Your Best T1D Year

SHOW NOTES: We’ve spent a week and a half in the problem, the spike, the loop, the fear. Today the sun comes out. Neil turns the corner to the fix, and it’s almost annoyingly simple: your food is fast and your insulin is slow, and when they start at the same time, the food wins the first hour. The fix isn’t more insulin or better carb counting. It’s timing. You give the insulin a small head start...

SHOW NOTES: Here’s the quiet part said out loud: the reason you don’t pre-bolus is not that you’re lazy or that you don’t care. It’s that it scares you. Neil names the specific fear at the center of the whole challenge, the fear of going low before the food arrives, and tells you the truth, 34 years in, it still scares him too. This is the episode nobody put in the pamphlet. The pamphlet says “pre...

SHOW NOTES: Here’s the quiet part said out loud: the reason you don’t pre-bolus is not that you’re lazy or that you don’t care. It’s that it scares you. Neil names the specific fear at the center of the whole challenge, the fear of going low before the food arrives, and tells you the truth, 34 years in, it still scares him too. This is the episode nobody put in the pamphlet. The pamphlet says “pre...

SHOW NOTES: You counted the carbs. You took the right dose. Two hours later you’re 240, and you have no idea why. If that number breaks your heart a little, this episode is for you. Neil sits in the problem of the post-meal spike, the one that feels like a personal failing but almost never is. This is the roller coaster every person with type 1 diabetes knows: spike, correct, drift low, snack, cli...

SHOW NOTES: You already know you should pre-bolus. Your endocrinologist has told you. Every diabetes educator has told you. And you still dose with your first bite, same as the rest of us. Neil Greathouse, who has lived with type 1 diabetes since 1992, kicks off The Head Start, an eight-week challenge all about pre-bolusing your insulin, by admitting he doesn't do it perfectly either. Here is the...

SHOW NOTES: Eight weeks ago, Neil asked you to do one thing: write down how many hours you slept last night. That was the whole challenge. That was where it started. One number. And here we are. This is the finale of the While You Were Sleeping Challenge -- 24 episodes, 8 weeks, and the most thorough look at sleep and type 1 diabetes that Your Best T1D Year has ever done. Neil closes with the full...

SHOW NOTES: Eight weeks. Twenty-four episodes. The dawn phenomenon, cortisol, alarm fatigue, sleep stages, Fear of Hypoglycemia, CGM as a proactive tool. If Neil had to give you one thing to keep from all of it -- just one habit -- here it is: go to bed at the same time every night. This is not a joke, and it's not oversimplified. It's the finding from the 2023 T1D sleep study with 76 participants...

SHOW NOTES: Perfect is not the goal. This episode takes a stand on something that doesn't get said enough in health content of any kind -- and especially not in T1D content. If you've been measuring your sleep quality against general population benchmarks (the 8-hour standard, the 90% sleep efficiency score, the deeply uninterrupted ideal), Neil is here to tell you, with genuine care, that you've...

SHOW NOTES: You've been sleeping next to one of the most detailed health monitoring devices that exists. Every single night. For however many years you've had your CGM. It has been logging everything -- every rise, every drop, every 3am event, every overnight pattern. It has been very patient about all of this. Most T1D people use their CGM reactively at night. The alarm fires, you check, you resp...

SHOW NOTES: "Sleep hygiene" sounds like you're brushing your sleep's teeth. Nobody has ever said that phrase in a natural conversation. And this episode is not about a 12-step pre-sleep protocol that you'll implement on Monday and abandon by Wednesday when life gets in the way. It's about one thing. Just one. Because T1D brains are very good at building complicated systems -- we've been doing it s...

SHOW NOTES: Your Tuesday 8pm HIIT class has opinions about your 3am blood sugar. The data is pretty clear on this. Neil is giving you fair warning before the episode starts. This episode covers the timing of exercise and its downstream effects on both sleep quality and overnight glucose in type 1 diabetes. Afternoon and evening exercise produce very different results -- not because exercise is bad...

SHOW NOTES: You slept seven hours. By any reasonable measure, that should be enough. You woke up feeling like you slept four. You weren't imagining it. This episode breaks down sleep stages -- light sleep, deep sleep, REM -- and explains exactly where type 1 diabetes disrupts the sequence. The most important stage, slow-wave sleep (NREM Stage 3), is where your body does its deepest repair work: gr...

