreaza: Are cold IV fluids better/preferred over room temperature fluids?Cold IV fluids are recommended as an adjunctive therapy to help lower core temperature in heat stroke, but they should not delay or replace primary cooling methods such as cold-water immersion. Cold IV fluids can decrease core temperature more rapidly than room temperature fluids. For example, 30mL/kg bolus of chilled isotonic fluids at 4 degrees Celsius over 30 minutes can decrease core temperature by about 1 degree Celsius, compared to 0.5 degree Celsius with room temperature fluids. Arreaza: Getting cold IV sounds uncomfortable but necessary for those patients. Our favorite topic.Screening and Prevention:-Heat stroke prevention focuses on public health and individual awareness rather than routine testing. -High-risk groups—elderly, children, athletes, laborers, or those on impairing meds—should acclimatize gradually (7-14 days), hydrate preemptively (electrolyte solutions over plain water), and monitor temperature in exertional settings. -Communities during heat waves need cooling centers and alerts. -For clinicians, educate patients with CVD or obesity about early signs like dizziness or nausea. -No formal "screening" exists, but vigilance in EDs during summer surges saves lives. -Arreaza: I think awareness is a key element in prevention, so education of the public through traditional media like TV, and even social media can contribute to the prevention of this catastrophic condition.Jacob: Ya so heat stroke is something that should be on every physician's radar in the central valley especially in the summer time given the hot temperatures. Rapid recognition is key. Arreaza: Thanks, Jacob for this topic, and until next time, this is Dr. Arreaza, signing off.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! References:Gaudio FG, Grissom CK. Cooling Methods in Heat Stroke. J Emerg Med. 2016 Apr;50(4):607-16. doi: 10.1016/j.jemermed.2015.09.014. Epub 2015 Oct 31. PMID: 26525947. https://pubmed.ncbi.nlm.nih.gov/26525947/.Platt, M. A., & LoVecchio, F. (n.d.). Nonexertional classic heat stroke in adults. In UpToDate. Retrieved September 7, 2025, from https://www.uptodate.com/contents/nonexertional-classic-heat-stroke-in-adults. (Key addition: Emphasizes insidious onset in at-risk populations and the role of urban heat islands in exacerbating classic cases.) Heat Stroke. WikEM. Retrieved December 3, 2025, from https://wikem.org/wiki/Heat_stroke. (Key additions: Details on cooling rates for immersion therapy, confirmation that anhidrosis is not diagnostic, and fluid titration to urine output for rhabdomyolysis prevention.)Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/. 

Why did the FDA deny sotagliflozin —even with strong data showing heart, kidney, and glucose benefits? In this episode, Dr. Steve Edelman sits down with special guest Stacey Simms to break down the full story behind SGLT inhibitors and their complicated path in type 1 diabetes.Together, they walk through how SGLT inhibitors transformed type 2 diabetes care, why many clinicians believe people with type 1 should have access, and how the risk of DKA shaped the FDA's decision. Dr. Edelman also shares insights on who might benefit, how to reduce risk, and why continuous ketone monitoring could be a game-changer for future approvals.They also touch on the growing discussion around GLP-1 medications in type 1 diabetes, new study results, and what emerging evidence could mean for future treatment options.In this episode: • Sotagliflozin & SGLT Inhibitors in T1D: Why these medications matter and what the latest data shows.• The FDA Denial: Understanding the DKA concerns and why approval remains challenging.• Real-World Experience: How clinicians are using SGLT inhibitors safely today in select patients.• Continuous Ketone Monitoring: Why dual-analyte sensors could unlock safer use in T1D.• GLP-1s in Type 1 Diabetes: What recent research reveals about potential benefits.• Who Might Benefit Most: Kidney protection, heart health, and metabolic improvements.• Looking Ahead: How ongoing studies and patient advocacy could shape future guidelinesLearn more about Diabetes Connections with Stacey Simms: https://diabetes-connections.comVisit TCOYD's Website for more diabetes edutainment for people living with diabetes: tcoyd.org**Tune in for two new episodes each month! Like what you hear and want to help us grow? Please rate and review this podcast so we can reach more people living with diabetes!**Follow our social media channels to empower yourself with the essential areas of diabetes knowledge led by two endocrinologists living with type 1 diabetes: Facebook  |  Instagram  |  YouTube ★ Support this podcast ★

Dr. Nicole Glaser is the Chief of Pediatric Endocrinology and a professor of Pediatrics at UC Davis Children's Hospital. She is recognized as an international expert in pediatric diabetic ketoacidosis (DKA), an important complication of diabetes in children. She has led many of the key multi-center studies that guide DKA management. She has also been involved in the development of several national and international guidelines for DKA management in children that guide current practice worldwide.Learning Objective:By the end of this podcast, listeners should be able to discuss an expert guided approach to the identification and management of children with hyperosmolar DKA.Key reference: Glaser N, Fritsch M, Priyambada L, Rewers A, Cherubini V, Estrada S, Wolfsdorf JI, Codner E. ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2022 Nov;23(7):835-856.Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Rachel shares her chaotic journey through three pregnancies misdiagnosed as Gestational Diabetes before a life-threatening DKA event revealed she has LADA (Type 1). She discusses the dangers of misdiagnosis, the "smash and dash" humor of her marriage, and managing her fourth pregnancy with the right tools. Go tubeless with Omnipod 5 or Omnipod DASH * Dexcom G7 CONTOUR NextGen smart meter and CONTOUR DIABETES app Get your supplies from US MED  or call 888-721-1514 Tandem Mobi  twiist AID System Free Juicebox Community (non Facebook) Eversense CGM Medtronic Diabetes Drink AG1.com/Juicebox Touched By Type 1 Take the T1DExchange survey Type 1 Diabetes Pro Tips - THE PODCAST Use code JUICEBOX to save 40% at Cozy Earth  Apple Podcasts> Subscribe to the podcast today! The podcast is available on Spotify, Google Play, iHeartRadio, Radio Public, Amazon Music and all Android devices The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here or buy me a coffee. Thank you! * Omnipod Wilmot E, et al. Presented at: ATTD; March 19-22, 2025; Amsterdam, NL. A 13-week randomized, parallel-group clinical trial conducted among 188 participants (age 4-70) with type 1 diabetes in France, Belgium, and the U.K., comparing the safety and effectiveness of the Omnipod 5 System versus multiple daily injections with CGM. Among all paid Omnipod 5 G6G7 Pods Commercial and Medicare claims in 2024. Actual co-pay amount depends on patient's health plan and coverage, they may be higher or lower than the advertised amount. Source IQVIA OPC Library. Disclaimer - Nothing you hear on the Juicebox Podcast or read on Arden's Day is intended as medical advice. You should always consult a physician before making changes to your health plan.   

