Leah Orleans shoots a bow and arrow with her toes, juggles fire, puts knives on her face, and performs around 300 shows a year as Tiny Girl Big Show. In her late twenties, in the middle of a tour, she landed in the ER with an A1C of 14. A few months later, a well-meaning doctor asked what other skills she had, and suggested she start looking for a desk job.

She didn't. Instead, she got loud about it. Leah started writing comedy about diabetes (it turns out it's a genuinely funny word), performed a song called "Diabuddies" using a giant cardboard pancreas, and now when she asks "Who's diabetic?" from the stage, hands go up all over the crowd. We talk about the $2,000-a-month reality of living with type 1, how the logistics skills of a touring performer turned out to be life-saving, and why she has convinced food vendors near her stages to keep an insulin pen in their fridge for her. (They've never said no.)

We also get into the Big Nonprofit Insulin Party happening in Brooklyn on Friday, October 23, benefiting Project Insulin, the nonprofit working to sell insulin at cost. And we land on a question I keep coming back to: what are you optimizing for? If you've ever been told to trade the life you want for the one that feels safe, this conversation is for you.

Chapters

00:00 Welcome and meet Tiny Girl Big Show

03:01 From touring acrobat to an A1C of 14

05:26 Following your passion versus healthcare security

06:13 Turning a $2,000 monthly bill into logistics

07:31 Diabetics are everywhere, even at Ren Faires

08:57 Why "diabetes" is a hilarious word

10:25 Diabuddies and a giant cardboard pancreas

11:22 Health content doesn't have to be sterile

13:13 The Big Nonprofit Insulin Party in Brooklyn

14:24 Why Project Insulin's mission hits home

17:02 The doctor who said find a desk job

20:10 Advice: pick the problems you want to solve

22:43 Systems, habits, and insulin in strangers' fridges

24:12 What are you optimizing for?

28:25 Where to find Leah and her diabetes content

Resources:
Tiny Girl Big Show Website & Schedule

Tiny Girl Big Show Instagram

The Big (Non-Profit) Insulin Party Tickets

Youtube Channel

When Aurelian Briner's wife was diagnosed with type 1 diabetes about twelve years ago, the hardest questions kept coming back to the plate: how many carbs are in this or how big is this portion? Aurelian, a product manager with a business background and an entrepreneurial itch, decided that was a problem worth solving. In 2017 he co-founded Snaq, and today the app has more than 300,000 registered users and around 20,000 monthly active users around the world.

In this episode, Rob and Aurelian trace Snaq's evolution from a photo-based carb counter, to a platform that connects meals with CGM, pump and activity data, to the AI Nutritionist, a 24/7 companion built to help people reach their nutrition goals. They also dig into what it takes to bring AI into healthcare responsibly: fast product iteration on one side, slow and careful clinical validation on the other, and why both matter.

Rob makes his case: he doesn't want your vibe-coded diabetes app. Not because building your own tools isn't exciting (it is), but because there's a huge gap between a weekend prototype and a product that's used, trusted and clinically backed. Aurelian breaks down Snaq's moat (users, data and clinical validation), shares an MIT finding that app releases roughly tripled while engagement stayed flat, and explains why building got easier for everyone while marketing got harder.

Snaq's published RCT showing a 6.6% time-in-range improvement on top of AID systems, upcoming research on the AI Nutritionist versus standard of care, a US study on T1D pregnancy (one Aurelian's family lived firsthand), the shift from reactive apps to proactive AI agents, and the founder lesson Aurelian would give his younger self: it always takes longer than you think, so make sure you care enough to stay.

Chapters:

00:00 Meet Aurelian Briner, CEO of Snaq

01:10 Why AI health tech changed in 2026

02:20 A wife's T1D diagnosis sparks Snaq

03:42 From carb counter to AI companion

05:10 Late-night questions and clinically safe AI

06:20 Build fast, iterate, then prove it clinically

08:09 Why insulin pumps lagged behind iPhones

09:26 Rob's case against vibe-coded diabetes apps

11:40 Snaq's moat: users, data, clinical validation

14:05 Triple the apps, flat engagement: MIT study

17:13 What users say about the AI Nutritionist

19:49 New research: 6.6% more time in range

21:05 Studying T1D pregnancy while living it

22:14 From reactive tools to proactive companions

24:50 Ten years in: lessons for founders

Resources:
Snaq.ai

At 15, Liz Van Voorhis landed in the ER on spring break with a blood sugar of 1,200. She weighed 78 pounds. She had two questions for the doctor. First, when could she get back to cheer conditioning? Second, did this mean she couldn't finish her Halloween candy? It was April. That mix of grit and humor is Liz Van Voorhis.

