Diabetics Doing Worldwide Adventures & Commitment with Oren Liebermann

[00:00:00] Rob Howe: Hello everyone, Rob Howe here, and welcome to the Diabetics Doing Things podcast. Just wanted to let you know that if you've been listening all the way to this point from the beginning, you're inching ever closer to hearing over 1,000 years of living with type 1 diabetes. Now, certainly there are some similarities in how we all deal with the disease, but I find it super rewarding to dig into the tactics, tips, mindsets, and insights that make us all different. If you hear something new, interesting, or polarizing, drop me a line. I'd love to discuss it. Holler at me on Instagram or shoot me an email. Okay, let's get back to the episode. Hello and welcome back to another episode of Diabetics Doing Things. We're telling the amazing stories of type 1 diabetics from all over the world. And I'm very excited to introduce my special guest today because not only is he calling from the other side of the world, from Jerusalem, but his story will take us all over the world as well. So I'll do my best to give him a worthy introduction here. So my guest is Oren Liebermann. He is an Emmy Award-winning journalist and the author of The Insulin Express, which is One Backpack, Five Continents, and the Diabetes Diagnosis That Changed Everything. And Oren is a CNN correspondent, and like I said, he's over in Jerusalem right now. So, Oren, welcome to the show. So glad that you were able to make the time.

[00:01:15] Oren Liebermann: Rob, it's a pleasure to be with you. I'm glad you can have me on.

[00:01:19] Rob Howe: So, for those of us who may not be as familiar with your story, You know, you're relatively, I believe you were diagnosed about three years ago, a little over three years ago. Why don't you walk us through sort of the background and the context of how you came to join the type 1 diabetes family?

[00:01:38] Oren Liebermann: So back in September 2013, I was 31 years old and my wife and I decided we'd been married for a year. My wife and I decided that's it, we're going to travel the world. We could either do the sort of the quote unquote normal thing and buy a house and buy a car and start a family, or we could sell everything we own, buy a couple of backpacks and just start backpacking our way around the world. So we chose option B and just began backpacking. At this point, both my wife and I are perfectly healthy. I might have been just a touch overweight, but we decided, you know, what will backpack and work it off. So we did a couple of months in Europe, a couple of weeks in Africa. We did a couple of weeks in Israel and Jordan. and then we did six weeks in Nepal. And it was during the time that I was in Israel, actually, that I began to feel symptoms. The only problem is I didn't actually know they were symptoms. I distinctly remember the first night it was at my aunt's house that I couldn't sleep through the night because I had to get up and go to the bathroom. And from there, these classic symptoms of diabetes began. But when you don't know they're the classic symptoms of diabetes, you just keep walking around and pretending like nothing's wrong. And especially with traveling, it was easy to do that. It was easy to keep making excuses for why I was constantly thirsty because we were constantly hiking. And of course, I had to go to the bathroom because I was constantly drinking. So a couple of weeks in Israel, I was feeling these symptoms. Oh, go ahead.

[00:02:58] Rob Howe: Yeah. I think it's one of those things that we all deal with, right? Because we end up with this chronic illness, but the symptoms are just heightened everyday things, right? Like, you know, you've got the dehydration and you've got the, you know, extra frequent urination and you got some weight loss. But, you know, in the grand scheme of things, if you're busy and going from one place to another, pretty, pretty easy to just, you know, chalk it up to, you know, like you said, either hiking or being in a different place or, you know, heat.

[00:03:26] Oren Liebermann: Exactly. It's so easy to write off these symptoms and make excuses for them. And sure, I felt a little bit weak, but we were constantly moving. So, of course, I felt tired. So then we went we were in thailand for just a couple of days and then we were in nepal and we decided nepal would be our big stint we we knew we wanted to give back in some way because we were able to travel so we were teaching english um to young buddhist monks at a monastery in a city called pokhara nepal the third biggest city in nepal very outdoorsy city there's a lot of activities you can do there so we kind of hunkered down we had a host family and we stayed for for quite some time before we began teaching at this monastery we are our host organization the organization we were volunteering with had set up a hike to Annapurna Base Camp. Not Everest Base Camp, obviously the more famous base camp, but Annapurna Base Camp, which is about at 14,000 feet. And at this time, I had type 1 diabetes and didn't know it. This is before my diagnosis. And it was on the first day of hiking that cramps attacked my legs. And I don't mean just mean I felt cramps. I mean, they attacked my legs and I had to stop and stretch them out and keep drinking. I thought it was just hydration. And this continued for the next four or five days

[00:04:36] Rob Howe: as we kept climbing. And I think, you know, as somebody who, so I've climbed one 14er and it was like Pike's Peak. So it's like the most tame 14er of all time. For those of us now who, you know, you go into a workout and your blood sugar is a little bit high and you're very sensitive to how you feel, what was kind of going through your head as you're like, man, what is going on? Because that feeling that you have, whether it's cramps or just general feeling ill, what was kind of going through your mind? Was it just again like, oh, I'm climbing a mountain. Of course, I should be feeling some sort of adverse feelings. Yeah, climbing a mountain in

