#1970 Once You Step on the Plane
Once You Step on the Plane
Four weeks after his diagnosis in 1992, thirteen-year-old Christian flew to England alone for language school. Today he lives in Switzerland and travels constantly — and he has a system.
Jump to a moment
- He left home four weeks after diagnosis. Christian was diagnosed at thirteen in Germany after a summer of unquenchable thirst — freezing water because he couldn't get enough of it — and, weeks later, traveled alone to England for language school. His host mother was an emergency room nurse, arranged partly so it wouldn't go off the rails. He credits that trip with putting him on a path of not being afraid.
- He was diagnosed at the right moment in history. His hospital was one of the first in Germany to specialize in intensified insulin therapy — basal and bolus — staffed by enthusiastic doctors and nurses. Scott points out that a few years earlier and he might have spent decades on older regimens. He later moved to a pump to avoid injecting several times for a single meal.
- Thirty-four years, with the last fifteen in the fives and low sixes. His early A1cs were higher; routine and technology brought them down, and he's been in the high fives to low sixes for about fifteen years. He now DIY loops with Nightscout and shares his data with an endocrinologist who is open to it — she describes him to others, fondly, as the patient who does all these crazy things. What he wants next is technology that takes him out of the process, and insulin that knows when to stop working.
- His time-zone rule for long flights. The moment you step on the plane, the new time zone has started. Flying east means shorter days, so he gives long-acting earlier and aligns to the new zone; for short trips of a day or two, he stays on home time and doesn't adjust. Setting a phone to the destination's time zone helps. This is one traveler's approach — work your own plan out with your care team.
- Practical lessons from a lot of airports. Glucose tablets are fast, easy, and nobody cares about them at security. Insulin is less fragile than the packaging implies, though heat still deserves respect. He once cracked half his pods on a summer vacation because he didn't know aerosols affect the material. Scott's rule to add: if you're bringing one spare pod, bring two.
- Diabetes Pro Tip series — Episodes 1000-1025 — settings, insulin timing, and food impact.
- Juice Cruise 2027 — Travel with the Juicebox community — July 21, 2027, from Orlando.
- Juicebox Podcast Facebook group — 86,000 people who might have your experience — private, free to join.
Every word of the conversation
Cold open & sponsors0:02
Hello, friends, and welcome back to the juice box podcast. If you don't love today's episode, you can have your money back. You should not, in any way, shape, or form, take anything you hear on the juice box podcast. As medical advice, I'm talking about medical advice, regular advice, any kind of advice. This is a podcast.
Nothing you hear on the juice box podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your health care plan. I cannot stress that enough. Three fast things. Juiceboxpodcast.com/juicecruise.
Check out the cruise. T1dexchange.org/juicebox. Fill out the survey. One other thing. I don't know.
I said three things. Now I only have two things. Oh, why don't you go follow the private Facebook group and the public Facebook page? Juice box podcast type one diabetes. There's two.
You'll see. One has, like, 87,000 followers. One has, like, 30. Today, we've got a great podcast, and it's sponsored by great advertisers. US Med, the Eversense three sixty five, and Twist.
You know about Twist? It's an insulin pump. I'll tell you all about it in a second. I'm having an on body vibe alert. This episode of the Juice Box podcast is sponsored by the Eversense three sixty five, the only one year wear CGM.
That is one insertion and one CGM a year. One CGM, one year. Not every ten or fourteen days. Ever since cgm.com/juicebox. This episode of the podcast is sponsored by the Twist AID system powered by Tidepool.
That features the Twist loop algorithm, which you can target to a glucose level as low as 87. Wanna learn more? Go to visit.twist.com/juicebox. That's visit.twist.com/juicebox. And Twist has two i's.
Understand? Twiist.com. Visit .twist.com/juicebox. Hey. US Med is a longtime sponsor of the podcast.
It's where we get our diabetes supplies from. You could as well. Usmed.com/juicebox, or you can call (888) 721-1514. US Med, that's where my daughter gets your supplies. Use the link or the number.
Get your free benefits check today and get started with US Med.
Hi. My name is Christian. I was diagnosed with type one diabetes in 1992 at the age of 13. And four weeks after my diagnosis, I traveled from Germany to England without my parents for summer language school. I've traveled ever since, living and working across seven countries in three continents.
Alone to England, four weeks in2:44
Oh, no kidding. How old were you when you're diagnosed?
I was 13.
13 in '92. 2002, '12, '20 '2.
One on second. So I'm 47 now.
Thank you.
Almost thirty five years
ago. You, Christian. I see you saw me struggling. You're like, let me jump in. I
I I did the math prior to coming out of the call.
Thank you. That's awesome. I I, you know, I I just popped up your your kinda your intake here. You said maybe the funniest thing that I've that I've seen in a while, how did you put it? The how how scared people are of scanners in the airport.
Yes. Yeah.
I I I I can't wait to get to all the traveling that you do when we talk about it because I have to be honest. I I sometimes think the same thing. Like, I I I don't know exactly how to feel. Like, I don't want people to be scared, and I certainly don't want them to go against anything that might be in a package insert or anything like that. But, you know, I've watched my daughter go through, you know, hand scanning, the big body scanners, the old scanners.
Nothing's ever happened. So,
you know I totally understand why it's scary because there's so much information out there. Some it's conflicting, and it's a stressful situation. So I think if we can, you know, educate and help people a little bit to take some of the stress off, that would be very helpful.
Yeah. No. I agree. I you're not wrong either. You're standing in that line, and if it's in your head in a moment, I'm gonna walk through that scanner on the other side.
My pump's gonna stop working. My CGM's gonna shut off any of those things. I can you know, it it's a big deal. And some people are not excited to get a hand pat down either. Although I Yeah.
And in some some regions, that's even frowned upon. So I've been to airports where it's really like, really, do you have to? Okay. We have to get find somebody, and then already it's a bad situation.
Oh, they don't even wanna do it. I actually I I I almost, I almost left the airport with a date, I think, recently. So I the gentleman gentleman was very thorough. He found he found everything and there was nothing to find. So
Well done. Yeah. Yeah. Yeah.
So tell me a little bit about being diagnosed back then and what it was like growing up with type one.
Diagnosed at thirteen, in 19924:55
When I was diagnosed, think, 9010, '92, you know, I was a skinny teenager, tall, not lots of skin on my body, and I was physically very active. I was playing soccer. I was playing basketball. And, you know, I've heard it so many times, but people attribute that then to the symptoms that are coming up. And I had experienced lows during school.
I didn't know what it was at the time, but I realized afterwards that I I was having lows. So there was something going on already in my body, maybe one or two years before that. And then at the beginning of the year around February, I had a really bad virus infection. I remember that. I was really knocked out cold for two weeks, feeling really, really bad.
I can't remember what it was. But then a few months later, late spring, early summer, remember the weather getting hot, and I was doing lots of outside activities, and I just started getting really thirsty. And then the peeing started, the weight loss started. And my parents recognized that something was going on, but they kinda assumed it was from the sports and that they thought I was maybe doing too much exercise. And looking back, all the obvious signs were there, but nobody was around knowing what these signs meant.
I remember putting water into the freezer to freeze it over because I couldn't quench my I was so dry in my mouth. I was literally drinking ice cold water and not being able to quench my thirst. And that's been going on for a few weeks. And eventually, had other friends pointing it out to me. One friend said, you've just finished a quart of milk in one zip, in one go.
What's going on? And that's when I started feeling really uncomfortable as well. And then eventually I got those those flu like symptoms. I got really tired and I stayed at home for a couple of days. And eventually, one night after my parents had gone to bed, I started being really sick to the stomach and only bile came out.
So the body clearly was reacting to something. Something wanted to come out. And I went through this for a few hours. And then early morning, I woke my parents in the middle of the night cause I was feeling so bad. And my mother looked at me and she told me afterwards she saw my chest and hip bones showing out.
They were protruding from under the skin because of all the weight loss and the dehydration. So she rushed me to the ER where I was luckily immediately seen by the head doctor. And what I remember was that he bent over me and he smelled my breath and he said, this is likely diabetes. And then I passed out. That was the last thing I heard.
Really? Oh my gosh. Yep. How long were you out?
I didn't know what it meant.
Yeah. Of course. Well, you didn't have time to wonder either. How long were you out for?
Than twenty four hours. So I I got to some point the next day.
Oh, it still feels like a lot. It feels like such a long time to to be on your your parents must have been beside themselves.