Jess and Wendy sit down with registered dietitian Tiana Lavin, who brings both clinical insight and lived experience with type 1 diabetes. Tiana shares her diagnosis story, from being brushed off to landing in the ER with DKA during college finals, and the tough stretch that followed with restrictive eating and confusing advice. Tiana talks about what she wishes she knew sooner, like why chasing “perfect” numbers can backfire. We also get into the strategies that actually help! Tiana also digs into mental health and the power of finding even one person in the diabetes community. If you're living with diabetes or prediabetes and want personalized support from a Registered Dietitian Nutritionist covered by insurance, visit diabetesdigital.co to connect with our culturally aware and weight-inclusive team. And if you love the show, don't forget to rate and review us on iTunes or Spotify—it makes a huge difference! For additional resources and show notes, head to diabetesdigital.co/podcast.

When Shannon's 7-year-old daughter, Raelynn, went from gymnastics practice to the ICU in DKA within 48 hours, her family's world flipped overnight. In this episode, Shannon shares the real story behind their viral TikTok family: the trauma of diagnosis, the mental load of T1D parenting, the role of their diabetic alert dog Spy, and how she and her husband found a rhythm that gives their daughter both safety and independence. If you're a parent navigating Type 1 — or worried about your other kids' risk — this conversation will make you feel less alone and more equipped.What we cover:The day a “virus” turned into an ICU DKA diagnosisHow Shannon and her husband divide T1D responsibilitiesThe impact of T1D on siblings and family dynamicsWhat their diabetic alert dog Spy actually does day-to-dayHow their TikTok community started and what it means to themThe emotional weight of screening another child for T1DKey takeaways:1️⃣ You don't have to be fearless as a T1D parent — you just have to keep showing up.2️⃣ Kids with T1D often grow up faster, and that maturity can become a powerful advantage later in life.3️⃣ Community, tools, and support make the mental load of T1D lighter and your decisions clearer.What's next:

🧭 REBEL Rundown 🗝️ Key Points ❌ Don’t chase perfect numbers: Adequate and safe is often better than “perfect but harmful.”💨 Oxygenation levers: Start with FiO₂ and PEEP, but remember MAP is the true driver.🫁 Ventilation levers: Adjust RR and TV, tailored to underlying physiology.🚫 Watch your obstructive patients: Sometimes less RR is more. Click here for Direct Download of the Podcast. 📝 Introduction Ventilator management can feel overwhelming—there are so many knobs to turn, numbers to watch, and changes to make. But before adjusting any settings, it’s crucial to understand why the patient is in distress in the first place, because the right strategy depends on the underlying cause. In this episode, we’ll walk through three different cases to see how the approach changes depending on the problem at hand. ️ The 4 Main Ventilator Settings Tidal Volume (Vt) 🌬️ Amount of air delivered with each breath Typically set based on ideal body weight (6–8 mL/kg for lung protection) Respiratory Rate (RR) ⏱️ Number of breaths delivered per minute Adjusted to control minute ventilation and manage CO₂ FiO₂ (Fraction of Inspired Oxygen) ⛽ Percentage of oxygen delivered Adjusted to maintain adequate oxygenation (goal SpO₂ 92–96%, PaO₂ 55–80 mmHg). PEEP (Positive End-Expiratory Pressure) 🎈 Pressure maintained in the lungs at the end of exhalation to prevent alveolar collapse and improve oxygenation 🧮 Modes of Ventilation AC/VC (Assist Control – Volume Control)How it Works: Delivers a set tidal volume with each breath (whether patient- or machine-triggered).When It’s Used / Pros: Most common initial mode; guarantees minute ventilation; good for patients with variable effort.Limitations / Cons: May cause patient–ventilator dyssynchrony if set volumes don’t match patient’s demand.AC/PC (Assist Control – Pressure Control)How it Works: Delivers a set inspiratory pressure for each breath; tidal volume varies depending on lung compliance/resistance.When It’s Used / Pros: Useful in ARDS (lung-protective strategy), limits peak airway pressures.Limitations / Cons: Tidal volume not guaranteed; must closely monitor volumes and minute ventilation.PRVC (Pressure-Regulated Volume Control)How it Works: Hybrid: set target tidal volume, ventilator adjusts inspiratory pressure breath-to-breath to achieve it (within limits).When It’s Used / Pros: Common default mode on newer vents; combines benefits of VC (guaranteed volume) + PC (pressure limitation).Limitations / Cons: Can increase pressures if compliance worsens.SIMV (Synchronized Intermittent Mandatory Ventilation)How it Works: Delivers set breaths, but allows spontaneous patient breaths in between (without guaranteed volume).When It’s Used / Pros: Used for weaning; allows patient effort.Limitations / Cons: Risk of increased work of breathing if spontaneous breaths are inadequate.PSV (Pressure Support Ventilation)How it Works: Every breath is patient-initiated; ventilator provides preset pressure support to overcome airway resistance.When It’s Used / Pros: Weaning trials; patients with intact drive who just need assistance.Limitations / Cons: Not a full-support mode; not for unstable patients without spontaneous drive. ♟️ Ventilation Strategies Airway ProtectionLow GCS, seizure, strokeLoss of gag/cough reflexHigh aspiration risk (vomiting, GI bleed, poor mental status)Hypoxemic Respiratory FailureSevere pneumoniaARDSPulmonary edemaInhalation injuryVentilatory (Hypercapnic) Failure / Increased Ventilation DemandSevere metabolic acidosis (DKA, sepsis, renal failure) → need high minute ventilationCOPD, asthma (if decompensating)Neuromuscular weakness (myasthenia, Guillain–Barré, spinal cord injury)Airway Obstruction / Anticipated Loss of AirwayTumor, anaphylaxis, angioedemaFacial or airway traumaPre-op / anticipated deterioration Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO) 👤 Show Notes Priyanka Ramesh, MD PGY 1 Internal Medicine Resident Cape Fear Valley Internal Medicine Residency Program Fayetteville NC Aspiring Pulmonary Critical Care Fellow 🔎 Your Deep-Dive Starts Here REBEL Core Cast – Pediatric Respiratory Emergencies: Beyond Viral Season Welcome to the Rebel Core Content Blog, where we delve ... Pediatrics Read More REBEL Core Cast 143.0–Ventilators Part 3: Oxygenation & Ventilation — Mastering the Balance on the Ventilator When you take the airway, you take the wheel and ... Thoracic and Respiratory Read More REBEL Core Cast 142.0–Ventilators Part 2: Simplifying Mechanical Ventilation – Most Common Ventilator Modes Mechanical ventilation can feel overwhelming, especially when faced with a ... Thoracic and Respiratory Read More REBEL Core Cast 141.0–Ventilators Part 1: Simplifying Mechanical Ventilation — Types of Breathes For many medical residents, the ICU can feel like stepping ... Thoracic and Respiratory Read More REBEL Core Cast 140.0: The Power and Limitations of Intraosseous Lines in Emergency Medicine The sicker the patient, the more likely an IO line ... Procedures and Skills Read More REBEL Core Cast 139.0: Pneumothorax Decompression On this episode of the Rebel Core Cast, Swami takes ... Procedures and Skills Read More The post REBEL Core Cast 146.0–Ventilators Part 4: Setting up the Ventilator appeared first on REBEL EM - Emergency Medicine Blog.