[00:05:18] Oren Liebermann: a foreign country. My wife was moving well. By day two, we were above 5,000 feet. So altitude begins to affect you. So that was another excuse. So of course it's affecting me. It's the altitude. And then the food, it's Nepali food. So it's not, it's not sort of rich in fat and calories and carbohydrates like our Western food. So that's another excuse I was able to use as to why I wasn't feeling a hundred percent and why I was moving a little slower. Um, and then shortly before our trip, I'd actually torn my ACL in my right leg. So that was another thing I was able to use as an excuse for why I wasn't moving quickly because my leg forced me to slow down, Even though my knee was doing great, I'd recovered quite well. But it was all these excuses as for why I was moving slowly. And the plan was to spend the night at essentially one camp below base camp. And then we'd wake up early in the morning and hike to the top or hike to this base camp and then begin our descent. And I woke up feeling tired. We woke up at about six in the morning. It was supposed to be an hour and a half hike. and that hike from from one camp below base camp to actually 14,000 feet took me three hours and I I wanted to stop I wanted to quit I want to sit down and crawl and cry and just turn back because I hadn't eaten anything and I felt exhausted and my wife was way up ahead of me she kept looking back to see if I was still moving and and that three hours almost broke me broke my spirit I I wanted to just sit down and just call it. And eventually I got to the top. It took every bit of my strength. And we passed the sign for Annapurna Base Camp. And my wife said, stop, let's take a picture. And I said, we're not there yet. We still have to get to the top of this little hill. And then I sat down. I had the most expensive Coca-Cola I've ever had in my life. And I felt great. And of course, I had no idea what was happening. In hindsight, I woke up with low blood sugar and then tried to hike at 13,000 feet with low blood sugar. And of course I felt great after having a can of Coke. It's pure sugar. And I spiked my blood sugar and we made our way back down. And that took a couple of days of much more relaxing hiking on the way down. And then we started teaching. And this whole time I've type 1 diabetes and I don't know it and I'm losing weight. But again, I didn't think I'd lost that much weight. So, of course, I felt good. Hey, I'm losing weight. Who cares? I'm thirsty. It's the dry season here. Of course I'm thirsty. And by this point, it is early February 2014. And we Skyped with my parents one night and with her parents one night, back to back. And they both asked me, have you lost some weight or you want a diet? And I kind of shrugged it off and said, yeah, I might have lost some weight. Whatever, no big deal. And my parents urged me to step on a scale. And we figured eventually, all right, you know what? let's find some pharmacy here that has a scale and we'll step onto it. And we find one and I step on the scale and it's in kilograms. So, you know, I'm used to thinking in pounds as an American. And I'm doing the math in my head and I looked at the pharmacist and I said, is this accurate? And she said, yeah, it's accurate. And at that point I realized I'd lost about 20 kilograms. So 40 to 45 pounds. Wow. And that's when I realized that whatever's happening inside of me is not me just being thirsty and me just being hiking. That's when I realized something much more serious was wrong.

[00:08:45] Rob Howe: So at that point, because you're in Nepal, you've obviously got something. You get enough data and you get on the scale and you say, okay, something's wrong. What was the process like for you to find a doctor or a hospital? I imagine it's a little bit different than the U.S. um you know what what was the sort of the process for you going in and finally getting to see

[00:09:09] Oren Liebermann: somebody so at first i refused to believe anything serious was wrong i thought maybe just a virus that i would kick in a couple days or something like that or malnutrition because the food was so just wasn't sort of rich in fats like we're used to um so the monastery we were teaching at didn't half class. It was a Monday. So we decided, okay, let's go to this clinic. Not quite a Western clinic, but sort of a clinic that got good reviews online. So we figured, let's go check it out. And the guy, the guy welcomes us in and I tell him everything that's been wrong. I, you know, I'm constantly thirsty. I have to, I have to pee all the time. I've lost a tremendous amount of weight. What do you think? And he listens to my symptoms. He does a blood test. and he comes back to us a couple hours later and he says you have a low-grade infection i'll give you some uh some some medicine other than that it sounds like it's just malnutrition here's some electrolyte powder drink more or eat more and drink more fruit juice um so i said great i emailed my parents a very a very angry email essentially because they demanded they insisted that something was wrong and i sent a very angry email and telling them absolutely nothing's wrong. I'm absolutely fine. Um, so for the next three days, I followed his instructions to the tea. I drank all the fruit juice I could find. I used his electrolyte powder. Um, and, and, you know, I tried to eat as much as I could because it was just malnutrition. I followed his instructions. And at some point in those three days, I noticed the taste in the back of my mouth. And I kept thinking it's the electrolyte powder because it had this tangy, fruity taste to it. Except every time I took a swig of the electrolyte powder mixed into water, I could tell it was a different flavor. So three days later, and in these three days, I was going to the monastery to teach. During these three days, I couldn't make it through about four hours of classes that we had to teach. I would be with my wife for the first class, and then I would have to go sit down in the library and rest for the second class. And I think on the third day, I got to the monastery and immediately told Cassie, I'm going to take a cab home. I just don't feel well. So in those three days, I went downhill pretty quickly. And we decided the following morning, she would go teach and I would take a cab over to the clinic and ask him, Hey, do you mind? Let's try this again. Cause obviously something's not right. Um, so the following morning, it was February 13th, 2014. The following morning I took the cab over Cassie went to school or went to the monastery to teach. And I sat down and this time he didn't take me into his examination room. We just sat in the lobby and talked. And I remember the distinct feeling that he was not surprised I was back. Just it seemed like he was ready for me to return. And I walked him through all the symptoms again and said, I'm not feeling better. I'm feeling quite a lot worse. And he motioned to his assistant and his assistant knew exactly what to do, which is why I also got the feeling he knew I might come back. And his assistant pulled out a blood sugar monitor and tested my blood sugar. And I remember the countdown on the numbers. It was one of the older OneTouches that had the five second count. And the number came back in the high 300s. And there was this pause here and he said, I'm sorry to tell you, my friend, but you are a diabetic. And that was it. That was my diagnosis with type 1 diabetes. And we talked a little bit more. Go ahead.