Yeah. The my my mother was was terrified. And when I woke up, then I was in the ICU, and then I learned that I had a glucose level of around 700 plus. I can't remember the exact number. Obviously, was in severe DKA.
So there was a lot going on, but luckily I made it in time.
Right.
And then I got hooked up to IV for fluids and nutrients at least for a couple of days just to get my body back to to a normal functioning.
It's interesting. You were pretty thoughtful about the process even at a young age, the way you were thinking it through and talking about it and and even your friends. I mean, when when you're counting on, you know, young boys to to notice things are different, That's, sounds like a a fairly, adept group of kids for some reason. Would you guys all grow up to be engineers or rocket scientists or something?
I don't think any of us are rocket scientists, but, I did have some or still do have some very smart friends. Interestingly, the girl that pointed out to me, not one of the boys, so she was mostly the the most empathetic of the group. Mhmm. And I I think for them, it was just weird, you know. Me seeing me standing in front of a fridge downing a full quart of milk like it was nothing.
Yeah. And they they found it funny, but also a bit disturbing.
Jeez. That's something. Diabetes, as you know, comes with a lot of things to remember. So it's nice when someone takes something off of your plate. US Med has done that for us.
When it's time for Arden supplies to be refreshed, we get an email. Email just rolls up in my inbox. It's like, hey. This is, you know, time for your supply order. I don't exactly know what it says.
Open the email. There's a big button. I click on it. I reorder, and I'm done. Finally, somebody taking away a responsibility instead of adding one.
And boy, oh, boy, has US Med done that for us. An email arrives, we click a link, and the next thing you know, your products are at the front door. That simple. Usmed.com/juicebox or call (888) 721-1514. I never have to wonder if Arden has enough supplies.
I click on one link, I open up a box, I put the stuff in a drawer, and we're done. US Med carries everything from insulin pumps and diabetes testing supplies to the latest CGMs like Libre three and the Dexcom g seven. They accept Medicare nationwide, over 800 private insurers, and all you have to do to get started is call that number, (888) 721-1514, or use my link, usmed.com/juicebox. Using that number or that link helps to support the production of the juice box podcast. This episode of the juice box podcast is sponsored by the Eversense three sixty five.
Get 300 and get three hundred and sixty five days of comfortable wear without having to change the sensor. When you think of a continuous glucose monitor, you think of a CGM that lasts ten or fourteen days. But with the Eversense three sixty five, it lives up to its name, lasting three hundred and sixty five days. That's one year without having to change your CGM. With the Eversense three sixty five, you can count on comfort and consistency, three hundred and sixty five days a year.
Because the Eversense silicone based adhesive is designed for your skin to be gentle and to allow you to take the transmitter on and off to enjoy your shower, a trip to the pool, or any activity where you don't want your CGM on your body. If you're looking for comfort, accuracy, and a one year wear, you are looking for Eversense three sixty five. Go to eversensecgm.com/juicebox to learn more. You still friends with these people?
Yeah. Most of them.
No kidding. That's pretty cool. Out of the hospital, do you remember what the marching orders were? Like, what is it like, what were your goals? What were your your targets?
Yeah. The first thing I remember in the hospital, in the ICU, was maybe a day later. A nurse came up to me and she told me that now it's time to inject myself with insulin for the breakfast. And I said, what? What's what's happening?
I don't think anybody so far had properly told me my diagnosis. And I told her, no. No. This is not happening. And she was the one then explaining to me, you know, if if I wanna eat, I need this injection and that's how it's going to be the rest of my life.
“That's how it's going to be”12:27
And that was my first confrontation with a new situation. What is So I took the jab or she gave it to me.
Yeah. I was gonna ask what that confrontation feels like internally.
It was really weird at the time because I didn't understand the implication or the the vastness of the consequences. But at the time, my reaction, I say it was more like, okay. If if that's how it is, you know, authority figure, then that's that's how it's gonna go.
Okay. Okay. You're not not a lot of, like, internal struggle or just you you needed somebody to put it to you once you understood you okay. This is what I'm gonna do. I'll move forward with this.
Yeah. And I remember, like, over the next few months, several doctors telling my parents, you know, there's going to be this reaction and Christian is gonna throw everything away and say, I'm not having this disease. I don't care any longer. That interestingly never happened for me. So I think I was accepting quite quickly, and it never really changed.
You know, there's fatigue and all that that comes with the disease, but I I never got to do that situation where I just rejected it outright.
How often do you think the fatigue comes and how long does it stay?
I didn't really think about it maybe for the first twenty years or so, but now it's something that I think about more often. And, you know, I I love all the devices that I have now, but part of that fatigue comes from having the devices and comes from having the information and and the frustration that comes with, you know, not having that great glucose level that you were looking for after lunch.
Mhmm.
So I would say more fatigue now than in the past for sure.
Okay. Is your health better, but the fatigue is different?
It's mental fatigue. Yeah. It's it's it's this exhaustion of having to deal with it all the time.
Are there ways to give it away for stretches of time or no?
I haven't found them. No. I I would say I'm I'm quite serious about managing my diabetes or at least I have been for for the last decade or so. And I I want to be in good control. I want to have good outcomes.
And that also then requires me to deal with it quite regularly.
So when it's not a in stretches of time when it's not a burden, are you paying less attention to it? Are you willfully putting it out of your head? How do you how do you make the gaps?
I think the burden comes from not achieving my goals. So having diabetes, I've I've had it for forty years almost, so that that's that's not the issue. And it's knowing what can come with bad control, understanding the consequences, aiming for good a one c's, and then, you know, having lunch and running back with a 200 blood glucose level and not knowing why that happens even though you've done it a 100 times the same thing. That's what's exhausting me.
The genuine you're genuinely trying. If the outcome isn't where you'd like it to be, where you expect it to be, or where you've seen it go in this the same situation previously, then it makes you think about long term issues, and that's the drag.
Part of it. I think it's it's mostly frustrating for me. So, you know, having a certain food, knowing how to manage that, eating the food, and not ending up where I want to be. And seeing it on the graph, you know, that you got the the double arrows going up or down and trying to manage that, knowing the roller coaster is coming and maybe not being able to get out of it quickly enough, that I find exhausting.
Do the people around you know this is happening to you?
In a limited degree. So I've always been very outspoken about having diabetes and what it means, but the daily ins and outs, I'd say even my family only have a limited understanding of how it feels like.
How old you have children?
Yes, I do. My wife and I, we have three children. The oldest is 14. His name is Lucas. And then we have two girls, Laura, who is 13, and Lily, who is eight.
How much to share with his wife16:37
If you let your wife in to the depth of how this feels, would that be comforting to you, worrisome? Why doesn't she have that kind of access?
I've always been private about the numbers or or where I am with it. I don't think I wanna bother anybody too much with it. I I don't think she would mind necessarily, but I've I've never done it that way. And we've been together since we are 17 years old, so I think we are a little bit past the point of of me letting her into bed.
Well, what she she'll hear this. Right? Yeah. What do you think her reaction will be?
I don't know.
I don't either. I'm super interested.
It's it's yeah. It's it's interesting to find out. Right.
Yeah. I mean, is she going is she gonna come to you and say, you you should tell me everything. I want to know. Do you think she'll just stand back and respect the fact that you haven't come to her? And I I just the the thing I wonder about is is, like, what happens at the end when eventually something like this comes out and you realize that the person you were with wanted to know and would have liked to have known, it could have unburdened you.
You could have done it more together, and now it's too late and you can't go back. That's the feeling, the the too late feeling is that I worry about.
Yeah. I don't know. I that's that's not the worry I have that that she feels excluded. We we talk about the disease occasionally and, know, especially if I'm having a rough day, I share that with her. But what I don't do, for example, share my DexCom results with her.
She has a life on her own. She's traveling also a lot for work. So from a practical perspective, I never saw much value in sharing that with somebody in my family because they wouldn't be physically around in case something actually happened. And also because I've been growing up with diabetes many, many years before that technology, I never felt the the need of having that information shared to anybody else. So I might be a bit old fashioned that way.
May yeah. Maybe. So if you get very low, no one is warned but you?
Well, only through the beeping. So for example, at night if something happens, then, of course, all my devices starting going crazy. And then my my wife wakes up and and wakes me up if that is necessary.
There's no value in her having a follow-up that just has a 55 alarm on it? And then if you get, like, urgently low, she'd know?
I never saw as really valuable for me because we don't spend much time physically together, and I'm very sensitive to lows. So I I don't sleep through lows. For example, I wake up fairly early on. Mhmm. And that way, I can pretty much control it myself.
