Diabetes Forecast

Nat Strand's Amazing Race

A physician with type 1 circles the globe and wins on reality TV

By Carolyn Butler ,

Does the stress of having to bungee jump off a 150-foot crane (when you're deathly afraid of heights) affect your blood glucose?

Is it possible to get some much-needed rest if your insulin pump is beeping every hour on the hour—and you're sleeping on a sidewalk in the middle of a busy foreign city?

How do you dose insulin when you're eating a boiled sheep's head—eyeballs, tongue, and all?

These are just a few of the absurd quandaries faced by Nat Strand, the first contestant with diabetes on The Amazing Race, the rugged, exhausting reality-TV competition. From dog sledding in the Arctic Circle and rappelling down a canyon in Oman to speed skating in South Korea and toiling in Russian potato fields (while dressed like babushkas, of course), she and best friend and teammate Kat Chang traveled a total of 32,000 miles in just 23 days, sprinting their way across four continents, 10 countries, and 31 cities, all in pursuit of a $1 million prize.

"The race is probably the hardest situation you can imagine for a diabetic: limited supplies, an irregular schedule, the inability to control your food, extreme amounts of activity at intermittent times, time zone changes almost every day," says the bubbly, energetic 32-year-old. Strand was diagnosed with type 1 at the age of 12 but hasn't let that stop her from, well, anything—whether it's going to medical school and becoming a doctor, running half marathons, skiing, scuba diving, or traveling as much as possible. Still, she knew the Race would present her greatest physical and mental challenge yet: "Honestly, I figured, 'If I can do this, I can do anything.' "

Amazingly, Strand and fellow anesthesiologist Chang didn't just "do" the race: They won it, beating out 10 other teams by quietly but steadily working through the course—never fighting or even getting snippy, despite fatigue, hunger, stress, and other aggravations (which is definitely not the norm for the show). And while much has been made of the fact that "the doctors" were the first all-female duo to win The Amazing Race, in its 17th season on CBS, Strand is far more excited to be the first victor with diabetes.

"As a woman, I know I can do anything, but as a diabetic, I was nervous—I felt like I was biting off a little more than I could chew," says Strand. "I'm glad we were the first female team to win and that we did it while getting along and proving that you can be strong, smart, athletic, quick-witted, and competitive, and still be humble, polite, nice, and respectful to each other. But I was way more surprised and happy that we finished the race without my health causing a huge problem. It felt like a huge accomplishment, and I hope it shows that you can be as active as you want, and do pretty much anything, with diabetes."

Who Is Nat Strand?

Birth date: Dec. 15, 1978
Hometown: Scottsdale, Ariz.
Occupation: interventional pain management physician in Newport Beach, Calif.
Hobbies: skiing, scuba diving, travel
Best thing about traveling: learning about different cultures
Worst thing about traveling:
jet lag
Favorite Amazing Race destination: the Arctic Circle
Most dreaded Amazing Race challenge: jumping off a crane!

How do you pack light when you have diabetes—and absolutely no idea where you're going?

Essentially, The Amazing Race is a worldwide scavenger hunt that pits 11 teams of two against one another, in an ongoing quest to solve cryptic clues that lead them from one new city or country to another. As they trek from place to place using a set allowance to cover expenses, the duos must compete in a series of challenges—anything from skydiving to a memory test to drinking a goblet of pig's blood—with myriad "detours," "roadblocks," setbacks, and switcheroos along the way. The goal is to finish all tasks and arrive at each destination's "pit stop" checkpoint first, in order to win prizes or an advantage of some sort—and, ultimately, to avoid elimination.

All of the crazy riddles, bizarre brain games, and harrowing physical tests notwithstanding, Strand insists that the most difficult aspect of her reality-TV gig, by far, was cramming everything she'd need to stay healthy into a single carry-on backpack: a month's worth of insulin, test strips, syringes, batteries, alcohol swabs, snacks, a continuous glucose monitor (CGM), several blood glucose meters, glucose tablets and gel, a glucagon emergency kit, extra pump reservoirs, cartridges, and more.

"I didn't know what countries we'd be in, what the weather would be like, or what we'd be doing or eating," she recalls. "I had to think of every single disaster that could happen and try to plan ahead for it." This careful preparation was even more critical because the show's producers gave her no special treatment and steadfastly refused to carry extra insulin or other supplies during taping, which took place in May and June of last year.

Nat Strand and Amazing Race teammate Kat Chang.

As a result, Strand spent weeks working with her medical team to determine exactly what she might need for a month of madcap globe-trotting. "My biggest concern, honestly, was that she wouldn't be able to fit everything in the stupid backpack and that we'd have to make some hard decisions about leaving important stuff behind," says her diabetes educator, Carolyn Robertson, RN, ACNS, BC-ADM, CDE, of the University of California–Los Angeles. Robertson made valuable suggestions like repacking bulky pump reservoirs and infusion sets into Ziploc bags to save space and bringing a handy-dandy Frio pouch to keep insulin cold in warmer climes. She also recommended that Chang carry a full set of supplies in her bag as well, in case one backpack was lost, stolen, or held up in customs.