[00:12:35] Rob Howe: And I think, you know, because I've heard now quite a few diagnosis stories and I think most people their only experience is their diagnosis story right but those moments leading up to and immediately after and during a diagnosis whether it's bedside manner whether it's the uh this not only the news delivery but like the implications of what's going on are really important for the development of type 1 diabetics i think both as adults and you know as children or teenagers. So for you, you're in Nepal. Your wife's working. You're there alone. You just had a conversation with a doctor and his assistant. And now you get this news dropped on you. What's going through your mind?

[00:13:22] Oren Liebermann: So for, I mean, nothing made sense at that point. There were a couple of thoughts that kind of like floated around the edge of my subconscious and I kind of knew them to be true, but also couldn't believe them at the moment. First, he told me that he was diabetic and everything is going to be fine. The doctor says this. I kind of wanted to ask that, how did you misdiagnose me three days ago? But that wasn't the right time to get into that argument. One of my best friends has had type 1 diabetes since he was 10 years old. And I knew he was one of the first people I had to reach out to. And he's funny. He's great. He's positive. He's warm and caring. And I knew he would become incredibly important to me. And he became and still is my type 1 diabetes mentor. So I knew I had to get in touch with him. I also knew I had to get in touch with my wife. So I kind of immediately tried to put aside the emotional reaction and think rationally for a minute. I need to get in touch with my wife, Cassie. I need to talk to my host family. I need to pack my bags. I need to get on a flight home. That became the goal of everything I had to do was get on a flight home and get to Western care because I knew I wasn't going to find amazing care in Nepal. So we talked, I talked to the doctor for a few more minutes. I hailed the cab and And I headed back to my host family's house. And all I had to say was, call Cassie. She has to come home immediately. And at this point, I was still kind of thinking somewhat rationally, or at least trying to. And the moment my host family, my host mother, Dimala, opened the door, I broke down. I couldn't get a single ward out. I mean, just absolute tears. And I was just, you know, I couldn't function at that moment. She came over and gave me a big hug. And I wrote about this in detail in the Insulin Express, the book I wrote. And I said at that moment she wasn't a mother. She was my mother. She cared for me like I was her son. And it took me quite a while until I could sit down and actually tell her, you know, please call Krishna, your husband, to call a monastery to Delkasi to come home.

[00:15:17] Rob Howe: Yeah, because, you know, those moments are – there's so much unknown, right? And so I think you hear, and even though one of your best friends had type 1 diabetes and sounds like you knew that he was living fine with it, just the weight of that moment I think is overwhelming. Absolutely. Think back to mine as well. I had a 20-minute drive from the clinic where I was diagnosed to the hospital, and I just remember crying the whole time. I was 16 and way too cool for anything that anybody wanted to tell me at the time. But at that moment, you're just like, I don't know what I'm going to do. What is going to become of my life at this point?

[00:16:03] Oren Liebermann: Absolutely. Absolutely. We had the exact same feelings as I'm sure so have so many others. Cassie took a cab home, so she got home fairly quickly. I don't remember if my host family told her it's diabetes, but I told her the second she arrived. We called my family pretty quickly and they were, you know, based on my angry email that I'd sent a couple of days earlier, They had every right to yell at me and they didn't. They were immediately understanding and they knew, do whatever it takes to get home. So the doctor had said, come back the next day and we'll do an official diagnosis. Do a fasting blood sugar test, eat something and we'll test afterwards just to make sure. So we had a plan. It was February 13th. We would go back on the morning of Valentine's Day, February 14th. We had a flight. We booked a flight out that afternoon and we would be home on February 15th or 16th. So we'd be home pretty quickly. And so we booked our flights. We packed our bags. Valentine's Day in the morning, we went. We got my blood sugar tested. Fasting test was in the high 300s or low 400s. Two hours later, we came back and it was the same thing. So my official diagnosis came on Valentine's Day. We took a cab home. We had our bags packed. We were ready to get on a flight. We started heading for the airport. and as we walked through my host family's gate, I sat on their stoop and broke down again for the umpteenth time of 24 hours. And Cassie looked at me and she said, do you want to go to the hospital? And I said, yes. I didn't think at that point I was strong enough to get on a flight. So we went to the hospital in Pokhara, Nepal. And thus began the four hardest days of my life. I don't quite know what I was expecting from a hospital in a fairly small city in Nepal but I got exactly what I should have expected

[00:18:04] Rob Howe: yeah I was wondering that was my next question when you say going to the hospital in that size town in Nepal paint the picture for us because as Americans or most of my listeners, I think, come from pretty developed, modern, Western-style countries where the variance between hospital experience is relatively similar. So give us the full spectrum of what a hospital in Nepal is like.