🧭 REBEL Rundown 📝 Introduction Welcome to the Rebel Core Content Blog, where we delve into crucial knowledge for emergency medicine. Today, we share insightful tips from PEM specialist Dr. Elise Perelman, shedding light on respiratory challenges in infants, toddlers, and young children during the viral season. Understanding that most cases involve typical viruses, we aim to equip you with diagnostic pearls to identify more serious pathologies. Click here for Direct Download of the Podcast. 🔍 Recognizing Respiratory Patterns Pearl #1: Look at Your PatientBegin exams from the doorway. Observing patterns such as accessory muscle usage can reveal a patient’s respiratory effort. Specify whether the work of breathing occurs during inspiration, expiration, or both. Inspiratory work indicates difficulty getting air in, while expiratory work suggests trouble pushing air out. Silent tachypnea may point to other issues, like acidemia or pneumothorax. 🩺 Localizing Sounds for Accurate Diagnosis Pearl #2: Localize the SoundBreathing noises signal varied respiratory issues. Stridor, often heard on inspiration, results from obstructions above the thoracic inlet. Conversely, wheezing, generally linked to exhalation, indicates obstructions in the lower airways. Watch for signs like ‘silent chest’—a dangerous, severe obstruction, and distinguish grunting as a bodily mechanism to prevent alveolar collapse. Correctly identifying the sound assists in determining the appropriate intervention. 💉 Tailoring Treatment for Effective Results Once a sound is localized, treatments vary. We explore Soder from nasal congestion, typically needing supportive care and suctioning. Stridor from conditions like croup is eased with interventions to reduce airway swelling, such as steroids or inhaled epinephrine. Conversely, wheezing in infants is often due to bronchiolitis—not bronchospasms—and over-treatment is to be avoided. Supportive measures including suction, hydration, and oxygen are preferred unless improvement warrants bronchodilators. 🌬️ Intervening with Severe Asthma In severe cases of asthma or bronchiolitis, where standard at-home treatments fail, immediate adjunct therapies like intramuscular epinephrine become essential. Administering this quickly can alleviate obstruction when inhalants aren’t effective due to low air movement. 🦓 Navigating the Zebras of Respiratory Cases When recognizing Zebras—uncommon cases overshadowed by routine diagnoses—remain vigilant for histories or presentations that don’t conform. Conditions like pneumonia, bacterial tracheitis, and even myocarditis may mimic more common issues. 📌 Conclusion As attending physicians, our role extends beyond conventional treatment—it’s about discerning the atypical from the typical. Dr. Perelman urges continual reassessment, emphasizing reliance on observational skills as much as technological aid. Keeping keen on respiratory nuances ensures we catch those outlier cases, paving the way for adept medical care despite the overwhelming prevalence of viral infections.Stay tuned for more pearls and insights in our future posts, as Dr. Perelman shares further strategies for effective pediatric emergency care. For more resources, continue exploring our faculty’s valuable contributions on our site. Until then, stay safe and perceptive in your practice. Post Peer Reviewed By: Mark Ramzy, DO (X: @MRamzyDO), and Marco Propersi, DO (X: @Marco_Propersi) 👤 Guest Elise Perlman MD Pediatric Emergency Medicine​ Assistant Professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Meet The Team 🔎 Your Deep-Dive Starts Here REBEL Core Cast – Pediatric Respiratory Emergencies: Beyond Viral Season Welcome to the Rebel Core Content Blog, where we delve ... Pediatrics Read More REBEL CAST – IncrEMentuM26 Speaker Spotlight : Drs. Tarlan Hedayati, Jess Mason and Simon Carley Host Dr. Mark Ramzy shines a spotlight on three distinguished ... Resuscitation Read More REBEL Core Cast 145.0: Understanding QTc Prolongation: Causes, Risks, and Management The QT interval is a vital part of ECG interpretation, ... Procedures and Skills Read More REBEL Core Cast 144.0: Tourniquet Tips In this episode of the Rebel Core Content podcast, Swami ... Procedures and Skills Read More REBEL CAST – IncrEMentuM26 Speaker Spotlight : George Willis and Mark Ramzy 🧭 REBEL Rundown 📝Introduction In this exciting episode of REBEL ... Endocrine, Metabolic, Fluid, and Electrolytes Read More REBEL Core Cast – DKA: Beyond the Basics Part 2 – SCOPE DKA-Trial Managing diabetic ketoacidosis (DKA) requires careful consideration of fluid therapy, ... Endocrine, Metabolic, Fluid, and Electrolytes Read More The post REBEL Core Cast – Pediatric Respiratory Emergencies: Beyond Viral Season appeared first on REBEL EM - Emergency Medicine Blog.

Dr. Caroline Roberts is a board-certified physician and leading clinician at Virta Health, where she helps patients reverse type 2 diabetes through evidence-based, nutrition-focused care. Known for her compassionate approach and expertise in metabolic health, Dr. Roberts empowers individuals to reclaim their health using sustainable, real-world strategies. Her work blends cutting-edge science with practical guidance, making her a standout voice in the movement to transform diabetes care. In this episode, Drs. Tro, Brian, and Caroline talk about… (00:00) Intro (02:44) How Dr. Caroline discovered the power of keto for reversing Type 2 diabetes and controlling Type 1 diabetes (08:46) Why you don't need to eat 120 grams of carbs per day (10:36) DKA risk in Type 2 patients (18:15) Type 1 patients and low carb diets (23:36) Ketogenic diets and cardiovascular outcomes (30:44) Why the medical world has been so slow to acknowledge the benefits of keto and low carb diets (44:08) Dietary sustainablility  (45:58) CGMs, finger sticks, and keto diets (54:36) Long term patient outcomes from Virta patients (58:57) Keto and psychiatric health (01:04:08) Outro For more information, please see the links below. Thank you for listening! Links: Please consider supporting us on Patreon: https://www.lowcarbmd.com/ Dr. Caroline Roberts: Papers:  https://www.researchgate.net/profile/Caroline-Roberts-17 Virta Health: https://www.virtahealth.com Dr. Brian Lenzkes:  Website: https://arizonametabolichealth.com/ Twitter: https://twitter.com/BrianLenzkes?ref_src=twsrc^google|twcamp^serp|twgr^author Dr. Tro Kalayjian:  Website: https://www.doctortro.com/ Twitter: https://twitter.com/DoctorTro IG: https://www.instagram.com/doctortro/ Toward Health App Join a growing community of individuals who are improving their metabolic health; together.  Get started at your own pace with a self-guided curriculum developed by Dr. Tro and his care team, community chat, weekly meetings, courses, challenges, message boards and more.  Apple: https://apps.apple.com/us/app/doctor-tro/id1588693888  Google: https://play.google.com/store/apps/details?id=uk.co.disciplemedia.doctortro&hl=en_US&gl=US Learn more: https://doctortro.com/community/ 

We've got two special guests on the latest show! TRC alumni Pat and Cristina join us with a couple of great segments. First Critina tackles a number of myth about diabetes, including her own recent serious experience with DKA or diabetic ketoacidosis. Then Pat delights us with another round of everyone's favourite mostly guessing game Name That: Spot the Fake edition. This game has a special twist that really challenged the contestants.

