Diabetics Doing Aviation with Jeremy Robertson

[00:00:00] Rob Howe: Welcome back to the Diabetics Doing Things podcast, where we're telling the amazing, untold, wacky, weird, and inspiring stories of type 1 diabetics from across the world. I'm your host, Rob Howe, and I wanted to let you know that we now have over 500 years of living with T1D on the podcast, and we're on track to be over 1,000 by the end of the summer, which is pretty exciting. I also wanted to chat about my new email series, Friday T1D Feels, where I send you a personal note, no fancy graphics or anything like that, about what I've been thinking about in the world of type 1 diabetes during that week. If you're into that, just go to diabeticsdoingthings.com and sign up. I'd also like to take a minute to talk about hashtag coverage to control. JDRF is raising awareness around the fact that most of us don't get to pick the insulin pumps we have, just the ones our insurance will cover. Just imagine if your cell phone was like that. Except this isn't a phone, it's what keeps us alive. So let your voice be heard and tell your insurance company that T1Ds and their doctors should decide what kind of pumps they use, not the companies. I'm looking at you, Aetna, UnitedHealthcare, Blue Cross Blue Shield. Let's get this right. Okay, enough chatter. Let's get back to the episode. Hello and welcome back to diabetics doing things. We're telling the amazing stories of type 1 diabetics all over the world. And I'm very, very excited for our episode today because not only do we have an international guest, but we have an exciting diagnosis story as well. So Jeremy Robertson, welcome. Welcome to the

[00:01:33] Jeremy Robertson: show. Thanks, Rob. Thank you very much for letting me join in. Oh, well, absolutely. And I think,

[00:01:39] Rob Howe: you know, we were chatting a bit before we got on the episode, but you're calling from Sydney, Australia. So, you know, right now it's my Friday evening and it's your Saturday morning.

[00:01:49] Jeremy Robertson: Yeah, that's right. It's a beautiful, sunny Saturday here in Sydney.

[00:01:55] Rob Howe: And just because I'm curious and also sort of ignorant to it, it's about to be winter in

[00:02:01] Jeremy Robertson: Australia. Is that correct? Yeah, we've just kicked over into the first couple of weeks of autumn. So it's cooling down. But the weather is still lovely in Sydney. It's 25 degrees Celsius yesterday. I don't know what that is in Fahrenheit, I'm sorry, but it's a lovely, warm, sunny day.

[00:02:16] Rob Howe: It's kind of the exact same here in Dallas, except we're just sort of on the other, we're going the other way, because it's going to be really hot here in a couple weeks. Great. Okay, so Jeremy, because your diagnosis story when you reached out to me, it really stands out for a few reasons. One, because of your late sort of adult diagnosis, and then two, just because of the drastic career change. So why don't you just give everyone just a little bit of a background on sort of leading up to your diagnosis and sort of who you were before you were diagnosed because a lot of people, because they're diagnosed so young, don't really remember their life before type 1. So I think your perspective on that is going to be really unique.

[00:03:04] Jeremy Robertson: Yeah, okay. Okay. Yeah, I definitely have a life before diabetes and life after diabetes. So I grew up in Canberra, the capital of Australia, and then I came up to Sydney to go to university. And all I ever wanted to do growing up as a little kid was fly aeroplanes. And I was very lucky that I had the support to be able to pursue that as a career. and I was also lucky that my timing with the cycles of the aviation industry meant that I managed to get a job with Qantas, Australia's international airline, at quite a young age. I was 21 when I joined Qantas and I was a second officer on the 747 flying all over the world. I used to spend a lot of time in Los Angeles. So the second officer is third in charge of the 747 And then after a few years of doing that, I got promoted to being first officer or co-pilot on the Boeing 767. And again, that was flying internationally around Southeast Asia and the Pacific and doing a lot of domestic flying in Australia.

[00:04:09] Rob Howe: So before we kind of get into more specifics, I want to just focus on the fun part, right? Like talk about flying. So, you know, I'm sure, you know, most of our guests have flown on a commercial passenger airline, but what kind of like operations go into that? Like, obviously, it's a huge crew of people, both on the ground and in the aircraft. Like, what's that like? What's the dynamic?

[00:04:36] Jeremy Robertson: Well, yeah, there's an incredible, incredible, I guess, giant machine going on behind every airplane flight, commercial flight. But as a pilot, my experience was that I would arrive at the Qantas offices an hour or two before my flight was due to depart. And I would go up to the flight planning desk and I'd meet the other pilots. On a 747 flight to Los Angeles, there's generally four pilots on board. And by the time we arrived, the flight planners, as a dedicated flight planning department, they'd already looked at all of the weather and figured out what the most efficient flight plan between Sydney and Los Angeles was. So we'd be handed a flight plan and all of the weather en route, and we'd look through all of the weather, all of the notices for various airports along the way, and we'd figure out if we wanted to add more fuel or if we wanted to fly a slightly different way. And once we'd sorted all of that out, we were taken out to the airplane. And by the time we got to the airplane, generally the passenger boarding was already underway. Certainly all the freight and baggage loading was underway. Our fuel order has been communicated to the refuelers, so they were refuelling the aeroplane. So there's all this huge number of people that are all making decisions and contributing to getting everything on board the aeroplane so that you can depart at a set time. And then again, from the pilot point of view, someone would go outside and walk around the aeroplane and just basically do a last-minute gross error check, make sure there's no glaring problems with the aeroplane. and an engineer would have done the same thing before the pilot did it. The pilots inside the flight deck are preparing the flight deck and setting up all the systems, the navigation computer, all that sort of stuff, getting ready to go. And then it sort of all came together at the last minute. The last passengers would get on. The head flight attendant would call us to say everyone was on board. The engineer, standing at the nose wheel, would ring up and tell us that all the cargo doors were being closed. the refueller would come up and we'd sign for the fuel receipt. And, yeah, we'd all be ready to go, and hopefully that would occur on time. And, you know, you were always aiming to lock the doors and push back the aeroplane and start the engines within one or two minutes of your scheduled time. So really, as the pilots, we're just another cog in this giant machine that's got all these different components all coming together simultaneously to get a flight departed on time. So it was pretty amazing to be a part of that. And then I guess the fun stuff started for me because that's when we went flying.

