Anjanette Tan, MD

06/08/2026

the heat sign nobody warns you about. ☀️ we’re all taught to watch for heavy sweating. but in heat stroke — the most serious heat illness — the skin is often hot and dry, because sweating has already stopped. and if diabetes has affected your nerves, your sweat response may be blunted to begin with. the clearest warning isn’t sweat at all. it’s confusion.

save this one — it’s the part most people miss.
share this with someone you know has diabetes.🎗️💙

06/07/2026

06/05/2026

The vitamin D target for patients with osteoporosis is not the same as the general population target. For known or suspected metabolic bone disease, the goal is 30 to 50 ng/mL — not just 20 ng/mL.

Mineralization defects become evident below 30. Maximal calcium absorption occurs around 40.The VITAL trial found no benefit of vitamin D supplementation in people who were already near sufficient levels.

This does not mean vitamin D does not matter. It means the benefit is in correcting insufficiency, not in supplementing beyond it.
Know your number.
Dose to your target.
Recheck.

Save this and share it with someone managing a vitamin D prescription they have never had rechecked.☀🛟

06/04/2026

The bone health supplement market is large. The evidence base for most of it is small.

Vitamin K, magnesium, and resveratrol all have some biological rationale and early data — but none are supported by major guidelines for routine use. The exception is documented deficiency, which warrants correction.

Strontium supplements sold online are not the pharmaceutical compound studied in fracture trials. They have no fracture data, and they falsely inflate your DEXA score — making your bone density appear better than it is while your actual risk goes unaddressed.

Food first. Correct deficiencies. Ask before you add.

Which supplement on this list surprised you? Drop it in the comments.💬⬇️

06/02/2026

Calcium comes from your plate first. Food sources are absorbed more efficiently, arrive with supporting nutrients, and are distributed naturally across the day.

The supplement fills the gap. It does not replace the foundation.And if you have been diagnosed with osteoporosis: calcium and vitamin D are essential coadministration with antifracture therapy.

They are not the therapy itself.

Save and Share it with someone who is managing a bone health diagnosis.🦴⛑️

06/01/2026

Calcium and vitamin D are essential for bone health. They are not treatment for osteoporosis.

If you have been diagnosed with osteoporosis, calcium and vitamin D are the foundation — not the intervention. FDA-approved antifracture medications reduce fracture risk by 40 to 70 percent. Calcium supplements do not.

Additionally: most adults are already getting 600 to 700 mg of calcium from food daily. Supplementing beyond what your diet cannot provide is guideline-concordant.

Pushing total intake above 1500 mg/day increases kidney stone risk without adding bone benefit.

Food first. Supplement to fill the gap. And if you have osteoporosis — ask your doctor whether you need medication.

If you have been diagnosed with osteoporosis, are you on a prescription medication for it? Drop ✅ yes or ❌ no. This data matters.

05/30/2026

People ask if GLP-1s work in type 1 diabetes. Yes. But not just for weight loss. In ADJUST-T1D: 36% of patients achieved TIR >70%, TBR

05/29/2026

If you or your patient is starting a GLP-1 receptor agonist with type 1 diabetes, here is what the clinical trial evidence says should happen.

Insulin drops fast — at the starting dose, within the first 4 weeks. Bolus more than basal. The reduction is mostly a direct drug effect early on, not weight loss.Reduce bolus settings by 20–30% at initiation — proactively. Monitor closely for 8 weeks.

Then continue adjusting as weight loss accumulates.The AID system helps. But it works within the parameters you and your endocrinologist set. Those parameters have to change.

Save and Share this with someone you know who’s starting GLP-1.📍🛟

05/28/2026

Real talk: the drop in bolus insulin when you start a GLP-1 in type 1 diabetes is bigger than the drop in carb intake — and that gap tells us something important about mechanism.

In ADJUST-T1D: carbs down ~20g/day by week 4. Bolus insulin down 23%.
In TIRTLE1: bolus insulin down 49% by week 2.Gastric emptying slows. Meal bolus frequency drops from 4.6 to 3.4 per day.

The AID system's automated corrections were not significantly changed — it wasn't compensating for missed boluses. The bolus need genuinely fell.
The basal-to-TDD ratio shifted from 0.56 to 0.62. The whole insulin profile changed.

Bolus settings — ICR and correction factor — need proactive adjustment at initiation.
The pump works within the parameters you set. If those don't change, hypoglycemia risk is real even on closed loop.

Tomorrow: the practical clinical checklist.
Save and share this series with someone who can relate. 📍

05/27/2026

The evidence for GLP-1 receptor agonists in type 1 diabetes is no longer sparse.

It is growing — and it is specific.ADJUST-T1D. TIRTLE1. Two years of real-world data. Meta-analyses pooling hundreds of patients. These medications work in T1D, and when paired with automated insulin delivery and a structured titration protocol, they work safely.

The earlier trials that showed more risk ran without CGM, without AID, without an insulin adjustment plan. The safety profile is different when the clinical infrastructure is right.Slide through.

References on the last slide — always.
Save this. 📌
Share it with your endocrinologist if you have T1D.🩺