"My baby went from fussy to lifeless in hours—by the time we reached the PICU, they said he might have had six hours to live." In this episode, TikTok Influencer and Medical Mom Marlee Brandon, a pediatric speech-language pathologist turned full-time mom, shares the whirlwind diagnosis of her 12-month-old son Bain with Type 1 diabetes and severe DKA, the traumatic hospital stay, and the everyday advocacy that followed. Raw, practical, and deeply hopeful. Why this episode matters Emotional clarity: what a Type 1 diagnosis really feels like in infancy Practical advocacy: scripts, choices, and language that help toddlers cope System gaps: when even major hospitals say "we've never seen this in a baby" Hope forward: raising a confident kid who knows why care matters What You'll Learn Early signs & ER visit: how "ear infection" symptoms masked T1D in a baby DKA in plain language: what "acidic blood" means and how PICU treats it The learning cliff: carb ratios, breastfeeding while dosing insulin, and why it's OK not to "get it" on day one Toddler coping: give choices, narrate care, build independence Rebuilding trust after mistakes: when training/tools aren't perfect Finding your people: groups, podcasts, and creators who answer "what now?" Timestamps 00:00 Meet Marlee (pediatric SLP → motherhood) 01:40 Why speech therapy & pediatrics 03:55 Bain turns one → sudden "ear infection" → nonstop vomiting 06:30 Small-town ER: "He has diabetes" (dismantling stereotypes) 08:35 Life-flight & PICU: severe DKA, hourly sticks, no food for 48 hrs 10:20 Turning the corner: energy returns; the six-hour window 11:22 "I don't understand this"—carb ratios, nursing, overwhelm 13:05 "We've never seen this in a baby" at a major children's hospital 15:23 Tears → handing tasks to partner → first solo shot 17:20 The Chick-fil-A moment: necessity builds confidence 18:44 Finding community: Facebook groups, YouTube, TikTok 19:55 Narrating care for toddlers—SLP tools that build trust & language 21:19 Offering choices: stickers, shot sites, pushing the button 22:53 Caregiver reality: self-care with very young T1D 24:32 Why daycare felt unsafe: syringe mix-ups & trust 25:54 Joy check: rocks, crafts, and a kid excited by everything 27:56 Best resources for newly diagnosed families 29:52 "Diabetes doesn't define your life." Marlee Shares that... "Type 1 isn't about weight or diet—my baby was still nursing." "They told my husband he probably had six hours to live." "I thought I needed nursing school to understand our endo." "I won't chase him with a shot. I explain why—insulin keeps you safe." "You can be anything and do anything…and have diabetes." Resources & Links Support communities Diapers & Diabetes (Facebook group for infants/toddlers with T1D) Juicebox Podcast Related Child Life On Call resources Explaining shots, blood draws and vaccines to kids   SupportSpot App (by Child Life On Call) Procedure guides, coping plans, journals, and parent resources to feel prepared and advocate with confidence 

Send us a textPregnant? or coaching moms-to-be? Dr. Eric Westman and dietitian Lily Nichols, RDN (“Real Food for Pregnancy”) break down insulin resistance in pregnancy, the 175g carb myth, ketones vs. DKA, and real-food swaps that flatten CGM spikes—without piling on insulin.

Dr. Nicole Glaser is the Chief of Pediatric Endocrinology and a professor of Pediatrics at UC Davis Children's Hospital. She is recognized as an international expert in pediatric diabetic ketoacidosis (DKA), an important complication of diabetes in children. She has led many of the key multi-center studies that guide DKA management. She has also been involved in the development of several national and international guidelines for DKA management in children that guide current practice worldwide.Learning Objectives:By the end of this podcast, listeners should be able to:Describe best practices for triaging patients with DKAExplain the pathophysiology of acute cerebral edema in DKADescribe the evidence and physiologic basis for fluid selection and rate in DKA Describe the evidence supporting insulin infusion rates in pediatric DKA List best practices for lab monitoring in DKA, and how to define when a patient is ready for transition to subcutaneous insulin References: Abramo TJ, Szlam S, Hargrave H, Harris ZL, Williams A, Meredith M, Hedrick M, Hu Z, Nick T, Gonzalez CV. Bihemispheric Cerebral Oximetry Monitoring's Functionality in Suspected Cerebral Edema Diabetic Ketoacidosis With Therapeutic 3% Hyperosmolar Therapy in a Pediatric Emergency Department. Pediatr Emerg Care. 2022 Feb 1;38(2):e511-e518. doi: 10.1097/PEC.0000000000001774. PMID: 30964851.Kuppermann N, Ghetti S, Schunk J, et al. Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis. N Engl J Med. 2018;378:2275-2287.Glaser N, Barnett P, McCaslin I, et al. Risk factors for cerebral edema in children with diabetic ketoacidosis. N Engl J Med. 2001;344:264-269.Bergmann KR, Abuzzahab MJ, Perepelista V, Udeogu J, Qiu L, Lammers S, Nickel A, Watson D, Kharbanda A. Improving Emergency Department Care for Children With Medium- and High-Risk Diabetic Ketoacidosis. Pediatrics. 2025 Oct 1;156(4):e2024068959. doi: 10.1542/peds.2024-068959. PMID: 40907982.UC-Davis-Health-Magazine-Fall-2019.pdfQuestions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Scott talks with Marley, mom to one-year-old Bane, diagnosed after DKA and a life flight. From ICU to CGM and Mobi, she shares hard-won reality, faith, and growing TikTok advocacy. Free Juicebox Community (non Facebook) Type 1 Diabetes Pro Tips - THE PODCAST Eversense CGM Medtronic Diabetes Tandem Mobi ** twiist AID System Drink AG1.com/Juicebox Use code JUICEBOX to save 40% at Cozy Earth  CONTOUR NextGen smart meter and CONTOUR DIABETES app Dexcom G7 Go tubeless with Omnipod 5 or Omnipod DASH * Get your supplies from US MED  or call 888-721-1514 Touched By Type 1 Take the T1DExchange survey Apple Podcasts> Subscribe to the podcast today! The podcast is available on Spotify, Google Play, iHeartRadio, Radio Public, Amazon Music and all Android devices The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here or buy me a coffee. Thank you! *The Pod has an IP28 rating for up to 25 feet for 60 minutes. The Omnipod 5 Controller is not waterproof.  ** t:slim X2 or Tandem Mobi w/ Control-IQ+ technology (7.9 or newer). RX ONLY. Indicated for patients with type 1 diabetes, 2 years and older. BOXED WARNING:Control-IQ+ technology should not be used by people under age 2, or who use less than 5 units of insulin/day, or who weigh less than 20 lbs. Safety info: tandemdiabetes.com/safetyinfo Disclaimer - Nothing you hear on the Juicebox Podcast or read on Arden's Day is intended as medical advice. You should always consult a physician before making changes to your health plan.  If the podcast has helped you to live better with type 1 please tell someone else how to find it!  

