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

**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

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!**

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

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!**

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