We're always fascinated to find fellow diabetics living in other spots around the world and doing amazing things. That's the point of our Global Diabetes series, highlighting different perspectives from around the globe.
Recently, we came across longtime type 1 Jeremy Larsen, an American who's been living in the city of Osaka on Japan's main island for the better part of the past decade. Jeremy's had diabetes for three decades.
After visiting his dad in Florida earlier this year, Jeremy came up with a very cool D-Advocacy idea that combines photos, video, social media, and blood sugar management (!) -- to not only inspire PWDs to check their blood sugars, but also to teach people about the very interesting places he's visited in that part of Japan. His project is called Osaka 70-130, and it involves an alphabet-lineup of different video snapshots of him checking his blood sugar.
And this may be only the starting point for Jeremy, who says he's mulling the idea of creating more projects along the same lines.
Here's what Jeremy has to say about his personal D-story and what took him overseas, his hopes for the 70-130 project that's aimed at inspiring others to keep diabetes in check -- or as they call it in Japan: "tōnyō-byō" (the sugar urine illness) and "kettochi wo hakaru" (to check blood glucose).
DM) Let's of course start by hearing your diabetes story.
JL) I was diagnosed at age 9 after my parents noticed I had no energy and was going to the bathroom a lot. My BG (blood glucose) when I went to the hospital was somewhere around 700-900 (don't remember exactly). After a week, on Christmas Eve 1982, I was discharged. At that time I was on a strict regimen of three meals and three snacks per day plus basal/bolus shots. I remember my first 9pm snack at home -- a hamburger patty and some popcorn, chosen from a brochure about food the hospital gave us. My family and I gradually learned how I could eat and inject, and the following summer I went to a diabetes camp in North Carolina for two weeks. It was fun, and there I learned to give myself shots, which was quite a big deal for me.
Over the years diabetes just became a regular part of my life. I took candy to school in case I felt low (Lifesavers -- looking back, not a great choice), and I checked BG when I could. Life was normal otherwise. In my 20s I went maybe two or three years without checking much at all, but fortunately had no major complications other than having little energy from being too high.
In my 30s, I began to realize how much better I felt when I had good BGs. Now at 39, checking and targeting has become very important, and I find that it really isn't hard to do. There are highs and lows of course, but part of a diabetic's task is to try to minimize these.
Where are you from originally, and what took you to Japan?
I was born in Nashville and moved to Georgia (the state) at age 8. I lived in various places in Georgia, especially Augusta, throughout my teens and 20s. I got an art degree from the University of Georgia in 1996 and worked alternately as a graphic designer and in newspaper circulation. In 2004, I moved to Japan to teach English for a short time... I liked it and I'm still here.
I wanted to travel, and realized I could do a kind of "super travel" if I actually lived in a foreign country. I did some research and found that people taught English all over the world as a way to have an adventure and see a place in a deeper way than a regular tourist.
Japan has good salaries for teachers and no certification is required for my specific work, which is teaching adults at private companies (not the public school system or university). I lived here from 2004-2008, then again from 2011 to now. In the interim I traveled extensively around Asia, staying for months in a single country sometimes. But I haven't lived long-term anywhere else outside the U.S. I usually visit the U.S. once a year for two or three weeks.
What major differences do you see between the two countries in health care and D-management approaches?
The biggest difference for me is the national health care system in Japan, which removes all financial worry, and you can pretty much go to any doctor or clinic you want pretty cheaply - unlike in America, where many worry their insurance is only good in certain places. A consultation can cost about $3, and insulin and strips are much, much cheaper than in the U.S.
As far as actual care goes... embarrassingly, I avoided Japanese doctors for many years due to their reputation for using outdated methods and for not understanding diabetes. But about two months ago (just as I was finishing making the "70-130 Osaka" video) I finally searched and found an English-speaking doctor who specializes in diabetes, and she has been fantastic. I had gotten into some bad habits and mindsets, and she is straightening them out for me very effectively; she's one of the best doctors I've ever had anywhere. I kick myself that I didn't do this sooner because I went about seven years without seeing a doctor, and didn't realize how lax I had become (being in the upper 200s after breakfast almost every day seemed somewhat normal, for example).
What's the strategy for fixing your bad D-habits?
On my doctor's orders, I've been keeping a log of BGs, insulin doses, and carbs eaten. She then does a bunch of calculations, adjusting my formula and giving me illuminating tips. She was surprised at first when I explained that I adjusted each Humalog shot at each meal; apparently in Japan it is more common to have some kind of fixed-amount schedule because counting carbs can be so hit or miss. But she accepted my way quickly when she saw that I knew what I was doing. Most food is labeled with their carb count in grams as in other countries so I don't have to really guess too often. I eat rice but not every day.
Do people in Japan view diabetes differently?
Diabetes doesn't usually come up in conversation of course, but when I have mentioned it, people are usually at least vaguely familiar with it. They often say they know someone who has type 1. They can seem surprised by the insulin pens, but as long as I act like it's normal they too seem pretty nonchalant about it. "OK, this guy shoots up before eating, whatever." Everybody's got their own things to deal with; shots and BGs are our things but it isn't that remarkable.
OK, getting to your project... what's that all about?
