Your Best T1D Year

Neil Greathouse

Managing Type 1 Diabetes doesn’t have to be overwhelming.

Each 5-minute episode of Your Best T1D Year is packed with practical strategies, mindset shifts, and a little humor to help you feel more in control and less frustrated by diabetes.

Hosted by Neil Greathouse, this Monday, Wednesday, and Friday podcast delivers quick, relatable episodes that make learning about T1D effortless - so you can build small wins that lead to big changes.

📅 New episodes drop every Monday, Wednesday, and Friday.

🎧 Subscribe now and start making diabetes management feel easier - one small habit at a time.

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S1 · E241
Friday · 5 min
The Pre-Bolus Challenge Recap: All the Science | Type 1 Diabetes
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 science: 15 minutes early can cut your peak by about 50 points, the sweet spot is 15 to 20 minutes, and pre-bolusing did not raise lows. Plus the August numbers, 27% of meals get a late or missed bolus, a high-fat meal can need 42% more insulin, and even 20-year veterans miss carb counts by about 15 grams. Eight weeks, one real skill. In this episode: The full eight-week arc, from fear to flat lines The headline studies and numbers behind pre-bolusing The August real-life lessons: restaurants, pizza, tech, and the kids' table Proof of how far you've come since Episode 216 This Week's Challenge: Pull up your two-hour numbers from week one next to now. Compare them side by side. That difference is your receipt. Keep it. Helpful resources and newsletter: https://yourbestt1dyear.com Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1
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Wednesday · 5 min
How to Make Pre-Bolusing a Lasting Habit | Type 1 Diabetes
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 still takes effort, you're not failing, you're on a normal curve. The best finding: missing a single day did not break the habit. Neil also makes the timely case for locking it in now, heading into back-to-school season, so the new routine gets built while everything's already being rearranged. In this episode: Why habits that last are the ones that got easy, not white-knuckled The Lally study: about 66 days to automatic, and one missed day is fine How to habit-stack your pre-bolus so it survives busy seasons Why back-to-school is the perfect time to lock it in This Week's Challenge: Write down, somewhere you'll see it, the one reason YOU want to keep pre-bolusing. When motivation dips in a few weeks, that note is what carries you. Helpful resources and newsletter: https://yourbestt1dyear.com Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1
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August 24 · 6 min
What a Flat CGM Line Feels Like After Meals | Time in Range, T1D
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," "I forgot I had diabetes for a couple hours." And he grounds it in the science: a 2019 study by Beck found that every 10% you add to your time in range is roughly a 0.6% drop in your A1C, and a re-analysis of the DCCT linked higher time in range to lower rates of microvascular complications, your eyes and kidneys. That flat line isn't just a calmer evening, it's years. In this episode: Why the first flat post-meal line feels so good What time in range actually buys you, day to day The Beck study: every 10% more time in range ~ 0.6% lower A1C How better time in range protects against long-term complications This Week's Challenge: Catch one flat line and actually notice it. Don't scroll past your own CGM, look at it, and say, "I made that happen." Credit the win. Helpful resources and newsletter: https://yourbestt1dyear.com Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1
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August 21 · 5 min
Is It OK to Dose Insulin After a Meal for Kids? | ISPAD Guidelines, T1D
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 unreliable eaters. It's not a loophole, it's the guidance, built on the real risk of lows in tiny bodies. And the other direction is backed too, when you can dose before the meal, kids hit a lower glucose peak and a lower A1C, with no extra hypoglycemia. Before when you can, after when you can't, and both are in the book. In this episode: Why dosing after the meal is allowed for young kids (per ISPAD) The reason the guidelines built in the toddler exception The research supporting pre-meal dosing when it's safe Letting go of the guilt you don't need to carry This Week's Challenge: For the parents, let go of one piece of guilt. If you've been forcing an early dose and stressing about lows, try dosing right after the meal this week for what they actually ate, and bring it to your care team. Helpful resources and newsletter: https://yourbestt1dyear.com Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1
