Diabetics Doing Track & Field and Stanford Medical School with Jonathan Tijerina

[00:00:07] Rob Howe: Welcome to the Diabetics Doing Things podcast. We've been telling the amazing stories of type 1 diabetics all across the world since 2015, and we have over a thousand years of living with T1D on the podcast. The interviews range from incredible feats to everyday victories, and we celebrate them all just the same. Thanks for listening, and if you want to get involved even further, just send me an email at rob at diabeticsdoingthings.com. Hello and welcome back to another episode of Diabetics Doing Things. We are telling the amazing stories of type 1 diabetics from all across the world. And my very special guest today, calling me from California, is Jonathan Tijerina. Welcome to the show, sir. Howdy, Rob. Thanks for having me. Appreciate it. Hey, not a problem. Glad that you're here. And Jonathan, you are a third-year med student out at Stanford University, if any of you have ever heard of that distinguished institution. And you also did some undergrad at Baylor, so not too far from where I'm currently calling you from in Dallas.

[00:01:23] Jonathan Tijerina: Right. Exactly right. Yeah. I'm on a research year now, so I'm not taking any class, but just doing research with the hospital.

[00:01:29] Rob Howe: Awesome. And a lot of that research has to do with type 1 diabetes in a lot of different categories and capacities. So I'm really looking forward to kind of digging into some of those. But before we get into that, why don't you tell everybody how you joined the type 1 diabetes family and give us your diagnosis story?

[00:01:49] Jonathan Tijerina: Yeah, absolutely. So I think my diagnosis story, you know, it's pretty, I think, pretty classic in terms of the symptoms that I experienced. But it went pretty long before I was diagnosed just because I'm from a really rural town called Marshall in Texas. I'm not sure if you've heard of that guy, but it's pretty small. It's right next to Shreveport, Louisiana, a really small town. So in my, you know, my sort of upbringing, we don't really go to the doctor unless you're like, you know, really, really hurting. So I went for a long, you know, six or seven months before we even thought about maybe going to the doctor for any of the symptoms that I was having. Yeah. Yeah. I think the first time we actually thought, you know, it was just like I thinned out, but I was also getting tall and I was tired. But, you know, I was also 13. So it's like, oh, is this something wrong or is this just, you know, puberty?

[00:02:41] Rob Howe: Right. Right. Yeah. It's interesting when you're diagnosed at different ages because there's so many changes going around, especially in your teens. And if you're a runner or an athlete, you could just be losing weight because you're getting into shape or one thing or another, getting taller. And also I had a guest on who sort of really reinforced something for me for people who are diagnosed with anything in rural areas is that just a different relationship with the hospital. and with access to healthcare. So while, you know, for us city dwellers, it's an easy, you know, maybe 20-minute drive or 5, 10-minute drive to the hospital. For others, it can be quite a hike, so quite an ordeal. So that's, you know, interesting and yet another perspective, another wrench to throw in the equation of type 1 diabetes.

[00:03:32] Jonathan Tijerina: Oh, yeah, for sure, yeah.

[00:03:35] Rob Howe: So you were diagnosed at 13. as you were kind of coming out of that sort of hospital experience, anything that stands out?

[00:03:43] Jonathan Tijerina: Yeah. Well, so with the initial diagnosis, I remember the first time we actually thought something was wrong. I was trying to do football at the time and it was coincidentally a blessing in disguise for me because I kept passing out in football practice. We were doing two days in the summer in Texas, which is like combined with the dehydration of undiagnosed diabetes, like the

[00:04:01] Rob Howe: worst possible combination. Right. And, you know, now you see, you know, and I think about it, you know, a lot, not as much when you're younger, but today, you know, a hundred, a hundred degrees, you know, not on the field, just like your everyday temperature. Yeah. Throw in the humidity and, you know, being on the field. So upwards of 20, 30 degrees hotter, plus you're inside a helmet, just a recipe for disaster without anything else.

[00:04:27] Jonathan Tijerina: yeah exactly no it was brutal so yeah I kept passing out in practice and they uh the football coaches actually told me they thought I should try something different uh and referred me to track which is what I ended up doing in college um so it's kind of like uh you know a good thing that

[00:04:41] Rob Howe: came out of a bad thing there yeah it's funny how that works isn't it so yeah if I'm if I remember correctly you you ran the mile in uh for Baylor like a great like a huge an awesome track school

[00:04:54] Jonathan Tijerina: I did. Yeah, I ran the mile and the half mile. I was kind of press ganged in a running cross country every year, which is a little bit outside my wheelhouse. You know, a 10K with hills and whatnot is like pretty brutal for a miler, but I did it. It kept me in good shape for track for sure.

[00:05:08] Rob Howe: It's sort of one of those things where it's like you just say yes to one too many things and before you know it, you're spilling down the finish line of a cross country race and people are passing out. That's something, this is way off topic, but I think that's something that everyone should experience is like the finish line of a competitive cross country race. Oh my gosh. Cause you know, I was a, I was an athlete in college and you know, when you're a football player or a basketball player, you sort of, I think it's just whatever alpha male syndrome, like you, you, you see that you have these athletes that are like the tier one, maybe like, you know, football, basketball, like the big school at, you know, at a big school, you're like, you know, everybody's in the public eye and then you don't really think about cross country, But man, that finish line experience, the last like 100 yards is one of the most brutal things I've ever witnessed. Yeah.

[00:05:56] Jonathan Tijerina: Yeah, I was so grateful that they didn't really expect me to be, you know, top finisher or like have an incredible time as a miler because, oh man, the people that were really trying for those incredible times were just like, you know, you see people just drop like flies the last 200 meters. Just literally just pass out because they're trying so hard.

[00:06:13] Rob Howe: Yeah, it's incredible. And the reason I got to experience one is because I was a sports management major in college. As part of our study and coursework, we had to, in one of our event classes, had to actually go and choose from three or four different events and work them. And one of those was a cross-country event, like actually work the finish line and help to wrangle because everybody's got to stay in line for the finish placements. and you know once you cross the finish line it can be pretty hectic so i was like a wrangler yeah yeah and like and i was so underprepared i cannot cannot say how underprepared i was for what i was gonna see uh people passing out people crying and like throwing up and like yeah everywhere just really really like violent and i just so under i was so underprepared for what i saw so anyway i had to i had to get that small story out um yeah but yeah long story short with diagnosis i

[00:07:11] Jonathan Tijerina: went to Guatemala with my dad who's a bilingual pastor in our area and there was this big pastors conference in Guatemala so he went down as a family you know I was having all the classic symptoms diabetes I was sleeping all the time and I was so tired and I had to pee all the time and I remember going through the jungle one time actually we're going to this really city this really pretty city called Antigua and it was like an hour and a half two hour ride through the jungle and we were driving through this like sketch jungle dirt road and I was like trying to talk to the driver and saying like i really have to use the bathroom the guy was like no you don't understand we can't stop here like we really can't stop in the jungle and so i was i was hurting so bad all the way to this beautiful city but then it ended up being a gorgeous experience