[00:07:15] Rob Howe: Right. So, I mean, you talked about your whole life wanting to be a pilot. What started that? Do you remember?

[00:07:23] Jeremy Robertson: I probably blame my father. He was always making model airplanes when I was a little kid. and I think I must have been a bit of a terror around the house because I quite often remember him just getting me out of the house and we'd go out to the airport and sit and watch the aeroplanes land and he was always pointing up to the sky. I remember him telling me how to tell if it was a 747 flying over because the shape of the contrails was different to the other aeroplanes. And growing up in Canberra, Canberra's about a four-hour drive from Sydney where all of our family were, and quite often I'd get stuck on an airplane as a little kid to fly up to Sydney to stay with my grandmother for the school holidays and that was in the late 80s so you were still allowed up in the flight deck so as a little kid I'd always ask to go up and sit in the cockpit and talk to the pilots and very occasionally you'd be allowed to stay for the landing and I think that just all sort of soaked in and I never I never really thought about it till about halfway through high school and there's this funny story where I failed a career test the careers advisor had this this barrage of 200 questions that you answered and it spat out an answer that that sort of told you what career path you were most suitable to and I wasn't suitable for any career according to that test not one not one not one not one it gave you a graph and my graph was this completely flat line at the bottom of the scale. And all it really was, was that there was not one question that said, do you want to be an airline pilot? And that was, I guess that test worked because it focused me and it made me realise that that's actually what I wanted to do. I just wanted to be an airline pilot. So I started making decisions from that point onwards to sort of get myself heading in that direction. You know, I changed high schools to one that had aviation subjects. I convinced my father that it would be good if he started funding some flying training. So the process of changing schools, I left a private school and went to a public school. So I convinced my parents that the money they saved on that, they could spend on flying lessons. And that was a bit of a hard sell, but they agreed eventually. And when I moved to Sydney to go to university, it was to do an aviation degree, which was designed to produce commercial pilots. so I finished that degree with a commercial pilot's license and all the appropriate ratings and managed to get a job as a flying instructor first of all here in Sydney and then I moved up to I guess Australia's equivalent of Alaska it's the remote northwest of Australia but instead of being freezing cold it's a tropical region but like Alaska it's very remote and it relies heavily on small aeroplanes to get a lot of freight and people and tourists around the place. I spent a couple of years up there flying little six-seat Cessnas around having a great time and as I said earlier I was just in the right place at the right time when Qantas was expanding and I got a job with

[00:10:24] Rob Howe: Qantas. So I mean you really took a verdict from that test of like no outlook and you turned it

[00:10:32] Jeremy Robertson: into a career like almost right away. Yeah I guess all of that passion was inside me but I had never had cause for it to be focused into a direction. And that test, even though I failed it, obviously had the desired result.

[00:10:50] Rob Howe: But it's all about perspective, right? So, you know, because I'm talking a lot these days about like zero-sum games, so like where there's only one outcome. And I think that there's so many outcomes if we just kind of look for it. And, you know, another person may take that test and take it to heart and say, I can't do this, or what am I going to do? But I think the outlook to say, well, this test really didn't have anything to do with what I wanted, so I'm just going to do what I want and what I know and how to work that plan. So I think it's really strong.

[00:11:27] Jeremy Robertson: Yeah.

[00:11:29] Rob Howe: So now you're flying for Qantas, and you're going back and forth from Australia to the U.S. to all over the world. I imagine there are some in the Far East as well, out to China, I flew a Qantas flight when I was out in Asia in 2015. So you're flying all over the world. And then you, let's get towards your diagnosis, sort of walk us through, you know, as things started to change.

[00:11:57] Jeremy Robertson: Well, after seven or eight years with Qantas, I managed to get involved in the flight technical department, which they're the part of Qantas that they do a few more interesting things with airplanes rather than just flying passengers from A to B. And I was trained as a maintenance test pilot, which means that every now and then one of the aeroplanes would be taken offline for one of the major inspections and they'd be disassembled and reassembled. And before they were allowed back to flying passengers, they'd have to be test flown. So myself and a captain and an engineer would go up and do a three to four hour test flight on the aeroplane, just running through all the different systems and redundancies to make sure the aeroplane was safe to go back to passenger flying. And that was great fun because you got to do all sorts of things in the airplane that you normally would do, like turn engines on and off and turn hydraulic systems on and off and check the stall warning system and all that kind of stuff. And this really sparked a bit of an interest in test flying. And I didn't have any formal qualifications in test flying. I was halfway through an engineering degree at the time that I was doing in my spare time. and I discovered that there was a test pilot school in Mojave in California and this was the only civilian test flying school in the world and they ran this fantastic little two-week introduction to test flying course. So I enrolled myself in that and in February 2010, I was in Los Angeles. I was staying in Riverside on the eastern side of Los Angeles and I was converting my Australian air transport pilot licence to an American one. And that's about a one-week course. And then I was going to go up to Mojave and start this two-week test flying course. And while I was in Los Angeles, I guess in the week leading up to heading over to Los Angeles, I'd been noticing in Australia that I was drinking more and more water. But it was the middle of summer. It was 35 degrees here. it was hot and I'd been really busy and I just didn't pay much attention to that. But that one week where I was in LA and it was winter in LA, so it was low 20s, I was still drinking a lot. I was urinating frequently and I was just starting to feel worse and worse. And by the end of that week, the thing that really tweaked me that something was wrong was that my vision went blurry. you know I wear glasses with a pretty mild correction anyway but it didn't matter if I was wearing them or not if I took my glasses off things were the same amount of blurriness as they were when I was wearing them and I just thought yeah something's not right so I went off to one of the local medical centers in Riverside and the doctor there you know listened to my symptoms tested my blood sugar level and uh it was what was it it was about it was about 450 i think in uh in your numbers 25 millimoles per liter is the number i remember which i think is 450