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August 19 · 6 min
Pre-Bolusing for a Picky Toddler with Type 1 Diabetes | Combo Bolus
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 rest after. ISPAD recommends a combo or dual-wave bolus for uncertain eaters, part before, the rest over 20 to 40 minutes once you see what got eaten. And there's good news in the research, a systematic review found that pre-meal dosing, when you can pull it off, lowered the after-meal peak and even lowered A1C, with no increase in lows. Keep fast carbs on the table, always. In this episode: The split-dose strategy for a kid who might not finish The ISPAD combo/dual-wave bolus for uncertain eaters The research: pre-meal dosing lowered peaks and A1C with no extra lows Why fast carbs on the table are non-negotiable with little ones This Week's Challenge: For the parents, try the split on one unpredictable meal. Dose for what you're sure they'll eat, then top up after. Notice how much less terrifying that is. Helpful resources and newsletter: https://yourbestt1dyear.com Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1
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August 17 · 54 min
Pre-Bolusing & Why Your Tech Can't Save You Alone // Natalie, Bellini, DNP
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 diabetes for 55+ years, her husband has it too, and she still uses the word pre-bolus a dozen times a day with the people she treats. This is the pre-bolusing conversation for the rest of us. Natalie breaks down why the two hours after each meal (that's six hours of your day) quietly decide your time in range, why even the best automated insulin delivery system can't catch a meal it never saw coming, and the baby-step way to start pre-bolusing when fear of lows has kept you on the sidelines. Then she gets real about the parts of care nobody talks about: meeting patients where they are, why having diabetes doesn't automatically make you a better clinician, and the screening mission she helped build with her own family's blood work. In this episode: What pre-bolusing actually is in plain English... your carbs are fast, your "rapid-acting" insulin is not, and timing is how you stop the chase Why post-meal spikes are 25% of your number, and where pre-bolusing lands on Natalie's top-four list for a 20-minute appointment The baby-step method: pick one meal (breakfast is the easy win), start with 10 minutes, split the dose, treat the high first, and know when NOT to pre-bolus "Your diabetes is a two-year-old"... why AID pumps still need you to announce meals, and what a missed pre-bolus looks like on your CGM The rookie mistake that makes people quit (too much insulin up front, usually at a restaurant), and how little swings beat big ones Her screening passion: three blood tests at ages 2, 6, and 10 can catch 80% of kids on the path to type 1 before DKA ever happens True or False, a Diabetes Confession Booth for the ages (she borrowed her husband's insulin pump at dinner... it works), and a tie of the Fastest Five Minutes world record (29 answers!) This Week's Challenge: Pre-bolus one meal. Pick a day you're not working, keep carbs within reach, treat the high first, and start with just a little insulin up front... even five minutes early counts. Trust the behavior, then watch the curve change. Slow and steady wins this race. Learn more about Blue Circle Health, get care, give care, or join the movement: https://bluecirclehealth.org Helpful resources and newsletter: https://yourbestt1dyear.com Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1
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August 14 · 6 min
Pre-Bolusing and Still Spiking? Check Your Carb Count | Type 1 Diabetes
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 that adults with type 1, averaging 21 years of experience, were off by about 15 grams of carb per meal, roughly 21% of the plate, and underestimated 63% of the time. Neil walks through the other usual suspects too, fat and protein, stress, hormones, and exercise, and how to troubleshoot with your care team. In this episode: Why perfect timing doesn't always fix a spike The Brazeau study: even veterans miss carb counts by about 15 grams The other suspects: fat, protein, stress, hormones, exercise How to play detective on one meal without changing doses solo This Week's Challenge: If you're pre-bolusing well and still spiking, play detective on one meal. Weigh or honestly eyeball the carbs, see if the count was off, and bring what you find to your care team. Helpful resources and newsletter: https://yourbestt1dyear.com Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1
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August 12 · 7 min
Fiasp, Lyumjev & Afrezza: Do You Still Need to Pre-Bolus? | T1D