[00:18:39] Oren Liebermann: So we walk in. First of all, the hospital's freezing, absolutely freezing. For four days there, I was freezing the entire time to the point where I slept in my sleeping bag all four nights in the hospital because there was no heat there. So we go into the emergency room. We tell them our story. I've just been diagnosed with diabetes. I'd like to be admitted to so you can. And at that point, we realized I was in DKA. I was in ketoacidosis. We knew that from the taste in my mouth. And we confirmed that a short bit later on when we found out I was at three plus. So I was at the highest level that the hospital measured. And they take me into just an emergency room and the girl right next to me, who's a young girl, is violently vomiting. So I just remember staring straight at the ceiling. They hooked me up to an IV and I was just staring straight at the ceiling trying to pretend like the girl next to me wasn't violently vomiting because I knew I'd be here for a couple of days. So eventually they take me to my room and in doing so they take me through the lobby. most people who are admitted and stay overnight most locals that is to say most nepalese who are admitted and stay overnight at the hospital put down a mat in the lobby and just sleep in the lobby so the lobby is full of people who are just getting their medicines administered to them on the floor we were taken to the special ward and as i found out as we realized pretty quickly the special ward is for those who can afford it so it's westerners and we met a couple of other Westerners in the special ward. A room at the special ward costs $10 a night. And that was too expensive for most, most of the people. Um, at one point on the first day, they told me they wanted to take me to the ICU. Um, so they, they walk us to the ICU and we opened the door and I took one step in. And I remember thinking everybody in this room looks like they're going to die. Just the whole feel of the room was these people are not getting better. They're just getting worse. And I stepped out and said, no, no way, with a few more colorful words than no way. So we went back and we had our room. And and that was it. I hunkered down for what I thought would be one to two nights in the hospital, because every doctor we had told us, including both Western doctors we were now talking to back home and doctors in Nepal said, we just need to flush the ketones 24 to 48 hours and you're on your way home safely. And so we were pretty excited. We knew, yeah, sure, we're in a hospital halfway around the world, but home is just 48 hours away. And that felt pretty great. Except things, we started to realize things were not, things were off pretty quickly. They tested my blood sugar once a day, and they took the blood sugar test in the morning, and I found out my results at 5 p.m. There was nothing in between. There were two shots a day essentially and they were giving me either 80-20 or 70-30 insulin which although very common in the rest of the world is barely used anymore in the US if I'm not mistaken. And most importantly my blood sugars weren't coming down and I was still in DKA. They would do a DKA test once a day and I was still in ketoacidosis. So they kept saying, and the doctors would come twice a day, once in the morning and once in the evening. they kept saying 24 to 48 more hours and then you can and then you can be on your way home meanwhile the hospital has no wi-fi nor does it have any heat so my wife would have to run to the hotel every night to update my parents and then would come back and this is how we communicated with the with our families and you can imagine how hard that was for my parents to not get updates until the end of the day, and then we would just send one email, and we wouldn't be able to communicate again.

[00:22:28] Rob Howe: Right.

[00:22:31] Oren Liebermann: So by the third night, we realized I was running in place. I wasn't going anywhere. I wasn't getting better. At least I wasn't getting worse, so I'll give them credit for that. But we weren't going anywhere. We happened to know a doctor in Kathmandu, and we were in touch with him. Not so much in the first two days, but by day three, we needed his help to figure out what the plan was, how we get out of here. And before the final night, so I think it was after the third night, he eventually said, all right, get out of there. Do whatever it takes. Just get out of that hospital. And thank God for this guy because he really was what got me home safely. He said, get out of that hospital, book a flight, and you're going to come to Kathmandu, Nepal's capital, the biggest city. There is a legitimate Western clinic here that's excellent. It's four hours door to door. From the moment you walk out of that hospital, going to the airport, packing your bags, it's four hours and you'll be in this Western clinic. And that final night, that third night before he said go, I can look at that night and say, that is the worst night of my life. Because it was really just having no idea what's coming next. So we followed his advice. We packed our bags. We caught a flight to Kathmandu. And we went to this Western clinic. And to give you a sense, by the way, of the first hospital, four nights, plus all the tests they did, plus all the medicine they administered, plus all the food we ate, came to $198.

[00:23:52] Rob Howe: Wow.

[00:23:55] Oren Liebermann: So we get to this Western clinic and I'm hoping they say, they take a blood test and say, yes, you're good enough to go home. That was kind of what I, that's absolutely what I wanted to hear. And they took one look at me and said, you're not going anywhere. You're staying at least one night. And I was so despondent at that point. But once I sat down with a doctor there, it became very clear, very quickly that this hospital was incredible. This hospital knew exactly what they were doing, even if it was a much smaller clinic. and that I was in good hands. And especially when we got the bill and saw that we were paying Western prices, we felt much better about it for some reason.

[00:24:30] Rob Howe: It just gave you a little bit of that financial reassurance.

[00:24:34] Oren Liebermann: Yeah, somehow. It hit our wallet harder but helped our heart and our mind, put our heart and our mind at ease.

[00:24:41] Rob Howe: Well, let me ask you this. So for me and I think a few other type 1 diabetics that I've interviewed, that disbelief of the diagnosis, at least for me and some of them, went away as soon as they administered like the first saline bag and the first, you know, dose of insulin, because, you know, for so long, you're wondering why you feel so terrible. And then all of a sudden, you know, you, you get that sort of insulin comes over you and you're like, Oh, okay, my, your blood sugar is coming down and you're back in balance. You start feeling like yourself again. Uh, you hadn't had any of that up to this point in, in a hospital or in, with a, with the doctor. Do you remember, you know, when you either in the conversations or as they're administering, you know, whatever they're giving you, that you were like, okay, now I'm in the right place. Like I know now I'm going to be okay.

