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 guidelines

Learn more about Diabetes Connections with Stacey Simms: https://diabetes-connections.com

Visit TCOYD's Website for more diabetes edutainment for people living with diabetes: tcoyd.org

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Continuous glucose monitoring didn’t start as sleek apps and tiny sensors — it began with chunky receivers, short wear times, and a lot of skepticism. In this episode, Dr. Jeremy Pettus and Dr. Steve Edelman sit down with Dexcom CEO and original sensor engineer Jake Leach to trace the evolution of CGM from those early “Tylenol-shaped” receivers and repurposed pagers to today’s G7 system and beyond.

They walk through the major turning points: abandoning long-term implants for subcutaneous sensors, proving that real-time CGM meaningfully improves time in range and safety, and pushing back against old-school thinking that insisted patients shouldn’t see their own data. From STS 3-Day to Seven Plus, G4, G5, G6, and now G7, Dr. Edelman, Dr. Pettus, and Jake Leach break down what each generation added — better accuracy, easier insertion, smartphone and cloud connectivity, and integration with pumps and AID systems.

Most importantly, Dr. Edelman, Dr. Pettus, and Dexcom CEO Jake Leach, focus on what’s coming next and what it means for people living with diabetes today: the 15 day Dexcom G7 sensor, Smart Basal insulin titration for people with type 2 diabetes, AI-powered food logging, and the upcoming G8 platform designed to measure multiple analytes (glucose plus ketones and more) — all while pushing toward broader access and affordability.

Key Topics:

• Early Dexcom Days & STS 3-Day: How Dexcom pivoted from implantable sensors to disposable subcutaneous CGMs and what the earliest systems were really like.
• Blinded vs Real-Time CGM: The ethics debate, safety implications, and studies proving real-time data improves time in range and reduces hypoglycemia.
• Seven Plus, G4 & G5: Major accuracy improvements, longer wear times, and the move to smartphone-based monitoring.
• G6 & Auto-Applicators: Eliminating mandatory calibrations and making sensor insertion faster and easier.
• G7 Wins & Growing Pains: Reduced size, faster warm-up, early reliability challenges, and how Dexcom addressed manufacturing and support issues.
• 15-Day Wear & Smart Basal: Extended wear life and CGM-guided basal insulin titration for type 2 diabetes.
• G8 & Multi-Analyte Sensing: A preview of Dexcom’s next-generation platform measuring glucose plus ketones and other markers.
• AI Food Logging & Smarter Care: Photo-based meal tracking and pairing nutrition data with glucose trends.
• Access & Affordability: Expanding CGM access globally and using data to reshape how diabetes care is delivered.

0:23 - Introduction & TCOYD’s 30th Anniversary
1:39 - Meet Jake Leach: 21 Years at Dexcom
3:08 - The Early Days: From Implantable Sensors to Patches
5:26 - The First Commercial CGM (STS 3-Day) & The "Pager" Receiver
8:35 - The Evolution to 7-Day Wear (Seven Plus)
10:15 - The Early Struggles with Insurance Coverage
12:32 - Why Unblinded Real-Time Data Changed Everything
16:36 - The G4 Era: Improved Accuracy & The "Share" Cradle
20:26 - G5: The Shift to Smartphone Connectivity
27:04 - Real Talk: Addressing G7 Connectivity & Sensor Failures
29:07 - Dexcom's "Unlimited Replacement" Policy for Failed Sensors
31:39 - CONFIRMED: The New 15-Day Sensor Launch
32:43 - "Smart Basal": A New Tool for Type 2 Diabetes
35:44 - G8 Reveal: Measuring Ketones, Lactate & Potassium
39:12 - New Feature: AI Smart Food Logging
41:22 - The Future of CGM: Pre-Diabetes & Heart Health
46:34 - Closing Thoughts

Visit 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!**

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Get a practical breakdown of Afrezza, the ultra-rapid inhaled insulin, with this comprehensive guide to efficacy, timing, and real-world application. Join Drs. Jeremy Pettus and Steve Edelman—endocrinologists living with Type 1 diabetes—as they reveal why this unique tool is often misunderstood and how to use it effectively to flatten post-meal spikes.

