T1D, INTS: Previewing the Future

Articles I'm working on for 2025

I can see the future of T1D: I’ll tell you next year.

I’m often asked what I think the future holds for T1D: New tech? AI? Better drugs? A Breakthrough?

My crystal ball is still at the cleaners, so I can’t really say. But the one thing I do know is that 2025 will see some pretty great results from clinical trials, academic research, epidemiological studies, and basic science, all of which will probably be published in academic journals that are read by, well, academics.

And me. 🙂

The point of my newsletter is to tease out interesting things from these articles to provide a greater understanding of topics critical to self-managing type 1 diabetes. It’s funny what medical literature can tell us, because research often reveals counterintuitive findings, often contradicting conventional wisdom. Indeed, nothing excites me more than to spend my nights and weekends pouring over quality medical journals. And I do all this just for you, my dear readers. (Oh, please. Even I don’t buy that!)

Truth is, I do love research and writing, but I spend most of my time hiking around the world and taking pictures.

Before I tell what you what I have in store for 2025, here are the most popular articles from my substack in 2024:

• Why Controlling Glucose is so Tricky

• Continuous Glucose Monitors: Does Better Accuracy Mean Better Glycemic Control?

• The risks and benefits of automated insulin delivery (AID) systems

• Why I Haven’t Died Yet: My Fifty Years with Diabetes

• How long will you live?

• The Paradox of Low-Carb Diets

The articles I’ve got slated for 2025 include these topics:

The US Healthcare System and Diabetes

• The number of endocrinologists is at an all-time low and dropping fast. In fact, all who specialize in diabetes are the lowest-paid specialties in medicine for a reason, but that reason is the byproduct of a series of events that have been happening for years. This article explains how and why America’s healthcare system is this way, and what the options are for fixing it.

Insulin Absorption Variability: A greatly underappreciated factor in glucose management

• If you ask your endocrinologist why your glucose levels happen to swing randomly on occasion, you might get more questions than answers: Did you just miscalculate dosage? Perhaps you didn’t count carbs right? Is exercise involved? Did you not sleep well the night before? But what never comes up is something that happens more often than not: insulin absorption variability. Understanding how insulin is absorbed, or not, can help you better plan your glucose management regimen. Better still, it can be useful for getting the effects you want, from a fast-acting bolus effect, to a long-lasting basal effect, all from the same insulin vial.

Insulin Resistance and the rise of “double diabetes”

• People normally associate insulin resistance (IR) as one of the early pathologies that lead to type 2 diabetes, but T1Ds are experiencing IR more frequently, especially as the rate of obesity in T1D is growing, leading to an increase in “double diabetes.” How and why IR happens is shockingly complex, with pathologies found throughout the body.

Carb Counting: They’re not absorbed the way you expect

• We’re all taught to count carbs so we know how to dose properly for the food we eat. And yet, it rarely really works out that way. Over time, most T1Ds eventually learn it’s more of an art than a science, largely because food, like insulin, does not absorb as predictably as we assume. We get used to our own bodies’ patterns, which is fine, but this life-hack doesn’t last long. It changes as you age, or gain weight, or have sleep disorders, or have inconsistent exercise patterns. When combined with insulin absorption variability, food malabsorption can make T1D nearly impossible to manage. But understanding some basic principles can help see through the fog.

T1D and the Placebo Effect: How the phrase, “it’s all in your mind”, really works.

• Most are aware of the placebo effect, a phenomenon where a person experiences an improvement in their health or symptoms after receiving a treatment that is inert or has no known therapeutic value. Obviously, one cannot replace insulin with a placebo, but what’s remarkable about the history of how the placebo effect was discovered, and why it works, can be applied to T1Ds self-management. This is a rare case where I say, it IS that simple, but it’s like the old joke about how many psychologists does it take to change a lightbulb: One, but the lightbulb has to want to change. In T1D, the “want” is the hardest part.

The Best Podcasts for T1Ds: The best way to learn about T1D is to study non-diabetics

• Most podcasts about T1D cover new products, news, reviews, and tips and tricks for dealing with the common ailments that we all face. How nice. And yet, I’ve never learned a single thing that helped me actually improve my glucose management from these. (Worse, there’s a lot of misinformation, though not intentionally.) It wasn’t till 2019 that I started to listen to podcasts that talk about metabolic health—how the body actually metabolizes glucose, independently of T1D—that I was able to maximize my glucose control. My A1c went from the mid 7’s to mid 5’s, my time-in-range (TIR) is now 95% (with very few lows), and my lipid profile (cholesterol levels) hit a target LDL <35. Achieving these healthy levels is not technically hard, but it does take self-discipline, and that part is much easier when you understand some very basic science. This curated list of podcast episodes will take about a week’s worth of your time, and the best way to do that, is to listen as you take a brisk walk. (Hint, all of the articles I listed above that I published in 2024 touch upon each of these themes, and I cite my own data to illustrate the concepts.)

I also plan to make shorter posts that call out very interesting and important papers that usually fly under the radar of most T1Ds, and will also introduce more topics related to the psychological factors, such as self-identity, habit formation, and more.

So, look out for these, and if you’re so inspired, feel free to contact me directly with questions, comments, jokes, or other thoughts about T1D.