Tandem’s Control-IQ+ Cleared for Pregnancy with Type 1 Diabetes
Tandem announced that the FDA has cleared Control-IQ+ automated insulin delivery technology for use in pregnancy and type 1 diabetes.
That matters because pregnancy with type 1 is not just regular diabetes with a baby involved. The targets are tighter, insulin needs can change quickly, and the whole thing asks more from people who are already doing a lot.
Control-IQ+ powers both Tandem insulin delivery systems, the t:slim X2 and Tandem Mobi. Tandem says this makes them the first and only commercially available automated insulin delivery systems cleared for pregnancy use in the United States.
The clearance follows the CIRCUIT trial, where people using t:slim X2 with Control-IQ spent 12.6% more time in the pregnancy glucose target range of 63–140 mg/dL compared with standard therapy. That works out to about three extra hours per day in range. If you’ve ever stared at a CGM graph like it personally owes you an apology, you know three hours is not nothing.
This also connects to conversations I’ve had on the podcast about pregnancy with type 1, and to episode #1826, “Re-thinking Control IQ Plus Technology.”Automated insulin delivery can be incredibly helpful, but it is not magic. Settings still matter. Correction factors matter. Starting fresh when switching pump systems matters.
Tandem also noted that maternal and neonatal outcomes were similar overall between groups, but favored those using Control-IQ. That keeps this where it belongs: encouraging, useful, and real.
For people managing type 1 during pregnancy, and for the clinicians helping them, this feels like meaningful progress.
Not magic. A tool. But a tool cleared for a moment in life that deserves better tools.
FDA Expands Tzield Approval to Children as Young as One
Sanofi announced that the FDA has expanded approval of Tzield for children as young as one year old with stage 2 type 1 diabetes, with the goal of delaying the onset of stage 3 type 1 diabetes. The approval was announced April 22, 2026. Read Sanofi’s announcement.
Stage 2 type 1 diabetes means the autoimmune process is already underway, with two or more type 1 diabetes-related autoantibodies and abnormal blood sugar levels. Stage 3 is the clinical diagnosis most families recognize: high blood sugars, symptoms, and the need for daily insulin therapy.
Tzield is not a cure. It does not prevent type 1 diabetes forever. But it may delay the start of stage 3, and for families with very young children, time to prepare can matter.
The approval was supported by data from the PETITE-T1D study in children under eight with stage 2 type 1 diabetes. Tzield is given as an IV infusion once daily for 14 consecutive days. View the PETITE-T1D study.
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More from Episodes 1812 & 1813
You manage your diabetes the way you do for a reason you've probably never said out loud.
Three people. One family. Decades of silence. This is what it cost them — and what finally changed.
Crystal has had type one diabetes since she was 14. Her brother Jason was diagnosed two years later. Their father Gary had it since he was three years old.
Three people in one family. Decades of insulin, blood sugar checks, and quiet struggle. And almost none of it — ever — talked about out loud.
This two-part episode is one of the most emotionally honest conversations the podcast has ever had. It's about what happens when a disease runs through a family for generations and nobody has the tools — or the language — to deal with it together. And it's about what finally changed that.
Dad knew. He just couldn't face it.
Gary was diagnosed at age three. By the time his daughter Crystal started showing symptoms in high school — drinking 32 ounces of water before bed, stumbling to the nurse's office with blood sugars in the fifties — he knew exactly what was happening. He tested her blood sugar before they left for the hospital. It was over 500. By the time they arrived, it was over a thousand.
He cried in the ICU. He told her mother it was his fault. He never said it to Crystal directly.
"I think dad was in denial. Because it was his fault."
— CrystalTwo years later, Jason was diagnosed too. And the family did what they'd always done: they kept moving. Kept working. Didn't talk about it. Gary managed with the tools available — four checks a day, NPH, regular insulin — and terrible A1Cs. His kids watched, absorbed it, and started managing the same way.
Fear shaped everything — in opposite directions.
Crystal had watched her father convulse and knock over a lamp during a severe low when she was four or five years old. She called her mom at work. The ambulance came. She never forgot it. For the next thirty years, that fear quietly kept her blood sugars running high.
Jason, meanwhile, had figured out that he played roller hockey better when his numbers were in range. So he ran aggressive with insulin. A1Cs in the fives and sixes — but lows that sometimes dropped him to the floor. He once woke up halfway under a coffee table in his San Diego apartment, seizing, vomiting, alone. A friend happened to try the door. It happened to be unlocked.