[00:15:06] Rob Howe: milligrams per deciliter right so like in in the u.s and it's i think it's becoming a little bit more popular with like ketogenic diets becoming so popular now, like people start measuring according to millimolars. But right, so about 450.

[00:15:23] Jeremy Robertson: Yeah, so five times higher than it should have been, you know. And he looked at me and said, have you just eaten? I said, no, haven't eaten for, you know, four hours since breakfast. And he just said, I think you've got diabetes.

[00:15:39] Rob Howe: Just sort of casual like that?

[00:15:44] Jeremy Robertson: Yeah. And I was sitting there because I'd come straight from the flying training school where I was doing my license conversion. So I was sitting there in my pilot's uniform and he said, I don't think you should do any more flying while you're here. I think, you know, you don't have insurance. You should probably try and get on the next flight back to Australia. And I knew enough about diabetes at that point to know that I probably didn't have type 2 diabetes. So this was probably type 1. And in Australia and most countries around the world, type 1 diabetes automatically invalidates your commercial flying medical. So you can't work as a commercial pilot if you've got type 1 diabetes. So I just had this realization that everything I'd worked towards professionally for the last 15 years just stopped then and there.

[00:16:47] Rob Howe: And right, and I think, you know, without, there's really no other option. And I think for those who have listened to the episode with Neil Greathouse, who is the Beaties on Instagram, he was in the military, the U.S. military, and was trained to be a pilot. and that was very similar, right? Like he was diagnosed and then instantly moved out of his unit.

[00:17:16] Jeremy Robertson: That's right. I listened to that one and the only job available to him was to be a trash collector or something, I seem to remember. Yeah, ridiculous.

[00:17:23] Rob Howe: It's just quite a transition, right? So for you, and I think also I want to touch on the fact that you were pretty familiar with the differences between type 1 and type 2, which I don't want to say is unusual, but most people I think have a casual maybe understanding. Was it just your training or just your understanding of the medical clearance?

[00:17:46] Jeremy Robertson: Yeah, you do do a little bit of medical study as part of your air transport pilot's license. I can't remember if that specifically covers diabetes or not. I have a funny feeling it doesn't. I think my knowledge from that was probably more from my friends that I made during my undergraduate years. I lived on campus at a residential college when I was doing my aviation degree. And a couple of my friends were studying medicine. And I always found their textbooks interesting and would often leaf through them. So I'm not sure where I picked up that knowledge. But I just remember knowing that it wasn't type 2. it was more likely to be type 1

[00:18:29] Rob Howe: so you're sitting there in Riverside, California in your pilot's uniform at a medical clinic or a local office 3,000 miles plus from home what goes through your mind?

[00:18:51] Jeremy Robertson: I remember the doctor giving me the diagnosis and then giving me a few minutes to myself and I just remember sitting there crying quietly for a while and pulling myself together enough to call my wife at that stage she wasn't my wife this was six weeks before our wedding so

[00:19:13] Rob Howe: so you got a lot going on so you were right yeah you were not only were you in the US and training and doing and you know under a lot of stress there but you're also getting married so no wonder you didn't notice that you were

[00:19:24] Jeremy Robertson: drinking too much water yeah life was busy um so i rang my my wife my fiancee and she was just about to head overseas on a big work trip we'd sort of timed these things so that we were both going to be overseas at the same time and we were both going to come back with a couple of weeks to go to tidy everything up before our wedding uh so she she was literally 10 minutes away from getting in the taxi to the airport. So she cancelled her trip. And then I rang the test pilot school and said, this is what's happened, I'm not coming. And then I rang Qantas and booked myself on the next flight home, which was, I think, the following evening. So that was a Friday lunchtime I got diagnosed and the next flight wasn't until Saturday night. so I had a day and a half to kill in Los Angeles yeah where I knew no one and to kind of yeah just ponder ponder my life and wonder what I was going to do so that was a pretty funny 36 hours I went back to my hotel and checked out the next morning and I went to the Plains of Fame Museum in Chino and if there's any other aviation enthusiasts out there it's a fantastic museum It's got all these wonderful airplanes and a lot of famous airplanes from the test flying that was done in California in the 50s and 60s. So I just remember wandering around looking at all these incredible airplanes that I'd read about and thinking, you know, I'm never going to fly anything like this anymore. This is a real shame. And then, yeah, hopped on the Qantas flight home and I didn't even have a regular doctor back at home in Australia then because I was never really sick. I guess a lot of people in their 20s can relate to that. I didn't have a family GP or anything like that. The only regular doctor I saw was my aviation doctor who I saw every 12 months for my flying medical. So I went and saw him and he sent me off to one of the big research hospitals in Sydney that has a diabetes research arm. So I went through the formal process of being diagnosed, antibody testing and all that sort of stuff. and it was very clear that I definitely had type 1 diabetes. So I was put in touch with an endocrinologist and a diabetes educator and a diabetes nurse. And I had six-month sick leave saved up at Qantas because I'd never been sick. So I just went on sick leave. And, yeah, my wife and I got married and that was fantastic. And we went on a honeymoon and that coincided nicely with my diabetes honeymoon. So my insulin requirement dropped to sort of one or two units of long acting a day. So that was kind of nice. We had a couple of weeks in Fiji at a remote little island and I didn't really need to take any insulin.