"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 than half its effect in the first hour, versus about 10% for regular rapid insulin. So the fast insulins shrink the pre-bolus window. But here's the honest part: most people aren't on them, and standard rapid insulins like Humalog and Novolog are excellent. The whole point of the challenge, timing, is the great equalizer. Know your insulin, and you know how big your head start should be. In this episode: The pharmacology of Fiasp, Lyumjev, and Afrezza, in plain English Why inhaled Technosphere insulin peaks in about 12 minutes Why the fast insulins shrink, but don't erase, the pre-bolus window Why standard rapid insulins still run beautiful numbers This Week's Challenge: Know your insulin. Look up, or ask your care team, roughly how fast the insulin you take starts working. That one fact tells you how big your head start should be. Helpful resources and newsletter: https://yourbestt1dyear.com Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1
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August 10 · 5 min
Do You Still Pre-Bolus on a Closed-Loop Pump? | Control-IQ, Omnipod 5
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, the algorithm poured in about 16% of their total daily insulin over the four hours after the meal trying to catch up, and it still couldn't stop the spike. These hybrid closed-loop, or automated insulin delivery (AID), systems are reactive, they respond after glucose rises. The guidance to bolus 10 to 15 minutes early is published, not opinion. In this episode: Why closed-loop pumps still need you to pre-bolus your meals The Omnipod data: the algorithm used ~16% of daily insulin and still spiked Why AID systems are reactive, not predictive Why bolusing TOO early can backfire on a closed loop This Week's Challenge: If you're on a closed-loop system, give your meal dose about 10 to 15 minutes before dinner and watch how your system rides along. Compare it to dosing at your first bite. Helpful resources and newsletter: https://yourbestt1dyear.com Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1
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August 7 · 6 min
Missed and Late Insulin Boluses: What to Do | Type 1 Diabetes
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. Remember that 27% of meals get a late or missed bolus? Here's the kicker: young people with type 1 who never miss their boluses were 24.5 times more likely to be in excellent control than poor control. So catching a forgotten dose and taking it late isn't damage control, it's the single biggest difference-maker on the board. A late bolus beats a no bolus every time. In this episode: Real-life moves for social meals, cookouts, and buffets What to do the night you completely forget to bolus Why kids who never miss boluses were 24.5x more likely to be in great control Why consistency, not perfection, is the whole secret This Week's Challenge: Have one of those messy nights, and practice not spiraling. Miss it, catch it, move on. Prove to yourself one imperfect night doesn't torch the whole thing. Helpful resources and newsletter: https://yourbestt1dyear.com Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1
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August 5 · 6 min
Why Pizza Spikes Your Blood Sugar at Midnight | Fat, Protein & T1D
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% more insulin over the following five to ten hours and drove hyperglycemia for hours, even with extra insulin. The reason is that fat slows gastric emptying, so glucose trickles out over hours instead of arriving at once. Neil explains the tools that help, extended, combo, and dual-wave boluses, and why carb-counting math alone can't cover pizza. In this episode: Why high-fat meals like pizza cause a delayed, second-wave spike The Wolpert study: 42% more insulin for a high-fat meal, same carbs How fat slows gastric emptying and stretches out your glucose rise Extended, combo, and dual-wave boluses, explained simply This Week's Challenge: Next time you eat a high-fat meal, just watch what happens two, three, four hours later. Witness the second wave, then ask your care team if an extended bolus makes sense for you. Helpful resources and newsletter: https://yourbestt1dyear.com Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1
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August 3 · 6 min
How to Pre-Bolus at Restaurants and Takeout | Type 1 Diabetes