[00:07:56] Rob Howe: isn't that funny like and i even think to today like if i was leading a group and a kid was trying to tell me to that he had to use the restroom yeah i would think it would be the like the least important thing in the world but for somebody with type 1 i remember i saw the aviator which is you know the movie leonardo dicaprio about howard hughes it's a really long movie i think it was probably a week before i was diagnosed and i'm sure i was drinking like a large coke in the theater because why because why wouldn't you right yeah um exactly and so i think i probably went to the restroom like 50 times in that movie and i remember hating the movie because i just felt so miserable trying to go in and out and it was embarrassing i was like i feel like these people just think i'm going outside or i'm doing weird teenager stuff yeah and and it was just a you know traumatic moment so yeah in in those things they seem trivial right and and yet like for you at that time is you know as as all type ones know like if when you have to go to the

[00:08:54] Jonathan Tijerina: bathroom before diagnosis like you have to go oh it's huge yeah of course and we were eating you know just the the carbiest everything there too like we had fried plantains and like sugar cream sauce for breakfast every day and all kinds of rice and delicious uh fruits for lunch and dinner and it was probably you know and like you said i feel like at that time in my life i was thirsty i was reaching for like a coke or i was reaching for like uh an orange juice you know not water

[00:09:21] Rob Howe: yeah right just your classic teenager teenager nutrition right you're just grabbing whatever you can. Uh, yeah. And I remember even on the day I was diagnosed, I was kind of nauseous and, uh, I think I vomited early in the morning. And of course, what calms your stomach better than a Dr. Pepper? Uh, I think that's in almost every, in every medical journal, they would tell you that. Yeah. Um, so that surely affected by, uh, my first blood sugar test that I ever took. I no doubt like 60 carbs in a can of Dr. Pepper. Yeah. Great. So after, after that, like, you know, your, your diagnosis, like you get through this six, seven months, like you've gone overseas, like what, what happened, you know, when you, when was the final, what was the straw that broke the

[00:10:06] Jonathan Tijerina: camel's back? Yeah. So, well, my mom was telling me, you know, in retrospect, and we've talked about it since then, but she was saying, my mom's an occupational therapist. So she works in the hospital, you know, it's usually more of like a physical therapy sort of rehabilitation setting, but she's seen a lot of diseases and she was thinking, um, in Guatemala was actually the, right when we got back from Guatemala was like the big, the big moment. She was thinking she was going to get me checked out for hypothyroidism or something because I was so tired and sluggish all the time. Um, but when we got back, uh, the night we got back, I was feeling really crappy and, and I was telling mom that, you know, I really think I need to go to a doctor. And she said, okay, you know, I'll take you to the doctor tomorrow. We'll get, we'll arrange for an appointment like tomorrow or this week. And then that night I ended up waking up and throwing up just repetitively, you know, like 10 times and dry heaving for an hour or two. And then I fell asleep finally. And they were like, okay, we'll definitely take you to a doctor in the morning. And it still wasn't, you know, hospital then it was like, oh, we'll take you to a doctor. You'll be okay. So they were thinking that I was hadn't had some sort of tropical stomach bug from Guatemala at this point. And then I got up and I was going to go to school and check out to go see the doctor later. And then I ended up passing out that morning. And they're like, okay, no, we're taking you to the doctor now. So we went to see the doctor and he told me later that he really, before we even said anything, he said he could smell that fruity ketone sort of smell on my breath. And he was like, oh, I think this kid's diabetic. We need to get him tested

[00:11:31] Rob Howe: for diabetes. Isn't that funny how like, and I don't know about you and like your high blood sugar symptoms now, but I remember times where, you know, I've been, you know, in the two, 300s and have not felt any sort of you know ketone flavor or whatever in my mouth but then other times where maybe not even as high where i definitely feel that is that sort of weird like yeah you wonder you wonder who like didn't know what they were like looking for and still smelled that weird ketone type uh ketoacidosis flavor i guess or like aroma on yeah i don't know just

[00:12:11] Jonathan Tijerina: weird things to think about such a strange yeah it's so strange to try to explain to people too because it's like uh it's it's yeah it's it's really like a taste slash mouthfeel thing where you're like oh yeah i think i'm high i think my blood sugar is high yeah and i think i've heard

[00:12:26] Rob Howe: some people say it feels like they have like a metallic flavor in their mouth or like a very very strange uh just association with with with diabetes um so yeah so right then i mean you got diagnosed and then what was the, I know sometimes you mentioned being from a small town, the diabetes education is a little bit limited compared to other health systems where they have a bigger team. Do you remember what the sort of outlook was for you from your doctor

[00:13:00] Jonathan Tijerina: when you were diagnosed? Yeah. So I think my experience with diabetes education was pretty bad. I think that we, in my own hometown, they didn't really tell me much about the insulin that I was going to be taking. I was doing multiple daily injections with vial and syringe for about three weeks after I got diagnosed. And I was taking just kind of a flat dose with every meal. I wasn't carb counting or anything like that. So my sugars were super unpredictable in terms of getting high or low because I wasn't adjusting the dose at all. And then eventually, I went to go see a pediatric endocrinologist in this town that's about an hour away from where I live. And he got me on a sliding scale. We went back, I think, once a year after that. And I still, my blood sugars were still very sort of chaotic. But, you know, I hadn't really been educated in terms of why it's important to control them. I really didn't know that there were any sort of consequences for not controlling them. And, you know, at the time in my life, I was just like a 13 year old kid who is not probably not going to be super responsive to limiting my diet or limiting my activity anyways. But, um, I didn't find out about really how to carb count and, um, uh, adjusting my diet, uh, until I got to Baylor actually about, um, I guess six years later,

[00:14:18] Rob Howe: six years after I was diagnosed. And you know, that's, you know, looking back on that, Like you didn't know what you didn't know, right? Yeah. So, you know, you're a 13-year-old kid. You're like, hey, my doctor told me to do this. You sort of don't question it, right? I mean there's just – and that's I think something that I've been sort of opened up to in the last few years is, you know, when your doctor tells you something, you just sort of assume – at least I have, and I don't want to generalize. But at least I assume that they know exactly what they're talking about and they've dealt with it before and it's not something that they really ever question. So why would I question it? You know what I mean? And so did you – what was – when you went to Baylor and they were like, hey, you need to do this differently, looking back, what did that – what kind of like response did that elicit from you?