[00:22:20] Rob Howe: Oh, that's great. It's like the real honeymoon alongside the diabetes honeymoon. Yeah, the double honeymoon. Oh, that's fun.

[00:22:30] Jeremy Robertson: And then, yeah, back to Australia to sort of sort out life. So I went through the process of getting a medical discharge from the airline. And as I said, I was doing that engineering degree part-time, so I kept doing that, not because I sort of intended on working as an engineer, but more to give myself something to do and something to focus on. And, yeah, I just did a lot of thinking about what I wanted to do professionally for the rest of my life because I wasn't going to be able to fly aeroplanes. and that's where I realised I'd always had an interest in medicine. I enjoyed complex careers. Flying was a complex job. But the one thing I found lacking in flying was that I didn't really feel like I was contributing to society as much as I possibly could and I think that's where the thought of a medical career really kicked in. And, you know, a medical career is so broad. There are so many different areas you can end up in. I thought, like, I'll start, I'll have a go, and I don't know where I'll end up, but I know that somewhere in there there'll be a niche for me, and I'll find it interesting enough and rewarding enough that I'll be able to make a useful career out of it. So that sort of began the process of starting applying for medical school and going through entrance exams and interviews and all that sort of stuff.

[00:23:57] Rob Howe: and and when you when you were going through that process um obviously like i think you know emotionally um a lot of people go through maybe like a burnout or you know a denial phase or um you know you know obviously it's a hard situation um but you know what was what were those conversations like even with yourself like you know i'm gonna what am i gonna do um you know what do I, my first love is obviously aviation and now I can't do that. What do I, you know, where do I go from here? Talk through some of that, some of those things.

[00:24:36] Jeremy Robertson: Yeah, I guess there's sort of two sides to the flying. One was, yes, I certainly couldn't do any professional, commercial, large aircraft flying. And that was devastating, absolutely. and I definitely went through, in hindsight, having now learnt more about depression and adjustment disorders and so on, I definitely went through a period of some form of depression and it probably would have been better if I'd gone and sought some help with that but I chose not to and I guess I dealt with it by keeping myself busy and I kept myself busy with the engineering degree. I kept myself busy with the diabetes and I guess I kind of threw myself into the diabetes management and there's a lot of overlap with the sort of the ongoing thought process you have while you're flying a big airplane to the constant thought process you have being a type 1 diabetic. Flying a big airplane, you've always got a contingency plan in the back of your brain and you always know sort of what the energy state of the airplane is. So you know how much fuel you've got on board, how far you can get with that fuel, where the closest usable aerodromes are if you're going to have an emergency and you're constantly running sort of mental calculations and updating them as you go. And I guess I just transferred that mindset to managing my diabetes. uh you know i knew how much food i'd eaten i knew what types of insulin i had on board how long they were lasting and i always had my little backup plan of various foods and juices available and i just applied that thought process to managing my diabetes and i think that yeah that kept my

[00:26:32] Rob Howe: brain really busy gave me something to focus on well and it's it's i imagine much like a flight plan, like, you know, even the best laid plans, like they're still, you know, oftentimes like small adjustments you've got to make throughout that, um, you know, course changes, or like you said, you know, fuel, um, and, you know, preparing for a long journey, um, because, you know, every

[00:26:56] Jeremy Robertson: day is different. That's right. And I'm, I know everyone listening will be able to relate to just how many different things impact your sugar levels. Uh, and flying's the same. There's so many variables that you can't predict and that's why it was you know an interesting and enjoyable career because you're always you're always thinking and everything's every day is different and it's the same with diabetes so yeah you're always you're always ready to react to whatever variable you know unforeseen variable gets thrown at you so I think yeah that that mindset that I had from my flying career has really helped me with my diabetes and certainly helped me early on get things under control pretty quickly. But also, I came very close to burning out pretty quickly. And I remember one of the diabetes nurses that I was seeing on a regular basis just said to me at one point, just relax a little bit. Don't be so focused on getting your sugars down to that level all the time because you're going to stress yourself out. and I think that was sage advice very early on because again you and I all know that you'll do everything right and some days your sugars will just be completely berserk and you have no idea why and if you let that get to you yeah you're going to burn out and so I just had to learn to take a deep breath and carry on

[00:28:24] Rob Howe: sometimes it's difficult because you're holding on tight you're looking at that number and you want to do well I think you and I are very similar in that regard, like, especially when I was competing as an athlete, like I wanted to be my best all the time. And some days it just wouldn't happen. And, you know, if you're if you're holding on too tight, and you can, you know, that sort of self talk, you start being too hard on yourself. And I think that's where, you know, sometimes it seems so simple, like, hey, just breathe, relax. but you know I totally identify with yeah sometimes that's maybe not the first instinct you know for somebody who's really trying to I guess accomplish the mission right?

[00:29:06] Jeremy Robertson: Yeah that's right and I think again having a bit of a type A personality you know I wasn't going to let diabetes cause me any trouble you know I was going to control diabetes not the other way around so that's what I was out to do when I was first diagnosed and I was probably channeling a lot of my anger into managing my diabetes, which, yeah, maybe that was good. Maybe that gave me the motivation to keep it tightly controlled. But, yeah, also the negative of that was I was – if I kept going like that, I would probably have burnt out fairly quickly.

