The Glucose Never Lies® Podcast

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How do some countries consistently achieve lower HbA1c and better outcomes in type 1 diabetes while others struggle — even with the same technologies?
In this episode, John Pemberton speaks with Dr Peter Adolfsson, paediatric diabetologist in Sweden and lead author of the ISPAD 2022 Exercise Guidelines, about what actually drives population-level improvements in type 1 diabetes care.
Full show notes:
https://theglucoseneverlies.com/episode-34-building-high-performance-type-1-diabetes-care-technology-targets-and-equity-dr-peter-adolfsson/

KEY TOPICS
• How Sweden’s national diabetes registry drives accountability and rapid improvement
 • Why structured onboarding and early follow-up are essential for CGM and AID success
 • The role of national collaboration between clinics to share best practice
 • Why the highest HbA1c group should often be first in line for AID systems
 • Moving toward time in tight range (3.9–7.8 mmol/L) as the next clinical target
• Equity in diabetes technology: checking subconscious bias with real data
• Why celebrating small improvements builds long-term engagement
WHAT YOU’LL LEARN
✓ Why early investment in education and follow-up changes long-term outcomes
 ✓ How national benchmarking between clinics improves diabetes care
 ✓ Why targets matter — changing what you measure changes what improves
 ✓ How to use AID systems strategically for people struggling with bolusing
 ✓ Why the first two years after diagnosis are a critical window for glycaemic outcomes
 ✓ The importance of psychology, social support, and multidisciplinary teams
FUTURE OF TYPE 1 DIABETES CARE
• AI-supported platforms that analyse CGM data continuously
 • Clinics responding earlier when glucose control deteriorates
 • Personalised therapy combining insulin with adjunct treatments (e.g., GLP-1RA)
 • More flexible care models where stable patients may need fewer clinic visits
Disclaimer
This podcast is for education and informational purposes only. It does not constitute medical advice and is not a substitute for individualised care.
The Glucose Never Lies® is independent by design
We do not accept sponsorships and advertising. We operate via education grants and donations from listeners who value independence. So, consider:
Buying the GNL a Coffee:
https://www.buymeacoffee.com/jspfree2
Enquiries
Collaboration: John Pemberton — [email protected]
Creatives: Anjanee Kohli — [email protected]
Follow The Glucose Never Lies®
Website: https://theglucoseneverlies.com/
Instagram: https://www.instagram.com/theglucoseneverlies
LinkedIn: https://www.linkedin.com/company/theglucoseneverlies
LinkedIn: John Pemberton: https://www.linkedin.com/in/john-pemberton-587104361/
X: https://twitter.com/GlucoseNLies
Disclaimer
This content is for informational purposes only and does not constitute medical advice.
© The Glucose Never Lies Ltd. All rights reserved....

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Exercise guidelines for type 1 diabetes are built on research dominated by male participants. Professor Jane Yardley, a leading exercise physiologist, bridges the research gap between male and female exercise physiology in type 1 diabetes.

This conversation reveals why carbohydrate recommendations systematically overestimate female needs, how menstrual cycle phases alter insulin requirements during exercise, why peripheral hyperinsulinemia creates unique barriers to fat loss, and how fasted morning exercise offers a low-risk, high-reward strategy for improving insulin sensitivity and accessing fat stores.
Full show notes: https://theglucoseneverlies.com/females-exercise-t1d/

KEY TOPICS:
• Why ~60-70% of females experience luteal phase insulin resistance (10-50% increased needs)
• How AID systems struggle to keep up with rapid menstrual cycle changes
• Why per-kilogram carb recommendations overestimate female athletes' needs
• The peripheral hyperinsulinemia barrier: 4-8× higher insulin blocks fat release
• Fasted exercise: zero planning, minimal hypo risk, maximum fat burning
• Why muscle and bone health in your 20s-30s determines mobility in your 60s-80s
• Menopause transitions and accelerated cardiovascular risk

WHAT YOU'LL LEARN:
✓ Luteal phase exercise may require larger insulin adjustments
✓ Females use more fat as fuel — estrogen promotes fat oxidation
✓ Bolus insulin lasts 6 hours, not 2-4 (why "between meals" isn't truly fasted)
✓ Morning fasted exercise depletes glycogen and improves all-day insulin sensitivity
✓ How to overcome the fat loss barrier created by high peripheral insulin
✓ Why resistance training NOW prevents fractures and disability later
✓ Pregnancy exercise principles (sparse data, clear physiology)

