To a casual observer, Dr. Nat Strand might look like an over-achiever. After all, she and her partner won Season 17 of her favorite television show, “The Amazing Race.” Winning the race opened her world up to the diabetes community, which, interestingly enough, inspired her to take better care of herself. Her mission now is to encourage everyone with diabetes to connect with the diabetes community and benefit from knowing others who understand the daily challenges of managing type 1 diabetes. When I caught up with Dr. Strand, we began by talking about what drove her to enter the Amazing Race.
Nadia: What inspired you to participate in the Amazing Race and travel 32,000 miles in three weeks to four different continents?
Dr. Strand: I have to say that my original inspiration was just that it sounded like a ton of fun. I’d seen the show several times, and I was a big fan of the show before we even applied. Kat and I got to talking one night after watching an episode about how fun it would be. The show combined a lot of our loves, such as travel, exercise, and adventure.
Having lived with type 1 diabetes for so long, I think I have an aspect of my personality where I want to prove that I can do absolutely anything, so I thought, “Wow, what an amazing platform.” The Amazing Race combines almost every single challenge that you can think of with diabetes, and it wraps them all into a tight little box. I thought, “Well, if I can do this, I can absolutely do anything.”
I also knew it was going to be a wonderful platform, with millions of viewers, and that it was really going to be able to get into the diabetes community and hopefully motivate people. There were a lot of selfish reasons for doing it, but I also felt that it would leave a trail of motivation.
Nadia: What were the challenges that you faced in the remote areas?
Dr. Strand: The Amazing Race has physical challenges, mental challenges, and then just endurance challenges. The entire thing takes place in only 22 days, which I never knew. When I watched the show at home, it seemed like it took six months to film. It’s just so grueling. There’s so little sleep, so little opportunity for eating and resting and catching up. You’re really racing almost all the time.
The fatigue just builds up, the mental fatigue and the physical fatigue. We were on a plane almost every other night, and I’m one of those people who just cannot sleep on planes. Of course, you’re getting dehydrated and your back hurts and you’re cramped, and then the next day you might spend 12 or 16 hours racing. You might get a good night’s sleep only every three nights, and even then only for four to six hours. So the endurance requirements were a challenge.
It was also very challenging to get ready for the race, because I had no idea where I’d be going or what I’d be doing. They didn’t let us know beforehand what the activities were going to be or what the locations were, and all I had with me was a backpack. I wanted to prepare for being in an extremely cold climate and an extremely warm climate. Having shoes and socks and just packing the clothes is one challenge, but then you add on having to pack diabetes supplies for one month. You know, your pump supplies, your snacks, your glucose, your insulin, syringes, batteries: I mean every single thing. I knew I wasn’t going to be able to run to a CVS or a Walmart if I forgot something.
So figuring out what I would need, trying to imagine every single diabetes snafu that might happen and having something on me to deal with it, took a lot of thought. Even trying to figure out how to get all the supplies to fit in the backpack with enough room for an outfit was quite challenging.
Once I started the race and saw how things were going, I realized that the time zones were going to be a big challenge. I was changing time zones every 24 hours, so I never got a chance to acclimate to a single time zone. Then, having unexpected activity was a challenge. You might get a clue that told you to run three miles to find a cave on Cheung Chau Island. Normally, I have to eat some carbs 30 minutes before exercise, and maybe alter my basal rate, but this was just “Okay, go now!” So you had to get really good at dealing with things on the fly with no preparation.
Nadia: How did you make those adjustments when you couldn’t anticipate anything?
Dr. Strand: What I ended up doing was just calculating the 24-hour insulin requirement that I had and making it a continuous basal rate over 24 hours. I just accepted the fact that I wasn’t going to be able to get on top of the time zones. As far as unexpected foods, one of our challenges in the race was to chug a glass of sugar cane juice, and another one was to eat a boiled sheep’s head. You know, I never had a reference point. I just tested a lot to try and identify trends. I had the CGM, and I had a lot of fast-acting glucose tablets, so if I needed to run, I could just eat them as I was going. It was just a speeded up version of what we do every day in life with diabetes: Once in awhile, you have an unexpected speed bump. The race just compressed a lot of diabetes spontaneous challenges into a small time.
Nadia: When you applied for the Amazing Race, did you tell them that you have type 1 diabetes? Were you concerned that if you revealed it, they wouldn’t let you participate?
Dr. Strand: I wasn’t sure at first what they would think about my having type 1 diabetes. We did have extensive physicals before going on the show, and I had to undergo a few extra examinations. I also had to have letters from my diabetes care team. I was a little bit anxious about what they would think, but when I met with the physician who was evaluating me for the show, he was very enthusiastic and said “Oh, you ski, you spin, you run half marathons, okay, fine.” He really thought, “You’ll be fine doing this.” I think the fact that I was a physician doing the race with another physician also worked in my favor.
I don’t know how much the producers knew about diabetes, and I don’t know if they realized what a challenge it would be. I didn’t highlight that until I found out that I was going to be on the show. But, of course, it was important to me. I really wanted my diabetes to be part of my story.
Nadia: When they introduced you as the contenders, did they mention that Dr. Natalie Strand has type 1 diabetes?