[00:25:28] Oren Liebermann: So I had some of that feeling at the first hospital on the first day with my first couple of IV bags, saline bags. I started to feel hydrated and wasn't constantly thirsty. And that was, that was good. That feeling, unfortunately, that feeling of, of not comfort, but okay, I'm getting used to this. That went away pretty quickly because the first hospital was so, such a bad experience. The second, the clinic, the second hospital in Kathmandu, that's where I started to come to grips with what was happening and get a better sense of it at this point I'd also had had a few emails back and forth with my friend so those helped a lot because he made me laugh for the first time just in these emails but and the doctors at the second clinic were they were just far more down-to-earth and sat me down and they put me on an insulin regimen and they really explained what is it that was missing right what does insulin do for the body what are these injections doing for you why are you checking your blood sugar. And that's such a critical part of it, to understand why it is that we do all the things that we do. And the first hospital didn't do that at all. The first hospital was ready to put me on a flight without any way of checking my blood sugar. And having had diabetes for three days at that point, or known that I had diabetes for three days at that point, even I knew that was a terrible idea. The second hospital really, really put my mind at ease. And at that point, you start to get a grip of, okay, I'm going to be fine. It's going to take a while, but I'm going to be okay. Um, it also helped that, that they had normal food. Um, you can order from the, there was a restaurant next door. All of that helps just to make everything seem more, more normal. Um, and to get used to it. Um, my wife did my injections for, I think two weeks, um, because my eyesight couldn't, I couldn't focus on my eyesight. My blood sugar had been so high for so long that when it came down into the normal range, I couldn't, I couldn't focus my eyes for quite a few days. So we had to get used to that. But after two nights at the second hospital and they gave me an insulin regimen and at that point I was on Humalog and Lantus, which I'm still on to this day, I felt much better and we caught a flight home. We stopped in Abu Dhabi. That was where we had a layover. And coincidentally, my brother-in-law was working in Dubai. So he took a cab over and my brother-in-law was the The first family member I saw on my way home, and it was the greatest feeling to see him. I don't think he realized what I'd been through in the last week, so it was just amazing to see him. We had a wonderful evening, even if it was just a few hours of wandering around Abu Dhabi. Then I got home. I was home for a few days, and then I think I got home on a weekend. It was a few days before I was able to see my doctor. My doctor was great about it. Again, very down to earth. he was quite happy with the insulin regimen the second hospital had given me. And he just talked me through, again, what type 1 diabetes is, what it means, what the risks are. And he said his brother's had type 1 diabetes for 40 years and is absolutely fine. It's had no complications or anything like that. And it was after that first week that I started to believe, okay, it's going to be fine. I have to get used to injections and a whole lot of them, but it's going to be absolutely

[00:28:36] Rob Howe: fine. Yeah. And I think that that's so important, right? The, the, I'm going to be okay, you know, seeing those other people. And you mentioned earlier, you know, getting those emails, you know, from your friend, it's when you hear from someone who's not your doctor or someone who's not, you know, a nurse or whatever the case is that, Hey, you know, you're going to be fine. I know exactly what you're going through. I can only imagine the, what made you laugh in those emails, just either the tests or something the doctor said or just something that he knows that you're now going through. And you can sort of attach yourself to those people. I think a lot of times as type ones, we can try to do everything ourselves. And just when you see somebody else living and thriving and laughing about or having a different approach or attitude about what you're going through, it just changes things so much.

[00:29:32] Oren Liebermann: Absolutely. The whole, your diabetes family, it's one of the most critical things to dealing with it on a day-to-day basis because to me, the most frustrating thing about diabetes is you can have three perfect weeks and in no way does that guarantee you that the next day is going to be good. And sometimes you just want to bang your head against the wall and that's when you reach out to your diabetes family and they make everything just so much easier. And Drew, my friend, from day one, he made everything so much easier. And part of it is just lab being able to laugh about it is so important, but also he's got great advice. He gave me some of the most important books for him that he read to help him manage his own diabetes. And then if I ever have a question, I know I can email him or give him a buzz. So I am the first person with diabetes type 1 or type 2 in my entire family. So I was very much from a family perspective, an immediate family perspective on my own. And my dad hates needles, so he couldn't watch me inject. He'd have to turn away when I injected. And, you know, my whole family was trying to help me out in any way they could. But because they don't have diabetes and they hadn't been through the diagnosis with me and hadn't been through the learning steps, there was definitely some frustration there because they would try to give advice that didn't have anything to do with diabetes.

[00:30:52] Rob Howe: So, go ahead. I imagine it was tough for them too because you're a grown man at that point, right? Right, of course. They don't have to take care of you. But I guess there's still that family, parental, wanting to contribute, wanting to help in some way, and then just not really knowing how to do that.

[00:31:11] Oren Liebermann: Of course. And my dad even acknowledged that. He said, no matter what happens, I will always be his son. Even if we bang heads, he is always my father and I'm always his son. And from that perspective, all he wants to do is help. and sure, you know, we argued about diabetes a few times and what I could do and what I couldn't do but at the bottom of my heart I know that he's just reaching out from the bottom of his so at this point oh, go ahead

[00:31:41] Rob Howe: yeah, yeah, I was going to say and just sort of in that same vein the things that you could do and the things that you couldn't do at this point you had a decision to make, right? because you and your wife were this trip of a lifetime was interrupted by your diagnosis. And now you had a choice to make of whether to continue or not.