PRACTICAL STRATEGIES:
→ Fasted morning exercise: roll out of bed, black coffee, go — no adjustments needed
→ Luteal phase: consider 60-70% basal cuts (not 50%) for postprandial exercise
→ Start with LESS carbohydrate than guidelines suggest, adjust based on YOUR response
→ Build peak muscle/bone by age 30 — you can't make up for lost time at retirement
→ Post-meal walks in pregnancy: 15-20 min keeps glucose <7.8 mmol/L
Disclaimer
This podcast is for education and informational purposes only. It does not constitute medical advice and is not a substitute for individualised care.
The Glucose Never Lies® is independent by design
We do not accept sponsorships and advertising. We operate via education grants and donations from listeners who value independence. So, consider:
Buying the GNL a Coffee:
https://www.buymeacoffee.com/jspfree2
Enquiries
Collaboration: John Pemberton — [email protected]
Creatives: Anjanee Kohli — [email protected]
Follow The Glucose Never Lies®
Website: https://theglucoseneverlies.com/
Instagram: https://www.instagram.com/theglucoseneverlies
LinkedIn: https://www.linkedin.com/company/theglucoseneverlies
LinkedIn: John Pemberton: https://www.linkedin.com/in/john-pemberton-587104361/
X: https://twitter.com/GlucoseNLies
Disclaimer
This content is for informational purposes only and does not constitute medical advice.
© The Glucose Never Lies Ltd. All rights reserved....

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The menstrual cycle affects half of people with type 1 diabetes, yet it's nearly invisible in clinical guidelines, research, and technology design. Dr. Cecilia Nobili — a pediatric diabetology resident and researcher living with T1D — bridges the gap between lived experience and clinical evidence.

In this episode, Dr. Nobili shares findings from her observational study of 170 women, revealing how different insulin delivery systems handle monthly hormonal shifts, which phases create the biggest burden, and why this represents a genuine gender gap in diabetes care.
Full show notes: https://theglucoseneverlies.com/menstrual-cycle-t1d/ 
KEY TOPICS:
• Why 60% of women on MDI experience ≥5% drop in time in range during luteal phase
• How AID systems cut glucose deterioration in half — but aren't perfect
• Why hypoglycemia when bleeding starts is often more burdensome than luteal phase highs
• Practical strategies for each AID system (780G, Omnipod 5, Control-IQ, CamAPS FX) and MDI
• The progesterone effect: why insulin resistance peaks before your period
• How to anticipate changes and adjust proactively rather than reactively
• Why this should be built into algorithms (but isn't)

WHAT YOU'LL LEARN:
✓ The five phases of the menstrual cycle and their glucose impact
✓ Which AID systems show the most stability across cycle phases
✓ Target adjustments, boost functions, and profile switches that actually work
✓ Why pre-bolusing matters more during the luteal phase
✓ How to prevent the hypoglycemia tsunami when bleeding starts
✓ Why one bad day per month is not catastrophic

Dr. Nobili's research is funded by a grant and represents the first multi-center study specifically examining menstrual cycle glucose patterns across insulin delivery modalities.

This episode provides the structured guidance that should exist in every diabetes clinic — but doesn't.

GUEST: Dr. Cecilia Nobili
Pediatric Diabetology Resident, Turin, Italy
Living with T1D 
Multi-center researcher on menstrual cycles and glucose control

Full show notes, practical checklists, and related episodes: https://theglucoseneverlies.com/menstrual-cycle-t1d/ 

Disclaimer
This podcast is for education and informational purposes only. It does not constitute medical advice and is not a substitute for individualised care.
The Glucose Never Lies® is independent by design
We do not accept sponsorships and advertising. We operate via education grants and donations from listeners who value independence. So, consider:
Buying the GNL a Coffee:
https://www.buymeacoffee.com/jspfree2
Enquiries
Collaboration: John Pemberton — [email protected]
Creatives: Anjanee Kohli — [email protected]
Follow The Glucose Never Lies®
Website: https://theglucoseneverlies.com/
Instagram: https://www.instagram.com/theglucoseneverlies
LinkedIn: https://www.linkedin.com/company/theglucoseneverlies
LinkedIn: John Pemberton: https://www.linkedin.com/in/john-pemberton-587104361/
X: https://twitter.com/GlucoseNLies
Disclaimer
This content is for informational purposes only and does not constitute medical advice.
© The Glucose Never Lies Ltd. All rights reserved....

Suggest guests or get in contact
Professor Eleanor Scott, one of the UK's leading experts in pregnancy and diabetes, provides the evidence-based roadmap that cuts through the noise. 
Full Show notes: https://theglucoseneverlies.com/pregnancy-t1d/
This episode covers the complete journey: pre-conception planning (why HbA1c <48 mmol/mol and 70% time in pregnancy range matters), the chaos of first trimester insulin sensitivity and hypos, the dramatic insulin resistance of trimesters two and three (where insulin needs can increase 3-5× baseline), and the instant drop in insulin requirements after delivery.

