I've interviewed athletes, musicians, artists, and even acrobats with type 1 diabetes. But Nat Strand "takes the cake," if you'll excuse the expression. She's a 31-year-old anesthesiologist who, along with fellow doctor and friend Kat Chang, won the 2010 reality TV Amazing Race competition, which challenges two-person teams to race across the globe in a frenzied international scavenger hunt with just one backpack each and very little money. Contestants travel by bus, hot air balloon and boat. They scale mountains and castle walls. They're challenged to eat things most of us would never touch, like sheep heads.

 

In the 17 seasons the race has been on TV, no all-female team has ever won. Until now.  No type 1 diabetic has ever won either. Until now. This is why I take a little bow to Nat Strand today (in photo, on the left), as she talks about breaking boundaries on what is possible when living with diabetes:

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"I think when you have type 1 diabetes, you have to get really good at just imagining disasters."

Nat Strand, on packing all the supplies needed for a round-the-world adventure in a single backpack

DM) I have to start by asking: didn't anybody ever tell you there are things you can't or shouldn't do with diabetes?

NS) I remember when I was diagnosed someone said, 'You can't be a truck driver and you can't be a pilot.' So that left everything else on the list of things I could do.

My parents were very good. They never told me there was anything I couldn't do.  I still went on vacations, I still slept over at friend's houses, I studied abroad.

So you were diagnosed as a small child?

I was 12 years old, and oddly enough one of my really good friends from kindergarten had type 1, so I knew what it was. I had gone away to camp one summer and I remember I was so thirsty. All the kids in the camp were actually building a pyramid out of all the soda cans I was drinking!

I came home and obviously my parents took one look at me and knew something was wrong. My dad took me into the emergency room where they tested my blood, and it was off the charts. I was admitted (to the hospital) right then and there.

Do you remember that being traumatic?

I remember my mom had bought me a big bag of gummy bears as a Welcome Home gift from camp, and I remember I was just so sad. All I was thinking was: 'There go my gummy bears!'

When did you become a pumper?

I got my insulin pump after my sophomore year in college. I use the Minimed Paradigm.

So you use the combo pump and CGM?

I don't actually wear the CGM on a day-to-day basis. At first when I got it, I was a (medical) resident, and it was just so expensive... Residents we don't make very much money.

Then on the show, my blood sugars were varying so much so quickly because of all the time zones and the variations in activity levels and stress and all — I found that the CGM works well if you're relatively stable, like overnight or to see how you're trending on a normal day.  But when you're going up and down so fast, it wasn't very accurate. Also, mine was alarming all night long, so it just kept me from getting any sleep.

I'm thinking that lots of us with type 1 worry about going out on a boat for a day, let alone traveling the world in roughing-it style. Didn't you have any trepidation about that?

I definitely was aware of what I was undertaking. Even if I wasn't doing the Amazing Race, just going somewhere with only a backpack to carry every single diabetic thing you need for a month — that was the biggest part for me.

Production wouldn't hold anything — no exceptions. They had strict rules. So I had to get a little crafty with what I was going to need and try to imagine every worst-case scenario.

I think when you have type 1 diabetes, you have to get really good at just imagining disasters. It's almost like being an anesthesiologist — at the beginning of a case, you have to imagine everything that can go wrong and just have everything set to go in case that thing happens.

That's basically what we did. Kat carried a whole set of a month's supplies -- pump stuff, insulin, syringes, and batteries. We both had duplications of everything.

Did you have a healthcare team or doctor supporting you during the race?

I worked with my diabetic nurse-educator Carolyn Robertson (at UCLA). She has the most can-do attitude of anyone I've ever worked with, healthcare-wise.

She was very good with helping me think of what might go wrong, and planning — things like taking your pump cartridges out of the packaging and putting them in a ziplock bag to stay safe.  They are so bulky; I just didn't have room for all those boxes. I credit her with a lot of the craftiness of making it happen.

Did you have people meet you at the pit stops with more diabetes supplies then?

Nope. Everything had to be in my backpack at the start, including shoes, underwear, clothes for warm weather, clothes for cold weather, any toiletries...  So this is my excuse for why didn't I bring a hairbrush and why I got really crazy hair; I had a lot of diabetic stuff in there.