In this episode, we move beyond the basics to correct the biggest mistake users make regarding Afrezza dosage. If you’ve tried this therapy before and felt it "didn't work," the issue often lies in the conversion ratio. We review data from Afrezza MannKind studies (such as INHALE-3) to explain the shift from the old 1:1 ratio to the more effective 1:3 ratio. We also cover why this "rapid-on, rapid-off" insulin is the ultimate solution for exercise and how to navigate insurance coverage and prior authorizations.

Topics covered in this episode:

• The Dosing Fix: Why you often need a higher Afrezza dosage compared to subcutaneous insulin.
• Speed & Kinetics: How inhaled insulin mimics the body's natural beta cells to clear glucose fast.
• Lifestyle Benefits: Managing "sticky highs," exercise without crashing, and dietary freedom.
• Safety & Screening: Spirometry requirements and who should (and shouldn't) use Afrezza.
• Pediatric Updates: The latest on clinical trials and potential approval for children.
• Whether you are managing Type 1 or Type 2 diabetes, this episode provides the practical "tips and tricks" you need to determine if Afrezza is the missing tool in your diabetes management kit

Timecodes: 

0:00 Start 
0:24 Intro: What is Afrezza? 
1:39 "Rapid On, Rapid Off" vs. Injectable Insulin 
2:44 Preventing Delayed Hypoglycemia (Lows) 
4:03 The Early Dosing Mistake (The 1:1 Ratio) 
4:35 Jeremy’s Story: Why He Quit Using It Initially 
5:44 The Correct Dosing Conversion (1:2 to 1:3) 
8:09 Timing: Do You Need to Pre-Bolus? 
9:16 "Follow-On" Doses for High Protein/Fat Meals 
11:00 Cartridge Sizes & "Bucket" Dosing Strategy 
13:10 Using Inhaled Insulin for Exercise 
14:23 Real-World Test: Trix Cereal & Afrezza 
15:28 Storage Tips: Fridge vs. Room Temp 
16:44 Managing the Cough Side Effect 
17:29 Proper Inhalation Technique 
19:37 Using Afrezza with Insulin Pumps (Hybrid Closed Loop) 
21:54 Pediatric Update: Is it Safe for Kids? 
23:11 Why You Must Use a CGM 
23:49 Lung Safety, Smokers & Spirometry Tests 
24:49 How to Get It Prescribed (Overcoming Doctor Resistance) 
26:27 Utilizing Trainers & Prescription Combos 
29:08 Conclusion

Visit 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!**

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Type 1 diabetes doesn’t always travel alone — in fact, it often brings other autoimmune conditions along for the ride. In this episode, Dr. Jeremy Pettus and Dr. Steve Edelman shine a light on the most common ones that tend to show up with T1D, why they happen in the first place, when you should be screened, and what subtle symptoms should raise a red flag.

They walk through what’s common but manageable, like thyroid issues and celiac disease — as well as what’s rare but critical not to miss, like Addison’s disease (adrenal failure), which can be dangerous if left undiagnosed but incredibly treatable once caught early.
Most importantly, Jeremy and Steve explain how simple blood tests can catch these conditions before they spiral, and how the right medication can completely change how you feel day-to-day.

