In our latest episode of The Hard Things About Healthcare, we sat down with Dr. Stephen Ponder, a pediatric endocrinologist, author, and innovator in diabetes care. With over 40 years of experience, Dr. Ponder’s perspective is crafted by both his career and his personal journey as someone living with type 1 diabetes since childhood.
Diabetes Technology: Progress and Challenges
Dr. Ponder has witnessed and contributed to significant advancements in diabetes technology over the years. From the early days of insulin pumps and urine glucose testing to today’s continuous glucose monitors (CGMs) and hybrid closed-loop systems, the progress has been extraordinary. But he reminds us that at the heart of diabetes care lies the power of human decision-making:
“There’s always been some sort of technology surrounding diabetes ever since insulin was created. That itself required technology in the early 20th century… The ability to measure sugars was done through urine testing back then… Over the span of decades, these technologies became easier to use and more affordable… But for a long time, there was very little management that was actually given to the patient or the person with diabetes or the family with diabetes. It was all very paternalistic management.”
Dr. Ponder’s philosophy of “sugar surfing,” a real-time, pattern-based approach to managing blood sugars, is a practical and empowering framework for patients and clinicians alike.
Managing Data Overload
One recurring theme in our discussion was the sheer amount of data generated by modern diabetes devices and its impact on everyone involved. While this data is invaluable, it can also be overwhelming:
“Being overexposed to data constantly… creates a lot of problems with raising children healthy, parents having good relationships with each other, communication. Being inundated with information can be a detriment, quite honestly. There’s a balancing point everybody has to reach.”
For clinicians, navigating this influx of information means focusing on actionable insights rather than getting bogged down by raw numbers:
“You can collect a multitude of data… but how does that relate to human actions and behaviors, the self-management choices and decisions that are essential to living well with this condition?”
Remote Care: Early Innovations and Modern Practices
Dr. Ponder’s contributions to remote diabetes care date back to 2006, when he developed a system allowing patients to share glucose data and receive feedback from home. Reflecting on this work, he shared:
“We experimented with this… By then, we’d actually developed a system that we could actually collect blood sugars remotely from handheld meters… We did that for several years and people could be seen in their homes hundreds of miles away… So I did the very first telehealth for diabetes.”
While he’s optimistic about these advancements, Dr. Ponder cautions against losing sight of the human element:
“Managing that information… knowing the context that you’re getting it from is also something that’s lost… Being inundated with information all the time creates a lot of anxiety in people.”
Supporting Families Through the Diabetes Journey
Guiding children and their parents through the complexities of diabetes care is central to Dr. Ponder’s work. He prioritizes creating a guilt-free environment for families:
“The very first contact I ever make with a new family is that first, there’s no guilt. There’s no guilt in diabetes… Nobody can “will” their blood sugar to be what they want.”
As children grow, transitioning responsibility for their care can be tricky. Dr. Ponder emphasizes patience and adaptability:
“Very few eight- or nine-year-olds can manage diabetes independently… It’s not until their late teens that many begin to take full ownership of their condition. Until then, it’s about helping them build the skills they’ll need.”
The Emotional Side of Diabetes
The emotional toll of managing diabetes is something Dr. Ponder sees often. He identified burnout as one of the biggest hurdles for families and clinicians alike:
“Burnout creates a lot of problems… That’s why I see that as the biggest challenge to managing diabetes. Cause you have to maintain a pace. This is, as many people have used the metaphor, it’s a marathon. It’s not a sprint. And you’re going to have some setbacks.”
By encouraging families to focus on progress rather than perfection, Dr. Ponder helps them build resilience and reduce stress.
The Role of Motivation in Self-Management
Motivating young patients is an essential part of Dr. Ponder’s approach. He shared an inspiring story of a teenage athlete who turned his management around after understanding how it could improve his football performance:
He recalls the teenager’s mom saying, “Whatever you said to him on the way back home resonated with him. From then on, he started being much more attentive to his diabetes self-care skills because it was going to help him with his football, with his football performance.”
Aligning diabetes care with what matters most to a patient—whether it’s sports, academics, or relationships—can make all the difference.
Looking forward
Dr. Ponder’s decades of experience remind us that while technology plays an important role in diabetes care, it’s no substitute for human insight and empathy.
To hear more from Dr. Ponder, including his advice for clinicians and families navigating diabetes care, tune in to the full episode of The Hard Things About Healthcare. Subscribe to Honey Health for updates and insights from leading voices in healthcare.
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