Scott talks with Marley, mom to one-year-old Bane, diagnosed after DKA and a life flight. From ICU to CGM and Mobi, she shares hard-won reality, faith, and growing TikTok advocacy. Go tubeless with Omnipod 5 or Omnipod DASH * Dexcom G7 CONTOUR NextGen smart meter and CONTOUR DIABETES app Get your supplies from US MED  or call 888-721-1514 Tandem Mobi  twiist AID System Free Juicebox Community (non Facebook) Type 1 Diabetes Pro Tips - THE PODCAST Eversense CGM Medtronic Diabetes Drink AG1.com/Juicebox Touched By Type 1 Take the T1DExchange survey Use code JUICEBOX to save 40% at Cozy Earth  Apple Podcasts> Subscribe to the podcast today! The podcast is available on Spotify, Google Play, iHeartRadio, Radio Public, Amazon Music and all Android devices The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here or buy me a coffee. Thank you! The Pod has an IP28 rating for up to 25 feet for 60 minutes. The PDM is not waterproof. Brown et al. Diabetes Care (2021). Sherr et al. Diabetes Care (2022). Pasquel FJ, et al. JAMA Network Open (2025). Single-arm studies comparing 3 months of Omnipod 5 use to standard therapy in 240 people aged 6-70 years and 80 people aged 2-5.9 years with type 1 diabetes and 305 people aged 18-75 years with type 2 diabetes. Disclaimer - Nothing you hear on the Juicebox Podcast or read on Arden's Day is intended as medical advice. You should always consult a physician before making changes to your health plan.  If the podcast has helped you to live better with type 1 please tell someone else how to find it!

Crystal, 33, T1D since 12, recounts DKA, insulin restriction for weight, congenital health challenges, and her turnaround—prebolusing, diet tweaks, and pursuing an insulin pump—with community support and hope. Free Juicebox Community (non Facebook) Type 1 Diabetes Pro Tips - THE PODCAST Eversense CGM Medtronic Diabetes Tandem Mobi ** twiist AID System Drink AG1.com/Juicebox Use code JUICEBOX to save 40% at Cozy Earth  CONTOUR NextGen smart meter and CONTOUR DIABETES app Dexcom G7 Go tubeless with Omnipod 5 or Omnipod DASH * Get your supplies from US MED  or call 888-721-1514 Touched By Type 1 Take the T1DExchange survey Apple Podcasts> Subscribe to the podcast today! The podcast is available on Spotify, Google Play, iHeartRadio, Radio Public, Amazon Music and all Android devices The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here or buy me a coffee. Thank you! *The Pod has an IP28 rating for up to 25 feet for 60 minutes. The Omnipod 5 Controller is not waterproof.  ** t:slim X2 or Tandem Mobi w/ Control-IQ+ technology (7.9 or newer). RX ONLY. Indicated for patients with type 1 diabetes, 2 years and older. BOXED WARNING:Control-IQ+ technology should not be used by people under age 2, or who use less than 5 units of insulin/day, or who weigh less than 20 lbs. Safety info: tandemdiabetes.com/safetyinfo Disclaimer - Nothing you hear on the Juicebox Podcast or read on Arden's Day is intended as medical advice. You should always consult a physician before making changes to your health plan.  If the podcast has helped you to live better with type 1 please tell someone else how to find it!

An ICU nurse mom recounts her child's type 1 diabetes DKA diagnosis, winning school CGM monitoring, juggling celiac, and data-driven management with pump/CGM—practical advocacy and tactics parents can replicate. Go tubeless with Omnipod 5 or Omnipod DASH * Dexcom G7 CONTOUR NextGen smart meter and CONTOUR DIABETES app Get your supplies from US MED  or call 888-721-1514 Tandem Mobi  twiist AID System Free Juicebox Community (non Facebook) Type 1 Diabetes Pro Tips - THE PODCAST Eversense CGM Medtronic Diabetes Drink AG1.com/Juicebox Touched By Type 1 Take the T1DExchange survey Use code JUICEBOX to save 40% at Cozy Earth  Apple Podcasts> Subscribe to the podcast today! The podcast is available on Spotify, Google Play, iHeartRadio, Radio Public, Amazon Music and all Android devices The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here or buy me a coffee. Thank you! * The Pod has an IP28 rating for up to 25 feet for 60 minutes. The PDM is not waterproof. Among all paid Omnipod 5 G6G7 Pods Commercial and Medicare claims in 2024. Actual co-pay amount depends on patient's health plan and coverage, they may be higher or lower than the advertised amount. Source IQVIA OPC Library. Disclaimer - Nothing you hear on the Juicebox Podcast or read on Arden's Day is intended as medical advice. You should always consult a physician before making changes to your health plan.  If the podcast has helped you to live better with type 1 please tell someone else how to find it.

Leslie shares her teen's type 1 diabetes diagnosis and DKA, rapid self-management with Dexcom G7 and Tandem t:slim Control-IQ, ADHD challenges, camp chaos, and parenting tactics that build independence. Free Juicebox Community (non Facebook) Type 1 Diabetes Pro Tips - THE PODCAST Eversense CGM Medtronic Diabetes Tandem Mobi ** twiist AID System Drink AG1.com/Juicebox Use code JUICEBOX to save 40% at Cozy Earth  CONTOUR NextGen smart meter and CONTOUR DIABETES app Dexcom G7 Go tubeless with Omnipod 5 or Omnipod DASH * Get your supplies from US MED  or call 888-721-1514 Touched By Type 1 Take the T1DExchange survey Apple Podcasts> Subscribe to the podcast today! The podcast is available on Spotify, Google Play, iHeartRadio, Radio Public, Amazon Music and all Android devices The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here or buy me a coffee. Thank you! *The Pod has an IP28 rating for up to 25 feet for 60 minutes. The Omnipod 5 Controller is not waterproof.  ** t:slim X2 or Tandem Mobi w/ Control-IQ+ technology (7.9 or newer). RX ONLY. Indicated for patients with type 1 diabetes, 2 years and older. BOXED WARNING:Control-IQ+ technology should not be used by people under age 2, or who use less than 5 units of insulin/day, or who weigh less than 20 lbs. Safety info: tandemdiabetes.com/safetyinfo Disclaimer - Nothing you hear on the Juicebox Podcast or read on Arden's Day is intended as medical advice. You should always consult a physician before making changes to your health plan.  If the podcast has helped you to live better with type 1 please tell someone else how to find it!