[00:29:43] Rob Howe: No, and I think it's a common – because it's a common reaction, common response because you're looking for a way to feel and, of course, you're upset. that you're going through those six stages of grief or acceptance. You go through them sometimes quickly, sometimes over a long period of time. I specifically would be short with people sometimes who were just asking questions because they didn't know. They didn't know any better, and they were interested in what was happening to me. For a long time, I remember one interaction in particular. I snapped at one of my teammates my freshman year of college, and he kind of was taken aback by it. And I ended up apologizing to him later just because I was trying to beat diabetes. I was trying to not be different. I was trying to not be affected by it. And I think it's easy to do as you're going through some of those cycles.

[00:30:35] Jeremy Robertson: Yeah, I agree. I agree. And I guess going back to your original question about dealing with post-diagnosis, the big thing that changed was not doing commercial flying. But the thing that never changed was that even when I was flying for the airline, I've always loved flying little aeroplanes. And I always used to take friends for scenic flights and stuff like that. And I was lucky that about six months after my diagnosis, I managed to restore my medical to allow me to fly ultralights, which is aeroplanes that weigh up to 600 kilograms and only carry two people. so really just fun little airplanes to go flying on a sunny day so i was very lucky that after a very short period of time that component of my life sort of went back to normal if i felt the urge to go for a fly in a little airplane and just uh you know do something that i really enjoyed i

[00:31:35] Rob Howe: could still do that what was that first what was that first flight like uh it's just magic

[00:31:42] Jeremy Robertson: just fantastic to get back up in the air and uh and do something that i loved and and i guess that gave me a bit of hope it's like you know yes i've lost the big airplane flying but it's not the end of the world i can still i can still do this little airplane flying and i've always loved this so i know i can continue to to love this so i've lost a component of my passion but i haven't lost everything that i'm passionate about so now so now you're um you

[00:32:09] Rob Howe: You know, you're going to medical school. You're, you know, you're working to be working on a new passion, something that's, you know, finding a place to land in a very complex field, like you said, where you can, you know, know that you'll have some sort of application. So now what do you, you know, as you're channeling your passion and you're really working and maintaining to stay busy, what are you hopeful for? And what do you want to affect as you now, you know, go into another phase of your life?

[00:32:39] Jeremy Robertson: Well, I guess, yeah, life has changed drastically since diagnosis because I'm married. I've now got two young children. I completed the medical degree, which was hard work with two young children. But, you know, I got an enormous amount of support from my wife and our families. And I guess what I've found happening throughout that whole phase is just sharing my story. You know, people are always very interested to find out my background because I've come to medicine a lot later in life. I'm usually about a decade older than most of the other medical students or junior doctors I work with. So they always ask what I did beforehand. So I guess I'm always happy to talk about my story and talk about type 1 diabetes. and I use that opportunity to bring people that I get exposed to up to date with what the latest is with type 1 diabetes from a management point of view or a research point of view. And it's always interesting to find out what people know and don't know about diabetes and just, yeah, to kind of give them an update on what's happening.

[00:33:52] Rob Howe: And I imagine, especially in like a medical community, it's even more interesting because the, you know, not everybody gets the full education. Obviously, you're, you know, there's so many things you can focus on that, you know, diabetes sometimes isn't even sort of in that purview. What are some of the responses that you've gotten or, you know, maybe ones that surprised you or, you know, memorable conversations that you've had about it?

[00:34:17] Jeremy Robertson: I guess the common themes are a lot of people are surprised that I'm on a CGM, but I'm not on a pump. and a lot of people are surprised that you can't be a commercial pilot if you've got type 1 diabetes. And a lot of people, a lot of doctors, it's just interesting. Like you said, a lot of doctors, their level of knowledge of type 1 diabetes varies immensely. And it basically comes down to, as you said, what area of medicine you're focusing on. And if you pursue a direction that just doesn't expose you to people with type 1 diabetes, you just, yeah, you don't stay up to date. Certainly not as up to date as someone like you or I who's dealing with it every day.

[00:35:05] Rob Howe: Right. And I think, you know, it's much like someone who doesn't know anyone with type 1 diabetes or has never had a friend or family member associated with the disease. They don't necessarily need to know the difference. They've never been exposed to it. So, you know, I think it's all about that awareness level. It really depends on your proximity to the material.

[00:35:29] Jeremy Robertson: Yeah, exactly. So I just try and use myself as a little, I guess, a little walking update service for anyone I come across. And I don't hide the fact that I've got type 1 diabetes. You know, my Dexcom is always visible on my upper arm, and I usually have a brightly colored GrifGrip sticker on it that's a rocket ship or, you know, something like that. I let my kids choose which sticker I'm wearing from week to week. So that's a bit of fun. So people always ask, you know, what's that thing on your arm? And that's just an easy introduction to the whole conversation.

[00:36:03] Rob Howe: Right. It's just an icebreaker almost instantly.

[00:36:06] Jeremy Robertson: Yeah. Yeah. So that's something that I'm trying to do in the medical world. The other side of it is the aviation world. Right.

[00:36:16] Rob Howe: I was going to ask because people ask you or they say that they're surprised by type 1s not able to be pilots.

