Your Best T1D Year

It's Labor Day, college football is back, and Neil just sat through a noon kickoff and surfaced at midnight. Perfect timing to explain what a three-hour sit actually does inside a body with type 1 diabetes: your leg muscles clock out, sugar hangs around in your blood, insulin works alone, and that stubborn afternoon high parks itself on your CGM. You might not have eaten your way into it. You migh...

How many steps do you actually take on a normal day? Not your best day, a regular Tuesday. Check your phone, and prepare to appeal the ruling. In this episode Neil breaks down the gap between how active we feel and what the step count says, and why being busy and actually moving are two different things for blood sugar. Then two stats that change the whole conversation. Most adults with type 1 dia...

Welcome to Keep It Moving, the new 8-week challenge for people with type 1 diabetes, and meet the villain: the chair. Nobody decides to sit for half a day. The chair decides for you, quietly, like a Netflix autoplay countdown, and your blood sugar pays the tax. Neil opens with his own confession: eight back-to-back Zoom meetings, a 4am run that turned into a fully sedentary day, and the insulin se...

Eight weeks ago, you were spiking after dinner and blaming yourself for it. This is the finale of The Head Start, and instead of another recap, Neil reads two listener stories that say what these eight weeks were really about, one from a woman who cried at her kitchen sink the first time she saw a flat 140, and one from a 31-year veteran whose time in range jumped from the low 60s to 81%. Then Nei...

Raquel Baron was diagnosed with type 1 diabetes at five years old and left the hospital late to her own birthday party. Twenty-four years later, she's the founder and CEO of Type One Together, home of the T1D Babysitter List, now over 4,000 sitters nationwide who either live with type 1 or love someone who does. It started as one college student in Austin with 14 names written on a piece of paper....

Previously, on The Head Start: a man admitted he's had type 1 for 34 years and still sometimes doses with his mouth full, and an entire audience realized the after-dinner spike was never their fault. This is the greatest-hits recap, and this time it comes with the receipts. Neil runs the whole arc, the fear, the junk drawer of reasons, why food beats insulin to the finish line, and then the scienc...

The challenge is almost over, so the real question is what happens next week, when Neil isn't in your ears three times a week. This episode is about making the pre-bolus habit last past the finish line, and it's grounded in habit science. A study by Phillippa Lally found it takes about 66 days on average for a behavior to become automatic, but the range is huge, 18 to 254 days. So if pre-bolusing...

Remember day one, when the after-dinner spike was just the rent you paid for eating? Now think about last week, when you pre-bolused, ate, and looked down at a flat, boring, beautiful CGM line. This episode is about that feeling, because that feeling is the whole point. Neil shares what people describe when it clicks, not the number, but "I didn't have to correct," "I wasn't cranky all evening," "...

Here's the permission slip every T1D parent needs: with a young child, dosing during or after the meal is not cheating. It's not failing at pre-bolusing. It is, in plain black and white in the international pediatric diabetes guidelines, an okay thing to do. Parents, exhale. The people who write the rules for kids with type 1, ISPAD, carve out a specific exception for infants and toddlers who are...

Your toddler asked for the macaroni, then looked at it like you served packing peanuts and demanded the one other food in the house, and you've got insulin on board for a meal that just got canceled. This episode is for the parents dosing into pure chaos. Neil pulls the playbook straight from the pediatric diabetes guidelines. The split: dose for the part you're sure they'll eat, then give the res...

She stopped counting years with type 1 a long time ago. Natalie Bellini counts days... more than 20,000 of them. This week Neil finally gets his dream guest: Natalie Bellini, DNP, FNP-BC, BC-ADM, CDCES, nurse practitioner, assistant professor of medicine at Case Western Reserve University, and program director for diabetes technology at University Hospitals in Cleveland. She has lived with type 1...

You pre-bolus. You give it the 15 minutes. You watch the arrow. And you're still spiking. Don't throw out the challenge, that spike is a clue. Neil puts on the detective hat, because timing is huge, but it isn't the only dial on the dashboard. If your timing's perfect and you're still climbing, the amount may be the problem, and the most common culprit is the carb count. A study by Brazeau found t...