"I had so much [diabetes-related] stuff that I didn't even pack a hairbrush," says Strand, lamenting her "pretty crazy hair" throughout the race, usually kept in place by her trademark blue bandanna. "But thankfully, I had absolutely everything I really needed."

Robertson was also helpful when it came to strategizing about the daily ins and outs of blood glucose management on the road. "We talked a lot about the double-edged sword—the impact of exercise, which potentially could drop her blood sugar, versus the impact of stress, especially high-performance stress and that competitive adrenaline surge, which could raise blood sugar—and neither one of us knew how she would respond," says Robertson. "I just resigned myself to the fact that nobody was going to be able to predict it. . . . She had the basic tools, and we just had to walk through all of the potential scenarios."

Before she left, Strand made the decision that it would be best to run a little high over the course of the race. "I wanted to avoid any disastrously low blood sugars," says the competitor, who tested six to eight times a day on the road, be it in taxis, on trains, or in a gondola in Norway. She reports that her blood glucose fluctuated from the low 40s to the high 300s, but tended to stay right around 200 mg/dl, with the largest spikes coming in moments of high stress: like at the aforementioned "Drop Zone," where she had to fling herself off a crane towering above California's Long Beach Pier, with only a second to spare to yell, "I didn't even pee my pants!" before helicoptering on to the next battle. "That part was difficult," she recalls, "because normally if you have a high, you deal with it—you hydrate, you try to rest a little bit—but we had no downtime at all. If we had a free minute, we were either doing laundry, eating, catching a quick nap, or competing or doing research, and it made it a little bit more challenging to deal with the rough moments."

Strand and Chang reading their first clue at Stonehenge.

There were other trials, too: dealing with a fickle CGM, which wasn't terribly accurate with her constantly fluctuating blood glucose, for one thing, along with the occasional logistical disaster, like when Strand's insulin spoiled in her backpack as she ran around a Bangladesh alley in 110-degree heat, trying to build a rickshaw. (Luckily, her partner had enough time to activate the Frio case to keep her extra stash cold.)

It was also tough to eat healthfully—or even just regularly—with a limited budget and hectic traveling pace. Indeed, for a full month, Strand subsisted mainly on a diet of hotel breakfasts, airplane food, and lots of sports energy gels (what she calls her "goo"), Power Bars, and other snacks, trying her best to count carbs. "It's less than ideal, but then again, everyday life's kind of like that—when you go to dinner at a friend's house or a restaurant, you're always estimating," she says, before acknowledging that it was tricky with foods she'd never seen before, like that boiled sheep's head. "I just gritted my teeth and hoped that since it was protein, it was low-carb," she says with a laugh.

Another complicating factor was Strand's insulin pump, a MiniMed Paradigm Revel. On the one hand, it was a lifesaver, in terms of flexibility and making it "a lot easier to roll with the punches," says Strand, who has had a pump since college. Still, she says it was a challenge to program across multiple time zones and that there were plenty of frustrating moments where the team lost time trying to safeguard her equipment—such as having to remove and waterproof the pump before crossing a lake on a shaky medieval boat in England. That cost the duo their lead in that leg of the race. In addition, the pump's alarm often went off all night long, because her blood glucose was more variable than usual.

"Other teams would be asleep for eight hours straight, and her insulin pump would be beeping every hour—sometimes every 10 minutes—and we just wouldn't get a full night's sleep," recalls Chang. Even as a fellow doctor, she says she had no idea how all-consuming diabetes management was until she lived it, right alongside her best friend: "Being with her 24-7 for an entire month straight was really enlightening," Chang says. "I definitely have a new respect and understanding for diabetes—that it is just so, so, so difficult to manage, and it is absolutely 24-7."

Is it possible to weather a low blood glucose episode with a television camera in your face?

Strand hit her personal rock bottom on The Amazing Race in the middle of a pitch-black Hong Kong harbor, sailing around on a rustic sampan, using flashlights to try to locate one specific shipping vessel among hundreds—a frustrating task that ended up taking hours, during which she had her worst low blood glucose episode of the competition. "I was stressed out about if I'd had enough glucose and really not feeling well," she says. "I wanted the challenge to be over, and I was wondering if we were ever going to find that silly boat; it was a moment where I thought, 'Oh jeez, maybe we're done.' " She notes that she shone her light directly into the camera lens, at a certain point, to prevent the crew from filming her, because "the last thing you want, at that moment, is someone all up in your face."