[00:15:09] Jonathan Tijerina: Yeah, it was really, I think, frustrating for me at the time because when I got to Baylor, my endocrinologist was like, oh, well, you've only seen a doctor once a year. You're supposed to be seeing a doctor three or four times a year. You've only done your A1C once a year. You're supposed to be doing it three or four times a year. And no, it's not okay that your A1C is like 10. And I was just so taken aback. And then, you know, of course, I'm kind of a scientifically minded sort of algorithmic thinker. So I was like, OK, well, what are you know, what are the steps? What are the changes that I need to do? And even in Waco, my endocrinologist only really gave me a brochure and wasn't super involved with my actual treatment. But she did push me to get a Dexcom, which I think was the biggest thing. It was a huge change for me in college and it really, really helped me in terms of diabetes management. I think I definitely, you know, I felt some sort of frustration, maybe a little bit of resentment that I wasn't really clued in into how exactly the best way is to go about managing my diabetes closely. Because I wanted to at that point. I didn't know that I hadn't been doing it before that. But then I was thinking, you know, I really want to get this dialed in.

[00:16:24] Rob Howe: Yeah, and I think that's a, you know, you are and everyone is to some extent a product of their environment, right? And you look back and you, you know, as you mentioned with some sort of resentment or like, how could this happen to me? Or how did I not know better? Or why would they, why would, why did this happen to me? And then, you know, you get, you know, as you kind of grow, get older, and then also just like have a little bit more experience, you know, hopefully that, you know, becomes a little bit, you know, less, you know, not as hard on yourself or on others. But, you know, like you said, it's not OK to have an A1C of 10 or like there's a better option, right? So what did you – you know, what did you think – you know, what do you think was the biggest impact when you realized, hey, oh, I do need to go to the doctor more often. Oh, I am learning all these other things. You mentioned you're an algorithmic-style scientific thinker. I imagine you felt a whole lot better, especially as an athlete, as you sort of got more exposed to more information in your journey with type 1.

[00:17:32] Jonathan Tijerina: Yeah, no, that was it was huge for me in terms of feeling better on a day to day basis, but also athletic performance wise, you know, because until then I hadn't even been really checking my sugar before races or before runs. I would just, you know, if I felt okay, then I would just gobble a bunch of gummies and go for whatever length of run I wanted to. And that was, you know, I wasn't even carrying snacks with me while I was exercising, actually. And, you know, in retrospect, that's like so shocking and scary to me now because I was going on, you know, 10, 15-mile runs with the team and I wouldn't have anything with me at all. No one would. We were just running in our little skimpy short shorts and our, you know, tennis shoes.

[00:18:12] Rob Howe: Right. Right, and I mean like if there's anything that you'd look back, if I only knew what I knew now or then what I knew now, I mean obviously like there's a huge amount of like preparation and tossing whether it's gummies or gel packs or Gatorade or insulin or whatever before you prepare for any kind of exercise but much less long distance intense running. It's tough. Like there's, you know, so many factors into not just feeling good, but also being prepared to, you know, run a very intense, you know, track and field event.

[00:18:51] Jonathan Tijerina: Exactly. Yeah, I think my treatment, athletics in college actually drove me to really try to dial in my treatments for myself as well as my athletic performance. So I ended up getting the Dexcom when I was in a junior in college and I ended up going on an Omnipod when I was a senior. The Omnipod, the Dexcom was just wonderful. I mean, if I had to pick one diabetes tool, it would definitely be the Dexcom. Um, but the, the Omnipod was huge for me too, because before then I'd been using, uh, you know, Lantus injections with a Humalog sliding scale and the Lantus, it was just background active for 24 hours. But whenever I would run, um, you know, there was no way to turn that Lantus off when I was going on these 15 mile. And then when I was a senior, I was doing a hundred mile a week. So I was running like 20, 20 mile runs on Saturday, like every week. and there was no way to turn off this background insulin. But with the Omnipod or with any pump, really, you could shut that off an hour beforehand and your sugars would be way, way less likely to get low on the run, which was huge for me. And my team was super supportive when I finally realized that I needed to be carrying gels and things around. So I would pack my little running shorts pocket with three or four gels that have like 30 carbs in them and then my teammates would bring some. Um, sometimes a trainer would meet us out at halfway points. So 10, 12 miles out, she'd meet us with gummies and Gatorade just in case I was low or anyone needed to rehydrate. Um, so I think that the athletic community at Baylor was huge in terms of supporting me to get better control, um, over my blood sugars. Uh, it was really, really wonderful experience to have everyone helping me out and, you know, asking me, are you okay? Or asking me, um, you know, do you need anything or just, just reassuring to have people out there with me.

[00:20:34] Rob Howe: And I think that's a really important thing. And I want to focus on it here for a minute because, you know, when you're on a team, obviously like you have, you know, the support of your teammates, I think on good teams, I think comes as a by-product of that. For elite athletes who are, you know, performing on the college level or, you know, elite high school level or professional level, a relationship with your athletic trainer sort of is mandatory, but also can go a couple of different ways. For me, when I was evaluating colleges where I wanted to pursue an athletic career, my parents and I, it was really important to us to go and talk to the athletic training staff and talk to them about what I experienced so far and some things that could come up and things that we needed to think about. how would you, you know, looking back, you know, and, and after a great college career and, and, you know, coming out of that successfully, what would you tell somebody who was, you know, either concerned or what are the questions that they should ask or, you know, what did you learn from, you know, your experience with, on the college level with your athletic training staff

[00:21:47] Jonathan Tijerina: and how did you approach those things? Yeah, absolutely. I think the, the athletic training staff was a huge part of me getting better control. Even before I got the Omnipod of the Dexcom, I remember when I had a really bad A1C my sophomore year, I went and talked to our head athletic trainer, his name's Kevin. Wonderful, wonderful man. Just so, so nice and really supportive. And I talked to him and I said, hey, bro, Kev, I'm really, really struggling with this. It's hard for me to go to dining halls and constantly eat with these other cross-country guys who are just scarfing down carbs on carbs on carbs and keep up with them in practice when I'm having to not eat those things or if I do eat those things, having to feel really bad afterwards physically. He was just the most supportive. He was like, look, we can come up with a customized plan for you nutrition wise and support wise from the team and we're all here to help you not only the staff but but your teammates you know and i think that one thing i learned from that whole experience and one thing that i would a piece of advice i'd love to give to any diabetic out there aspiring to athletics at any level is not to be ashamed of the fact that you have diabetes and not to be ashamed of the fact that you have to deal with some concerns that a lot of other people don't have to deal with. That was huge for me and just realizing that none of my teammates are going to hold it against me if I have to stop and eat on a run. None of my teammates are going to hold it against me if I ask them to bring some gels for me. No hiker, if you're out on a trail run and you don't have any carbs with you or you ran out of carbs and you're low, I've done this before. I had to stop and ask hikers for snacks. I was literally, I don't know, I felt super, super shaky. I had no carbs with me and I just stopped and said, hey, I'm so, so sorry to bother you, but I'm diabetic. I think I have a really low blood sugar. I'm wondering if you have any snacks. And they were the nicest, most sharing, caring people,