Dr. Strand: They did introduce it in the first episode, but throughout the filming of the Amazing Race, I don’t think they quite knew how much I was dealing with. With type 1 diabetes, or diabetes in general, a lot of what you’re dealing with is in your head. People aren’t seeing you thinking about adjusting your basal rates, or what this exercise is going to mean, or what this stress is going to mean, or how to estimate the carbs in a meal. It’s like being a duck, where you see the duck gliding smoothly across the water, while the invisible legs are paddling like crazy underneath the surface.
I don’t know that the producers or editors of the show really saw how much diabetes was playing into my experience, but people who have diabetes know. At the end, when we became the first female team to ever win the show, Phil Keoghan, the host, did a really nice job, saying “Nat, I know you wanted to do this as a person with diabetes.” He gave me a chance to get that message out there.
Nadia: Did your diabetes ever set you back in the race?
Dr. Strand: Oh, sure. I was not on the OmniPod at the time, so whenever there was a water challenge, I had to stop and take off my pump and secure it somewhere where it would be dry, and then do the challenge, and then stop and put the pump back on.
For example, we were in first place during the first leg of the race, and we had to do a challenge in which we had to scale a castle wall and then float across a lake on a little boat that was very easy to flip over. It was expected that we would flip over again and again. By the time I had stopped, taken my pump off and gotten it secure, and then started the challenge, we had fallen back into third place. We still ended up finishing second, but every now and then a few minutes matters. There were times when I did get low, so we walked instead of ran.
It also made for a stressful night if I miscalculated my carbs. There were some nights when my blood sugars were a little erratic, when my pump was alarming all night long, saying, “Hey, pay attention to me.” I thought “Oh my gosh, this is maybe the first four hours I’ve gotten good sleep. I don’t want to hear that right now.”
Nadia: I’m surprised you had highs during the race. I would think that with 22 days of this grueling schedule, the biggest battle would have been to avoid having low blood sugars all the time.
Dr. Strand: I intentionally chose to raise my target. I just figured that if I’m in the middle of Oman, I’d rather be 200 than 50.
Nadia: It’s such a wonderful thing that you challenged yourself and won the Amazing Race. How has your win played out in the diabetes community?
Dr. Strand: The biggest gift from being in the race has been the involvement that I now have with the diabetes community. It was amazing, the amount of interest and support that I received as the race went on, and especially after winning at the end. I had a series of media interviews, and that became a wonderful opportunity to do public speaking. I’ve done a lot of work with the JDRF on a national level, have worked with the ADA, and have done a lot of speaking for community groups, and it’s just been fantastic. It’s wonderful to connect with the diabetes community and meet people who are so inspiring and who have dedicated their lives to diabetes.
Nadia: Your success inspires other people with diabetes to know that they can achieve and succeed in extreme events.
Dr. Strand: I’m sure that I’ve gotten tenfold back in the inspiration department. Every time I meet people who are putting together these community programs, who have dedicated their lives to helping others with diabetes, it inspires me to raise my level of self-care and refills my tank for motivation with diabetes. My own personal outlook on diabetes is a lot more positive than it was before I did the race, and that was a really unexpected gift.
Before the race, I wasn’t really involved in the diabetes community on any level. Diabetes was sort of a lonely thing that I kept on the back burner. Now diabetes is something that I actively engage in because of conversations like this, or meeting Diabetes Sisters or TCOYB. For example, what you do, Nadia, with Diabetes Health, is give people an avenue to engage in the community with diabetes. It really gives back a lot, and that is something that, unfortunately, I’d never done before. Connecting with other people who live with diabetes and seeing the power of sharing the burden with a group has been fantastic.
Nadia: You mention that you have had a different perspective on your diabetes since you won and became more involved in the diabetes community. Has this changed how you manage your diabetes? Have you changed the products that you use?
Dr. Strand: I’ve made a lot of changes. The first change I made was switching from the Medtronic CGM to the DexCom. Everybody “in the know” told me to try the DexCom, and once I tried it, I found that it was not only so much more comfortable, but also way more accurate. I loved it, and that’s something I probably wouldn’t have tried if I hadn’t had several people tell me “No, this is a big deal, you should try it.”
Of course, I’m exposed to a lot more stuff now at these conferences and events, so I think I have a better grasp of what’s available. I have switched to the OmniPod as well. That’s been another fantastic change that was inspired by people telling me their personal experiences with the pump. I had several people tell me about it before, and I wish that I had had it during the race. I hardly feel like I’m wearing an insulin pump at all right now.
Nadia: That’s wonderful. Now that you are a spokesperson in the diabetes community, do you have a message that you would like to share?
Dr. Strand: My initial message was that diabetes is a challenge, but it’s not a limitation, and that’s what I really wanted to convey in the race. No doubt it’s harder than not having diabetes, but it doesn’t have to limit what you do. Participating in a race that is so extreme really takes home that message.
My message has changed a little bit over time, though. I am now encouraging people to connect with the diabetes community in some way, whether it’s blogs or meeting up in groups or just going on the Internet and getting information. I think that the diabetes community is so powerful, and I’ve gotten so much out of it. I’ve been diabetic for 23-plus years now. The burnout, or the lack of energy that you put toward it, sometimes can really be helped by sharing it with others. So my main thing right now is that I try and tell people to be inspired, to follow their dreams, and also to draw upon the strength that the diabetes community can offer.