[00:36:25] Jeremy Robertson: Yeah, and I just explained to them that aviation medicine is inherently conservative. And yes, times are changing because management is so much better these days. But given the conservative nature of the industry, change is happening, but it will take time. and the interesting change that's going on in that space at the moment is that there are four countries in the world that allow private flying with type 1 diabetes and there are two countries that allow commercial flying with type 1 diabetes so Australia is one of the countries that allows private flying but doesn't allow commercial flying and it's quite an effort to get your private license back. It took me three or four years of building up sufficient data on my diabetes management to convince the authority here that I was safe to fly a private airplane without a safety pilot sitting next to me. And I guess what I'm, I'm in this interesting intersection of careers where I have all this commercial aviation knowledge, but I now have a smattering of medical knowledge and it sort of has put me in this ideal position to be someone who can advocate for pushing the boundaries of the restrictions on flying with type 1 diabetes and I guess what I'm trying to do is follow in the footsteps of a wonderful gentleman from the UK by the name of Douglas Cairns he was a an Air Force fighter pilot when he was diagnosed with type 1 diabetes and he has been an enormous champion for lifting the restrictions on type 1 diabetes he circumnavigated the world in a light aircraft and he set up an organization called flying with diabetes and there's a they've got a website that's just flyingwithdiabetes.com and you can read all about their exploits there's quite a number of pilots in the u.s that are involved with them and they do things like fly pasts at jdrf events and they try and set point to point speed records in light aircraft and when there's more than one pilot they'll do a formation flight and set a point to point speed record flying in formation so they're just using their passion for aviation to again i guess erase awareness for type 1 diabetes and also push the point that type 1 diabetes need not be something that limits your ability to fly an airplane. So I'm trying to emulate that kind of thing here in Australia. Obviously, we have a much smaller population. So I'm in touch with about half a dozen different pilots here in Australia that have type 1 diabetes. And yeah, I guess I'm just hoping in the future to do a few more of the things that Douglas Cairns has done. And in the meantime, every time I apply for my annual aviation medical, I always ask to have some of the restrictions lifted just to allow me to do more and more

[00:39:30] Rob Howe: flying. And with your now, you know, background in medicine as well as aviation, and you're Obviously, like every year you go back for your exam, like you've had another year of experience. How do those conversations go with your medical examiners from an aviation perspective? Are you able to, you know, make progress with there? Or is it just sort of, again, very incremental with the conservative nature of the industry?

[00:40:00] Jeremy Robertson: There is definitely progress, but it is definitely incremental. yeah I guess now being able to speak fluent doctor I my aviation medical doctor is very supportive of what I'm doing and that's excellent and the I guess I now just try and use as much medical data to back up my applications to the aviation authority here so this year I've had some success they've reduced some of the restrictions around me having insulin when I go flying. So I used to have to wait 90 minutes after administering insulin before I was allowed to go for a flight. I've given them enough data for them to shorten that window to 60 minutes. I'd love it if I didn't have any restriction at all, but that reduction is better than nothing and it's progress. So I'll just keep working on that. And this year for the first time, I've actually asked for a commercial medical. for the first time. And Australia is not one of the countries that allows that to happen, but they've indicated that they will actually consider my application. So I'm in the process of setting up a conference call with two of the senior doctors at the Aviation Authority to discuss my application. So again, that's progress. Prior to that, it would have just been a blanket no. So I'll be interested to see this year where that progresses to.

[00:41:31] Rob Howe: And that's fantastic. I think, you know, I didn't even really expect to have that come up in our conversation this early, like to think that, you know, something that you love and obviously have passion for immensely and have had your whole life taken away from you. and then to end up with the choices that you've made and the work that you've done to position yourself to be able to maybe help someone else and again, maybe get your commercial medical reinstated. The idea of that to me, without all this happening, maybe that wouldn't have even been possible.

[00:42:14] Jeremy Robertson: Yeah, that's exactly right. I think, yeah, like I said, I've just ended up in this unique position. It's not, I think in Australia, I'm certainly the only former commercial pilot now with type 1 diabetes and qualified as a doctor. So that's definitely put me in a unique position to be able to advocate for this kind of stuff.

[00:42:37] Rob Howe: No, it does. And I think, you know, it speaks to your, obviously, you know, passion and dedication and character to, you know, even go down, consider going down that path. But again, like very, very, very interesting and like and unique and and awesome. I think it's exciting. I'm very glad, you know, that we're having this conversation. And I think that, you know, has the potential. I imagine that there are the people that you meet in Australia, as well as the pilots you talk to in the U.S. and throughout the world who have very similar feelings towards aviation as you do. and to be able to potentially have even the inkling of the idea that there's hope that they could get clearance again. What a worthwhile cause.

[00:43:25] Jeremy Robertson: Yeah, absolutely. And I'm certainly keeping the pilots that I'm in touch with here in Australia up to date with my progress. And I'm not expecting enormous progress in one step. If I am able to get a commercial medical back, I'm expecting that it will be significantly restricted to small aeroplanes with more than one pilot and that kind of stuff. But I guess I've kind of got it in my mind as a bit of a five-year project. If I can make incremental steps every year, then I'll be happy. And that's right. I know there's a couple of Australian pilots overseas because you're allowed to fly with type 1 diabetes commercially in the UK. so there's a couple of Australians over there doing that and I know that they would they'd love to come back to Australia if the rules were changed here eventually

[00:44:19] Rob Howe: and is that the UK allowing Type 1s to fly commercially is that because of the work of the organization and the gentleman you mentioned earlier yes that's almost directly associated with their work there in the UK

[00:44:36] Jeremy Robertson: yeah absolutely Yeah, the flying with diabetes and Douglas Cairns have been an enormous champion for that cause and have been an enormous influence on the medical authority over there to allow that to happen.