Yeah. And she's traveling a lot. I'm traveling a lot. So she she might get alarms at all sorts of times that I can easily manage myself.
Okay.
And and that's why I never set it up.
Has it ever been an issue? Have you ever been in a situation you couldn't help yourself?
Only twice in the thirty five years.
Here's what makes Twist different. It measures the volume of insulin delivered with every dose using Soundwave technology. That gives it the ability to recognize a blockage quickly, allowing you to step in and deal with it before things potentially get out of range. It is also the only automated insulin delivery system that can be controlled from an Apple Watch, so you can discreetly check-in, enter carbs, or deliver insulin right from your wrist. You can also set your glucose target anywhere from 87 to 180 milligrams per deciliter and adjust it for different times of day.
So if mornings, workouts, schoolwork, or bedtime all need a little different approach, Twist can flex with that. And here's a real life example. You enter carbs then something changes and you do not actually eat what you planned. With Twist, you can go back and correct or remove the carb entry and the system adjusts based on the new information because diabetes doesn't always follow the plan, and your tech probably should not expect you to either. If you'd like to learn more, go to visit.twist.com/juicebox.
That's visit.twist.com/juicebox. Don't forget, Twist has two i's.
And both of the times she was with me, and she was able to help me.
And she helped you. I I wonder, people who haven't been married a long time don't know what you just said. I bet you're not physically together very often. I I there are days that I'm in the same house with my wife all day long, and I don't see her for ten minutes.
Mhmm.
Yeah. It's it's No.
No. That's possible. But it's also she has a job where she needs to travel a lot. And just, you know, being physically in the same country is mostly on the weekends, not during the week.
Interesting. Yeah. It's something. Your children, have they been tested for antibodies? Is that a thing you ever thought about or or or considered?
Yep. My oldest was tested a couple of years ago. He started reporting something that I thought might be hypos and, you know, remembering my own hypos before my
When one of the kids had symptoms22:01
Your diagnosis.
Being diagnosed. Exactly. And that made me nervous. So I took them to the doctor and and they checked them out. I put a Dexcom on them for a week or so.
All the stuff that freaked out type one parents do with their kids. And the doctor eventually said, okay, let's just do a test, see if anything's coming up. None of the five reacted, so he should be fine as far as we know now. I might do it also for the girls when they grow up a little bit. But so far, they don't show anything whatsoever.
That's good news. Other autoimmune for you or your family members?
Not for me. My older sister so I have two siblings. And my older sister, she used to have or has thyroid issues. I think it's hypothyroid, but I'm not sure. And my younger sister has clinical depression, which is not necessarily an autoimmune issue, but I know it's linked to that.
I've heard quite a few people talking about that on your podcast, so I found that interesting as well.
Your parents' celiac, thyroid, anything like that?
No. Nothing that I'm aware of. Also, in the wider family, seems to be really just me with diabetes and and the the hypothyroidism, my sister's side.
Just something special about the pairing of your parents, I guess.
Yeah. Probably. Yeah. Well They tried their best.
They tried their best. Can you imagine? Can you imagine if that was a prerequisite for dating? You know, you had to get screened to see if you had autoimmune issues before you got together.
I wouldn't be surprised if that's happening in the future at some point.
Yeah. Well, listen. I've You
know, bring your DNA to the first date.
I've told both of my kids. I was like, if they have any sketchy autoimmune things and you're not interested in raising a buy a baby with diabetes, I would I'd slow down a little bit. The the, your I'm sorry. Your kids, don't have other autoimmune stuff either. Generally healthy.
Not a thing you're thinking about totally. Okay. I think I got all that. Tell me about how you manage today and how that's changed over the years. So you're using a CGM and a pump, I imagine?
Yes. I do now. But I've only done that now for the last ten years maybe where I started with CGM and then later on moved over to a pump as well. So when I started in 1992, that was just around the time when a big study came out. It was called diabetes control and complications trial, DCCT.
Does that mean anything to you?
I I don't I know the time frame, but I'm not I didn't know about the study.
No. So essentially, that study was the first big longitudinal study that showed over many years that you would get much better treatment results when you actually manage your diabetes with basal and bolus. And not the old, you know, once a day or twice a day and then regulated mealtimes, etc. And I was lucky in the sense that when I was diagnosed, my hospital was one of the first hospitals in Germany to specialise on intensified insulin therapy. So effectively what we now know is basal and bolus.
Early to intensified therapy25:22
So they started me out with ACTRAPID and Protophane, I think it was called, from Novo Nordisk and having to test my blood sugar four to five times per day. And that was new at the time. So that was the cutting edge of science. And they kept me in the hospital for about two weeks to teach me about carb counting and insulin. Right.
And all the things that we now take for granted. And because it was new, I had really excited and enthusiastic doctors and great nurses teaching me lots and lots of things that I really benefited from. And I stayed on MDI for the majority of my care all the way through school, all the way through university, later on work. And also because I always felt I don't want anything on my body. I want to have physical freedom.
I'm doing fine with the needles until eventually my body started to really change in how I process especially fat and protein. Mhmm. So I needed to have, you know, double boluses and so on to cover these meals, and I got so fed up with having to inject me multiple tiles for one meal that I eventually considered a pump.
That's the only thing that moved you over to it?
Mostly. Yeah. Yeah. Well, for me, it was, you know, I looked at pumps maybe twenty years ago and the the doctor told me, you know, here's this pump and you need to change the insulin every twenty four or forty eight hours. You need to change the tubing every seventy two hours.
You need to change the battery every forty eight hours. Now this is way too complicated for me. And that basically stopped the conversation then for another ten years. And then when I came back to it, there was at least the Omnipod. And then I was looking to get something, you know, which was not an additional device that I needed to carry.
And eventually, technology progressed to a point where I felt, oh, this is kinda neat. I just slap it on my arm. I have everything on the phone. I can run with this.
I think it's interesting to to realize that wherever you get put in the beginning is where you generally stay and that it takes something or a lot of time to move you along. And to say that Yeah. If you had been diagnosed just a few years sooner before the basal bolus idea, you could have been regular in Miles per hour for those fifteen or twenty years.
Yeah. And that's the scary thought. Right? Yeah. You you really need to push yourself sometimes to make that step in in technology or in in the way you manage it and and get forward.
You have to pay attention to how things change. Resist the urge to jump at everything, but be able to step back enough to see a big picture and realize when things have taken a leap and you've been left behind. It's, not easy to do because who's gonna tell you about it? Right? You you know what
I mean?
Yeah. Like, your doctor's gonna say, you're fine. We don't think about we don't think about Christian anymore. Christian comes in, does great. We say, yay.
Good job. Move you on the way. Make sure you have your prescriptions, etcetera. No one thinks they go, oh, wait. We've changed how we've done everything until there's some giant push from organizations to move people, you know, like you talked about into pumping, for example.
And, you know, and some doctors' offices will ignore it. Some will never hear about it. Some will decide not to tell you about it. You don't know who's who. And it it's a I listen.
I'm particularly I'm particularly touched by this because as I've shared on the podcast, I think a fair amount of times when right at the end of my high school career, which would have been around '88, '89, my friend was diagnosed with type one. Yes. And he's he's just not here anymore. He you know, he he lived regular in Miles per hour for a long time. A long, long time.
I didn't even realize. And when they finally tried to get him to just go to MDI, it was completely confusing for him. And he was causing himself to be low all the time and having different issues. He was having, you know, episodes and falling out of bed. He crashed his car.
He had all kinds of problems. And and then, you know, before you knew it, his, you know, his kidney started to have issues and then his heart. And and and I just as as you're talking, I think I'm thinking about Mike, and I'm thinking, gosh. If he was diagnosed four years later, he would have been on the other side of that curve. Isn't interesting?
Yeah. Yeah. It's just really something.
That's a scary thought. And back in the day, if if your doctor didn't tell you, you didn't have any opportunity to find this out yourself. Sure. And these days, we have all these opportunities to learn if we want to. And this is just ads, you know, you can hear about five different CGMs, you know, just listening to your podcast, maybe.
And, you know, that's already great information that there is choice. You know, not everything is for everybody. I've tried things and felt, okay. I don't wanna use this, but I found something else that works instead. Yeah.
And I speak to so many people who say, I've tried this once. I didn't like it, and then I stopped. And then then you don't move forward, and then you get into all these problems that you've just mentioned.