[00:32:01] Oren Liebermann: Exactly. So we were halfway through our trip. The next stop was supposed to be Southeast Asia, China, Japan, South America. And we had to make a decision if we were going to get back on the road. So we were home for about a month and pretty quickly we decided, yes, we wanted to finish the trip. And it was just a function of how long do we stay at home? How much can I learn about diabetes? Of course, my parents and most of my friends disagreed with this decision. They thought cancel the trip, call it off. And their argument was traveling with diabetes is different. And my response to that was traveling with diabetes will always be different. I could live for 50 years with diabetes in my house and traveling will always be different because it's a completely different set of circumstances. So whether or not I know how to deal with it on a day-to-day basis in the office or at work or something like that, in my opinion, had little to do with dealing with it on the road. And we also, we had a couple of conversations with my doctor as well, who said, look, it's a simple disease in terms of, it's a simple disease to treat. If your blood sugar is high, take insulin. If your blood sugar is low, eat sugar. Its complications can be very serious if you don't do that well, but at its heart, the treatment is quite simple. And that was reassuring. It reassured me. It probably did not reassure my parents, but we decided after, I think we were home for 31 or 33 days, I used to know exactly, we decided that's it. We're getting back on the road. So we packed our bags and now suddenly I had a lot more to pack. I had a camera bag that I always carried around with me and we packed it with essentially a Tupperware that had insulin pens, needles, replacement needles, replacement lancets, glucose tabs, measuring cups so I could measure out my food for carbs. One of those books that tells you, one of those carb counting books that tells you how many carbs and calories are in everything. And I had this little kit. I had my little diabetic toolkit and this went with me everywhere. And we kind of looked at where we could resupply for certain things. And my parents were going to meet us in Japan. So we had them bring us some extra supplies. And that's it. We decided we're getting back on the road. And I consider that decision, the decision to keep traveling, the most important decision I've ever made. It's not the smartest decision. It may not be the most responsible decision. I acknowledge that it is the most important decision. Because in my mind, had I said no at that point, and I said, okay, I'm just not going to do this because I have diabetes, so early into my diagnosis, I would always have that as an excuse. And I'm so glad that I didn't allow myself that excuse. So we got back in the road and we headed straight for Thailand. And it was incredible. We traveled a little slower to keep the insulin cool because at that point, it was 90 something degrees every day. We had to book hospital rooms that had refrigerators, little things like that. We had to make little adjustments. We moved a little slower. But most importantly, we kept traveling. We stayed on the road and it was such an incredible experience. I had some highs, I had some lows, both emotionally and in terms of blood sugar. But that's part of the experience. And I think we're both so glad that I did. And one of the other things that was a great help at that point was because Cassie had been through everything with me to that point, she knew my diabetes as well as I did. She knew how much insulin I should take for a certain meal. She knew my symptoms of low blood sugar. And that made everything so much easier when we got back on the road.

[00:35:25] Rob Howe: And I imagine in some ways it was almost an immersive sort of crash course into type 1 diabetes because you didn't take the easy way out. you you know could have stayed like you said you could have stayed at home you could have gone back to work you could have gotten into that routine but you sort of went to the distance from the from the start so now you know hey yeah this is if I want to go do this traveling or if I want to if I want to try to have like a logistical planning period for how I'm going to get supplies on a long journey here's how I'm going to do it and you did that right away and I think you know you you mentioned it being the most important decision that you've ever made. Uh, yeah, because if you, if you played it safe, um, you would have had to learn that some point anyway. Uh, and I think at that point, you know, you may have had, you know, predispositions about, you know, what it would take and you can find a million reasons why not. But I think, you know, it speaks to the type of people that you and your wife are like, that you just decide, Hey, we're going to do this now. And we're going to, you know, sure. It might not make our family or our doctors extremely excited right off the bat, but now look how much easier everyday life is because of that decision.

[00:36:39] Oren Liebermann: Absolutely. And it was also a great logistical test. What happens if we lose certain supplies? How do we restock? Where do we go for... We have to know where the pharmacies are so that if we run out of insulin for some reason or we run out of test strips, we need to be able to know where to resupply. So that was part of the logistical challenge. It wasn't easy to get back on the road and we had a lot of homework to do before then. But once we felt like we did our homework and had all of our preparations made, there was no compelling reason not to. And we felt that it was a, we honestly felt it was a safe decision that we could handle anything that came up. And we did. One of the more difficult challenges we came upon was in Phnom Penh, Cambodia. So about a month and a half, I think, after we got back on the road, I had my diabetes supplies in this little sort of, this baggie that I stuck in my left cargo pocket as we were walking around, walking to dinner one night in Cambodia. And I heard a motorbike accelerate behind me and didn't think anything of it until that motorbike snatched my diabetes bag thinking that it was my wallet and sped off. So I just had my glucose monitor stolen and a little bit of insulin. Insulin wasn't a big deal. I had spares back at the hotel room, but I suddenly had no way to test my blood sugar. So I immediately start chasing down a motorbike, which is just an exercise in stupidity because I'm not that fast Cassie did the much more intelligent thing and flagged down a car or flagged down a motorbike and hopped on the back of a motorbike so she pulls up 10 seconds later and she asks what color were they wearing? I don't know what was the license plate? I don't know what was the color of the bike? I don't know that either and then she speeds off for a few minutes until we both realize this is pointless so suddenly we were faced with a great logistical challenge I had to find a blood sugar monitor Phnom Penh, Cambodia. Thankfully, that wasn't all that hard. We just bought some generic brand until we could get to San Francisco about a month later. And we bought a OneTouch because at that point I had so many OneTouch test strips. But it was one of those like, oh, right, we didn't plan on my diabetes, my glucose monitor getting stolen, but now we have to make this work.