"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 matters, with real numbers. Researchers found that 27% of meals get a bolus that's either late or skipped, and eating out is one of the biggest reasons, because you can't time what you can't predict. A 2024 study found that later dosing meant lower time in range all evening. So "I'll bolus whenever the food shows up" isn't harmless, it's a measurable hit to your numbers. In this episode: The one rule for pre-bolusing when you don't control the clock Why 27% of meals get a late or missed bolus (ADA data) How eating out quietly tanks your time in range The "wait until you see the food" strategy for restaurants and delivery This Week's Challenge: One restaurant or takeout meal. Practice the "wait until you see it" move, dose when the food is in front of you or clearly on its way. Helpful resources and newsletter: https://yourbestt1dyear.com Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1
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July 31 · 7 min
Start Pre-Bolusing With Just 5 Minutes | Type 1 Diabetes Habit
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 the posture that makes this stick: observe, don't judge, and beat the forgetting with a system, tie your dinner dose to something you already do every night. He also recaps the whole month and previews August, where we make this habit survive real life, restaurants, the tech, and the kids' table. In this episode: Why even a 5-minute pre-bolus beats dosing at your first bite How to build from 5 minutes up to your personal sweet spot Beating the forgetting by stacking the dose onto an existing habit A full recap of month one, and a preview of August This Week's Challenge: Keep pre-bolusing dinner. Start at five minutes if that's your comfort zone, build toward your number, and stack it onto a habit so you don't forget. Helpful resources and newsletter: https://yourbestt1dyear.com Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1
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July 29 · 5 min
Why Dinner Is the Best Meal to Start Pre-Bolusing | Type 1 Diabetes
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 kills the "I dosed and the food never came" fear), and you've got time while it cooks. Then the simple how: check your number and arrow, dose about 10 to 15 minutes before you eat, watch the arrow, and eat, with fast carbs on the table as backup. Check, dose early, watch, eat. In this episode: Why dinner is the smartest meal to start pre-bolusing The four-step dinner pre-bolus routine, kept simple How being home removes the biggest pre-bolus fear What to compare against your day-one "before" number This Week's Challenge: This is the week. Pre-bolus your dinner. Check, dose 10 to 15 minutes early, watch the arrow, eat, net on the table. Then compare your two-hour number to where you used to land. Helpful resources and newsletter: https://yourbestt1dyear.com Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1
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July 27 · 56 min
Pre-Bolusing, Fear of Lows, and What Your Endo Really Sees on Your CGM // Dr. Monica Gomberg from Blue Circle Health
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. Gomberg breaks down what pre-bolusing actually is in plain English, why the fear of going low is real trauma and not weakness, and the smallest, safest way to start if you've been burned before. Then she takes the doctor hat off entirely: why she walked away from private practice to help build Blue Circle Health, what she wishes she could say in every appointment, and why the system, not you, is the thing that's failing. In this episode: What pre-bolusing is and why timing matters (hint: your food is faster than your insulin) The two real reasons we skip it... life happens, and fear of lows. Neither one makes you lazy The smallest first step for someone who's never pre-bolused: one familiar meal, a safety net, and permission to start with just five minutes When you should NOT pre-bolus (gastroparesis, high fat and protein meals, exercise timing) What a missed pre-bolus actually looks like on your CGM, and why your pump can't fix it alone, even in automated mode Why the 15-minute appointment fails patients AND doctors, and how Blue Circle Health defines care differently (community, insurance help, keeping the lights on... all of it counts) True or False, the Diabetes Confession Booth, and a new Fastest Five Minutes world record (29 answers!) This Week's Challenge: Pre-bolus dinner. Start wherever feels safe, even just a few minutes early, even with a split dose. Carbs on the table, eyes on the arrow. You've got the net now. Time to use it. Learn more about Blue Circle Health, get care, give care, or join the movement: https://bluecirclehealth.org Helpful resources and newsletter: https://yourbestt1dyear.com Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1
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July 24 · 4 min
You're Closer to Pre-Bolusing Than You Think | Type 1 Diabetes