Key Topics:
• T1D & Autoimmunity 101: Why having one autoimmune condition raises your risk for others
• Thyroid Disorders: The most common — hyper vs. hypo, yearly screening, easy treatment
• Celiac Disease: Why it’s up to 10x more common in T1D and often missed without symptoms
• Addison’s Disease Awareness: The “silent” cortisol deficiency you don’t want to miss
• Proactive Care Mindset: How to build autoimmune screening into your diabetes warranty plan

(00:00) Intro: The "Raindrop" Analogy
(02:26) Thyroid Disease: The Most Common T1D Link
(05:25) Hypothyroidism (Low Thyroid): Symptoms & Easy Treatment
(09:30) Hyperthyroidism (Graves' Disease): Symptoms & Cures
(13:25) Your "Diabetes Warranty": Why You Need a Yearly TSH
(14:48) Celiac Disease: The 10% Risk Factor (19:28) Celiac Screening vs. "Gluten Sensitivity"
(25:31) Addison's Disease: The Other One to Know
(29:43) Final Takeaway: Be Your Own Advocate

Visit 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!**

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Gene therapy isn’t science fiction anymore, it’s becoming one of the most exciting frontiers in diabetes care. In this episode, Dr. Jeremy Pettus and Dr. Steve Edelman sit down with Dr. Fraser Wright, career gene therapist and Co-Founder/Chief Gene Therapy Officer at Kriya Therapeutics, to explore how gene therapy could one day help the body make its own insulin.

Together, they unpack what gene therapy actually is, Dr. P’s involvement as a medical consultant for Kriya Therapeutics, how AAV (adeno-associated virus) vectors work, and what makes this “one-and-done” approach so different from traditional treatments. From success stories in blindness and hemophilia to emerging type 1 diabetes studies, the trio breaks down the science, the safety, and the hope behind this revolutionary research.

You’ll learn how gene therapy has moved from rare diseases to more common ones, why the first human trials in diabetes are on the horizon, and what and what this could mean for long-term blood sugar control and independence from injections.

Key Topics:

• Gene Therapy 101: How gene therapy differs from protein-based drugs like insulin, and why AAV vectors act as safe, engineered delivery vehicles rather than infectious viruses.
• Why AAV, Why Now: Seven FDA-approved AAV-based therapies have proven the potential of long-term, single-dose treatments.
• From Eyes to Endocrine: Lessons learned from retinal gene therapy are now guiding approaches to metabolic conditions like diabetes.
• The Type 1 Diabetes Approach: A muscle-targeted program aims to help the body naturally produce insulin and stabilize blood sugar levels.
• Control and Safety: Built-in glucose sensing and the ability to turn off gene expression ensure precision and reversibility.
• Real-World Considerations: How exercise, treatment site, and existing technologies like pumps or CGMs could work alongside this therapy.

0:00 – Intro: Jeremy and Steve introduce gene therapy and why this topic is a game-changer
2:15 – What gene therapy is and how it’s different from standard protein-based treatments
4:54 – Understanding AAV: safety, engineering, and why it’s the preferred delivery method
8:50 – Real-world success: seven FDA-approved AAV therapies for genetic diseases
12:20 – Lessons learned from treating blindness and how they apply to diabetes
17:40 – The Type 1 Diabetes model: using muscle tissue to produce insulin
22:15 – Managing control, glucose sensing, and preventing hypoglycemia
25:50 – Safety measures and how treatment can be reversed locally if needed
28:30 – Exercise, durability, and what animal studies reveal about real-life performance
31:10 – Timelines, trials, and what’s next for gene therapy in diabetes. What’s Ahead: Clinical trials expected to begin around 2026, offering cautious but real optimism for the future of diabetes treatment.

Visit 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!**

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The diagnosis of Cushing's Syndrome is often missed because its underlying cause, hypercortisolism, masks itself as 'just diabetes,' 'just stress,' or 'just getting older,' which can lead to serious problems. In this conversation, Dr. Steve Edelman talks with a military veteran named Phil and his wife Cherese about years of unexplained fatigue, tough-to-control blood sugars, and high blood pressure, and the one test that made everything make sense. This episode discusses the early warning signs, how to advocate for answers and the hypercortisolism treatments that helped Phil feel like himself again. You’ll also hear why targeted hypercortisolism treatments and diabetes-specific approvals are on their way.