[00:38:45] Rob Howe: And I think right off the bat too, you get to learn that crazy lesson of not all blood glucose monitors are compatible with each other. So you could have, you know, a thousand test strips of OneTouch, but if you don't have a OneTouch meter available to you, they're almost worthless.

[00:39:01] Oren Liebermann: So we actually found at one of the pharmacists in Phnom Penh, a OneTouch monitor, but you're exactly right. It was the wrong test strips. So we kept traveling and we just used the generic brand and it worked fine. The numbers were a little off, but it worked absolutely fine. And then we got to Hong Kong and I thought, great, I can get a OneTouch monitor here. And then I learned something else about diabetes. The rest of the world measures diabetes differently than we do in the U.S. They use the millimoles scale. And there's no way to change the monitor to milligrams per deciliter like we measure. So we still kept using the generic brand until we could get to San Francisco and buy a good old American OneTouch monitor. Again, these are just some of the challenges we faced. And we decided we would face them. We would figure out what we were going to do. And we did. And it was amazing. Um, one of the, so there were two experiences on the second half of the trip that I consider very, very important for me personally. One was hiking on the Great Wall. We spent the night in the Great Wall of China. Um, and that was my first night outside of a city or outside of a town. So we were nowhere near a hospital if something went wrong. And we approached it carefully. I was definitely still a little nervous because we were, we were nowhere near help essentially. And everything went great. it was just one night away from away from town but it was a great test to make sure we were able to handle that and then a few months after that about a month and a half after that I think in May of 2014 we and that's away from a hospital four nights very far away from medical help along with hours and hours of hiking each day that was an amazing challenge

[00:40:44] Rob Howe: and I imagine that was a little bit close you know, important from a, you know, a personal perspective as well, because you were hiking in the Himalayas before you knew you had a type 1. And then, you know, now you're doing that same, you know, strenuous days of hiking about, you know, at a, at a high altitude. Um, was it, you know, a little bit of a, you know, a breakthrough for you personally, you know, more than just actually climbing the peak, right. You know, internally, you were feeling that sort of conquering mentality?

[00:41:17] Oren Liebermann: Absolutely. And there were weird parallels between the two hikes. They both went up to the exact same altitude, right around 14,000 feet. It started raining on the third day of both hikes. And there were other just weird parallels that reminded me so much of the hike in the Himalayas. The first night I slept in the sleeping bag on the Inca Trail, I realized as I climbed into my sleeping bag that that was the first time I slept in that sleeping bag since the first hospital in Nepal. and that kept me up for a bit just thinking about everything I've been through but it felt it felt amazing to hike and get to Machu Picchu and see it and and what I say is I was learning to cope with my disease up until that point it was when I walked into Machu Picchu that I came to peace with my disease that is that that was suddenly like okay this is it right this is it the rest of my life I'm going to be fine I have to be disciplined and I realized that very quickly but going to be just fine. And it was, and for that reason, the Machu Picchu hike was, was absolutely critical to me sort of being, being absolutely okay with the fact that I have diabetes. And speaking of the diabetes family, I had another friend in high school who had type 1 diabetes, but I wasn't as close to him, but what, but I knew he'd hiked Machu Picchu. And when I reached out to him and asked him for any advice, even though we hadn't talked in years and we weren't all that close growing up, he came forward with all the help he could give, words of encouragement, how he approached certain, how he approached his preparation. And that was so fundamentally helpful. Not only his help, but also to realize there is always help out there.

[00:42:59] Rob Howe: Yeah. And I want to focus on that for a second too, because I'm very grateful. I have to like slap myself sometimes to see if I'm dreaming because of all these amazing people that I've met who are so giving in the type 1 community. But one thing I really want to focus on from your perspective is that you reached out and you asked. And that's something that I think we just culturally or as young people or millennials or whatever you would, however you classify, I think we don't ask for things enough. And when you do and you really mean it and it's earnest, it's like, hey, I'm going to climb this. I know we weren't that close growing up, but now we have type 1 diabetes, most people are so excited to help. So I encourage anybody who has – it may not be climbing Machu Picchu, but I think most people, especially in the type 1 community, are so giving of their time and energy, but we've got to ask for it.

[00:43:58] Oren Liebermann: Absolutely. And if there's one perspective from which I consider myself very lucky is that I was diagnosed at 31. And to me, that made it very easy to be disciplined. From my perspective, for 31 years, I could eat whatever I wanted. For 10 years, I could drink whatever I wanted. But it was also very easy. I felt like I had nothing to hide, right? I have type 1 diabetes. I'll be open with it. And that made it much easier to ask for help because I knew right when I was diagnosed, I had absolutely no idea what I was doing. I didn't know how to eat right. I wasn't particularly healthy before. I played some sports, but I didn't eat healthy. So I didn't know how to eat healthy. I didn't know how to count carbs. I didn't know how to do long hikes with diabetes. So I reached out. And the same thing, by the way, when I started my job at CNN. On day one, I walked into my office in Jerusalem and said, guys, I have type 1 diabetes. Here's everything you need to know. Here's where my supplies are. Ask me whatever you want. I absolutely understand why people are afraid of coming out and saying, I have type 1 diabetes. I need help. It's difficult to ask for help sometimes. I think for some people, it's embarrassing to have type 1 diabetes. There's still very much a stigma attached to it, to diabetes in general, type 1 and type 2, even if there shouldn't be. But the community, the entire community, type 1 and type 2, everyone is willing to help, I've found. And you're absolutely right on that point. And that's so critical to everybody. Everybody needs help with this because it's chronic. It's every day. It's every hour. And it can be frustrating. So a helping hand is always out there. And look, I use that helping hand and I try to help whoever I can from this perspective.