[00:23:48] Rob Howe: you know? And I think that's, man, that's like a super powerful story and an experience that you sort of have to, you know, you can't really prepare for until it happens to you. You can't really experience, but you know, that can change your entire outlook on, you know, on life almost. And I don't want to like, you know, cheapen it by just kind of giving that hokey kind of answer I just gave. But I think until you have that type of experience where you're like in a place where you have to say, hey, I need help. I need to ask somebody for this. You really don't know, you know, what you're getting into. Right. And I don't know. I think the power of asking is something that we don't talk enough about in culture, as athletes, as people with diabetes, as men even. And I think it's something that can really like push you and really help you level up because, you know, when you realize that, you know, people, those things that you're telling yourself, those fears, oh, I don't know if I should ask someone for help. When you do and you say, oh, this was great. This wasn't as hard as I thought. This really helped me. It can really like open up a whole new world for you.

[00:24:58] Jonathan Tijerina: Absolutely. Yeah, absolutely. And I think that it's a big realization in your mind when you realize that everyone is so willing to help. Yeah.

[00:25:06] Rob Howe: Yeah, I think two things for me before we get back to you. One, this podcast is entirely built off of standing on the shoulders of giants and asking for help for other people. And I've been so fortunate and blessed by people's help and time, being willing to come on the show and talk about their experiences and then share those with other people. Those are fantastic. And then another one very similar to you. I remember being on a hike in Colorado with my cousin when I was probably like a sophomore, maybe in college. And we went on this hike and I had this sort of joke with myself. Whenever I go on a hike, it always ends up being this like way bigger experience than I bargained for. Like, I'm like, yeah, yeah, I'll go on a one mile hike for an hour. And it ends up being like a five hour, you know, five to ten mile experience. And this was no different. And like we didn't bring water. We were in Colorado. we like went on this very pretty advanced hike with no water and I didn't have any like, you know, anything to treat my diabetes. And we got like halfway through and I was like, man, I'm in trouble. And these people that we passed just like, you know, similar to your experience were so giving and so nice and gave me like a 32 ounce Gatorade and really helped me get through this, you know, this hike, which could have been, you know, really bad had I not, you know, had they not been there. So yeah, I would definitely encourage anyone if you're ever in trouble, please ask people for help, you'd be surprised how giving people are. Even in today's time where you'd think, you know, you'd look out there and say, oh man, like no one's going to want to help each other today. Couldn't, you know, in my experience, couldn't be more the opposite. People have been so giving and are so willing to help you if you just ask. Absolutely echo that. Yeah, for sure. Cool. So let's get back to your story here. You're in college. You're stabilizing your blood sugars. You are getting help from your trainers and doctors and teammates. It's not only improving your A1Cs and performance as a diabetic, but also as an athlete. Absolutely. So what kind of impact did that have on you as an athlete from a confidence perspective and kind of everywhere in between? What did that give you as – how did that encourage you to kind of live your life and continue to grow as a type 1 diabetic and an athlete and a person?

[00:27:41] Jonathan Tijerina: Yeah, absolutely. Well, it's – yeah, confidence – from a confidence perspective, it was huge just knowing that going into a race, especially one thing that I was just I was so grateful that I am built to be a miler or you know a middle distance ish runner because you know in a collegiate mile you're you're racing for for you know four and a half minutes or less and um that's so friendly towards blood sugars because you don't have to really take a big snack before that um you know you can eat 15 grams of carbs like an hour beforehand when you start warming up and you're good to go for that whole race which was awesome for me. But just knowing that my blood sugars weren't going to do something unexpected, you know, and even if they did, I had the technology to enable me to respond to that well, I think was huge. And from a performance perspective, I think just getting them under better control helped regulate my weight, helped regulate my mood and my drive to work out well. And it was just really, really good for me physically also. And it culminated in a really good senior season for me. Um, but I would, yeah, I think a huge part of that was getting my sugar

[00:28:49] Rob Howe: under control. And, you know, I think, you know, when I think back to, you know, basketball games where, you know, I, I, and I guess I'll, I'll put that on pause for a second. I was, I sort of resisted having a CGM and I really couldn't tell you why. Um, I think not from a, you know, an idea, but maybe I just didn't want something else attached to me or I thought, you know, that I wouldn't be able to live the lifestyle that I live if I had a CGM on or something. And I mean, most of that was just like me in my own head and not making decisions that were based on anything logical. But, um, you know, I, I remember performance wise when my blood sugar was higher and I would test it and I, and I was playing poorly or performing poorly, of course, like, yeah, I knew that this was due to my blood sugar. Uh, and on the other side of that, when my blood sugar was in range and I, you know, prepared accordingly and prepared and got everything in line and, you know, really made sure that I approached everything the right way and my diet was on point and I was taking the right amount of insulin. My performance was no surprise, much better. Yeah, much better. And, and so, you know, for me, you know, and, and, and I think I, what I want to know for you, like, is there any time where you looked at like a competition or a particular moment and you said, Hey, I know I feel good. I'm going to really push and, um, and, and, you know, be confident in what I'm doing. And I, and I can attribute some of my success as an athlete to my preparation and my good, you know, numbers from, as, from a diabetes perspective.

[00:30:28] Jonathan Tijerina: Yeah, absolutely. Absolutely. I think one of my best seasons, um, uh, in cross school, my best season in cross country was my, uh, my grad school year. So I finished up, um I finished up my undergrad at Baylor uh did a degree in biology uh in four years but I had registered my freshman year so I had an extra year of eligibility left for track and cross so I hung around for a one year it was like uh regular semesters but then you also had to do a summer's worth of work to graduate in one year um master's degree in biology and so during that time And in cross-country season, I had really low in-class attendance load. It was more like research and lab work sorts of things. So I was really able to customize my own daily schedule and regulate what I was eating and work out at exactly when I wanted to work out. And so my sugars were really good during that time period. And my cross-country times got a good bit better and ended up finishing the season. And it was a huge, huge shock and honor for me. I ended up winning the Big 12 Scholar Athlete of the Year that season. And that was just huge for me, I think, because it really validated for me that doing that work and, you know, getting those things all settled in paid off.

[00:31:48] Rob Howe: Yeah. And, I mean, what a, you know, obviously congratulations. Thank you. You know, that's a huge accomplishment. but also, you know, just internally, like, hey, wow, I was able to get my, I had these great sugars, and I was having this great performance, and I have all this confidence, and I'm feeling really good. That's, you know, what a great story, right? What a great, you know, thing to just be able to tell people with not only diabetes, but any other kind of medical or injury related hurdle that you have to come over and then be able to come through that and come out of there with a non-diabetic award like Big 12 Conference Scholar-Athlete of the Year. That's incredible.