You’ll learn why hypercortisolism is more common than most people realize, how it can hide behind type 2 diabetes, and what tests and treatments can make a life-changing difference.

• Why hypercortisolism is so often overlooked: Symptoms overlap with diabetes, stress, and other common health issues.
• Phil’s story of resilience: From managing diabetes with multiple medications to discovering hypercortisolism as the root cause.
• The partner’s perspective: How Cherese noticed the warning signs and pushed for further testing.
• The Catalyst Study: Why research shows up to 1 in 4 people with hard-to-control type 2 diabetes may have hypercortisolism.
• Diagnosis explained: The 1 mg overnight dexamethasone suppression test and why it matters.
• Treatment and transformation: How targeted therapies improved Phil’s blood sugars, energy, sleep, and overall quality of life.
• Key takeaways: Be your own best advocate—if your numbers don’t add up, it’s worth asking why.

Timecodes: 
0:00 – What is Cushing's Syndrome (hypercortisolism) & guest setup

0:41 – Steroids & cortisol 101: why persistently high cortisol wreaks havoc

2:01 – Phil’s backstory: diabetes diagnosis and years of “uncontrolled” numbers

4:55 – Escalating meds, rising A1C, growing fatigue—when things stop making sense

7:25 – Cherese’s Story: lifestyle overhaul, then deeper testing when sugars don’t improve

10:47 – Classic signs of Cushing's Syndrome (buffalo hump, thin arms) & sleep issues

11:23 – CATALYST study: up to 1 in 4 with tough-to-control T2D show evidence of hypercortisolism

13:10 – Diagnosing Cushing's: The hypercortisolism suppression test

16:06 – Treatment wins: targeted therapy improves glucose, mood, sleep; “new era” in care

20:45 – Takeaways: Recognizing Cushing's, self-advocacy & red flags

Important Links:
Cortisol in Control website:
https://www.cortisolincontrol.com/ 
https://www.cortisolmatters.com/patient

Visit 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!**

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Type 2 diabetes is one of the most common chronic conditions in the U.S., but it doesn’t have to define or limit your life. In this episode, Dr. Steve Edelman and Dr. Jeremy Pettus—two endocrinologists with decades of experience—break down practical strategies for living well with type 2. From the latest medications and tools to everyday lifestyle choices, they highlight what really makes a difference in the long run. Their goal? To show you that type 2 diabetes is not only manageable but that taking control can actually improve your health and quality of life.

• Get Educated About What’s Happening in Your Body: Understanding insulin resistance, metabolic syndrome, and why type 2 diabetes is more than just “high blood sugar.”
• Know Your Numbers: The key benchmarks for A1c, blood sugar, cholesterol, and blood pressure—and why even small improvements matter.
• Build the Right Care Team: How to find and work with providers who can guide you through treatment options and keep you on track.
• Food and Drink That Work for You: Why portion control, balance, and smart substitutions matter more than strict diets or deprivation.
• Move Your Body (Without Overthinking Exercise): How realistic activity goals—walking, stretching, or even gardening—can improve insulin sensitivity and overall health.
• The Medications Changing the Game: Why GLP-1s, SGLT2 inhibitors, and CGMs are considered life-changing tools in type 2 diabetes care—and what you should know about them.

• And That’s Just the Start…: From mental health to long-term complication prevention, there are even more strategies in this episode to help you thrive with type 2 diabetes.

Living with type 1 diabetes is a daily grind, full of numbers, decisions, and constant adjustments, but it doesn’t have to feel overwhelming. In this episode, Dr. Steve Edelman and Dr. Jeremy Pettus two endocrinologists who also live with T1D, share their top 10 tips for making life with diabetes more manageable and a little easier to navigate. They cover everything from setting realistic blood sugar goals and understanding the metrics that matter most, to smart supply hacks that can save you stress when you least expect it. They also dive into why celebrating the small wins like getting through the night without a low or nailing your pre-meal insulin timing can make a big difference in your long-term mindset. Whether you’re newly diagnosed or decades into the journey, this episode is packed with advice you can use today and into the future.

