Juicebox Podcast: Type 1 Diabetes
Episode #1621 Best of Juicebox: DKA on a Plane
Host: Scott Benner
Guest: Jennifer (“Jen”)
Date: September 6, 2025
Episode Overview
This heart-stirring episode centers on Jennifer, an American expat living in Jordan, and the harrowing story of her daughter Nora’s type 1 diabetes (T1D) diagnosis while traveling internationally. Through candid conversation, Jen shares the unique challenges of raising a child with T1D overseas, the emotional impact of a traumatic diagnosis, and strategies for resilient, well-informed diabetes care. The host, Scott, and Jen also explore cultural differences in diabetes management, healthcare access, and the power of the diabetes community.
Key Discussion Points and Insights
1. Life Before and After T1D Diagnosis
[02:15–03:21]
- Jen recounts that Nora was diagnosed at 3.5 years old; now almost 7.
- Reflects on the transition from overwhelming fear to confident, routine management:
- “At one point it felt like we couldn’t get through the day… and then it didn’t. Then it’s just part of life.” (Jen, [02:51])
- The shift happens when understanding “why,” even prior to perfect glycemic outcomes.
2. Managing Blood Sugar in Changing Circumstances
[04:10–09:47]
- Jen describes life during lockdown in Jordan and new diabetes challenges due to restricted activity.
- Nora now needs more insulin due to decreased physical activity, but also experiences frequent lows following stress, excitement, or brief activity—especially after online schooling.
- They strategize about preemptively using snacks (like Skittles) to prevent post-school blood sugar drops.
- “Maybe doing a snack a few minutes before school ends… Maybe that will be a good solution because it’s now regular enough that I know it’s coming.” (Jen, [09:23])
3. The Role of Stress and Routine in Blood Sugar Fluctuations
[09:47–11:13]
- Scott shares a story from another guest about stress-induced blood sugar highs during her husband’s surgery.
- Jen observes that the absence of normal school social interactions and movement led to increased insulin needs for Nora, as well as more erratic lows.
4. Life as Expats and Navigating Multiple Cultures
[11:22–16:31]
- Jen, originally from Pittsburgh and Washington state, left the U.S. at 18 to study in France. Married someone from Yemen, lived in Yemen, then Jordan.
- The value of a supportive, open-minded family is emphasized; Jen’s father encouraged her international path.
- Cultural adaptation, language learning, and life in Jordan are described with warmth and honesty.
5. Living Under Pandemic Restrictions in Jordan
[22:14–24:39]
- Jen outlines Jordan’s curfews (24-hour every Friday, nightly curfew), school closures, and family adjustments, highlighting their resourcefulness and sense of community.
6. Healthcare Access and Insurance Challenges Abroad
[26:05–30:30]
- In Jordan, insulin is accessible and affordable (~$25/vial, no prescription needed).
- Navigating dual healthcare systems: local care in Jordan, plus annual visits and prescriptions in the U.S. to access advanced technology.
- “Things are available here… but I get that there’s a whole bunch of other things [in the US].” (Jen, [26:05])
- Private, globally-valid insurance is costly and complicated, often acting as travel insurance for coverage in both countries.
7. The DKA on a Plane Diagnosis Story
[38:01–49:53]
- The pivotal segment: Jen’s retelling of Nora’s acute onset of diabetic ketoacidosis (DKA) during a long-haul flight from Jordan to America with a 5-week-old infant and a 3.5-year-old.
(see detailed timeline below) - Notable Quote:
- Scott: “This is the most, like, viscerally disturbing diagnosis story anybody’s ever told. Like, I’m vibrating.” ([42:57])
- Kindness of strangers shines (“the lady on the plane just held my baby for five hours…”), as does the resilience of Jen and her family.
Diagnosis Timeline:
- Strange symptoms begin in Jordan, attributed to “jealousy of new baby” by local doctor.
- During the flight (London to Phoenix), Nora becomes unresponsive and vomits; a pediatric doctor on the plane recognizes seriousness but information is withheld to maintain calm.
- Plane makes emergency landing in Canada; Nora is unconscious on arrival, recovers after 12 hours in hospital.
- Language and medical confusion, lack of supplies, and isolation from family compound the trauma.
8. Recovery, Cultural Contrasts, and Ongoing Management
[49:55–54:44]
- After stabilization, they travel onward to the U.S. (Phoenix) with a “food exchange chart” from Canada, navigate different care philosophies across Canada, U.S., and Jordan.