"You're experiencing your dad get low, then hearing about Jason — keeps you a little on the high side. And Jason, your desire to be good at roller hockey keeps yours on the lower side."
— ScottSame disease. Same family. Completely different responses — both shaped by fear, neither of them spoken out loud.
Then Wesley was diagnosed at two and a half.
Jason's son. Two and a half years old.
That's when everything shifted. The family had spent years telling themselves it would skip a generation. Instead, it arrived in a toddler who couldn't describe how he felt or treat himself. Jason started waking up two and three times a night to check his son's finger. He used himself as a guinea pig — testing every new approach on his own diabetes before trying it on Wesley. He found the podcast. He found the community. He leveled up fast and completely.
And for the first time in decades, the family started talking.
"I felt that Wesley's diagnosis was a big turning point in the family — that it was okay to talk about it. Because what had always been done wasn't working for any of us."
— CrystalGary — who had lived with type one for over fifty years without ever really discussing it — started asking questions. Started seeking advice from his own kids. Eventually agreed to try a Dexcom. Then an Omnipod. Late. But not too late to matter.
He didn't die from diabetes. But it contributed.
Gary passed away two years ago. Jason believes he would have lived longer if all of this had happened sooner — if the conversation had started earlier, if the technology had existed, if someone had found the words.
That weight sits with both of them. Crystal carries the same question: if she'd pushed harder, talked more openly, would things have gone differently for her dad?
And here's the part that stops you cold: in this episode, sitting together on a podcast, Crystal and Jason realize they've never actually talked about this with each other before. Not at this depth. Not ever.
"I'm glad it wasn't just me."
— Crystal, hearing Jason describe his grief for the first timeThis episode is for anyone who grew up with diabetes in the room but never in the conversation.
It's for the person who learned to manage from a parent who was barely managing themselves. For the sibling who didn't know what their brother or sister was going through until decades later. For the parent who sees their own diagnosis repeating in their child and doesn't know what to do with that guilt.
It's also a reminder that the tools we have right now — CGMs, closed-loop systems, communities, honest conversations — are a generational leap. Crystal went from an A1C of 11 to 6.8. Jason uses himself as a test case so his sons don't have to learn things the hard way. Gary, in the last years of his life, finally let his kids in.
It wasn't too late to matter. It just would have mattered more, sooner.
"I didn't know to that depth. But I completely sympathize with it — because I had the same feelings. If I had talked to dad earlier about my experience... would he have had better control? Could we have prevented the stroke, the heart attack, that stuff.
I'm glad it wasn't just me."
I used to be a blogger or let's find out if people still read...
I get bored sometimes, but the boredom manifests as waste because I desperately hate wasted time.
Every regret I have is about time. I don’t mourn not doing something, I despise not having done it, because the opportunity to do so is lost.
I’m not a person who feels as if every moment must be electric. I value quiet and stillness. But once the moment has passed, I think about what I can’t retrieve.
Time.
When this feeling strikes, I never see it coming. It often arrives after massive amounts of effort that don’t quite bear the fruit I envisioned. Lately, I’ve been working on creating alternative learning environments for type 1, but eventually I’m met with the truth that most people will never know they exist. And even if I find a way to introduce them, an even greater percentage won’t spend the time to look.
That cycle makes me feel useless.
Not in a “my life is worthless” way, but in an “I’m wasting time” framework.
Should I do more speaking events, create more social media that the algorithms will support, do live chats online, make more content, come up with new ways to say the things you need to hear?
I don’t know.
I spend a fair amount of time reexamining the podcast for universal truths. I find them, then stop short of sharing because the methods at my disposal are designed to limit my reach. That feeling leads me to wonder if I’m overvaluing my impact.
That happened to me today, at 5 a.m.
I started to wonder if I am actually doing anything valuable enough for it to be worth the 1,343 remaining weekends I have left. I’ve already lived 29,219 days that spanned 4,174 weekends. There are far fewer of both remaining, and I don’t want to waste one.
All of this led me down a rabbit hole.
Am I doing enough with my time such that it can be considered not wasted when I cease to be here?
That question is multifaceted, of course. How have I impacted those around me? The planet? Do I take lessons after I’ve inevitably made mistakes?
I once pulled a chair out from under my mother. I was very young. I remember her falling. I remember where it happened. I remember how disappointed she was, that she was hurt both physically and spiritually.