"Neil, I use Fiasp, or Lyumjev, or Afrezza, do I even have to wait?" Great question, and this episode gets genuinely nerdy about the answer. Fiasp and Lyumjev are ultra-rapid analogs, built with ingredients (niacinamide in Fiasp, citrate and treprostinil in Lyumjev) that speed up subcutaneous absorption. Afrezza is inhaled Technosphere insulin with a Tmax around 12 to 15 minutes that delivers more...

If you're on a closed-loop system, Control-IQ, Omnipod 5, or Loop, you've probably wondered whether the algorithm means you're off the hook for pre-bolusing. Neil has to be the one to tell you: you still do it. These systems are an incredible co-pilot, but they're not a self-driving car you can nap in. Here's the reason, with a real number. In Omnipod 5 data, when people skipped the meal bolus, th...

Some nights you do everything right and it still goes sideways. The dinner party, the cookout with the moving-target food, the night you're so fried you only remember to bolus while scraping the plate. This is permission day. Missing doesn't mean you failed the challenge, it means you have a life with other humans in it. Neil gives the real-life moves for the messy nights, and grounds them in data...

Some meals spike you and move on. Pizza spikes you, waves goodbye, and comes back four hours later like a horror-movie villain. If you've ever been 110 at bedtime and 260 at midnight, this episode explains the ambush, and it's backed by real research. A 2013 study led by Howard Wolpert in Diabetes Care fed people the same carbs, but one meal was high in fat. The high-fat meal required about 42% mo...

"It'll be right out" might be the most cursed sentence in all of type 1 diabetes. August is about making your pre-bolus habit survive the real world, and we start with the hardest place to do it: restaurants and delivery, where you don't control the clock. Neil's move is simple, wait for proof of life. Dose when you can actually see the food heading your way, not a second sooner. And here's why it...

You do not have to be a pre-bolus athlete on day one. If "10 to 15 minutes" felt like too much, Neil takes the pressure all the way down: start with five minutes. Even five to seven minutes of head start beats dosing with your first bite, because insulin is a slow sunrise, not a light switch. Then you build, five, then seven, then ten, creeping up to your sweet spot. Neil closes out month one with...

If pre-bolusing were a video game, breakfast would be the level everybody rage-quits on. You're rushed, half asleep, and half of us don't even eat it. So we don't start there. We start on the easy level: dinner. Neil makes the case that dinner is the cheat code for learning to pre-bolus. Three reasons: you see it coming (you've had all day to plan), you're usually home and control the clock (which...

We all know we're supposed to pre-bolus. We've known for years. So why do almost none of us actually do it? This week Neil steals an hour with Dr. Monica Gomberg, board certified endocrinologist at Blue Circle Health and, as far as this podcast is concerned, America's Endocrinologist. This is the conversation you wish you could have if your endo appointment lasted longer than 15 minutes. Dr. Gombe...

A short, warm one before the start line. Neil reminds you how far you've already come. Three weeks ago, pre-bolusing was a scary thing you knew you should do and didn't. Now you've named the fear, you understand why the spike happens, you've seen the studies, and you've practiced reaching for the safety net. You've already done the hard parts. Neil is also honest about what starting actually looks...

Consider this your permission slip, signed by 34 years of mistakes. If you pre-bolus and the food shows up late and you start to drop, you are allowed to eat a few fast carbs to hold steady and cover them later. That's not failing. That's the move. Neil lays out the three-part safety system that turns pre-bolusing from a leap of faith into a thing you just do. Move one: catch an early drop with fa...

The fear of going low is real, and Neil would never talk you out of it. But it's also quietly running a tab, and the bill comes due in time in range. A 2024 study found that people with more fear of hypoglycemia dosed their meals later, and those later doses tracked with lower time in range and more time running high. Here's the part that should shrink the fear: in the studies that tested pre-bolu...

Today Neil stops saying "trust me" and starts saying "here's the study." A trial published in Diabetes Care found that dosing rapid insulin 15 minutes before a meal dropped the blood sugar peak to about 167, versus about 221 when dosing at the meal. That's a 50-point lower peak, from timing alone. Same dose, same food. Then the twist that keeps you from getting weird about it: a second study in Di...

Half the planet is watching the World Cup, so Neil explains the mechanism of the post-meal spike in soccer terms. Your food is the striker, already past the defense. Your insulin is the defender who got subbed in late and is still jogging back. That mismatch is the entire reason you spike. This is the "how it works" episode. Regular rapid-acting insulin takes about 15 minutes to start, peaks aroun...