[00:32:33] Jonathan Tijerina: Yeah, it's so gratifying. Yeah, incredibly gratifying. And the same is true of that track season. I was able to carry that over and get some really good personal best times in track my last season, which is always great. Actually, my dad ran for Nike back in the day, and his personal best in the mile was a 406. and I only beat his personal best my last two races in college, which was also a huge win for me.

[00:33:02] Rob Howe: Yeah, that's awesome. First of all, that's not only a super fast mile, but yeah, what a great way to say, hey, finally get the monkey off your back and beat your dad's time. Exactly, exactly. um so from there um you know graduating and not only graduating undergrad but getting your master's um in a short amount of time a year obviously um coming out of that where did you you know where were you looking to i guess you know what were you looking to do next both as a in your career uh and then also as an athlete what did uh you know and a diabetic what were those things that

[00:33:41] Jonathan Tijerina: you said, hey, what's next for me now? Yeah. So I think coming from undergrad, I was looking at going into med school. When I got to Baylor, I was thinking I want to do something in politics. And then I thought I wanted to do sociology. And then I took a biology class and I really just fell in love with the sciences and eventually settled on medical school. So I took my entrance exams and did some research and did some TAing and then was interviewing. and I came out to California and my friends, my classmates make fun of me for this so much, but I literally came out here and thought to myself, this weather is the most perfect running weather I've ever experienced in my whole life.

[00:34:23] Rob Howe: So just like cliche, right? Like, Hey, California, great weather. This is super great.

[00:34:28] Jonathan Tijerina: It was huge for me though. Yeah. Because, you know, I'm sure as you know, in Dallas, it gets it's so hot in Texas all year and then it gets so cold and miserable for like two months and then you know springtime is nice fall is nice but summer is just oh it's brutal and you come out here and it's you know 70 and sunny almost every day you can't beat that especially if you want to

[00:34:53] Rob Howe: be outside or running like um just to give people who don't know I mean yeah you hear Texas is hot in California is great. But like, um, this summer I moved close enough to my office where I could walk to work. Um, and it's not even, it's probably half a mile, so not a long walk. And in the summertime when it's a hundred degrees and humid, it is, it is no, I do not want to do it is sweaty. You know, you're, uh, you know, you've got to, you know, bring a separate t-shirt or like, you know, you know, put your, put your actual work shirt in your backpack or something because it ruins whatever your outfit was for the day. You are soaked through with sweat after that type of walk. So for you as a distance or medium distance runner, yeah, it makes total sense going to California in Northern California too. Yeah, that's the perfect mix for perfect weather for a runner.

[00:35:50] Jonathan Tijerina: Yeah, absolutely. And I'm kind of a hiking enthusiast. I like climbing and skiing is a recent, I'm a recent skiing convert, but it's just so cool being able to be out here and go surfing, drive an hour or 30 minutes to go surfing. And then I have mountains right here to go hike and beautiful trails to go run and then drive three or four hours to Tahoe and go skiing. And it's all just right here. It's just so cool for me. And that was honestly really big when I was picking a medical school to go to. Stanford is super, obviously an incredible institution, and the research experiences and the clinical experiences here are really, really cool too. But they really bill it here as a school, as a place that allows you a lot of freedom to do what you want with your spare time. You know, they're not locking us in the library all day, and I really have enjoyed taking advantage of that out here. So that was a huge part of picking a place that I wanted to go to for medical school.

[00:36:48] Rob Howe: Yeah, no doubt. I mean, obviously Stanford as an institution, like you said, carries a lot of weight from a name perspective. But then finding that fit, I think you can't really put – whether it's a college or a university or a graduate school program or a postgrad or a work environment or a career. Like culture and fit goes so far. And I don't think you know that until you experience it. Yeah. Until you really feel the empowerment of, hey, I am in the right place and I'm getting the benefit of being here. And so, yeah, great for you to find that. And then also what pays off from a diabetes perspective as well is not only do you have the same – do you have better resources, but also you get to experience what – hey, not as much stress and the benefits of that. and or hey better resources and the benefits of that um on your you know health from a health perspective so um yeah great that you got to do that um yeah so now um you know kind of going into you know your medical school post-grad uh now you're in uh you're doing a research year so not as much in the classroom um what things have you found from a diabetes perspective um you know in those moments, both, you know, learning about it from a clinical perspective, but also, you know, living in it. And I'm kind of rambling on now, but I know you're involved in a lot of other outside of outside of the schoolwork and the study. I know you're involved in a lot of

[00:38:33] Jonathan Tijerina: other organizations. Talk a little bit about that. Yeah. So, I mean, the buzzword for me coming here in terms of diabetes was 100% just the community. This is something that I had never really had back in Texas. I think I knew two type 1 diabetics when I was in high school, and that's only because we went to the nurse's office at the same time at lunch to take our insulin. And then I got to college, and I didn't know – I don't think I knew any other diabetics, maybe one or two at Baylor. But I wasn't super close. And so I didn't get that word of mouth advantage that I got when I got here. People, I really enjoyed. The support was huge. I linked up with this awesome organization called CarbDM. It's a Bay Area type 1 diabetes organization that just has so many cool programs. And Tamar Safiri is the director. And I met up with her and we talked about some things that I wanted to get involved with. And we ended up creating the Bay Area Running Group, which was so, so fun. And we're starting things up again this January with that group. But it's basically – my idea was that it took me so long to figure out how to manage my sugars on long runs that it's something that I really wanted to pass on to people who – especially people who were just diagnosed. And so that was a really cool experience for me. And I ended up actually meeting a great local high school runner here who was recently diagnosed with diabetes. And I was coaching him over this Christmas break. And we're going to pick up coaching here again in another couple weeks. But he was diagnosed his junior or his sophomore year in high school. And my endocrinologist linked me up with him. And he came to the running group and now doing some coaching with him. So that's been super, super cool to get to share that knowledge with a group of people who I'm hoping they don't have to go through. the same lows and highs and, and all kinds of crazy stuff that I did to figure it out.

[00:40:39] Rob Howe: Man, what, how rewarding is that? That's so cool. I'm like, man, what a cool, I'm kind of getting like goosebumps a little bit because like, you know, both from a coaching perspective, first of all, I think that there's nothing more rewarding than to get to help to somebody, you know, find and do something better that they really care about and, and point them in the right direction and offer a little bit of guidance there in coaching. But also from a health perspective and a diabetes perspective, I would love nothing more than to get to have that opportunity. So again, wow, what a cool thing to get to utilize all of your different areas of expertise and pour that into somebody else's life. What a cool thing.