And so I never did that again.
Is my family better off for knowing me? Do I create a better space for the people I intersect with? Have I told my children enough that they will do the same?
But what I’m talking about here is my uneasiness that I am professionally wasting time. Time I can’t spare.
I don’t know how many of you spend your days, but I work a lot. Many of the activities you may enjoy, or even need, don’t interest me. I don’t want to go to a bar or travel for the sake of traveling. I like being with my loved ones, thinking, standing outside, going for a drive.
I love people, but even in a social setting I need to feel as though my time is not being wasted.
I am, as you can plainly see, searching today for my value.
So I asked an LLM that has been fed my podcast content which phrases, specific to diabetes care, I might have coined. Then I Googled them to see if they’re colloquial within this community, or if I’ve deluded myself into believing that my impact is significant.
Before I go on, I thought it would amuse you to know that I’m beginning to think writing this was a waste of time.
Insert laughter here.
It is, at the very least, self-indulgent and, at its worst, about to appear boastful.
Time to turn this ship in a direction that has the potential to be valuable for you.
In 2018, about two years after I started Juicebox, I ran across a person online saying they were going to be “more bold” with their insulin. That was the first time I felt like the podcast was reaching people.
Today, people tell me the show has been valuable to them, but it can be difficult to personally quantify those messages.
But today, as I mentioned, I looked.
I found a mother talking about “nudging” up a low blood sugar. A blogger talking about the intention of “crushing and catching” a high BG. People still say they are being “bold with insulin.” Google references me about pre-bolusing. It references the “tug of war” at mealtime. I saw references to “stopping arrows,” using a “blanket of insulin,” and a lot more.
And still, please don’t read this as melancholy, because I’m not melancholy, I wonder what I am not doing that I could be.
Not for you so much.
For me.
So that I can stop feeling like I am wasting time.
If you want to help me feel like my time is being spent valuably, take some of yours and learn about your diabetes in a way that gives you more. More health, more happiness, more time.
Now Enrolling: Join the SEMPA Trial for Type 1 Diabetes and AID Systems
The SEMPA clinical trial (NCT06894784) is a Phase 3 crossover study currently recruiting adults with Type 1 Diabetes. The trial evaluates the clinical effect of adding semaglutide and empagliflozin to standard Automated Insulin Delivery (AID) systems on Time-in-Range (TIR). Below are the core details, timelines, and eligibility requirements for the study.
Study Overview
Study Name: SEMPA (Semaglutide and Empagliflozin Combination Therapy Added to Automated Insulin Delivery in Adults with Type 1 Diabetes)
ClinicalTrials.gov ID: NCT06894784
Condition: Type 1 Diabetes (T1D)
Purpose: To evaluate if adding semaglutide, empagliflozin, or both to an Automated Insulin Delivery (AID) system improves Time-in-Range (TIR) compared to using an AID system alone.
Current Status: Recruiting
Timeline: Started April 2025. Estimated completion in January 2027.
Interventions (Treatments Tested)
Participants will be tested with the following medications alongside their personal AID systems:
Semaglutide: Subcutaneous injection, titrated up to 1.0 mg weekly (or matched placebo).
Empagliflozin: Oral tablet, 2.5 mg daily (or matched placebo).
Study Design
Phase: Phase 3
Structure: 2x2 factorial, randomized, double-blind, crossover.
Crossover Mechanism: Participants do not stay in one group. Every participant will cycle through four 4-week intervention periods, meaning they will eventually test all four combinations:
Semaglutide + Empagliflozin
Semaglutide + Placebo
Placebo + Empagliflozin
Placebo + Placebo
Key Eligibility Criteria
Age: 18 years or older.
Diagnosis: Clinical diagnosis of T1D for at least 1 year.
Device Use: Must have been using a commercial AID system for at least 3 months.
BMI: ≥ 23 kg/m².
Exclusions: Recent use of GLP-1 receptor agonists (within 1 month), recent severe hypoglycemia or DKA, or significant kidney/gallbladder issues.
Recruitment Location
Currently, the study lists one primary recruiting location:
Research Institute of the McGill University Health Centre (Montreal, Quebec, Canada)
Contacts: * Keddy Moise (438-531-6896 / keddy.moise@affiliate.mcgill.ca)
Dr. Ahmad Haidar (514-398-4491 / ahmad.haidar@mcgill.ca)