SHOW NOTES: Your CGM says 115. Flat arrow. No active insulin. You've checked it twice. The number is completely fine. And you're still awake at 2:48am. This is not you being dramatic. This has a name: Fear of Hypoglycemia (FOH). It's a documented, peer-reviewed phenomenon in T1D populations -- a specific pattern of nighttime hypervigilance that persists even when blood sugar is stable. The anxiety...

SHOW NOTES: Cortisol isn't trying to ruin your blood sugar. It's trying to help. It has never once, in your entire life, acted with malice. It is a useful, important hormone that is -- in the modern world -- very confused about what an actual emergency looks like. This episode is about cortisol: what it's designed to do, what it's actually responding to in modern life ("quick question" emails at 1...

SHOW NOTES: Neil wants to be upfront: this episode is going to sound like wellness content delivered by someone standing in a field in linen pants. He knows. He can't control how it sounds. What he can tell you is that there's actual research behind all of it, it specifically applies to T1D glucose management, and he read most of it at midnight on his phone in bed with the screen at full brightnes...

SHOW NOTES: You already do this. You check your blood sugar before bed, glance at your CGM, maybe set a temp basal. You've been doing it for as long as you've had T1D. Here's the reframe: you've been doing it as a safety check. "Am I okay to go to sleep?" This episode argues it's also a sleep decision -- and that shift changes what you're actually optimizing for. Active insulin at midnight is a sl...

SHOW NOTES: Four weeks ago, Neil asked you to do one thing: write down how many hours you slept. That was it. Just a number. And now here we are. This is the halftime checkpoint of the While You Were Sleeping Challenge. Neil does what any good coach does at halftime -- pulls everyone in, takes a breath, and goes over what we actually know. Because the first four weeks covered a lot: recognition, t...

SHOW NOTES: When did you last actually look at your CGM alarm threshold settings? Not to silence an alarm. Not to check a number. To actually look at the thresholds -- the settings, the specific values, when they were last changed. If your answer is "when I first set up the device," this episode is for you. Neil walks through what CGM alarm thresholds are, why they're not permanent features of hav...

SHOW NOTES: How many times did your CGM alarm last night? If you have to guess -- or if you're honestly not sure because your arm is doing the silence-and-go-back-to-sleep thing on autopilot -- that's alarm fatigue. And it's a documented, peer-reviewed phenomenon that's costing you sleep in ways that quietly compound every single night. This episode is about the complicated relationship T1D people...

SHOW NOTES: 200 episodes. Neil didn't plan on this. He definitely didn't plan on spending episode 200 explaining what your liver does at 3am without your permission. And yet here we are. This is the episode that contains the most important thing Neil has said in this entire challenge. Most T1D content talks about sleep in two ways: the safety angle (set your alarms right) or the wellness angle (ge...

SHOW NOTES: You've been told to get eight hours. Here's what the research actually found. A 2023 study of 76 adults with type 1 diabetes tracked both CGM and sleep data for one week. The finding: sleep duration alone was not independently associated with time in range. What was? Bedtime consistency. Every extra hour of variability in bedtime was associated with roughly 10% less time in range. Your...

SHOW NOTES: Bad sleep makes your blood sugar harder to manage. Worse blood sugar disrupts your sleep. Worse sleep makes your blood sugar worse. You've been running a feedback loop -- without knowing it. This is the episode where things click. Neil connects all the pieces from Weeks 1 and 2 into the full picture: the bidirectional relationship between sleep and glucose management in type 1 diabetes...

SHOW NOTES: You went to bed at a perfect 110. No active insulin. Flat arrow. You did everything right. You wake up at 182. Nothing happened -- no low, no alarm. You just slept. Except something did happen. You just weren't awake for it. This episode introduces the dawn phenomenon: the pre-dawn hormonal surge (cortisol, growth hormone, glucagon, epinephrine) that causes your liver to manufacture an...

SHOW NOTES: Sleep deprivation reduces insulin sensitivity in everyone. That's not a T1D-specific finding. Here's what is. In people without diabetes, the system has a feedback loop. Insulin sensitivity drops, blood sugar ticks up slightly, the pancreas compensates automatically, and the whole thing resolves before they're even awake. They make coffee, go about their day, and have no idea any of it...

SHOW NOTES: Here's the number: 21%. One study. People with type 1 diabetes. Sleep-deprived condition (4 hours) versus adequate sleep (8.5 hours). Same food, same insulin, same activities. The sleep-deprived group showed a 21% reduction in insulin sensitivity the next day. Every single participant. This is the episode Neil has been building toward. If you've ever had a day where your insulin felt s...