[00:41:25] Jonathan Tijerina: Exactly. Yeah, that was super, super cool. And I got to sit on a couple panels with my endocrinologist, Dr. Marina Basina. She's a wonderful, wonderful physician at Stanford. Cannot say enough good things about her. And talk to kids about, you know, what it's like going through college with diabetes. You know, what it's like doing athletics with diabetes. And that was just, you know, some of the most rewarding things that I've done here, honestly. And something that I felt was lacking back in Texas. Probably mostly because I had a community already in the athletics at Baylor that I wasn't seeking that out. I'm sure it exists there, and I'm sure it's a wonderful thing for people who are able to find that. But I didn't find it then, and I wish I had because it's been an incredible experience here. And it's – go ahead.

[00:42:11] Rob Howe: It's kind of interesting, right? Because you don't know what you don't know. And I was similar when I was in college. I wasn't really involved. I was sort of doing what I was doing, sort of kind of one track mind and not really looking for, like you said, that buzzword of community. And I didn't know what I was missing out on. And now, you know, the last two, three years now, getting more involved in the type 1 community has been, I can't tell you how much it's, you know, what the, you know, the ceiling on that is in terms of reward and benefit into my life. Yeah. It's been incredible. So, yeah, wow, what a cool benefit to that. And I'm so glad to hear that you're more involved in the benefits that you're getting from that. I know I want to talk a little bit. You mentioned you're an awesome endocrinologist there. When you sent your first email to me, something that stood out was that you're on a closed-loop system, not a hybrid closed loop system from Medtronic, but one where you use your Dexcom G5. I'd love to kind of hear a little bit more about that and how it has benefited your work life, both as a physician, because I know when I was researching your bio, I think you mentioned looking into a product or a product, a research project about doctors who are T1D who don't go into other fields. It like influences the fields because there's longer, they're afraid of getting low blood sugars during surgery.

[00:43:54] Jonathan Tijerina: Exactly. Yeah.

[00:43:56] Rob Howe: So A, talk a little bit about that project and B, talk a little bit about being on that hybrid closed loop type with your Dexcom and how that's impacted your life with diabetes.

[00:44:08] Jonathan Tijerina: Absolutely. Yeah, so these are huge examples, I think, of the opportunities available at an institution like Stanford. And probably a lot of academic institutions, if you just take the initiative and go talk to people, they're so willing to help. So two projects that I picked up with my endocrinologist recently. One is this medical school class that we're actually registered. We're ready to go. It starts in spring, and I'll be TAing it, which I'm really excited about. but you know she it started with this conversation where she told me that sometimes in the hospital people will misprescribe insulin because they don't understand the terminology and they don't understand that diabetics have vastly different sensitivities type 1 type 2 and in between people as as individuals and so people get lows people get highs people get all kinds of out of range in the hospital because the they try to kind of apply this generic formula a lot of times to very individual people. And so we were thinking that, you know, what can we do to fix this knowledge gap in the hospital? And so we decided to create this class. We're calling it Diabetes 101 for Healthcare Providers. And it's a really, really cool idea. We're just really wanting to teach practical skills because in the books in med school, you learn a lot about the biochemistry about diabetes. You learn the drugs that you take. You learn how the drugs work. But, you know, we don't learn about closed loop systems. You know, we learn a little bit about insulin pumps. You know, a lot of med students can tell you what the half-life of various insulins are, but they can't tell you like what the doses are or anything like that. So these more practical skills we were hoping to put into a class. So we created this class and we're really excited. I think it's going to be like kind of an exercise-based class where we have the students actively participate in something. For example, one class I'm really excited about is the carb counting class. where I explain to my friends a lot of times how difficult it is and how intricate our kind of calculations have to be for picking out foods. And one thing I want to do is it's going to be a catered class, so I'll have everyone get their food from the little catering line. And then when they're sitting down just about to eat, I'm going to say, hey, pause. I want everyone to take a break and try to guess exactly how many grams of carbs are on this plate and also how many grams of protein. Divide that in half and give me the number you think. and then we'll kind of talk about the difficulties of counting carbs. That's one example of practical skills that I'm hoping to cultivate and show in this class.

[00:46:34] Rob Howe: That is incredible. I think two things, man. A, when I read that that's something that you were involved in, it made me really excited because as you mentioned, doctors know the half-life of insulin. but um i think a lot of times at type ones and i know if i asked if i would maybe uh i don't want to put you on the spot for this but if i asked maybe endocrinologists yeah um who their most difficult patients are just from a personality perspective i would probably say type ones because yeah we get a little bit rigid a little bit sharp on our edges because yeah uh we feel a lot of times i know by just in conversations i've had with others like that their doctors don't understand them and that their medical providers just, they feel like they understand the disease, but not the day-to-day life with it. And so I'm super, super glad that that's something that you're taking on. But also from a medical device perspective, I was having a conversation on campus at Medtronic Diabetes a few months ago. And I said, hey, the term better outcomes totally alienates patients. Yeah. Because they don't understand it. They don't know what it means. It's just jargon and buzzwords to them. And so they feel like, because, hey, my doctor doesn't understand me. My medical device company doesn't understand me. They don't know what I'm going through. So I'm really, really glad that you're able to be on the end of both of those equations, both as a medical providing medical practice perspective, and then also as a type 1 diabetes perspective because that's really important and I think that's where a lot of in life the true experts of different fields, a lot of breakthroughs happen when you're an expert on not one but two pieces. So both as a type 1 diabetic and then also in the medical profession side of things. Not have said that there.

[00:48:34] Jonathan Tijerina: Absolutely. Yeah.

[00:48:35] Rob Howe: So yeah, bravo to you for doing that. So yeah. Thank you. That's super cool. And I know for a fact, I'm really glad that we met and got together because I know that we're going to continue to have these conversations. And now I know that I'm encouraged by you and the things that you're doing because I know that those things are going to continue to get better both on the education side for not only physicians but also type 1 diabetics. And so I'm super glad you're doing that.