[00:45:39] Rob Howe: Yeah, and I think now your book is The Insulin Express. You're obviously doing a lot to raise awareness and sort of battle some of those stigmas associated with type 1. And your story is particularly inspiring. A lot of reasons for me because I think the voice of people with type 1 diabetes who were diagnosed later in their life we're only starting, I think we're at the very beginning of people who are really actively telling that story. I think there are more now, people are more feeling more confident, more vocal. There are more platforms for them to use. And so, you know, I'm really glad that there, you know, are stories like yours of people who, you know, really are, you know, living beyond and taking, you know, taking their diagnosis and saying, okay, this isn't defined, this doesn't define who I am, but I am going to own this and take it and live to the max on it. So for you, as you are continuing forward, and obviously you're in Jerusalem now, and as a CNN correspondent, you're using your platform to further awareness and good for type 1 diabetes. What are you hopeful

[00:46:54] Oren Liebermann: for? A cure? No, I'm kidding. I'm actually not that having now read the research. I've just decided I'm not banking on a cure. I'm just going to do what I have to do on a day-to-day basis to manage my diabetes. And once that's done, I can do whatever it is that I want, whether it's hiking or traveling or reporting. I do try to use my platform to get the word out there about diabetes. When the Insulin Express came out, which was May of this year, CNN Health was more than gracious enough to give me a platform to post an article. I pulled a quote from the first guy with diabetes to climb Mount Everest. I pulled a couple of quotes from endurance athletes who have type 1 diabetes. And it's the idea that there's no reason for this to slow you down, but you have to do the homework, right? You have to check your blood sugars and take the insulin. Once you take care of that part, there's nothing holding you back. And that's kind of the message I've tried to get out there. And I know there's so many just like you also trying to get that message out there and it's encouraging. I hope it's encouraging and inspiring to so many others. I had a moment, I think about two months ago when I was reporting in London and I was reporting at Downing Street and I thought there was something very cool about that. A CNN reporter with type 1 diabetes is covering a British prime minister with type 1 diabetes. If there are any doubts about what people with diabetes can do, that picture should eliminate any of them. That being said, there's still a long way to go in terms of both advocacy and education and awareness. So many people who don't have diabetes really don't know anything about it. So hopefully I can be a little part of changing that, whether it's through speaking to you or others, or hopefully a few people pick up the Insulin Express and give it a read,

[00:48:34] Rob Howe: or whatever else it is that I can do. No, definitely. And I think, you know, you really hit the nail right on the head. You know, a type 1 diabetic journalist interviewing a type 1 diabetic prime minister. What a great, just what a good feel. I kind of got like a little chills. I was thinking, you know what, those are my people, and we're out there doing amazing things. Orrin, I always ask this question on my podcast, and as we kind of are coming to the close of the interview, here's the context, and you can answer this however you want. I want you to feel you have full license on this, but here's the context that I always give. So imagine you're in an airport, which I'm sure you're very familiar with, and your gate is about to close in 30 seconds, and you can't miss your flight. It's utmost importance that you're on it, but you run into somebody who was either recently diagnosed with type 1 or struggling with their treatment of their type 1. What's the one

[00:49:37] Oren Liebermann: thing that you say to them? Wow, I need more than 30 seconds to think about this. Now I know that I need to have this answer ready. I would need to refine the wording, but the message would be live life to the fullest. I almost want to say don't be afraid, but that sounds too negative. It's kind of live life to the fullest. There's no reason for this to hold you back. And then I would give them my car so they can call me at any time. So we can continue the conversation.

[00:50:11] Rob Howe: Just to totally be fair, some people have said, I'm rejecting your context and I'm just going to

[00:50:15] Oren Liebermann: miss my flight. I assumed I couldn't say that, but I would happily miss a flight if somebody said, look, I need your help. There's another flight coming. I might not have another opportunity to talk to whoever it is, this guy or girl who needs my help. And just as so many people help me along the way, I see it as my obligation to help so many others along the way. As many as I can, I should

[00:50:37] Rob Howe: say. And we're lucky to have you in the T1D family and looking forward to the work that you continue to do. Oren, if our listeners want to reach out and find you, maybe social media, what's the best

[00:50:52] Oren Liebermann: way for them to do that? Social media is probably the easiest way. I have an official Facebook page, Oren Liebermann, O-R-E-N-L-I-E-B-E-R-M-A-N-N. That is two N's at the end of Lieberman. I'm on Twitter. Shoot me a note on Twitter, Instagram as well. The Insulin Express, if you're curious to read it, I hope it's fun. I hope it's inspiring. I hope it makes people laugh. That's available on Amazon. A portion of the proceeds go to the American Diabetes Association. Just trying to give back a little bit. But yeah, absolutely. Twitter, shoot me a note on Twitter or anything like that, and I'll reach out as soon as I can.

[00:51:30] Rob Howe: Yeah, and thank you so much again for taking the time and interviewing us today. I know you weren't feeling well the other day. I really appreciate you being willing to reschedule. And we will include links to all of your social media in the show notes so our listeners can either reach out to you or check out your book, The Insulin Express. I think I'm going to order myself a copy. I got to hear some more of these stories, man. It's pretty awesome.

[00:51:55] Oren Liebermann: Rob, I appreciate it. Thank you so much for having me on.

[00:51:57] Rob Howe: All right, thanks, Orin.

[00:51:58] Oren Liebermann: All the best.