Well yeah. And that's the next problem is that there's, I mean, five things to try, three CGMs, you know, all this other stuff, and you make you you finally get yourself to move once. And if you don't land on something that's great for you or if you don't even I mean, maybe it was great for you and you just didn't know how to accept it. There's a lot of things that could happen in there. Right?
And then you'll shut yourself back off for ten years again. And and then, oh, I'll just I'll put my head down and keep doing the thing I do. You know? And I don't know. It's a it's a really I'm going to say scary, but I think there's a bigger word that I can't find.
It's it's incumbent about it's incumbent upon somebody, and I don't know who that somebody is, to keep saying this stuff out loud so the next person can hear it so there's not a giant gap in time. I I just I the way I've learned to say it is that I I don't think you wanna wake up one day and realize everyone's doing it differently than you.
Wake up and everyone's doing it differently31:27
That's probably Then you're stuck.
Right.
If if if you're if you're the last one, you probably won't change. And if there's comfort in the continuity, right, that's why people also don't change because they know what they're doing or at least it's less scary than the unknown that they're faced with. But I totally empathize with what you're saying. And and for me, it it was an endocrinologist who kept on saying, well, how about that pump? You know?
Wanna have another look? And and eventually, I was ready for it.
Yeah. Mike Mike wouldn't wear a CGM. I tried really hard to get him to wear one, and he just he wouldn't have it. And now he's shooting NovoLog, and I don't even know. He's probably using Lantus.
I'm not sure. And but he was shooting it like he was like, it was still old school. So, you know, then, you know, he used to you know, the way he had his car accident is he was, you know, he's out getting his books. He's a comic fan. He's out getting his books one Saturday morning and, you know, decides he's gonna go to the diner after this like he does every Saturday by he's out by himself and, does what he always does.
You know? He would have shot his insulin and, you know, at forty five minutes later, sat down at the diner and ate. And, you know, now he's using NovoLog. Yeah. And it was too late.
And the reports had him 90 miles an hour down a a residential street disappearing into a cul de sac coming back out crashing into somebody's front lawn, you know, and he's lucky he didn't die that day.
So Yeah. That that sounds like a very confused man.
Yeah. Didn't know what he was doing. He'd been doing he'd been doing one thing for decades, and then someone without any direction just said, here, use this now. And he applied old ideas to new, you know, to new tools. Didn't work.
He didn't know what he was doing. He got caught in that loop where he was just chasing lows and panicking and not knowing what to do and, you know, it's just it's it doesn't need to be that way, I guess. So Yeah. Yeah. Anyway
I started out with a with a freestyle Libre in my late thirties about ten years ago, And I was amazed when I when I first laid my hands on that. I remember paying for it out of pocket because I just wanted to have it. That was such an improvement in quality of life, not having to prick my fingers five times a day, getting to see the curve, you know, and understanding timing and amount. And, you know, you always say it's that simple. Right?
That's that's all that it is. But this was the first time I could actually see, oh, if I do something now, it has an impact later. How can I bring these two together? So that was for me really a game changer.
And that was the you had to scan that one to get a number. Right?
Yeah. At the beginning, you have to scan that. And then a little later, they moved it onto the phone and then you could just scan with the phone. But even that was amazing at the time. You know, now it's all automated.
But I think the big step was then really just just see the graph over time throughout the day.
What do you hope happens next when you look at your technology? What is what's the next thing you'd like somebody to give you?
That's a difficult question. In the short term, I think better devices, all of them, you know, have their quirks and and could be improved upon. On the long term, I would love to something that love to have something that's so automated that I no longer have to worry about it myself. So right now, with the Dexcom and the Omnipod, I use Loop, and that's pretty dialed in, but it's it's still, you know, fairly intensive daily management. You need to know what you're doing.
What he wants next35:05
You need to put into the carbs and all that. And I would love to get to a point where I can eat and the system recognizes something is coming in and does it in a quick enough way that, you know, the reaction is fast enough. And the other thing I love to see, and I've I've read that once in a research paper a couple of years ago, there's a UK company that has created insulin that basically can shut itself off after a certain glucose level. So if you drop below, let's say 55, the the insulin that is still in your body would stop reacting and stop being used up. And I thought that's such an amazing technology because it basically would get rid of the lows.
And if if we can get that done, that would be amazing.
The idea of smart insulin. I haven't heard people talk about that in quite a while. That was a a a big push, I'm I'm gonna say, like, ten years ago now, where that's yeah. Well, we just shoot it in there, and it works when you need it. And when it doesn't, it shuts off, it'll and be like having a pancreas and everything.
But is the thing you read more recent, or do you think it was older?
It was more recent. It was maybe a couple of years ago, company from The UK. They said they have a breakthrough, but it was all on the academic side. Right? So not on a viable product side.
Yeah. Well, I mean, that's the rest of it is all that research that has to go in and people, it has to be viable enough for them to keep working on it and And and, you know, and then the and then the industry will change. GLPs have changed the industry now. Right? There's such a focus on on those medications now, and I wonder how many things get dropped along the way and never get figured out because I yeah.
I don't know. Smart insulin would be awesome. But if that happens
would be awesome.
I'd I'd be stunned. But I I appreciate the idea of, like, if you're asking me what I want, I want I want technology that works more quickly, that takes me out of the process, insulin that knows how to not make me low. So what you're telling me is those the the pain points that you mentioned earlier about, you know, having to be involved and being low. Those are your two things that you'd love to change. Yes.
Yeah. I can't see a different argument, really. Don't get high. Don't have to think about it. Don't get dizzy.
Yeah. Somebody That's almost perfect. Yeah. Somebody do that for me, please, quick. Yeah.
I'd love to give that one. Last night, Arden was I was working late, she passed by my door. I tried to talk to her, and she was, I I I can't talk. I'm low. And she was going downstairs to get food.
And even though she went downstairs, I heard her laughing. She came back up. She went to bed. She was fine. I think her blood sugar went up to, one thirty.
It leveled back out and came back down overnight. It's to hear you talk about it gives me some context about what that's gonna look like, you know, thirty five years from now. And it's gonna look like no matter how well I'm doing or how intelligent I am or how much I understand this, that burden's gonna be a burden. It doesn't stop because I do a good job of it or because I understand what's happening to me. It's still a burden.
Yeah. And I think as as long as we don't have something like the functional cure from the addendum trial actually being a real thing, it's going to stay that way. And I think it's, you know, it's much, much better than it was forty years ago, twenty years ago, ten years ago. So we're definitely progressing in the right direction. But in the end, it's something we have to deal with, and and some of us deal with it better than others.
It's probably also very different if your child has it. Probably heartbreaking hearing your children saying these things, and you don't know what you can do in that moment to help them. But, you know, they also will figure it out for themselves.
That's what I'm starting to believe. Yeah. How about that? Well, tell me, I guess, how the process of growing up, did it have any impacts on your long term health? Do you have any complications?
Did you get lucky? How did those years go?
For the most part, I got lucky. Just now I'm starting to see sort of the first signs of long term effects. I can see my digestion slowing down. My doctor wants to test me for Graspoperides. And I also feel now much more sort of coldness in my feet.
Neuropathy is a topic that I need to discuss. Mhmm. And I still feel really well in my feet. It's just that they cramp, they get cold, and my doctor said that's possibly one of the side effects of diabetes.
Oh, jeez. And how old are you again?
47.
47. Do you have any idea what your a one c's were were like in the first twenty years?
Three decades of A1cs40:07
Yeah. So mostly for the first five years, they were in the seventh. Then later on, when I then sort of finished high school, went off to university, they got worse, probably in the high sevens, in the eights. You know, the entire lifestyle took a toll on my diabetes management. Too much fast food, too much alcohol, too much fun.
And then when I was in my mid twenties, probably, you know, started working properly, had more of a routine. I went back into the sixes. By the time I was living in The UK, I had a very nice sort of general practitioner doctor who was supporting me, basically saying, you know, you have a a one COf six Something. That's all good. Do what you need to do.
You know more about this disease than I do. That was the care at the time. And then a few years later, I moved to Switzerland. Here, we have a very good health care system. I found a good endocrinologist who was also pushing me a little bit.
I'm expecting a bit more from me. And now for the last fifteen years, I was in the low sixes or high fives, five eight, five seven, usually around that. And I'm quite happy with that.
No knowledge of variability back then, though. If you had a seven A one C, you don't know how you came by it. Were you low a lot? Or do you think you were very variable?
I was quite variable, and that was always my main challenge. That was then where where I'm having a CGM really helped me because I could see things change over time and react more quickly. In the past, I was yo yoing for days simply because I figured couldn't figure out what was going on. And, you know, I would crash. I would eat something.