When you applied for this 'death-defying' race, didn't the producers have any issue with someone with a medical condition participating?

Not that I know of. I think it helps that Kat and I are both physicians — so I was basically traveling with my own personal physician.

But at the same time, most people don't know a lot about type 1 diabetes. They think of their uncle who's not supposed to eat cake. So I think maybe the unawareness of how big of a deal it could be probably helped me. {Nat giggles}

What about insurance issues. Weren't you some kind of liability for them?

This is the kind of situation where what you're doing is so extreme... things that could cause loss of limb, loss of life. We had to sign all kinds of waivers.

In the scheme of things, when you're traveling around the world, jumping off trains and scaling over canyons, everybody might die — so basically you're signing your life away anyway.

OK, so with all that wall-scaling and train-jumping, didn't your pump tubing get in the way?

I always wore it under my shirt or in my sports bra, so it never got pulled out by accident or fell off and went swinging into wilderness or anything.

We actually had to wear a microphone for sound, so we had these belts on that had a little pocket for the microphone. Whenever we did anything that could ruin the mic, (the producers) would stop us and cover it in plastic. So I just kind of treated my pump like part of the sound system; I kept it the same belt, and would also cover it in plastic or put it somewhere safe for the time being.

Where there any moments along the way where you thought the diabetes could ruin everything?

There were some moments — like in the first leg, where we took those little boats across the lake — where I had to stop and take my pump off and test, and afterwards stop again and put my pump back on. Those things cost you time, you know? You can't just keep running, like everybody else.

Any nasty hypos?

There were a couple of severe lows during the activities. We'd have these really long days, and you don't stop for a meal. I had Power Bars and gels in my bag, but it was tricky to maneuver being active all day long with no regular meals.

I brought a ton of glucose, and I just tested all the time, like every hour or two.  And I just planned to run a little high too.

Were you able to buy more glucose supplies along the way?

Kind of, but not really.  You're in places like Bangladesh, so you don't really have access. You're are allowed to buy stuff in an airport, but I didn't really, because we had so little money. I really just tried to bring everything that I could think of.

What did you do, food-wise? Just guess the heck out of the carbs of all that unusual food?

Exactly. It's sort of the same thing as going out to dinner for someone's birthday. How do you ever know what's in that plate?

I think with the only special trick with something like this with diabetes is to not expect great control. I just knew this was not the month where I would be 112 the entire time.

You've stated that your and Kat's race strategy was to "never, never, never give up — never." What a great a mantra for life with type 1 diabetes!

It's true. It gets frustrating, and there are times when you do everything right and your blood sugars still aren't where you want them to be. It's so easy to be like, 'I quit. I'm never going to have my A1c where I want it anyway, so why even bother?'

But that strategy of never-giving-up-no-matter-what I think works with everything, especially a chronic disease like type 1. You have to somehow dig deep. You can always take moments or breaks where you're not as motivated as other times, but the key is to never give up fully. So take a break, regroup, and then just keep on going.

So you know this makes you a hero in the diabetes world. Any plans to do something with that newfound D-fame? Or with your million-dollar prize money?

Absolutely.  It means a lot to me to have a platform like this to show anybody what you can do, especially diabetics and parents of newly diagnosed diabetics.

Whenever people at school found out I was diabetic, they would say, 'Oh my God, I didn't even know.'  Now parents are always coming up to me with their newly diagnosed kids and asking me, 'Did you play on the soccer team?'

I tell them I went abroad twice, I play a bunch of sports, I run half-marathons, I did a residency... so you can do all these things! I think lots of diabetics already know that, but new type 1s and especially their parents fear that their children will have limited lives or limited options.

I'd definitely like to use this platform to get the message out there that there are challenges, but no limits.

Also, both Kat and I are donating to diabetic research — our 'team cause.' We already donated to ADA, and we're looking at different organizations right now.  It's a really fun thing to research. I would love to do whatever I can.

You've done plenty already, Nat including showing more than 10 million TV viewers that type 1 diabetes doesn't bar people from doing anything on this planet. Hats off to you, and thank you for that!

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