[00:49:01] Jonathan Tijerina: Absolutely. Yeah. So the artificial pancreas system, I know we're getting kind of – getting a little close here. Yeah. The artificial pancreas system was something that I heard about through other diabetics, which is just another plug for the really cool community that's out there of diabetics who are in tech and diabetics who design, write code and do all kinds of really cool stuff. I heard about it. It's called Loop. There's another one called OpenAPS. They're both non-FDA approved. I do have to take a second to say that these are my own personal opinions and not a doctor's opinion or the opinion of Stanford Health Care or Stanford School of Medicine. and these are Jonathan Tijerina's opinions. And I heard about it from a friend, and I did a little research into it, and a speaker at one of the CarbDM events I went to was showing us his blood sugars live on the system. And it's really, really cool. I think we're not supposed to be using the terms hacked pump anymore because it's not technically hacked, but what you basically do is take an old pump and you force it to accept commands from an app on your phone. In this case, the app is called Loop. So you can link it actually to – one of the coolest things is that you can link it to any sensor you want. You can link it to Dexcom. You can link it to a G5, G4, or an Enlite. And then you put in, of course, your carb sensitivities and all kinds of things like that. And what it does is it takes the blood sugar readings from your Dexcom app, and it uses the active amount of insulin that you have on board that it's been recording, you've been getting over the past however many hours, three hours is what I have my insulin decay rate set at, and the active amount of carbohydrates you have on board. And then it makes a calculation every five minutes with each new reading from your Dexcom about whether or not you should get more or less insulin to bring you back down into range. And it works incredibly well, especially for sleep. That's been the biggest thing for me because, you know, I would try to keep my sugars really well regulated. And so I ended up having my alarms on my Dexcom set at around – I didn't want to get lows at night. And I didn't want to get highs at night either because I feel like when I sleep through the night with a high, I feel really bad in the morning. So I had my sugars alarm set at like, I don't know, I think it was 85 and 160 or something. So I was just not sleeping through basically any night. you know i'd get woken up a couple times and since i've gotten on this system um my sleep has been pristine it's been absolutely incredible there's no alarms um you do have to take on uh you know a couple more things that you need to charge like the pump goes through the batteries quicker because it's constantly making these adjustments you have to carry around this little radio frequency converter because the phone transmits in bluetooth but the pump only receives instructions in radio frequency. So it's another little thing that you have to carry around and charge. But the pump, I can't say enough good things about the system, as long as you tell it roughly how many carbs you're going to eat. And I like to bull this before the meal, but it'll adjust and it'll actually tell you if according to your carb ratios, you didn't count correctly. So for example, if I say I'm going to eat 45 grams of carbs and take the correct amount of insulin for that, but then my sugar goes up a little bit, it'll correct it for you without you even having to do anything. But also it'll let you know that you probably ate more than 45 grams of carbs. So if you want to log that meal for the future, you can say, oh, that meal I had at Chili's wasn't actually 45 grams of carbs. It was more like 65 grams of carbs, you know? Wow. So it has these super cool features. Yeah. I can't say enough good things about the system. Obviously have to consult with your endocrinologist about getting it set up. And you actually have to have a little bit of technological know-how. I had a friend set it up for me who's a little bit more technologically inclined. But once it's set up, the system is so easy to use and it works so, so well.

[00:53:03] Rob Howe: That's really cool to hear. Because I think, I'll give you a little bit of background information. I think literally this week, I'm going to receive my Medtronic 670G hybrid closed system. So So very soon I'm going to be going through sort of the learning curve of having the artificial intelligence make the decisions for me and kind of releasing my control on that. But having conversations with the people in the community about the loop system that you were on. And I think that was the thing for me that I, again, just didn't know what I didn't know. but one of the really cool things from the community that I came out of it because like you said, you'll look at a meal and a plate and after a certain number of years, you're like, yeah, I know how many carbs are in that. I'm going to eat that. And then sometimes you'll still go high or still go low because it's just a guessing game because you've got more insulin on board or you ate too many carbs or hey, maybe there's more fat in that meal or more protein and your insulin just didn't break down the carbohydrates the same way. You don't know. And I think you are what you measure. And so I'm really glad that there's systems in place and out there where you can learn from these things and you can say, hey, next time you eat this Chinese food, just know that there's going to be more than meets the eye to this meal and you're going to have to give yourself a different dose.

[00:54:38] Jonathan Tijerina: Exactly. Exactly. Yeah, that's one of the coolest features. And the retrospective correction is really cool because not only does it let you know that you ate more than you thought you did or somehow you got a little bit more carbs in there than you thought you did, it will fix it for you to an extent. I don't think it could keep up right off the bat if you ate like a whole Snickers bar. You didn't tell it that you were going to eat. But an extra 15 grams of carbs or an extra 20 grams of protein-heavy carbs, it can deal with that no problem. and it's super super cool and just gives you a little bit of confidence it also has the kind of a prospective cutoff feature which is really awesome if it predicts you're going to go low it'll cut off the insulin that you're getting which has been really great for me because I hate lows so much and it just you know my low the number of lows that I've had before when trying to keep my sugar you know my a1c in the right place I feel like I've struggled with lows so much. And, and that makes me shy away from having really good control. And I think this is not a rare story because lows feel so scary and so bad. They do. And I know there's a lot of, I guess I,

[00:55:46] Rob Howe: I never, uh, I guess I'm trying to, I'm trying to word this the best way because I know that a, a great fear of a lot of people with type 1 diabetes is going, going too low, losing consciousness. Um, and you know, potentially dying from, uh, from a low, you know, type seizure situation, right? And so I'm really excited for the suspend before low feature that I'm going to have on the new hybrid closed loop system. And I'm glad that there are those things that are out there on your type of loop, artificial pancreas type system that allow people to live with more confidence and feel more confident in their control. Because right now, you know, I feel really confident in my control. I've had an A1C, you know, I've never really had out of control blood sugars. My A1C has been between 6.1 and 6.4 for the last year and a half. I feel really good about that. Um, but right now I'm going through, um, this is actually, um, as I'm talking to you day two of my 30 day, uh, over the counter T1D challenge where I've now gone off of my pump and I'm on like R and NPH over the counter insulin, just so that I can document this for people who maybe lose insurance or lose their job or come upon financial strain. So I wanted to show, hey, that there are ways out there for you to treat your T1D over the counter. But I am wearing a Dexcom and I do have other sort of things in the background so that I can track these things. um but yeah so yeah i've the last two days have been super rocky for me both with highs and lows because i'm just adjusting to a new treatment wow that's cool i actually have a friend here

[00:57:33] Jonathan Tijerina: who's running the loop system with r um because once you buy these things they're your they're your property you know you can pick up a pump on ebay and you can buy this transmitter on on github so if you lose insurance you can still run this system with with an over-the-counter

[00:57:48] Rob Howe: insulin. Wow, cool. I need to, you might have to, after we get off of this interview, introduce me to that. Sure. Because I'd love to talk to him about that. It'd be really cool. Absolutely. Yeah,

[00:58:00] Jonathan Tijerina: that's very cool. And in terms of a quick segue, the reassurance that this kind of like low guard and just the confidence that it'll correct if I get a little high has really kind of massaged the fears that I was talking about that I was trying to address with that paper that we mentioned. So also with my endocrinologist and another really great endocrinologist at Stanford, who's also type 1 named Dr. Law here, we're, we're collecting data on the sorts of factors that go into doctors who have type 1 diabetes specialty choices. And this has been something that's kind of close to home for me recently, because I still have about a year and a quarter until I need to pick what I'm doing. But you know, that's, I had never thought about that before coming to med school ever. Um, are these surgeries going to be long? Am I going to get a load during the surgery? If, if I do, you know, am I even allowed to do long surgeries? Like, do I have to pay extra malpractice insurance or are there some kind of regulation on that? Um, turns out there's not, and I'm completely okay to do whatever surgical subspecialties I want. But, um, in terms of my own opinion on, on the thing, on the matter, um, that's been something that's kind of been on my mind a lot lately. And I was thinking, you know, there's no literature out there on that. So we decided to, um, pick a survey and, uh, start sending it out to type

[00:59:17] Rob Howe: one diabetic doctors out there. Wow. That's really great. And, and again, I just keep, I think I've said it now five times. You don't know what you don't know, right? Yeah. That's a really interesting thing to think about. It's something I hadn't thought of until I read your, uh, you know, research project or the little background on it. Cause I haven't read the, obviously the entire paper, but, uh, just reading about what you were doing and studying and trying to create awareness within your community.