It's In the News.. a look at the top headlines and stories in the diabetes community. This week's top stories: Sanofi lowers prices, oral pill for T1D prevention studied, updates from Medtronic, Tandem, and Sequel Med Tech, falsely lower A1Cs (and why that happens), Biolinq gets FDA okay for micro-needle CGM and more! Find out more about Moms' Night Out  Please visit our Sponsors & Partners - they help make the show possible! Learn more about Gvoke Glucagon Gvoke HypoPen® (glucagon injection): Glucagon Injection For Very Low Blood Sugar (gvokeglucagon.com) Omnipod - Simplify Life Learn about Dexcom   Check out VIVI Cap to protect your insulin from extreme temperatures The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Reach out with questions or comments: info@diabetes-connections.com Episode transcription with links:   Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and every other Friday I bring you a short episode with the top diabetes stories and headlines happening now. XX French drugmaker Sanofi says it would offer a month's supply of any of its insulin products for $35 to all patients in the U.S. with a valid prescription, regardless of insurance status. The program, originally meant for uninsured diabetes patients, would now include those with commercial insurance or Medicare, the drugmaker said. Patients will be able to purchase any combination, type, and quantity of Sanofi insulins with a valid prescription for the fixed monthly price of $35, starting January 1. Lilly and Novo also have similar programs through which they offer insulin products for $35 a month for U.S. patients regardless of whether the patients have insurance. There is no law at work here – the only legislation that has changed the price of insulin came with the Inflation Reduction Act in 2022 with the Medicare cap. Helping lower the cost here, biosimilars hitting the market and the huge profitability for GLP-1 drugs for Novo and Lilly https://www.reuters.com/business/healthcare-pharmaceuticals/sanofi-offer-all-insulin-products-35-per-month-us-2025-09-26/ XX A pill typically prescribed for rheumatoid arthritis and alopecia might help slow the progression of type 1 diabetes, a new study says. Baricitinib (bare-uh-SIT-nib) safely preserved the body's own insulin production in people newly diagnosed with type 1 diabetes.. and their diabetes started progressing once they stopped taking baricitinib, results show. They produced less insulin and had less stable blood sugar levels.   Baricitinib works by quelling signals in the body that spur on the immune system, and is already approved for treating autoimmune conditions such as rheumatoid arthritis, ulcerative colitis and alopecia, researchers said.   “Among the promising agents shown to preserve beta cell function in type 1 diabetes, baricitinib stands out because it can be taken orally, is well tolerated, including by young children, and is clearly efficacious,” Waibel said. “We are hopeful that larger phase III trials with baricitinib are going to commence soon, in people with recently diagnosed type 1 diabetes as well as in earlier stages to delay insulin dependence,” she added. “If these trials are successful, the drug could be approved for type 1 diabetes treatment within five years.”   Findings presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.   https://www.usnews.com/news/health-news/articles/2025-09-23/pill-effective-in-slowing-type-1-diabetes-progression XX An existing transplant drug has shown promise in slowing the progression of type 1 diabetes in newly diagnosed young people, potentially paving the way for the first therapy that modifies the disease after diagnosis. The Drug, called ATG, is currently used together with other medicines to prevent and treat the body from rejecting a kidney transplant. It can also be used to treat rejection following transplantation of other organs, such as hearts, gastrointestinal organs, or lungs. The researchers studied 117 people aged five to 25, who'd been diagnosed with type 1 diabetes within the past three to nine weeks. The participants were from 14 centers across eight European countries and were randomized to be given different doses of ATG (0.1, 0.5, 1.5, or 2.5 mg/kg) or a placebo. ATG was given as a two-day intravenous (IV) infusion. The main goal was to see how well the pancreas could still make insulin after 12 months, measured by C-peptide levels during a special meal test. C-peptide is released into the blood along with insulin by the pancreas.   The findings are promising, showing that ATG, even at a relatively low dose, can slow the loss of insulin-producing cells in young people newly diagnosed with type 1 diabetes. The lower dose also caused fewer side effects, making it a more practical option. https://newatlas.com/disease/antithymocyte-globulin-newly-diagnosed-type-1-diabetes/     XX The FDA has delayed its feedback on Lexicon Pharmaceuticals' application to bring Zynquista (sotagliflozin) to people with type 1 diabetes. The agency had planned to respond this month but will now wait until the fourth quarter after reviewing new data from ongoing studies. Zynquista, an oral drug meant to be used with insulin, has already been approved for heart failure (marketed as Inpefa). But in type 1 diabetes, it faces safety concerns: last year an FDA advisory committee voted 11–3 that its benefits don't outweigh the increased risk of diabetic ketoacidosis (DKA). The FDA later issued a complete response letter rejecting the drug. Lexicon is still pushing forward, hoping its additional submissions will strengthen Zynquista's case for type 1 diabetes approval. https://www.biospace.com/fda/after-fda-rejection-lexicons-type-1-diabetes-drug-hit-with-another-regulatory-delay     XX A common but often undiagnosed genetic condition may be causing delays in type 2 diabetes diagnoses and increasing the risk of serious complications for thousands of Black and South Asian men in the UK—and potentially millions worldwide. A new study found around one in seven Black and one in 63 South Asian men in the UK carry a genetic variant known as G6PD deficiency. Men with G6PD deficiency are, on average, diagnosed with type 2 diabetes four years later than those without the gene variant. But despite this, fewer than one in 50 have been diagnosed with the condition.   G6PD deficiency does not cause diabetes, but it makes the widely used HbA1c blood test—which diagnoses and monitors diabetes—appear artificially low. This can mislead doctors and patients, resulting in delayed diabetes diagnosis and treatment.   The study found men with G6PD deficiency are at a 37% higher risk of developing diabetes-related microvascular complications, such as eye, kidney, and nerve damage, compared to other men with diabetes.   "This study highlights important evidence that must be used to tackle these health inequalities and improve outcomes for Black communities. Preventative measures are now needed to ensure that Black people, especially men, are not underdiagnosed or diagnosed too late." https://medicalxpress.com/news/2025-09-hidden-genetic-delay-diabetes-diagnosis.html XX Novo Nordisk today announced the resubmission of its Biologics License Application (BLA) to the US Food and Drug Administration (FDA) for Awiqli® (insulin icodec) injection, a once-weekly basal insulin treatment for adults living with type 2 diabetes. If approved, Awiqli® would become the first once-weekly basal insulin available in the United States, providing an alternative to daily basal insulin injections for adults living with type 2 diabetes.   The resubmission is based on results from the ONWARDS type 2 diabetes phase 3a program for once-weekly Awiqli® which is comprised of five randomized, active-controlled, treat-to-target clinical trials in approximately 4,000 adults with type 2 diabetes. The clinical program evaluated Awiqli® vs. daily basal insulin and the primary endpoint in these trials was change in A1C from baseline.1-5 Awiqli® is approved in the EU, along with 12 additional countries. In addition, regulatory filings have been completed in several other countries, with further regulatory decisions expected in 2025. XX Interesting news from Sequel Med Tech – they've signed an agreement with Arecor to pair the twiist pump with AT278 an ultra-concentrated (500U/mL), ultra-rapid insulin in development. They also have a deal with Medtronic to develop insulin for new pumps. This insulin isn't yet approved, it's 5 times stronger than standard fast acting  it's hoped that a clinical study will begin next year. Arecor says its insulin could potentially be the only option capable of enabling and catalyzing the next generation of longer-wear and miniaturized automated insulin delivery systems.   https://www.drugdeliverybusiness.com/sequel-arecor-develop-rapid-insulin-twiist/ XX Tandem Diabetes Care announes its t:slim X2™ insulin pump with Control-IQ+ automated insulin delivery (AID) technology is now cleared for use with Eli Lilly and Company's Lyumjev® (insulin lispro-aabc injection) ultra-rapid acting insulin in the United States (U.S.).   – The t:slim X2 insulin pump with Control-IQ+ technology is now cleared for use with Lyumjev for people with type 1 diabetes ages 2 and above and all adults with type 2 diabetes. The companies are continuing to work toward securing Lyumjev compatibility for the Tandem Mobi pump. https://hitconsultant.net/2025/09/29/tandem-diabetes-cares-tslim-x2-pump-cleared-for-use-with-lillys-ultra-rapid-lyumjev-insulin/ XX You can now place your order for the MiniMed™ 780G system with the Instinct sensor, made by Abbott. And if you are already a MiniMed 780G user, you can place an upgrade order today. ​This is a 15 day wear sensor, with no transmitter or overtape required. It looks the same at other Abbot sensors such as the Libre but is proprietary to Medtronic. Shipments are scheduled to start in November.   ​ https://www.drugdeliverybusiness.com/medtronic-launches-minimed-780g-instinct-abbott/   XX The global type 1 diabetes (T1D) burden continues to increase rapidly driven by rising cases, ageing populations, improved diagnosis and falling death rates. ,   The study estimates that T1D will affect 9.5 million people globally in 2025 (up by 13% since 2021), and this number is predicted to rise to 14.7 million in 2040. However, due to lack of diagnosis and challenges in collecting sufficient data, the actual number of individuals living with T1D is likely much higher, researchers say.   In fact, they estimate that there are an additional 4.1 million 'missing people' who would have been alive in 2025 if they hadn't died prematurely from poor T1D care, including an estimated 669,000 who were not diagnosed. This is particularly true in India, where an estimated 159,000 people thought to have died from missed diagnoses. The study predicts that 513,000 new cases of T1D will be diagnosed worldwide in 2025, of which 43% (222,000) will be people younger than 20 years old. Finland is projected to have the highest incidence of T1D in children aged 0-14 years in 2025 at around 64 cases per 100,000. The substantial increases in T1D forecasts between 2025 and 2040 underscore the urgent need for action. As co-author Renza Scibilia from Breakthrough T1D explains, "Early diagnosis, access to insulin and diabetes supplies, and proper healthcare can bring enormous benefits, with the potential to save millions of lives in the coming decades by ensuring universal access to insulin and improving the rate of diagnosis in all countries."   The authors note some important limitations to their estimates, including that while the analysis uses the best available data, predictions are constrained by the lack of accurate data in most countries-highlighting the urgent need for increased surveillance and research. They also note that data on misdiagnosis and adult populations remain limited, and the analysis assumes constant age-specific incidence and mortality over time. Furthermore, incidence data from the COVID-19 period were excluded from part of the modelling to avoid bias. Future updates are expected to improve as new data become available and applied. https://www.news-medical.net/news/20250919/New-study-warns-of-millions-of-undiagnosed-and-missing-people-with-type-1-diabetes.aspx XX A new study has found that semaglutide — the active ingredient found in some GLP-1 medications prescribed for diabetes and to aid weight loss — may help protect the eyes from diabetic retinopathy. Researchers estimate that as much as 40% of all people with diabetes also have diabetic retinopathy — a potentially blinding eye condition caused by blood vessel damage in the eye's retina. There is currently no cure for diabetic retinopathy. The condition is often managed through injections of anti-VEGF medications into the eye, surgery, and blood sugar monitoring and control. For this lab-based study, researchers used samples of human retinal endothelial cells that were treated with different concentrations of semaglutide. The cells were then placed in a solution with both a high glucose level and high level of oxidative stress — where there is an imbalance of antioxidants and free radicals — for 24 hours.   Past studies show that oxidative stress plays a role in the formation of diabetic retinopathy.   At the study's conclusion, researchers found that the retinal cells treated with semaglutide were twice as likely to survive than cells that were untreated. Additionally, the treated cells were found to have larger stores of energy.   Scientists also found that three markers of diabetic retinopathy were decreased in the semaglutide-treated retinal cells. First, the levels of apoptosis — a form of cell death — decreased from about 50% in untreated cells to about 10% in semaglutide-treated cells. The production of the free radical mitochondrial superoxide decreased from about 90% to about 10% in the treated retinal cells.   Researchers also found the amount of advanced glycation end-products — harmful compounds that can collect in people with diabetes and are known to cause oxidative stress — also decreased substantially.   Lastly, scientists reported that the genes involved in the production of antioxidants were more active in the semaglutide-treated cells when compared to untreated cells. Researchers believe this is a sign that semaglutide may help repair damage to the retinal cells.   “Our study did not find that these drugs harmed the retinal cells in any way — instead, it suggests that GLP1-receptor agonists protect against diabetic retinopathy, particularly in the early stages,” Ioanna Anastasiou, PhD, molecular biologist and postdoctoral researcher at the National and Kapodistrian University in Greece, and lead author of this study, said in a press release.   “Excitingly, these drugs may be able to repair damage that has already been done and so improve sight. Clinical trials are now needed to confirm these protective effects in patients and explore whether GLP-1 receptor agonists can slow, or even halt, the progression of this vision-robbing condition.” https://www.medicalnewstoday.com/articles/ozempic-semaglutide-may-help-protect-against-diabetes-related-blindness-retinopathy   XX Biolinq has received De Novo Classification from the U.S. Food and Drug Administration for its lead product, Biolinq Shine, a patch on the forearm that provides real-time glucose feedback through a primary color-coded LED display, visible with or without a phone. This one is tricky – it's called a needle free CGM but it also says it uses micro needles. By the way, De Novo isn't exactly the same as what we think of for FDA approval for medical devices. It's not as rigorous but it's a streamlined route for novel, low to moderate risk devices with no existing equivalent. We'll see how this one turns out. https://www.hmenews.com/article/biolinq-s-multi-function-biosensor-receives-fda-de-novo-classification