Key Topics:

• Perfection Isn’t the Goal: Why aiming for progress—and not flawless numbers—keeps you healthier and less stressed.
• Know the Benchmarks That Matter: A1C, time in range, and minimizing hypoglycemia are key to long-term health.
• Celebrate the Small Wins: Even the little victories count, and they help build momentum in the day-to-day grind.
• Be Prepared With Backups: Why extra insulin, CGMs, and supplies are non-negotiable.
• Don’t Forget the “Non-Blood Sugar Stuff”: Eye exams, blood pressure, and cholesterol deserve just as much attention.
• And There’s More… From food strategies to mental health hacks, this episode is packed with practical advice you won’t want to miss—tune in for all 10 tips!

Visit 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!**

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Think sleep apnea is just about loud snoring? Think again. This common condition is a serious health issue that affects a staggering number of people with both type 1 and type 2 diabetes. In this eye-opening episode, Dr. Steve Edelman is joined by Dr. Jeremy Pettus, who shares his own recent and unexpected diagnosis of obstructive sleep apnea. From recognizing the subtle symptoms to navigating the diagnosis process and starting treatment, Dr. Pettus offers a firsthand account of what it's like to confront this underdiagnosed condition. This episode is a crucial wake-up call, revealing how untreated sleep apnea can impact everything from your heart health and blood pressure to your energy levels and insulin resistance. Whether you or a loved one has diabetes, this is essential listening.

Key Topics:

• What is Sleep Apnea? An explanation of how the airway collapses during sleep, leading to a drop in oxygen levels and triggering a "fight-or-flight" response throughout the night.
• Symptoms to Watch For: A breakdown of the classic signs, including loud snoring and gasping for air, as well as less obvious daytime symptoms like excessive fatigue, morning headaches, and low libido.
• Who Is at Risk?: A look at the surprisingly high prevalence of sleep apnea, especially among people with diabetes, affecting up to 80% of those with type 2 and half of those with type 1.
• Key Risk Factors: A guide to the factors that increase your chances of developing sleep apnea, such as weight, neck size, age, gender, and lifestyle habits like alcohol consumption.
• Getting Tested: An overview of the diagnostic process, from the simple STOP-BANG screening questionnaire to the modern convenience of home sleep tests.
• Effective Treatment Options: A comprehensive look at treatments that can improve your health, including lifestyle changes, CPAP therapy, and the new FDA-approved use of weight-loss medications like Zepbound for sleep apnea.

Visit 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!**

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What if you could learn about type 1 diabetes before symptoms even appear? In this powerful episode, Dr. Steve Edelman and Dr. Jeremy Pettus sit down with Senior Football Insider and Sanofi Spokesperson Adam Schefter to talk about why early screening for T1D is a conversation every family should be having.

Adam shares his personal connection to type 1 diabetes through his wife’s experience and how it changed his outlook on health, preparation, and the role of care partners. Together, they break down the importance of understanding early-stage T1D, how screening works, and why early knowledge is more than just information—it’s peace of mind.

Whether you’re newly diagnosed, a care partner, or simply looking to stay informed, this episode offers insight, support, and a meaningful call to action.

Key Topics:

• Adam’s connection to T1D: How his wife’s diagnosis impacted their family and sparked his passion for awareness and advocacy.
• Why early screening matters: The power of knowing about type 1 diabetes before symptoms begin—and how it can change everything.
• Understanding early-stage T1D: What auto antibodies are, what they indicate, and how type 1 develops in stages.
• Advice for care partners and families: Why loved ones should consider screening too, and how to start the conversation with a healthcare provider.
• Awareness is everything: How misinformation and lack of understanding can delay diagnosis—and why it's time to change that.
• Start the conversation: How to learn more about screening and what families can do today to stay one step ahead.

Visit 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