The 70-130 video project is a way to use the Internet and modern technology to effectively spread a specific message about diabetes. Plus, it satisfies my creative urges as I get to plan, execute, and edit together the clips, and record original music, to make what I hope is a high-quality finished piece that people will enjoy. I'll enjoy it at least!
How did you come up with the idea?
Two things came together: one, my BG was 100 one morning while I was visiting my dad in Florida, and I took a photo of me with my meter beside his pool for fun. And two, I found out that a T1D about my age that I know didn't even own a meter himself and never checked his BG, but had had complications including several retinopathy procedures. I found that shocking. wondered how many diabetics ignored their BG like that, and I wanted to tell them how easy it is to check and how extraordinarily better you feel with good BGs, short-term and long-term. Ignoring or resisting diabetes so you can live life without worry just makes you do less and feel worse doing it. You've got to accept the challenge and take control.
So I hit upon the idea of taking photos of me and my meter (with a good BG on it) at various photogenic locations and putting them together as a sort of unique commercial for BG control. I bought the domain name 70-130.com and mulled the idea over for a while. I had a few different ideas for videos or projects, but I didn't have the money to execute them properly. Back in Osaka, I decided I could use my free time to put together a "70-130 Osaka" video and came up with the idea of making a list from A to Z of places to go. It took over a month, and wasn't actually shot in alphabetical order, but the readings are, with maybe one exception, really live and taken at each location.
OK, be honest: weren't there blood sugar checks higher or lower than your 70-130 range?
People ask me how I maintained perfect BG throughout the video. I didn't. I was out of the 70-130 range often over the several weeks it took me to create the video; my average BG during that period was about 160. I would try my best to "sculpt" my BG on a travel day with shots and/or juice, but sometimes I had to return to a place and try again another day. I have a few "outtake photos" of me standing somewhere with a disgruntled look and a meter saying 250, for example.
Several of the places I biked to, and that exercise made it easier to take care of highs. For lows, I just had some juice that I always carry with me.
This was all before I found my new doctor, and BG control was not easy (specifically, I was injecting into my stomach which had swollen so much that insulin was being absorbed inconsistently). I've always used injections, and now I use Lantus and Humalog pens. As the project gained momentum, things started magically falling into place: the sun and shadows would be where I wanted when I got to a location, train and bus and work schedules seemed to line up, and my BGs were often right in range when it counted, even if they had been bad an hour before. Everything just kept working out; it was like the video wanted to be made!
Now that my control is better, my next video should be a little smoother to produce. All of this is part of the 70-130 project, though: nobody's going to have perfect BG all the time, and I create these videos around my diabetes, not in spite of it. If I have to go to a place 5 times before my BG is good, then that's how it is. It's a true reflection of the ups and downs of diabetes, built into the project's philosophy.
What's your goal with this project?
I hope that people love the concept of the "70-130 Osaka" video enough to tell their friends, and that diabetics who don't check enough will come away with three simple things planted deep in their brain: the number 70, the number 130, and the connection between those numbers and having more fun in life.
The basic message is: if your BGs are better, you will be physically able to do more, and more emotionally motivated to actually do it. I think many diabetics don't know how good it feels to be in-range for extended periods of time. It's a totally new you, and it's the real you. I want people to consider that if they don't already, and give it a try and see for themselves. 70-130 is all about dealing with diabetes as best you can.
Also, diabetes is not the enemy; it's part of you. Fighting diabetes as a worldwide condition is good, but if you fight your own individual case of diabetes, you fight yourself. Accept it as part of you, let the scientists work for a cure, and enjoy taking care of yourself, BG and all.
How's the reaction been so far?
So far, people like it. I get feedback that it is inspirational, that it's a good idea, things like that. I haven't yet heard from anyone saying it actually inspired them to check BG more, but I'm hoping it does, whether I hear about it or not. Some people ask if I have plans for another video -- and some say Japan looks nice!
I have only recently gotten into putting 70-130 on Twitter and Facebook and things like that, and I am very impressed with the online diabetes community. For every problem or frustration or experience I've ever had with diabetes, I've found that it is shared by everyone else. (For example, 199 doesn't seem *so* bad to me, but 200 seems pretty high -- turns out I'm not the only one who thinks that!) But the support and the humor and collective experience of the diabetes online community have been great, and in only a short couple months I've met a lot of great people who have taught me a lot. It's made my 70-130 video project even more special to me because I see there is a group out there who understands and appreciates it.
What are your thoughts now about further D-videos?
I can't stop coming up with ideas for 70-130 projects! Some are more ambitious than others, but they all revolve around the simple "good BGs leads to a funner life" idea. I can't afford the time or money to do the bigger ideas now, but I have some ideas bouncing around for videos I could do locally like I did "70-130 Osaka." I like to have a standard of quality, so careful planning and execution is important to make the best final video I can. I think people appreciate care and quality; I do. I learned a lot just from making mistakes during "70-130 Osaka." I also like to plan things that, even without the diabetes part, would still be just as interesting.
This is so very cool, Jeremy. Love being able to learn about these places in Japan while also sharing your BG experiences. We look forward to seeing what else you come up with, from across the globe and over the internet!