I would go up again. I would try to counter it again. And that's something which I can control much better now with the existing technology than I did in the past.
With your hindsight, have you gotten have you get a pump or a CGM more quickly than you did?
Well, I I got the CGM, I think, quickly as as they got up here in the market. Mhmm. And then when I when I got the pump, I didn't really see that having a big impact on the variability. It it really helped me with some of the foods and and the digestive issues, but not so much with the variability.
I see. So the the CGM taught you what you need to know. You were accomplishing it with a pen or injections or something.
Exactly.
Yeah. Then you gotta start making a bunch more injections around meals that irritates you. That puts you to a pump. When do you go to looping? When do you try AID?
I started about three years ago.
Oh, okay.
And quite quickly after having the pump. So that was really my aim. I said, I want I want to have this pump, and then, you know, as as soon as possible, I want to change. And at the beginning, the technology wasn't right because you needed to have another link in between that I couldn't get here in Switzerland. And eventually, they said, now we can do it through the iPhone.
And as soon as that happened, I jumped on loop.
Your doctor told you about looping?
No. I found that myself. My doctor is quite open to it. So when I started looping, I set everything up including NightScout, and I I shared my access details with my doctor so she can see what I'm doing there. She's not super involved on that side.
I think she she leaves that to me, but she appreciates me getting into that. And, you know, it's she learned something from that as well when I tell her about the new algorithm experiments that are coming. And over time, we've developed a good report on that.
Nice. Do you think you helped her to tell other people about it, or is it just a thing you guys do together?
I I do think she talks about it to other people, but more in the sense of, you know, I have this one patient who does all these crazy things.
Have I told you about Christian? It's interesting, but she sees your outcomes and and, I mean, you're you're clearly doing better now than you were before. Is that right? Like, outcomes wise? Say so.
Yeah. What about
So if you look at
Go ahead.
If you look at a one c, certainly, I went, you know, with a pump and then later on with with a loop from the low sixes to the fives. So there there was an improvement. And she sees that and she appreciates that, which, you know, allows me a bit more freedom. Know? So in the past, she wanted to see me every three or every six months, and now she says, okay.
As long as everything is fine, you know, come by once a year to renew your prescription for everything else. Just text me or send me a message.
You said earlier about going away to college, and I wonder, you you know, knowing yourself back then and being older and smarter now, is there anything that, like, today you could have said to that kid back then? Like, hey. Would you like your feet to be warm when you're in your forties? Or, like, is there would there have been any way to get through? I realized that that kid didn't have the tools and the technology, but he also didn't know what was happening.
Do you think there would have been any way to explain it?
I don't think so.
I don't either. Yeah.
It's it's it's super hard. I mean, I I think for the situation I was in and the tools that I had, I did quite well even at the time. And when I listened to the friends around me, they always considered me to be quite a conscientious diabetic, even though, you know, I did as many silly things as anybody else, whoever was on the podcast. But overall, I think I always took it serious, and I was always nervous about long term complications. So I wouldn't just ride high for hours on end and not be bothered.
So if if my blood sugar goes up, I want to act to get it back down. And that was always the case for me. On the other hand, I think what I didn't understand then and what I do understand better now is how the disease over time just impacts you mentally and physically. And that's not something you can explain to a 20 year old. You know, you're you're in that state of your life where you're amazing and life is endless and you have limitless energy.
And you don't sit down with this kid and tell him, you know, worry about this and worry about that. That conversation is not working.
And I wonder what it would even do. Like, say you could get through to that kid. What would that would there be a benefit in that or not necessarily, or would it be, you know, person to person? It's I I guess I'm I'm trying to, like, listen to your story, and you're a thoughtful guy, and you've been paying attention to this for a long time. You know how you feel.
You know what's happened to you. I'm wondering if you have any advice that would help somebody in that new situation now, but I I it does feel like a it does feel like there's no way to answer that question or or to come up with something that would just, I don't know, be, like, super impactful to a younger person.
Yeah. When I when I do speak to people who who've just started with diabetes, mostly I direct them to you because I think you can distill things in really good way when talking about it, especially when, you know, in your earlier episodes when you talk about how your daughter grew up with diabetes. I think this is extremely helpful for parents who have young children with diabetes, just to take that fear away. And that is maybe one of the main positive aspects looking back over the last thirty, thirty five years. I didn't have a lot of fear that was stopping me from doing something.
You know, I was concerned about a lot of things and I needed to take care of a lot of things. But I was never so afraid that I wouldn't live my life. And I see many people who are diagnosed with diabetes or listen to them on your podcast, especially when their kids are being diagnosed, they're almost catatonic from fear, you know, of killing the child, of doing the wrong thing, you know, of the terrible lows at night. And I think if you can give people a bit of peace of mind and and giving them the opportunity to look past the first six months even though it might not be easy, that's as much as you can do.
Yeah. No. I I agree. And I I don't know that it's I don't know that it's possible in every situation to not start inside of that fear in the beginning. That makes that just makes sense.
I I I really feel like getting to getting to the understanding of how insulin works and what technology can do for you and the idea that you don't need to be afraid, you can be a little bold. I think the sooner you get those things together, the sooner you can kind of move forward and hopefully break free of the fear quickly as possible. I mean, it's been my theory. It's funny. I'm asking you what you would do, and you're like, well, I would tell them to listen to your podcast.
Like, that help that help me at all, Christian. I'm trying to dig here. So I'm sorry. No. No.
No. You know, I just I have heard people say, I started listening to bold beginnings episodes in the hospital, and then I listened back to the the the podcast. And I hear some people who were have described being scared, and I think I never really felt that way. And so I'm I tend to believe that. I tend to believe that if you get people right away and you put them on a good path, it's very possible they could avoid a lot of the pitfalls that that others describe.
Yeah. And that was that was really my story back then. So when when I was in in the hospital, as I said, they had this really nice setup there and they they taught us a lot. And then during the second week after my diagnosis, my mother approached the endo because we had planned the summer school program for me in The UK. So I was meant to stay in The UK for three weeks, traveling over from Germany, living with a host family and attending language school during the day.
Language school, and an ER nurse host50:23
And my mom asked, you know, would it be better to cancel that trip, baby? And the doctor thought about it for a couple of minutes and said, your son needs to live with this disease his entire life. You know, he will likely be honeymooning. What's the worst that can happen? If we can train him to prevent lows, you know, send him on his way.
Do you think that did you think that decision helped put you on that path of not feeling afraid?
Definitely. Definitely. Because it it kind of told me, you know, first of all, you'll be alright. You can continue living your life. And as well as, you know, this is this is manageable.
And then there there were a couple of, you know, benefiting factors. So they found me a host family where the mother was an ER nurse, and and they would make sure that it wouldn't totally go off the rails. But eventually my parents were comfortable enough to let me go. And having this experience, you know, of almost independence at 13 for a few weeks just after this diagnosis, that really told me I can do anything, and I just kept on doing it.
Yeah. And I think Otherwise. The the lucky piece there is that in those three weeks, nothing terrible happened. Because if you Absolutely. Yeah.
If you tell that whole story and seven days into it, you have a seizure at the at the host family's house, well, then you're not here telling me how you felt empowered your whole life and you weren't scared. You're gonna it would literally be a different story.
Yeah. Yeah. You're probably right. Yeah. My biggest challenge at the time was that in The UK, they had something called no sugar chocolate.
And I thought, oh, this is awesome. I saw it. I bought it. You know, I can eat this. And it turns out that instead of sugar, it had maltose, which is highly diuretic.
Mhmm. So that was a learning experience.
You got the you got the British version of the trotz. Is that what happened?
That's right. So I spent a couple of days on the toilet just cleaning that out.
Yeah. People don't know. They they just don't know. I listen. I had a crazy experience once where I was landing.
I went out on a I don't know. I just went for a flight somewhere. Don't remember where. And in the, like, on the last fifteen minutes of the descent, I had some candy that I didn't realize had that in it. And my gosh, like, I got into the airport.
I was like I was like, something's wrong.
And it You'll be running fast. Yeah. No kidding. No kidding.
I don't know why they bother with all that prep for, colonoscopies. They can give you a roll of lifesavers made with that stuff. Be on your way. Yeah. Probably.
So let's finish up talking about the travel. So you've lived in how many countries and traveled for business? You traveled for pleasure? You traveled with people alone?