Liz is an executive coach and founder of The Fit Collective. She has built wellness programs for brands like Equinox, Peloton, and Lululemon. She tells Rob about the 15-year corporate career she walked away from after losing her mom to brain cancer. She also talks about her "brain sabbatical" year teaching 15 spin classes a week, where her class quietly became a safe space for people with Type 1 all over New York. She explains the values exercise from 2004 that she still revisits every New Year's Eve (her birthday) to decide what gets her commitment.

They also go back to the January 2025 LA fires. Liz used her retail-operations background to help organize more than 400 volunteers and get diabetes supplies to around 50 displaced families, which earned her the self-appointed title "diabetes drug dealer of Southern California." 

Along the way, Rob and Liz dig into several other topics:

• Rob's thesis that diabetes doesn't get easier, but you get better at it

• A million-dollar business loss

• A prayer for financial abundance that was answered by a stolen car

• Why "we are meaning-making beings" beats "everything happens for a reason"

• Why Liz put off switching to Omnipod for years for purely vain reasons, and how much she regrets it

If you've ever wondered whether you can build a big, beautiful life with or without type 1, this one's for you.

Chapters:

00:00 Meet Liz and the Thailand retreat

01:38 How the 2015 diabetes Instagram connected us

03:13 Diagnosed at 15 with a 1,200 blood sugar

08:11 From church-basement aerobics to corporate career

11:41 Losing her mom and blowing up her life

13:00 Teaching spin and finding her T1D community

14:13 Alignment and the courage to walk away

15:45 The values exercise that changed everything

18:51 Organizing diabetes supplies during the LA fires

26:04 It doesn't get easier, you get better

30:09 Breakthroughs, a $1M loss, and a stolen car

35:19 Meaning-making vs. "everything happens for a reason"

36:44 Identity, basketball camps, and embracing who you are

38:42 Tuning out the noise and never drinking

43:29 Omnipod, Dexcom, and getting over vanity

Resources:

1. The Fit Collective

2. Liz Van Voorhis Instagram

Rob sits down with a rare three-person interview: Danica Doble (@type1deeabetes) and her partner Lucas, who both live with type 1 diabetes. Their story starts with a genuinely wild diagnosis arc. Lucas was told he had type 2 diabetes, put on metformin, and left to figure it out on his own for over a year. It wasn't a doctor who caught the mistake. It was Danica, watching his Dexcom numbers from the outside and refusing to let it go until he got a GAD antibody test. She was right.

The conversation moves from that misdiagnosis story into what it's actually like to build a life and a relationship around two people managing the same disease. They talk about pre-bolusing habits rubbing off on each other, supply emergencies solved by sharing pods, and the strange comfort of dating someone who doesn't need diabetes explained to them. Danica also opens up about a year of debilitating fear around low blood sugar that came out of nowhere in 2022, how it shaped what she couldn't do, and how she worked her way back out of it.

There's also a real look at Danica's path as a creator from a fitness account that hit 300K on TikTok to launching as its own page, growing to 60,000 Instagram followers in under a year, and running a six-week fitness challenge built specifically for the T1D community. She talks candidly about online hate, why she doesn't shy away from clapping back, and how she's learned to hold onto the good instead of fixating on the one negative comment.

It's a funny, honest episode complete with the story of a PowerPoint presentation Danica made to teach Lucas about type 1 diabetes, a jiu jitsu sensor casualty count, and a love story that started at a casino. Press play for the full conversation.

Chapters:

00:00 Cold open and guest introduction

01:20 Welcome and introductions from Danica and Lucas

02:18 Lucas's symptoms begin and the misdiagnosis story starts

04:36 ER visit ends with a type 2 diabetes diagnosis

06:37 Danica suspects type 1 and pushes for testing

08:47 GAD antibody test confirms type 1 diabetes

10:00 Onboarding to insulin and Danica's PowerPoint presentation

12:52 Danica's content creation origin story begins

16:48 Danica's year-long fear of low blood sugar

20:04 How diabetes shows up in their relationship

23:05 Inside Danica's six-week fitness challenge

25:31 Handling online hate and diabetes stigma

28:23 How they actually met: the casino night origin story

33:03 Closing reflections and advice for listeners

34:53 Jiu jitsu, sensor casualties, and daily management tips

Resources:

1. Danica Doble Instagram

2. Danica Doble TikTok

Dave Holmes spent the late '90s and early 2000s as one of the faces of MTV, and these days he's a sharp, funny voice at Esquire — but before any of that, he spent six years being told he had type 2 diabetes when he actually had type 1. This week, Rob sits down with Dave to talk about that misdiagnosis, the strange cluster of friends who were diagnosed around the same time, and a diabetes-age chart Rob saw at a conference that will change how you think about who gets T1D.

