Melissa Slemp has lived with type 1 diabetes for 44 years — since she was diagnosed in 1982, before glucometers, before CGMs, back when insulin came from vials and syringes and "boiling your needles" was still a recent memory for a lot of people. In this episode, she and Rob trace that whole arc: what early management actually looked like, the high-risk pregnancy she navigated in the 90s, and the moment — after more than four decades on injections — she finally switched to a pump. If you've ever wondered what it's like to hand over that much control after that much time, this is the conversation.
But the real heart of this episode is the part almost nobody is talking about: what happens to blood sugar when a woman with type 1 diabetes hits perimenopause. Melissa walks through her own experience of watching her basal insulin needs climb for no obvious reason, the years she spent without an explanation, and what she eventually learned about estrogen, progesterone, and insulin resistance — knowledge she says she had to dig up herself, because most endocrinologists and OBGYNs simply aren't trained in the overlap. That research became the reason she wrote Highs, Lows, and Hormones, a survival guide for women navigating diabetes from their monthly cycle through menopause.
Along the way, Rob and Melissa get into hormone replacement therapy, why so many women blame themselves before they ever think to blame their hormones, and the bigger pattern underneath it all: how much of diabetes research and care has historically centered men, and what it costs women when it does. There's also a genuinely great story about how Melissa met her husband, who also lives with type 1 — on the side of the road, of all places.
This one's for anyone managing type 1 diabetes as a woman, anyone who loves someone who is, or anyone who's ever felt like their body changed the rules without telling them why.
Chapters
00:00 — Cold open and introducing Melissa Slemp
01:21 — Welcome, and 44 years living with type 1 diabetes
02:24 — Diagnosed in 1982, before glucometers existed
04:03 — Reframing: the best and hardest time to have diabetes
04:59 — Growing up rural with limited access to healthcare
07:09 — Early management: injections, mixed insulin, urine strips
07:46 — A high-risk pregnancy in the 90s
08:13 — Switching to a pump after 40+ years on injections
10:24 — How Melissa met her husband, also living with T1D
13:06 — Introducing the hormone and diabetes connection
20:14 — Rising basal needs and insulin resistance in perimenopause
25:25 — Community stories and menopause's hidden career toll
29:44 — The gender gap in diabetes research
33:04 — Hormones, GLP-1s, and insulin as hormone therapy
36:03 — Advocating for yourself with doctors and specialists