Yeah. All of the above. So after, you know, coming back from from the summer school, my next big day was to do a foreign exchange here in The US. Both my parents were at university in The US in the seventies, and I always dreamt of, you know, doing that, learning about the American way of life. And then in 1995, I got a placement in California and went to live in California for a year, stayed at the the local high school for the final senior year.
And, I basically travelled there with a big suitcase, half of it with diabetes supplies. I brought twelve months of insulin and six months of testing strips and all sorts of things. And then the rest got shipped to me from my parents throughout the year, I had enough supplies while I was there. And what was interesting, when I arrived, I spoke to the high school nurse and, you know, she was aware that I was diabetic, but she didn't know anything about that. She had nothing to do with it.
There was no four or five plans. There were no other kids with diabetes. Basically, she told me, you know, do your thing. Don't bother me. If you have a problem, you can come.
Yeah. Leave me alone. Leave me alone. I'll leave you alone, kid. Yeah.
Exactly. But but again, for me, was reinforcing. Right? So, yeah, you you can do it. Don't worry about it.
And then, you know, while I was in The US, I I traveled around from West Coast to East Coast, visited some people, And I built up this sort of travel routine at the time, you know, like, you know, bringing twice the amount of insulin that you need and, you know, what what to keep on you versus what you put into the suitcase for check-in and so on. And one thing I I wrote down to me at the time was, you know, always take glucose tablets with you when you travel because that's fast, it's easy, and nobody cares about it when you go through security.
Oh, it's not a liquidator. Yeah. Yeah. Yeah. Right.
Yeah. And then when I started listening to to your podcast, I I did it chronologically at the beginning. In one of the first episodes, you talk about, you know, carrying juice boxes into the airport and how complicated it can get, you know, to to get that through airport security. And I thought, ah, see, should have taken those glucose tablets. But, of course, that's very different when you have a little child
Yeah.
Versus a grown adult.
She didn't love those tablets. I don't I don't know that I I'll be honest with you. I think Arden's had diabetes for twenty years now. I don't think she's had two glucose tablets in her life. No.
Yeah. So she just never like, she she tried one once and was like, oh, not this thing. And then we had to find something different. That's how we got to the juice and how we got to, you know, the other things that we ended up doing.
Yeah. She's Like I said, that age, you just use whatever is working. Right? Oh, sure. There's no choice involved.
Yeah.
Have I have definitely opened up a small container full of juice boxes at the, you know, at the TSA and been like, look. I have to get these on the on the plane. Like, this is the only thing I know for sure is gonna get me through this flight if something goes wrong. Then they swab it to make sure it's not an explosive. It's a lot of fun, really.
Glucose tabs through security56:11
Yeah. They don't make you drink one, but, you know, I'm always surprised that one said open one up and drink it. I was was waiting for that, especially because, you know, not for nothing, but Arden was diagnosed in 2006. And, you know, the nine eleven thing was pretty fresh in people's heads. Yeah.
Close enough to 2000. You know what I mean? So Yep. Yeah. It was different going to the airport back then for and it you know, for a while.
I think overall, but my experience with, you know, TSA people or security people at airports has been mostly positive. Yeah. I was surprised how very little they care about the needles. So in in the past, I really cared, you know, a lot of needle tips or or syringes with needles. And I don't know whether they just didn't see them because they're so tiny over the you know, they didn't care.
But I was very rarely asked about what this is. Why do I carry this? And in the past, I had these, you know, documentations from my doctor translated into various languages. You saw it the Abednego, but nobody cared. Nobody ever cared about it.
So eventually, I just left it.
Christian, I listen. I'm a proponent of this idea. If you're gonna shoplift, just pick it up and walk out the door. Because once you start hiding and acting nervous, then people are like, what's going on over there? If you just act like you're supposed to be there, you'd be surprised how hard it is to get people to look up.
Like I think that's good advice for many situations in life. Sure enough. Just act like you're you should be there and people will accept it.
Act like you belong. Nobody's asking a lot of questions. Nobody's paying attention, really. I I'm I am incredibly interested in people. And even when I'm out in public, I am paying attention to my wife once said to me, she's like, do you look at every car that drives past us?
And I was like, yes. I assess every individual in every car that drives past us. And she's like, why? I'm like, I don't know. I just like to see people.
And so I look around a lot. If I'm walking through a parking lot, I look at everybody. I walk into the grocery store. I figure out what I try to imagine what people are thinking, what they're doing. Like, I don't know why.
That's a hobby. Whatever. But all I can tell you is with all that research, I'll make quotes around that. What I can tell you is no one else notices I'm doing it. No one's looking
That's interesting.
For the most part. People are people are in a bubble that is pretty close to them. They have their they're locked in their own thoughts. They have their own anxieties, their own schedules. They own they're they're worried about they're walking through the grocery store thinking, I think I think she's cheating on me.
Like, you know what I mean? Like, they're the the people are having those lives right there. They're not looking up very often. Anyway, if you wanna
still That's what I like about traveling because it gets you a different perspective. I I kinda tend to look more at these details when I'm in an environment that I'm not used to
Mhmm.
Because you're less on autopilot. Yeah. So my wife and I, in the last thirty years, we've been to so many places that sometimes we just, you know, sit on a square somewhere and look at people, and you get exactly these reactions. Right? And sometimes you can make up the stories about people saying, oh, look at him.
Yeah. He looks like he's they're just coming back from his mistress, now hiding. I love doing fun as well.
First of all, nine times out of 10, when you actually can make eye contact with somebody, they're thrilled for it. People light right up. They smile. Their eyes brighten up immediately when they make eye contact with another person. Almost always.
Once in a while, someone looks at you like, alright, creep. But that's not what's you know what I mean? But but, you know
Yeah. You don't wanna be that creep.
Yeah. Yeah. You know, you just you just said, like, you made me think of there's a game we my family plays in restaurants where we look around and try to we choose people like we're drafting them to be trapped on a desert island with them. It's like kind of like who would who would you wanna take with you? And then you try to, like, say why you think just from looking at the person.
It's a lot of fun. I don't think we've ever probably been right about one person, but it doesn't stop it from being fun. My question to you though is you said you wanted to go to America to experience the American way of life. I wondered if you could can you quantify what that means? How is it different than where you grew up or other places you've been, or is it not?
It's probably less different once you arrive. But at the time, you know, growing up in the eighties in in Germany, the The US was like the holy land. This this is where you had the genes and Coca Cola and opportunity. And both my parents spoke so fondly about their time there. And for me, it was always a place I wanted to visit.
And I think in 1993 or 1994, we had a longer summer break where we as a family went to The US together. We traveled from Kansas City to San Francisco by car over three weeks across many, many different states and beautiful different reserves. We saw the the different locations, and I really enjoyed that. And I just wanted to go back for a longer time.
Yeah. Is it really any different? Like, could I not drive across Germany and have the same feeling that I have driving across America, or is it is there a lot of different landscape here?
The US is so vast. I think you have all the landscape, which just depends on where you are. Yeah. But I I think, you know, it can be quite different. So I don't think it's the landscape.
It's, you know, when you come from Europe, you're stunned by the size. You're stunned by going into the Walmart. You're stunned by the school size. It's all so much bigger. And at the time, this was exciting for me.
And of course, learning a language, that was really exciting for me. And getting to know new people, and it's it's also part of growing up, you know, spending time away from your family. That was all really cool.
Yeah. That's awesome. I saw scope is really the biggest part. That just everything just feels bigger and more spread out?
That that is certainly one aspect. Yeah. Even now when I come back, I still travel to The US maybe once a year. And and and just the the scope of the continent and everything that is inside The United States, know, including all the pros and cons, I think is is such an amazing amalgamation. You can be in the middle of nowhere, the next neighbor is a 150 miles away, or you can be in a skyscraper in the city of millions.
Yeah.
And it's all it's all one country, and I always found that amazing.
Are the people do you find are people just people? Like, because you said you've you've lived in a number of different countries. I mean, obviously, like, the the bits and the bobs are different. Right? But, like, at their core, people pretty similar?
I think so. Most of the people I've met on my travels have been kind, have been genuine, have been helpful. You know, of course, I've I've I've met some thieves on the way as well, so not everything is great. But both of the people are are good people regardless of where they are. And, you know, how they present and and what they do is different.
Yeah. I get to meet a lot of people, and I have to say, I I don't I just don't think that I don't think we're all very different, you know, and in a good way, in in a in a way that's comforting, to be perfectly honest. So yeah. Well, I know you have to go get your kids, so I don't wanna keep you too much longer. So this is where I'll ask you if there's anything we haven't talked about that we should have because I don't wanna cheat you for what you wanted to come on.