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 like, and it's not fireworks. It's quiet. You dose a few minutes before dinner, you eat, you look up two hours later, and your number is a little flatter than usual. That's the whole event. It's a small habit, built one boring dinner at a time, until one day you forget it ever scared you. In this episode: Why you've already done the hardest parts of pre-bolusing What starting actually looks like (hint: not fireworks) How a small daily habit quietly changes your numbers Getting ready to take your first real pre-bolus This Week's Challenge: Pick the night. Find the dinner where you'll be home, relaxed, and in control of the clock, and decide, that's my first one. Don't even do it yet. Just pick it. Helpful resources and newsletter: https://yourbestt1dyear.com Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1
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July 22 · 5 min
3 Moves That Make Pre-Bolusing Safe | Avoid Going Low | Type 1 Diabetes
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 fast carbs. Move two: know when NOT to pre-bolus at all, when you're low or dropping, before cardio, when the food's timing is a mystery, or when you're queasy. Move three, the pro move: let your starting number and your CGM trend arrow set your timing. Seatbelt, airbag, backup camera. With these in place, pre-bolusing stops being scary. In this episode: The one move that catches an early low before it happens When you should NOT pre-bolus (exercise, restaurants, feeling low) How your CGM trend arrow tells you when to wait and when to eat first Why these three moves make pre-bolusing nearly foolproof This Week's Challenge: Keep the fast carbs on the table. If your number's on the lower side before dinner, eat a couple bites first, then dose. Practice "eat a little, then insulin." Helpful resources and newsletter: https://yourbestt1dyear.com Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1
S1 · E224
July 20 · 5 min
Your Fear of Lows Is Costing You Time in Range | Type 1 Diabetes
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-bolusing, the lows did not go up. Not in the big pediatric review, not in the 15-minute study. Pre-bolusing isn't more insulin, it's the same insulin at a smarter time. And in a survey of over 1,400 people with type 1, 52% said their fear of lows dropped once they felt more confident dosing. We don't bulldoze the fear. We out-confidence it. In this episode: How dosing late quietly lowers your time in range The research showing pre-bolusing did NOT increase lows Why confidence, not willpower, is what shrinks the fear Building the safety net before you start This Week's Challenge: Before you sit down to dinner, put fast carbs on the table, within reach. You don't have to pre-bolus yet. Just get used to the net being there. Helpful resources and newsletter: https://yourbestt1dyear.com Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1
S1 · E223
July 17 · 6 min
The Study That Proves Pre-Bolusing Works | 15 Minutes, 50 Points | T1D
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 Diabetes Technology & Therapeutics found 20 minutes early won at the one and two-hour marks, but 30 minutes early did NOT beat 15. There's a sweet spot, usually 15 to 20 minutes for most people on regular rapid insulin, and your exact number is yours to find. This is the proof that this one small change is worth it. In this episode: The Diabetes Care study: 15 minutes early cut the peak by about 50 points Why earlier isn't automatically better (the sweet spot explained) The 15-to-20-minute window most people land in How to start hunting for your own personal pre-bolus timing This Week's Challenge: Get honest about your natural timing right now. When you sit down, are you dosing early, late, or mid-chew? Find your starting line. Helpful resources and newsletter: https://yourbestt1dyear.com Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1
S1 · E222
July 15 · 5 min
Why Food Beats Insulin to the Finish Line | Pre-Bolus Science, T1D
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 around an hour, and lasts three to four hours. Your dinner carbs hit your bloodstream almost immediately. Dose them at the same time and the food scores before the insulin is even in the game. The fix is simply to put your insulin in first, so they arrive together and your CGM line stays flat and boring, which in type 1 is the dream. In this episode: How fast rapid-acting insulin actually works vs. how fast carbs hit The pharmacokinetics of insulin timing, in plain English Why a "flat and boring" CGM is the whole goal How pre-bolusing matches your insulin to your food This Week's Challenge: Keep watching the gap between your dose and your first bite at dinner, and now you know what it means. Every minute your insulin is behind, the food is on a breakaway. Helpful resources and newsletter Connect with Neil: TikTok | Instagram | Facebook | LinkedIn | Website Books on Amazon: Type 1 Diabetes – One Day at a Time | Type 1 Diabetes – True Stories

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