Laura, 55, was diagnosed with type 1 in March 2024 after months of missed signs, DKA, septic shock, and necrotizing fasciitis. Now on a GLP, she's honeymooning without insulin. Part 2 of 2 Free Juicebox Community (non Facebook) Type 1 Diabetes Pro Tips - THE PODCAST Eversense CGM Medtronic Diabetes Tandem Mobi ** twiist AID System Drink AG1.com/Juicebox Use code JUICEBOX to save 40% at Cozy Earth  CONTOUR NextGen smart meter and CONTOUR DIABETES app Dexcom G7 Go tubeless with Omnipod 5 or Omnipod DASH * Get your supplies from US MED  or call 888-721-1514 Touched By Type 1 Take the T1DExchange survey Apple Podcasts> Subscribe to the podcast today! The podcast is available on Spotify, Google Play, iHeartRadio, Radio Public, Amazon Music and all Android devices The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here or buy me a coffee. Thank you! *The Pod has an IP28 rating for up to 25 feet for 60 minutes. The Omnipod 5 Controller is not waterproof.  ** t:slim X2 or Tandem Mobi w/ Control-IQ+ technology (7.9 or newer). RX ONLY. Indicated for patients with type 1 diabetes, 2 years and older. BOXED WARNING:Control-IQ+ technology should not be used by people under age 2, or who use less than 5 units of insulin/day, or who weigh less than 20 lbs. Safety info: tandemdiabetes.com/safetyinfo Disclaimer - Nothing you hear on the Juicebox Podcast or read on Arden's Day is intended as medical advice. You should always consult a physician before making changes to your health plan.  If the podcast has helped you to live better with type 1 please tell someone else how to find it!