- Adapting to three different medical management styles in quick succession is challenging:
- “If I was…diagnosed in one place, they gave us one set of information, and then…I was just time warped somewhere else…That seems impossible to me.” (Scott, [54:08])
- Emphasizes the flexibility needed in managing T1D across diverse healthcare systems.
9. The Importance of Evolving Knowledge and Support
[54:44–65:04]
- Jen describes the overwhelming amount of (sometimes contradictory) information given by various providers, and her own challenges in questioning authority/adjusting advice.
- Discusses the potency of peer-shared resources and the need for up-to-date, fluid management approaches.
- Emotional burden and the slow transition from “just surviving” to proactive management (“it took me a long time to be okay with thinking about it”).
10. Empowering Independence in a Young Child
[71:51–73:49]
- Nora, 6, is now practicing diabetes self-management—using a smartwatch, responding to texts, tracking carbs, and even doing basic calculations for bolusing.
- “She’s so proud…She’ll give herself insulin, juice…or check her finger.” (Jen, [71:51])
- Strategies for gradually teaching carb counting (“how many carbs in a quesadilla?” game), independence vs. safety, and role of technology (texting between parent and child).
Notable Quotes & Memorable Moments
On the moment of diagnosis and the ordeal:
- “Nora went into DKA somewhere between London and Phoenix over a huge body of water.” (Jen, [39:24])
- “The head of Phoenix Children’s Hospital was on the airplane… They’re like, I think it might be time for us to land the plane early.” (Jen, [40:00])
- “This is the most, like, viscerally disturbing diagnosis story anybody’s ever told. Like, I’m vibrating.” (Scott, [42:57])
- “Kindness of people that day… The people I find the kindest are the ones that don’t know anything about diabetes and are just like, can I give you a hug or bring you a sandwich?” (Jen, [48:53])
On resilience, adaptability, and learning
- “At one point it felt like we couldn’t get through the day… and then it didn’t. Then it’s just part of life.” (Jen, [02:51])
- “You trust that what you know is going to happen is going to happen, and then those things that you expect…begin to be your outcomes.” (Scott, [71:11])
- “Wherever you are right now, someone’s telling you this is how you do it. And that’s not necessarily true. There are a lot of ways people do it.” (Scott, [51:08])
On independence:
- “She’s so proud…She’ll give herself insulin, juice or Skittles or whatever she needs at the moment or check her finger.” (Jen, [71:51])
- “I think you’re using one of the most important diabetes parenting tools that exists…texting.” (Scott, [75:12])
Important Timestamps
| Timestamp | Topic/Quote | |-------------|-----------------------------------------------------------------------------------------| | 02:15 | Jen’s family introduction, life abroad, Nora’s age/diagnosis | | 04:33 | Covid lockdown, impact on activity and blood sugar | | 09:23 | Preemptive snacking strategies for post-school lows | | 13:27 | The impact of family support and cultural adaptation | | 22:14 | Jordan’s pandemic restrictions, adaptation as a family | | 26:05 | Access to insulin, dual healthcare navigation | | 38:01–49:53 | “DKA on a Plane”: full diagnosis story | | 49:55 | Relearning diabetes care across Canada, America, Jordan | | 54:44 | The difficulty of inconsistent information and building confidence | | 62:20 | The challenge of questioning authority, value of fluidity in management | | 71:51 | Nora’s growing independence, teaching carb counting | | 75:12 | The vital role of technology (texting) in helping young T1Ds build autonomy |
Tone & Style
The episode balances humor, warmth, candor, and moments of deep emotion. Scott’s empathy and self-deprecating wit blend seamlessly with Jen’s earnestness and resilience. Together, they illuminate not just the hardships of T1D but also the unexpected kindness and strength that can arise from crisis.
Main Takeaways for Listeners
- T1D management is rarely “one size fits all” and often demands adapting to shifting medical, cultural, and emotional contexts.
- Parents/caregivers can move from overwhelm to confidence by seeking understanding, community, and evolving management approaches.
- Building a child’s independence is both possible and powerful, even from a very young age, especially with the aid of technology.
- The diabetes community offers invaluable support, both in sharing practical solutions and in moments of crisis or vulnerability.
- Healthcare systems vary greatly, and access to insulin/technology—while easier in some countries—still depends on advocacy and adaptability.
- Even in the darkest scenarios (like DKA on a plane), humanity’s capacity for kindness and resilience can shine through.
For new families or individuals living with T1D, this episode is an emotional but ultimately uplifting testament to perseverance, adaptability, and hope.