[00:59:45] Jonathan Tijerina: Yeah, absolutely. That's been really cool. I write a lot of short fiction too here, which has been really therapeutic, something that I hadn't done before, but just a sentiment that you kind of mentioned earlier, and I just love to echo the idea of doctor as patient and how no person in this entire world is one-dimensional. Like every single type 1 diabetic is also something else out there, whether that be son, mother, brother, father, doctor, or any kind of other thing that they're doing with their lives.

[01:00:18] Rob Howe: Yeah, there's so much more to people than meets the eye. And I love to – that's one of those things about the community where I get to meet people who, yes, are type 1 diabetics, but also have these other amazing qualities that they are so passionate about, whether they are athletes or are doctors or both or in your case. So it's really, really great. I'm really impressed with it. And I think from your perspective, I'm really glad we met because I'm sure that we could talk on an interview and continue to unpack all these types of questions and different subject matter for hours. So I'm really glad we got to do this. um, Jonathan, I, um, I know we, uh, we got a late start today, but, uh, I wanted to, um, I wanted to make sure that, um, I got this question out because I, it's a question and you mentioned that you, um, that you have, um, that you've listened to a few episodes. So I want to make sure that, uh, that we get this on here. So the context is important. I'm sure you've heard it. It's, uh, if you are, if you were in an airport and, uh, and you're the gate to your flight was about to close and, but you run into somebody who has type 1 diabetes or has either been struggling with it or been recently diagnosed, uh, and you've only got 30 seconds before they close, uh, your gate. What would you tell that person? What's the one thing you would leave them with in that 30 seconds before they close the door to your gate?

[01:02:01] Jonathan Tijerina: yeah I thought that was the funniest question when I first heard it because I went on a vacation to Iceland last summer and I remember sitting down at one point to drink some orange juice because I had a low and I saw a different brand of testing strip on the ground and you know of course I was just I was laughing so hard because I was like somewhere in this airport there's another diabetic

[01:02:21] Rob Howe: you know it's so true I love when I see those those test strips sliding around yeah they're

[01:02:27] Jonathan Tijerina: everywhere. They're everywhere. They fall out of my hair, I swear. Yeah, the one thing I think I would tell another diabetic if I had no other time is don't be afraid to connect and don't be afraid to reach out for help. Because I think that I struggled so long with trying to figure it out on my own. And I honestly think that help was just an internet search away back in the day. And I'm sure there are wonderful groups just to get together and support each other in cities all throughout the United States. And even if there's not one in your city, that's like the beauty of the internet. You know, you can connect like we're connecting now. And it's such a lonely place. If you are too scared or too ashamed, you know, to reach out. And I've been there thinking, you know, why can't I figure this out? I'm not a dumb person, but I'm having so much trouble figuring it out. And it's so much better when you distribute that, um, that load to other diabetics who are more than happy to share that with you. I couldn't agree more. That is super,

[01:03:32] Rob Howe: super powerful. Um, you know, this age of the internet, you know, there's so much, there's so much great information out there. Uh, and you know, I think social media gets a lot of negative backlash in the media these days for good reason. But the power of community, especially within the type 1 diabetes community has been nothing short of incredible to me personally, and I know to many others. And so, yeah, I would echo that. Don't be afraid to connect. Don't be afraid of anything related to that. I'm all about I'm banishing fear right now, 2018 for anybody, anybody who's making decisions about their diabetes or about their life based on fear. Reach out. Let's connect because I'm 100% ready to get you turned around and moved on to making better decisions based on other factors. And I totally echo that sentiment 100%.

[01:04:29] Jonathan Tijerina: Yeah. Could not agree more. Banish that fear. Yeah. Reach out. We're here.

[01:04:33] Rob Howe: We are. Yeah. And you know what? Ask for help. We talked about that earlier too. Yeah. You will be so surprised how those fears that you convince yourself that people in your head that you shouldn't ask for things, please allow yourself to be completely, completely surprised by how good people are and how much they're willing to help you.

[01:04:56] Jonathan Tijerina: 100%. Yeah, I could not agree more.

[01:04:58] Rob Howe: Jonathan, man, this has been, we're like an hour and five minutes now into this episode. And this has been, man, I know we could probably go for another hour and talking about this. And I actually would welcome you to come back anytime um and do that um but i'm so super super super grateful that uh that you reached out and i think you heard about um me from Lauren Bongiorno's instagram i did yeah who's a big i'm a i am a big fan of it i'm actually going to get to meet in person in a couple weeks uh as she comes to dallas uh for our jdrf type 1 nation event oh it's so cool So I will be sure to mention this to her when I get to meet her.

[01:05:40] Jonathan Tijerina: Wonderful. Thank you so much. Yeah, I really appreciate the opportunity. And like you said, yeah, it's been an incredible conversation. Easily could go for hours and hours talking about this kind of stuff.

[01:05:49] Rob Howe: With that in mind, I'd love to have you back. But I'd also, if anybody wants to get in touch with you, what's the best way for them to do that?

[01:05:57] Jonathan Tijerina: Best way is email the jdt2015 at stanford.edu.

[01:06:03] Rob Howe: Great. and if they maybe we're going to get I'm going to include your email in the show notes but maybe if they wanted to get in touch with you via social media any other platforms that you would recommend they connect you with

[01:06:15] Jonathan Tijerina: absolutely I'm on Instagram at Jonathan J-O-N-A-T-H-A-N underscore D-A-V-I-D underscore T-I-J-E-R-I-N-A

[01:06:27] Rob Howe: great well I will include links to both of those in the show notes and until then my friend. Yeah. Great to meet you. And you know what? Sic 'em Bears, my little brother graduated from Baylor. So definitely. Thank you. Appreciate it. Well, great. Well, we will be in touch,

[01:06:46] Jonathan Tijerina: my friend. Wonderful. Enjoy Dallas. Have a good one.