You seemed really excited when we logged on to do this, so I I appreciate that.
I still am.
Oh, oh, good. You're you're having a good time?
Yeah. Definitely.
Awesome. How long ago did you find the podcast?
I think around four years ago, 2021 Mhmm. I found the podcast. Yeah. It was was during the the COVID shutdown. And I just, you know, was looking for an additional resource to learn more about diabetes.
And when when I started listening to it, I think that the first kind of nugget that I picked up was around protein and fat. Okay. And what what was so interesting for me was when I was diagnosed back when I was 13 in the hospital, they told me about what they called the pizza effect. And the pizza effect is basically protein and fat, right? You need less insulin at the beginning and then you need more later on.
And I learned this and I knew how to handle pizza, but I never once thought about transferring this to other foods. For me, this was purely about pizza.
That's interesting.
It's it's really weird. Right? I never made the transfer. And surely, the doctor said, you know, I've taught them about the pizza effect. They'll be set up for life.
They know how to manage protein and fat, and it took me thirty years to figure it out listening to your podcast. So that was really interesting.
They just needed to call it something slightly different. You would have been right on board.
Maybe. Maybe. The label pizza effect sort of narrowed it down in my mind. Yeah. And that's that's, you know, maybe what happens when you talk to a 13 year old.
Listen. Not for nothing. Like, somebody handed me NovoLog and said this is insulin, and I never wondered if there was another insulin. I just I just assumed this was insulin. They gave it to me.
They called it insulin, and why would they, you know, why would there be others if this one works? It just little little simple things like that, but put you, again, on a path and you don't think about it again, and you look up however long later and somebody's saying to me, you know, have you ever tried a Pedra? And I was like, what's a Pedra? And they're like, what's it's insulin. I was like, well, there's I have insulin.
I have NovoLog. You you know? And they were like, no. There's this one too. I'm like, oh, how would I know that?
You know? So it's good news.
Insulin isn't that fragile1:05:53
I wanted to talk a little bit about what I learned from traveling. Please. Maybe pass on some some good ideas there as well. And the first one is really basic, and that's take enough supplies, which should be obvious to everybody who's travelling with type one, but also know that insulin is much more resilient than what pharmacies want us to believe. You know, when we pick up the insulin, it's always super chilled and they ask you, do you know how do you know how to get home with that?
You know, can you cool it on the way? And that gives you the impression that it's super fragile and one ray of sunshine will destroy the insulin. And that's just not the case. I mean, is being used across the world, you know, many places much hotter than ours. And insulin has fairly good shelf life.
So as long as you can keep it cool on room temperature level, you will be fine. And I I've been in the situation, you know, where it got warm and I got really nervous. Is it still viable? And I read other people's messages saying, you know, it's it's stayed out in the open for five days on the table. Do I need to throw it away?
And the answer to that is no. You know, you can really keep keep using it, and that can help you when you're traveling.
There are some studies just about that that I have to admit I I'd like to maybe dig into more to tell people about because you're not wrong. A lot of times, people freak out. And then the minute they have an experience where their blood sugar doesn't do the thing that they want to do, they they'll they'll they'll leap over 20 possibilities and go right to my insulin must be bad. And that's Yep. What a what what a weird leap.
You you know? But not if you were told because or what happens right away? You have to keep this cool. Well, I just put it in my insulin pump, and my insulin pump's outside with me, and it's not cool outside. How and
Still working.
It's still working. Something's you know?
How about that?
Yeah. Hello. Yep. And then and then like you said, they leave it on a table for a day, and they go, this must be bad. It's really interesting.
Yeah. Oh, well, I'm gonna dig into that more. I'm glad you brought that up. What what what else you got?
So so the insulin doesn't have to be super cool, but I think it helps a lot if you stay cool in the TSA line. Because if if I am stressed standing in the line, they get stressed. And I've been there myself. You sit there and say, oh, now they're gonna pat me down and what do I tell them and how do I say it to them? And most of the time, if if you're relaxed, when your kids are relaxed, it goes so much more smoothly.
And if they need to check you physically, my go to approach is always to just tell them upfront, I have this pump here. I have CGM there. And then they're usually super careful and very friendly. If I just walk up to them and stare at them in the mean face, they might accidentally rip it off. So just, you know, thinking about that while you stand in line.
I know it can be very stressful. That at least helps me, you know, preparing for that encounter.
Yeah. It'll be fine. It is it should be your take away.
In most cases, that that's it. Right? Yeah. And when you read about, what people write on your Facebook page, flying wreaks all sorts of havoc for diabetics, right? Some go high every time, others go low every time.
And we try to explain it and find justification like you just said, right? We lead directly to this must be it. The scanner destroyed my CGM. You know, the pump pushes more insulin during the flight. So even though cause and effect is not clear and all, we want to have that cause and effect very clear in our mind because it gives us comfort.
And
I really think, you know, traveling can be very stressful and stress messes up our glucose levels. And that's probably the reason for most of what we see when we travel. And I've changed CGMs and Omnipods at the airport mid flight. I've I've gone through all the different machines without any problems. Maybe I was lucky.
But I also think both of them don't cause any problems with your machines. There could be a correlation somewhere. You walk out of it and then, you know, you knock your arm and then it falls off. Yes. That happens.
But it's not everybody who goes through a machine will have a problem.
Yeah. Expect good things and often good things will happen. Yeah.
That's right.
You could just go read a stoicism book if you want and just try to apply it to your life or, you know, T shirts, slogans, or whatever makes you feel more comfortable. But in the end, it's probably gonna be okay. And chill out. I that's so far so far I've heard
you say usually not as easy as that, but that's the gist.
Yeah. But that's the gist. You have to find listen. You gotta find your way to that, whatever that is for you. But in the end, I take your point.
You know? First of all, if you look nervous, they're gonna wonder what's going on. It's their job to find people trying to sneak through doing stuff. There's also plenty of people doing things you don't realize, so now you've suddenly put yourself in the bucket with those people. Do you have any idea how many people try to bring a gun onto an airplane every day?
It's an astonishing number.
Probably more where you are than where I Yeah.
Well, it's an astonishing number. And often, it's they're mispacked. Like, people will, like, have them in bags and not realize it and stuff like that. So that person that person at that gate is thinking about that while you're there while you're there going, I hope I hope they don't care that I have a juice box in my purse.
Yeah. We got that with knives.
Yeah. Oh, yeah.
People tend to find knives in their suitcases or in their backpacks all of a sudden.
Oh, yeah. Society There
it is.
Societies that can't shoot each other love to stab each other. Exactly. Go ahead. What else you got?
Once you step on the plane1:11:35
So when it when it comes to flying, especially long haul, my mindset is always once you step on the plane, the new time zone has started. And my experience is the sooner you act like it, the faster your body will adjust to it.
Oh, what a simple What a simple smart idea. I'm cutting you off, but what a simple smart idea. Go ahead. Go, please. Yeah.
So
if if you're on MDI, you know, if you're going west, the day gets longer, add a second shot, long acting, maybe half of your normal dose or whatever you may need at the beginning of the flight. And if you go east, shorter days, which are often overnight, now give that long acting early and then align onto new new time zone. And that way, your your body can start. Of course, it's not that easy. Right?
The the body will still take some time to react to it. But my experience is when you get ready from the get go, it takes less time.
Is there a way to lie to your pump about what time it is to get ahead?
Well, with my pump, I can just change it on the phone. Yeah. The time on the phone, you know, change the time zone to Australia or wherever you wanna go, and that works.
Just like that. Well, that's such a brilliant thing. How long did it take you to figure that out? Is it like a day where you're like, oh, you know what I could do? And then you started doing it?
Yeah. I I think I think fairly quickly. I think first time when I came back from The US when when I was 16, 17, I remember being up all night before traveling back because I was so excited and saying farewell to my friends. And then I figured, oh, it's you know, it's it's early morning here in The US. I'll probably fall asleep on the flight anyway.
So this will just be my nighttime. And then I flew back to to Germany. And I woke up in the morning and that worked well for me. The only exception to that rule for me is if it's a short trip. So sometimes you just have to go somewhere, you know, for a day or two, then best to stay on your local time and not adjust at all.
Yeah. That that might be easier.
Travel is I mean, I won't say hard on the system, but it is obviously impactful. You know, people's bathroom habits, like, you know, eating habits, sleeping styles, a lot is impacted very, very quickly.