Professor Scott explains why the pregnancy glucose target is tighter (3.5-7.8 mmol/L / 63-140 mg/dL) — babies are extremely sensitive to raised glucose, which increases risks of miscarriage, congenital malformations, preterm delivery, and large babies requiring neonatal intensive care. She also offers reassurance: if pregnancy is unplanned or glucose control isn't optimal at conception, early intervention still makes a substantial difference. Absolute risk of complications remains around 10% even with high HbA1c at conception — not inevitable.

The technology discussion is critical: CGM is non-negotiable  But not all hybrid closed-loop systems are equal. CamAPS FX is the only system with robust RCT evidence (ADAPT trial) showing improved time in range, reduced gestational weight gain, smaller babies, and less maternal burden. It was developed specifically for pregnancy with adaptive algorithms and a personal glucose target as low as 4.4 mmol/L. The Medtronic 780G has a CE mark for pregnancy but didn't improve time in range in trials. Other systems aren't studied or indicated for pregnancy.

Practical strategies include pre-bolusing 15-20 minutes, choosing mixed meals over high-GI foods, walking after eating, moderate carbohydrate intake (30-40%), and building routine to help algorithms (and your brain) adapt to rapid changes.

For show notes, resources, and full transcript: https://theglucoseneverlies.com/pregnancy-t1d/
Disclaimer
This podcast is for education and informational purposes only. It does not constitute medical advice and is not a substitute for individualised care.
The Glucose Never Lies® is independent by design
We do not accept sponsorships and advertising. We operate via education grants and donations from listeners who value independence. So, consider:
Buying the GNL a Coffee:
https://www.buymeacoffee.com/jspfree2
Enquiries
Collaboration: John Pemberton — [email protected]
Creatives: Anjanee Kohli — [email protected]
Follow The Glucose Never Lies®
Website: https://theglucoseneverlies.com/
Instagram: https://www.instagram.com/theglucoseneverlies
LinkedIn: https://www.linkedin.com/company/theglucoseneverlies
LinkedIn: John Pemberton: https://www.linkedin.com/in/john-pemberton-587104361/
X: https://twitter.com/GlucoseNLies
Disclaimer
This content is for informational purposes only and does not constitute medical advice.
© The Glucose Never Lies Ltd. All rights reserved....

Suggest guests or get in contact
In this episode of Glucose Never Lies, John Pemberton welcomes Dr. Inge Van Boxelaer, endocrinologist and founder of Diabetotech, an independent education platform for diabetes technology. Together, they explore the critical role of education in maximizing the benefits of devices like continuous glucose monitors (CGMs), insulin pumps, and automated insulin delivery (AID) systems.
Dr. Van Boxelaer shares her journey from clinical practice to creating Diabetotech, highlighting how access to technology isn’t enough—patients and healthcare professionals need structured, unbiased, and up-to-date training. The conversation covers how Diabetotech delivers short, modular courses, device comparisons, and CPD-accredited content, helping clinicians, educators, and people living with diabetes gain confidence and improve outcomes.
Full Show notes: https://theglucoseneverlies.com/30-diabetotech-education/
Key topics include:
Overcoming educational barriers to adopting new diabetes technologies
The evolution of AID systems and CGMs, and their impact on daily management
How flipped learning and modular education can save clinician time while improving patient competency
Independent, consistent, and regularly updated resources for clinicians, patients, and care teams
Whether you’re a healthcare professional, a person living with diabetes, or part of a care team, this episode highlights why understanding the technology is as important as having it. Dr. Van Boxelaer also shares her vision for the future of diabetes education and how accessible learning can support better outcomes and fewer complications.
Explore Diabetotech and its resources at https://www.diabetotech.com/
Disclaimer
This podcast is for education and informational purposes only. It does not constitute medical advice and is not a substitute for individualised care.
The Glucose Never Lies® is independent by design
We do not accept sponsorships and advertising. We operate via education grants and donations from listeners who value independence. So, consider:
Buying the GNL a Coffee:
https://www.buymeacoffee.com/jspfree2
Enquiries
Collaboration: John Pemberton — [email protected]
Creatives: Anjanee Kohli — [email protected]
Follow The Glucose Never Lies®
Website: https://theglucoseneverlies.com/
Instagram: https://www.instagram.com/theglucoseneverlies
LinkedIn: https://www.linkedin.com/company/theglucoseneverlies
LinkedIn: John Pemberton: https://www.linkedin.com/in/john-pemberton-587104361/
X: https://twitter.com/GlucoseNLies
Disclaimer
This content is for informational purposes only and does not constitute medical advice.
© The Glucose Never Lies Ltd. All rights reserved....