[00:44:53] Rob Howe: That's fantastic. That's very, very cool. And I'm definitely going to look up because I haven't been exposed to anything associated with flying with diabetes, but it sounds like Douglas would be another great conversation to have and potentially… Oh, absolutely. You know, raise more awareness of, you know, the journey of, you know, type ones who have, you know, been, you know, restricted and then, you know, with the potential and through that incremental progress to give that kind of joy back to them.

[00:45:21] Jeremy Robertson: Yeah, yeah. Well, I'm just looking on his website at the moment because there's quite a few pilots in the U.S. that are involved with him. And he, they've got a flying with diabetes USA tour of the East Coast coming up in October this year. so yeah the website's got his contact details and the details for a number of the other pilots that are involved in the US so I'm sure any of them would be delighted to talk flying and diabetes at any point

[00:45:51] Rob Howe: well you know it's not something that I thought that I would be delighted to talk about again just awareness you never know but yeah it's fantastic and I'm definitely going to reach out to them and see to have more conversations about it because it's really fascinating

[00:46:06] Jeremy Robertson: yeah it's interesting it's uh i guess what i love is that people people have ended up with type 1 diabetes and they're just using whatever their passion is to to promote type 1 and i think that's probably the biggest thing i've taken away from listening to your podcast is all these different people have all these different passions things that i never would have thought of but they found a way to use that to to be a positive influence uh in the type 1 space and it's just so inspiring

[00:46:31] Rob Howe: to listen to it's i'm consistently i guess taken off guard or um or just impressed i guess i'm just i'm always impressed with how giving the members of the type 1 community are to each other um and just very genuine and uh it's like you know we have this thing in common this you know thing that could have been terrible. And for many people is devastating initially, but also, you know, continues to have devastating results in their lives. But there is a group of people and, you know, a lot of type ones who are doing amazing work, whether on a small scale with something that they're passionate about, whether that's art or fitness and exercise or, you know, or athletics, or even academics in the medical field, I think it's incredible to see how willing the type 1 community is to help each other and help spread those stories.

[00:47:33] Jeremy Robertson: Yeah, yeah. And I'm definitely, I mean, just last week, I had a really bad week with my sugars last week. I've been fiddling with my diet. And then we had my mother-in-law's 70th birthday party, which, you know, always leads to, parties always lead to bad blood sugars for a couple of days for me. And then I got sick, and that, again, that always makes my sugars unstable. So I just had this really bad week with sugars, and I was really, I was feeling really down about it all. And I was driving back from Canberra, where I'd been down to see my dad. And I just listened to that last podcast of yours.

[00:48:13] Rob Howe: with paloma with paloma yeah glitter glucose glitter glucose that's what i was trying to

[00:48:18] Jeremy Robertson: remember yeah and it just made me it was just what i needed it was the the kick in the ass to to make me feel better about it all and go yep it's okay i've had a bad couple of weeks but i know all the reasons behind it so i shouldn't let me you shouldn't let it get me down and you know there's all these wonderful people doing all this wonderful stuff and i just got to remember that I'm doing all right with my diabetes and I'm actually doing something useful. I'm out there showing people that I've got type 1 and that it's not slowing me down. And that's a good motivation for me if I can be a positive role model for other type 1s. And that cheered me up when I got back to Sydney and I was feeling better about it all. So I'm glad I'm feeling better about it before we had this podcast because I didn't want to be all doom and gloom.

[00:49:10] Rob Howe: I always, uh, it's so weird. Like right before I do an interview, I always like check my, my blood sugar just to make sure I'm like, you know what, if I'm going to go do this, I want to make sure that I'm not, you know, running low. Some people have, some guests have told me that they felt like they rambled because their blood sugar was low, which is never the case. I think people just are, you know, not necessarily used to being interviewed, but, um, yeah, it's always that little bit of like, Oh, you know, I wonder, and, uh, I even did a, I have some improv comedy friends and I've had a few of them on the podcast but we did a little show we called it A1C thinking which was a pun on some improv term called A to C thinking but we all tested our blood sugar at the top of the show we did like a little 10-12 minute set and it was just so nerve wracking to be like oh what is it going to be? and then all of us laughing it off afterwards everybody was within range and fine, but just that like brief moment. So, you know, it's fun to at least, you know, know that there are other people out there feeling the same way.

[00:50:13] Jeremy Robertson: Yeah, that's right. I'm sitting here watching my Dexcom at the moment, and it's actually remarkably stable. It's been flatlining at 6.9 for the last hour. What's that? That's 124. 124 milligrams. That's perfect. I'm pretty happy. Yeah, yeah. And actually on that, I'm very lucky at the moment. One of the other junior doctors I work with also has type 1. So we're often bouncing numbers off each other and laughing. When some of the nurses bring in cupcakes or something like that, we'll make jokes about how much we should or shouldn't eat or how much insulin we're going to need. It's kind of nice to have someone at work to bounce the type 1 jokes off.

[00:50:56] Rob Howe: It changes so much. I had no idea what I had been missing out on because for a long period of my life, just by happenstance, really, I didn't have any type 1 friends nearby. And I wasn't hiding my type 1, but I was just not calling any attention to it. And then now that I have interactions, I can get on Instagram and see a million people's blood sugars, or I can text my friends and just check in if I'm having a bad blood sugar day. like the difference that that has made just from like an attitude or, you know, in a feeling is

[00:51:32] Jeremy Robertson: phenomenal. Yeah, yeah, I know what you mean. I've never known anyone with type 1 diabetes. And this chap that I work with at the moment, we went through med school together. So it was nice to have someone else in my class. But apart from him, I haven't really known anyone. But I've, I guess I've built my own little circle of type 1 diabetics through getting in touch with other pilots with type 1 uh yeah and that's that's where i've built up my little my little support network i guess it's uh it's good to be able to email those guys and just uh talk about how they manage it with their flying oh and i'm sure good days and bad days i'm sure they've just been dying