From there, the conversation turns into a real, unpolished look at what it takes to live a creative life. Dave and Rob are both working through Julia Cameron's The Artist's Way right now — morning pages, artist dates, and all — and they get honest about guilt, perfectionism, and the fear of putting out work that isn't ready. Dave, a professional writer with a book and a byline at one of the biggest magazines in the country, admits he still feels like a fraud turning in a rough draft. It's a good reminder that "getting easier" was never really the goal — getting better at the hard parts is.

Along the way, Dave and Rob swap stories about the universe nudging you toward where you're supposed to be — a DJ gig that came out of nowhere, a stranger at a DVD store, a maintenance worker who turned out to also be living with diabetes. It's the kind of episode that starts as a diabetes story, turns into a conversation about creativity, and ends up being about paying attention to your life.

And because no DDT episode is complete without some fun, Dave and Rob close it out with a segment they're calling the Bad Advice Song Draft — three rounds each of picking the most beloved songs with the absolute worst advice buried in the lyrics. Stalking anthems, teenage recklessness, and one song so ethically questionable that Kidz Bop wouldn't touch it. Tune in for all of it.

Chapters:

00:00 Meet Dave Holmes: MTV VJ turned Esquire writer

02:52 Dave's six-year road to the right diagnosis

05:54 The surprising truth about T1D and age

07:13 How The Artist's Way found them both

08:37 Why Dave restarted the 12-week program now

12:48 Comparing morning page routines and habits

15:39 Getting unstuck: movement, walks, dumb writing

17:30 An artist date leads to an unplanned DJ gig

20:10 Beginner's mind and the fear of being filmed

21:09 Dave on perfectionism and feeling like a fraud

25:18 Resilience: "it doesn't get easier, you get better"

27:36 A screenwriter's ultimatum sparks Dave's fiction project

30:41 Meditation, synchronicity, and a DVD store coincidence

33:28 The ball-spinning experiment: "you can just do stuff"

38:05 Signs from Rob's dad, and a Disney parking-lot miracle

42:19 The Bad Advice Song Draft begins

Resources:

1. The Artist's Way by Julia Cameron

2. Dave Holmes on Instagram

3. Dave Holmes at Esquire — his latest writing and pop culture commentary.

It's episode 450 of Diabetics Doing Things — a milestone Rob almost forgets to mention until he's three topics deep. Fresh off Friends for Life in Orlando, he lays out what he calls the diabetes conference pyramid: the industry side (ADA, ADCES, ATTD, EASD) built for HCPs and brand messaging, and the community side, where Friends for Life stands alone as the one event he'd choose if he could only pick one. He also previews the upcoming Diabetes Legends Dallas clinic and makes his now-recurring case for why kids with diabetes belong on a team.

Then Rob shifts from the conference circuit to something he's been quietly building: a searchable AI archive of every Diabetics Doing Things episode — all 450 of them — that surfaces clips, timestamps, and quotes on demand. He walks through a live demo, asking it about diabetes and mental health and watching it pull exactly the right moments from years of the show's back catalog. It's his first real answer to a question he's been sitting with: what do you actually build for people with diabetes when you have this much lived experience and the tools to use it.

The back half gets more personal. Rob is wrapping a 90-day clinical trial on an unreleased insulin pump algorithm — a strange experience in handing over control of his own management — and talks candidly about what "locking in" has looked like lately: earlier mornings, journaling, lower-carb meals without the guilt spiral, and a real 30-day discipline streak. He closes with an unguarded account of the Diabetes Sangha meditation retreat he attended this spring, why the "woo-woo" label doesn't scare him off, and a new mental health resource from Omnipod and Calm worth knowing about.

If you're weighing whether diabetes conferences are worth your time, curious what an AI trained entirely on this show can actually do, or just want to hear someone talk honestly about discipline and burnout without the performance — this one's worth the full listen.

Chapters

00:00 Episode 450 and fresh Friends for Life recap

02:22 Mapping the diabetes conference pyramid: industry side

05:41 Why Friends for Life beats every other conference

08:20 TCOID, Connected in Motion, and Camp Diabetes

11:07 Diabetes Legends Dallas and youth sports advocacy

14:41 Insulin Sensitivity Playbook recap and fan-favorite guests

17:02 Unveiling the DDT AI archive (live demo)

22:00 Personal update: the 90-day clinical trial

25:51 Locking in: mornings, journaling, and low-carb peace

28:21 Inside the Diabetes Sangha meditation retreat

30:52 Omnipod x Calm partnership and mental health resources

32:46 What's coming next and how to find Rob