Laura, 55, was diagnosed with type 1 in March 2024 after months of missed signs, DKA, septic shock, and necrotizing fasciitis. Now on a GLP, she's honeymooning without insulin. Part 1 of 2 Go tubeless with Omnipod 5 or Omnipod DASH * Dexcom G7 CONTOUR NextGen smart meter and CONTOUR DIABETES app Get your supplies from US MED  or call 888-721-1514 Tandem Mobi  twiist AID System Free Juicebox Community (non Facebook) Type 1 Diabetes Pro Tips - THE PODCAST Eversense CGM Medtronic Diabetes Drink AG1.com/Juicebox Touched By Type 1 Take the T1DExchange survey Use code JUICEBOX to save 40% at Cozy Earth  Apple Podcasts> Subscribe to the podcast today! The podcast is available on Spotify, Google Play, iHeartRadio, Radio Public, Amazon Music and all Android devices The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here or buy me a coffee. Thank you! The Pod has an IP28 rating for up to 25 feet for 60 minutes. The PDM is not waterproof. Brown et al. Diabetes Care (2021). Sherr et al. Diabetes Care (2022). Pasquel FJ, et al. JAMA Network Open (2025). Single-arm studies comparing 3 months of Omnipod 5 use to standard therapy in 240 people aged 6-70 years and 80 people aged 2-5.9 years with type 1 diabetes and 305 people aged 18-75 years with type 2 diabetes. Disclaimer - Nothing you hear on the Juicebox Podcast or read on Arden's Day is intended as medical advice. You should always consult a physician before making changes to your health plan.  If the podcast has helped you to live better with type 1 please tell someone else how to find it!  

Nicole from Perth shares her 25-year type 1 diabetes journey — from pancreatitis at 13 to DKA, loss, GLP-1s, and thriving with CGM, Omnipod, and hard-won perspective. Free Juicebox Community (non Facebook) Type 1 Diabetes Pro Tips - THE PODCAST Juice Cruise 2026 - Come Sail Away Eversense CGM Medtronic Diabetes Tandem Mobi ** twiist AID System Drink AG1.com/Juicebox Use code JUICEBOX to save 40% at Cozy Earth  CONTOUR NextGen smart meter and CONTOUR DIABETES app Dexcom G7 Go tubeless with Omnipod 5 or Omnipod DASH * Get your supplies from US MED  or call 888-721-1514 Touched By Type 1 Take the T1DExchange survey Apple Podcasts> Subscribe to the podcast today! The podcast is available on Spotify, Google Play, iHeartRadio, Radio Public, Amazon Music and all Android devices The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here or buy me a coffee. Thank you! *The Pod has an IP28 rating for up to 25 feet for 60 minutes. The Omnipod 5 Controller is not waterproof.  ** t:slim X2 or Tandem Mobi w/ Control-IQ+ technology (7.9 or newer). RX ONLY. Indicated for patients with type 1 diabetes, 2 years and older. BOXED WARNING:Control-IQ+ technology should not be used by people under age 2, or who use less than 5 units of insulin/day, or who weigh less than 20 lbs. Safety info: tandemdiabetes.com/safetyinfo Disclaimer - Nothing you hear on the Juicebox Podcast or read on Arden's Day is intended as medical advice. You should always consult a physician before making changes to your health plan.  If the podcast has helped you to live better with type 1 please tell someone else how to find it!  

Noor's sudden DKA diagnosis sparks battle to survive, learn carb counting, and embrace tech while raising two young kids. Free Juicebox Community (non Facebook) Eversense CGM Medtronic Diabetes Tandem Mobi ** twiist AID System Drink AG1.com/Juicebox Use code JUICEBOX to save 40% at Cozy Earth  CONTOUR NextGen smart meter and CONTOUR DIABETES app Dexcom G7 Go tubeless with Omnipod 5 or Omnipod DASH * Get your supplies from US MED  or call 888-721-1514 Touched By Type 1 Take the T1DExchange survey Apple Podcasts> Subscribe to the podcast today! The podcast is available on Spotify, Google Play, iHeartRadio, Radio Public, Amazon Music and all Android devices The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here or buy me a coffee. Thank you! *The Pod has an IP28 rating for up to 25 feet for 60 minutes. The Omnipod 5 Controller is not waterproof.  ** t:slim X2 or Tandem Mobi w/ Control-IQ+ technology (7.9 or newer). RX ONLY. Indicated for patients with type 1 diabetes, 2 years and older. BOXED WARNING:Control-IQ+ technology should not be used by people under age 2, or who use less than 5 units of insulin/day, or who weigh less than 20 lbs. Safety info: tandemdiabetes.com/safetyinfo Disclaimer - Nothing you hear on the Juicebox Podcast or read on Arden's Day is intended as medical advice. You should always consult a physician before making changes to your health plan.  If the podcast has helped you to live better with type 1 please tell someone else how to find it!