[00:52:13] Rob Howe: to have those conversations with people um as well so it's it's always it's always cool to have that you know that sort of itch scratched you know to have yeah like oh i there is somebody like me so I know you listen to the podcast so you know what question I'm about to ask you if there's one thing you would tell someone or even you know a pilot or someone who was diagnosed late in life or just anyone living with with diabetes if the one thing that you

[00:52:36] Jeremy Robertson: could tell them what would it be I would say that that it's all going to be okay in the long run it's you know there's going to be ups and downs there's going to be times where you wish you could pick up diabetes and throw it out the window and then there's going to be other times when diabetes is behaving itself but it's going to be all right you know it's a learning curve but you you just keep learning and just yeah keep putting one foot in front of the other don't let it get you down lean on those around you learn as much as you can and and you'll get a handle on it. You know, you will find the best way for you to manage your diabetes because everyone's different and you'll get to that stage and it will be okay. I think that's what I would say to anyone with type 1 that's either newly diagnosed or struggling. You know, it'll be all right in the long run. Just keep chipping away at it and keep asking for help.

[00:53:40] Rob Howe: Definitely. and it will be okay. And I think, as you know, by reaching out, you can have great conversations and meet people that are totally willing to talk. And I just empathize even, just say, hey, yeah, I'm having a rough week of sugars myself.

[00:54:01] Jeremy Robertson: Yeah, that's right. And even just to get some different ideas. Like I said earlier, I'm experimenting with my diet at the moment. I'm trying to just minimize my carbohydrate intake and rely a bit more on proteins and fats. And it's caused some instability, but I can see that it's going in the direction I want. And it's been great to be able to get online and, yeah, look at a bunch of resources and just listen to other people's tales of doing the same sort of stuff. I go, oh, yeah, I can see that'll work for me. I'll use that. Or, okay, that tactic, I know that's not going to work for me. I'll ignore that. Rather than just trying to figure it out yourself.

[00:54:39] Rob Howe: And it's so funny, right? Like I just finished my sixth Whole30 and I'm always pretty vocal about my success with Whole30, but like very similar, right? Not eating very many carbs. Like the only carbs I really eat are like potatoes, sweet potatoes. But, you know, going online and looking at the results from different people, but also just knowing how you feel. I always knew and I said really from the time I was probably like 20, 21, I was like, yeah, you know, at some point in my life, I'll probably like, you know, only eat vegetables and maybe some meat or whatever. And then, you know, before you know it, you look up in your mid to late 20s and you're like, wow, I should probably start looking at that. You don't want to admit that your metabolism is slowing down or that you're getting older. You know what? Maybe I should start taking this more seriously. So, yeah, I'm kind of right there with you. I'm eating very healthy. I was even having a conversation the other day and it's like, you know what? I don't even want a cheap meal because I know I'm not going to feel good afterwards. And, you know, that's just such a weird mental headspace to be in as an adult. You're like, wow, I really am getting older. Yeah, I'm finally growing up. I'm growing more mature. Look at me go.

[00:55:55] Jeremy Robertson: Yeah, yeah, I failed at that last week. Someone brought in some rocky road to work. And I thought, I know that if I have that, it's just going to stuff up my sugars for the rest of the day. And I thought, ah, bugger it, I'll have some. And it did. And I just thought, no, I felt terrible for the rest of the day. But it's my own fault.

[00:56:11] Rob Howe: And you know what? For every once in a while for Rocky Road, you know, it's a worthwhile cause. That's for sure.

[00:56:18] Jeremy Robertson: Yep. Yep. I don't eat it very often, but it is nice.

[00:56:22] Rob Howe: Well, Jeremy, thank you so much for coming on the podcast and for reaching out. What a fantastic perspective that you have on everything. I think, you know, with so many different, you know, emotions that people go through all the time, you know, having to change careers, having taken your passion away from you and just, you know, looking at it with such a fresh set of eyes and like really changing the way that you approach those things. It's been an awesome time talking to you and it's been great to meet you.

[00:56:51] Jeremy Robertson: Well, likewise, it's an interesting experience talking to you now after listening to your voice for so many hours as I drive to and from work. I feel like I know you very well but of course we've only just met but I've really enjoyed this conversation it's been a lot of fun

[00:57:06] Rob Howe: well if our guests want to get in touch with you or want to reach out is there a place online I know you reached out via email but like website, Instagram where can they reach out and get in touch

[00:57:20] Jeremy Robertson: yeah get in touch is probably easiest via email my email is jr568 at gmx.com and uh and i'm on instagram i don't have a huge number of photos on there and i it's basically just photos of me going flying uh but if you want to look at some photos of me flying little airplanes i'm just on there as a type 1 pilot so yeah if you type that in i should pop up

[00:57:47] Rob Howe: perfect well um we'll definitely include links to all those in the show notes um and jeremy thanks so much again for spending your morning chatting and you know what I look forward to future conversations so

[00:58:00] Jeremy Robertson: yeah absolutely if you're ever in Sydney we'll go for a scenic flight

[00:58:03] Rob Howe: if that's what's waiting for me in Sydney that's a whole lot more incentive to go I'd love to

[00:58:11] Jeremy Robertson: absolutely alright thank you very much for having me on Rob it's been great fun

[00:58:17] Rob Howe: thanks for listening to Diabetics Doing Things subscribe to our newsletter for weekly emails and behind the scenes content And if you or someone you know has an amazing story to share, send an email to rob at diabeticsdoingthings.com.