Yeah. And some people are impacted much stronger than others. My wife, she can travel all over the place and she's usually fine within twenty four hours. It takes me longer. We have other friends who are knocked out for a week when they do long haul travel because it's so exhausting for them.
Yeah. No. No. For sure. Absolutely.
What else? Anything? You have a lot of good stuff here.
No problem. Thank you. Let me just have a quick look here. Just anecdotally, I think for people traveling to Europe, if you lose your gear and it does happen, it has happened to me before, it's been stolen, I lost it, I dropped it most pharmacies will help you out with the gear, but they struggle with insulin because that's regulated. It's a medication.
So depending on which country, easier or more difficult. Here in Switzerland, they have a very neat system where you can basically self declare that you need it. You fill out a form, you pay for it out of pocket, and then you have it. That's very neat. And Europe goes into that direction.
So in more and more countries, you know, with a sympathetic pharmacist, they will help you out. They'll give you the incident at least to cover you for the next couple of days, and then in that time, you can figure out your emergency plan. So that works really well now.
Okay. Oh, that's awesome. It used to be like that here. Because when when my friend was first diagnosed, like, I I real I remember him saying you don't you didn't need a prescription for the insulin. You needed it for the needles.
Yeah. Yeah. It's how it was at one point.
Interesting. Yeah. So the the the the most important and the least important part. Yeah.
Exactly. Oh, one without the other is pretty useless. I guess they figured it's funny because you said the TSA people kinda don't care about the needles. Like, I think the only damage you can do with an insulin needle is if you're a bullseye from the Daredevil comics. I mean, if you're not if if right.
If you don't if you if you
don't kinda have that kind of accuracy, I don't know how you're gonna hurt anybody too badly with an insulin needle.
So I don't know. If you you have 10 or so in your hand, I think you can wreak some havoc.
You gotta really go for it though, Christian. You know what I mean? Like, you're gonna you have to be on a mission, I guess. Yeah. Yeah.
I take your point.
That's true.
That's funny. Yeah. Well, I mean, it's it's encouraging to hear somebody that moves around so freely on planes and through time zones and country to country. And you've never had a problem to to speak of?
I did have problems, of course. Once I I lost my gear right at the beginning of a flight, and I was traveling through Hong Kong Airport and sort of all all my testing equipment, I left on the seat. I walked out of the aircraft and right when I was in the departure or in the arrivals hall, I realized. And the only way you can get into the airport is with a ticket. And I was trying to talk to this gentleman, you know, with a big gun at the entrance.
Please let me through. He only spoke one sentence in English, which was show me the ticket. So eventually, I just showed him a ticket from a departure a few days later. And he looked at us, oh, ticket. Great.
He let me in, and I could recover it. But but, you know, you lose things. Things break. A few years back when I was on my first Omnipod summer vacation, I cracked half of my pods because I didn't realize that aerosols would impact the material. And then, of course, you wonder what are you doing.
So I went back to MDI for a couple of weeks until we got back home. So these things happen. But I was always lucky enough to to feel comfortable enough to not have it stress me out.
Yeah. And you brought you brought a lot of I'm a I'm a I'm
a I extra supplies.
I bring extra. Yeah. I I joke all the time. Like, if you vacation with us, I could probably handle two or three more people with diabetes if I needed to. But I'd rather just carry a because in the end too, it's know, Omnipod, there's not a lot of stuff.
There's no, like, you know, infusion sets and tubing. It's just pretty small packaging. So you can carry Exactly. You know, you bring Yeah.
If you take it out, it's easy.
Yeah. You bring 10 pods with you and everything goes right. You've got a month's worth of pods with you.
So Yeah. And I usually put them into the That's where they can stay.
That's a good idea. I and I always do the thing I heard you say earlier too is I carry stuff on. I carry enough on that if things got sideways, we'd be alright for a few days, and then I pack the rest and carry on. And that way, I have it in two different places. Well.
Yeah. Yeah. There's you know, I take some insulin with me. I put some insulin in the carry on in in the, you know, in whatever gets in the belly of the plane, try to put that on ice. Nobody cares if there's ice in your checked bag.
Like, there's, you know, like, a lot of little, like, things you can do. So, anyway, it's it's it's in the end, I'm just gonna tell you something that is not gonna be completely comforting to anybody. It's just not that hard. Like, just go do it. Like, you're you're gonna mostly, I see people online create their own problems.
I went on vacation. I only brought one CGM with me. Why is that? Like,
go Yeah. Those those posts are scary because you feel okay. A little bit of planning, but, you know, life can be so difficult sometimes and things happen. So
Yeah. Just ask yourself. I've brought one. What if this one fails or I lose it? Maybe I should have two.
That's true.
Yeah. Yeah. Like that very simple idea. I I would never even on a day trip, if you're gonna bring an extra pod, you're bringing two. Because if it's important enough to have, it's important enough to have a backup in case something should happen to the first one.
And Yeah. And I think most people feel, you know, if if if you cannot go back readily to your home, you know, just just take a spare.
Have some stuff with you. Fine. Yeah. Yeah. I just I yeah.
I hate to say apply common sense, but apply common sense to it. Then go have a good time and travel. I mean, listen. Would I go to a would I go to a war torn country where no one speaks my language and I'm not sure about my safety? Maybe not.
You you
know take at least three pots. I would
You're saying take just take a few more pots. You'll be fine. Hide them in your parents. It'll be okay. Oh my god.
Christian,
you're So my my watch is beeping reminding me that I need to pick up my daughter. Be be before we sign off, I just wanted to say great work hosting the Juice Pod podcast.
Thank you.
It has given me a lot and your work really makes a huge difference and I really appreciate it.
Well, thank you so much. I I can't tell you how how much that's gonna make my whole day brighter. It really is terrific to know that that it's valuable for you and that it's finding its way out of America too is really is fantastic. I, I try not to talk about it too much, but I am super proud. I think I think the podcast charts in usually 35 to 40 other countries every day.
No. It's amazing. Yeah. And you're rightfully proud. I think it's it's really amazing what you've built.
Thank you so much, Christian. I really appreciate your time, and, you know, go ahead and get your kids. I don't want you to I last you thing need is to have this lovely afternoon and then go get yelled at for being late.
So Thank you for your time.
Thank you so much.
Great
day. You too. Take care.
Care. Bye.
Bye. To learn more and see if you might be able to get Twist from the pharmacy and try it for free, head to visit.twist.com/juicebox. That's visit.twist.com/juicebox, or give them a call at 18774. That's +1 (877) 489-4478 and tell them Scott sent you. TWIST requires prescription and is indicated for people with type one diabetes six and older.
Arden has been getting her diabetes supplies from US Med for years. You can as well. Usmed.com/juicebox or call (888) 721-1514. Many thanks to US Med for sponsoring this episode and for being and for being longtime sponsors of the juice box podcast. There are links in the show notes and links at juiceboxpodcast.com to US Med, Twist, and today's other awesome sponsor, the Eversense CGM.
They make, of course, the Eversense three sixty five, and that thing lasts an entire year. One insertion every year. Come on. You probably feel like I'm messing with you, but I'm not. Ever since cgm.com/juicebox.
Check it out. Let's face it. Diabetes is tough, but it's easier when you have a community around you. So if you're looking for a great community around type one diabetes, check out the juice box podcast private Facebook group. Juice box podcast type one diabetes, but everyone's welcome.
Type one, type two, gestational, loved ones, it doesn't matter to me. If you're impacted by diabetes and you're looking for support, comfort, or community, check out the juice box podcast private Facebook group. Juice box podcast, type one diabetes on Facebook. I promise you it is the most un Facebook like experience that you'll ever ever find. What a great group of people.
I don't like saying this usually because it dates the ad, but right now there are 86,000 active members. 86,000 people in there who might have your experience, know what to say, just be a great shoulder to lean on. Don't be too proud to find a community. It really does help. And it's completely free.
Juicebox podcast, type one diabetes on Facebook. I just wanna say thank you so much for listening. I'll be back very soon with another episode of the juice box podcast. If you're not subscribed, please subscribe in a podcast app. It really helps Apple Podcasts, Spotify, or whatever your favorite audio app is.
Like and subscribe. You know what the kids say on the YouTube, like and subscribe. It really does help. And if you're already subscribed, please tell a friend or your endo or somebody you think might enjoy the podcast as well. Word-of-mouth is the only way that it grows.
Once again, I've been Scott. You've been fantastic, and we'll be right back with another episode of the juice box podcast.
Read the full disclaimer
© 2007–2026 Juicebox Podcast. All rights reserved.