It was a scary episode for Chang as well. "At one point, I saw that Nat wasn't even looking [for the boat] anymore, her flashlight was down, and I said, 'Are you OK?' She was acting a bit confused and I was really worried," she says. After the duo finally located the vessel in question, they raced off to a nearby checkpoint, but had to pause so that Strand could drink some apple juice and take a breather. "It's amazing because Nat never once complained about anything, even though I knew there were times when she wasn't feeling well," says Chang. "But she was just so strong, so it was one of those things where sometimes I'd have to say, 'You're not feeling good, are you?' and we would slow down or stop for a second, so she could drink something or have a goo or glucose and then we'd continue on."

For her part, Chang says she was never bothered by having to put her friend's health and safety first, even if it cost the team a few precious minutes. "One of the things we said before we even left was: As much as we want to do this for fun, and as much as we'd love to win, our perspective is that our health—but hers, in particular, because of the diabetes—was a priority that we couldn't skip out on," she explains. The partners, who have run two half marathons together, were confident that their athleticism would help them compensate and make up time along the way.

Indeed, none of the diabetes-related challenges out on the racecourse were insurmountable, says Strand, who remained cool and levelheaded throughout the experience. "In the end, there wasn't anything hugely traumatic—no one big problem—just those little ankle biters of daily life, like your pump needs to be changed, the battery's low, it's alarming, you need a snack, you need to eat some glucose, you're tired of eating Power Bars," she explains. "I never had a big low that caused me to pass out or to have a seizure; I never had a huge high that debilitated me.

"Of course, there were times I just didn't feel well, that [diabetes] was a huge pain in the butt, but it wasn't an obstacle. It may have cost me some energy, a few minutes here or there, but it didn't hold me back," she adds. In the end, she says she was "pleasantly surprised by what really good preparation can do for you, as far as diabetes goes."

Strand believes that her disease actually helped her, in some ways, during the competition. "As a diabetic, you're very used to getting yourself out of a jam—like if you get low somewhere or you accidentally rip your pump out, or you run out of insulin or strips faster than you thought—you get pretty resourceful," she explains. "It breeds this part of you that gets creative about dealing with adversity, and finding solutions to adversity is the biggest advantage in the Race, and in life."

To be sure, Strand's cheerful, confident optimism and uncanny ability to stay calm under pressure clearly shone through on the course—even on that gloomy night in Hong Kong. "I just kept my head down and stuck with it, and we ended up pushing through and winning that leg, and at the end I had a feeling like, 'Oh my gosh, I know we're going to do the whole race now,' " she remembers. "I knew I would run the entire Amazing Race, which was the best feeling."

Harder than it looks: Strand in Ghana rolling a wheel with a stick.

How do you prepare to be the reality-television poster child for diabetes, when you have no idea how you'll handle the highs and lows of the experience—or how it will all be portrayed on national television?

Despite the fact that Strand was dealing with her diabetes all day, every day, her health situation got relatively little airtime when The Amazing Race 17 was broadcast last fall—much to her surprise. "This was the hardest thing I've ever done in my life—I'm having to test my blood all the time, to be a little behind because I have to take my pump off [like before a water challenge], here I am with my pump alarming all night and day, and I feel like crap—and that stuff didn't make the show," says the competitor. "I guess either they didn't think it was a big deal, or maybe it wasn't visually impressive; I don't know."

To her teammate, the lack of television coverage says more about how well Strand managed her health throughout the race. "There were lots of little things that people had no idea about, and that's a testament to Nat and how she handled herself," says Chang, who says she now admires her best friend more than ever before. "I think that she's even stronger and smarter and more amazing than I even thought. And I have so much more respect for, of course, diabetes . . . now that I have a real understanding of what it entails—what a challenge it is and how gracefully she handles it on a daily basis, especially in some of the most crazy, stressful, bizarre situations you can imagine. That's usually when people's true colors come out, and she really just handled it all with such grace."

Still, there was a little bit of diabetes drama on-screen, like a prominent scene showing Strand pricking her finger while driving and, with Chang's assistance, getting a blood glucose reading of over 300—which still annoys the doctor. "I had just gotten off an overnight flight, and I was driving a left-handed stick-shift car—it was very stressful!" she explains. "I mean, I'm trying to show that diabetics can do everything, that it doesn't have to hold you back, and here I am with super-high blood sugar." But she concedes that the overwhelming response to that one moment of truly real reality TV actually touched her, deeply: "I got so many e-mails saying thank you for putting out there that diabetes is difficult and that blood sugars get high and low, sometimes in the same day; thank you for the realistic portrayal."

In fact, this outpouring of support helped shift her own perspective on the constant ups and downs of the condition. "My diabetes has never really been under excellent control, and it's been frustrating, because it's difficult to have a busy life in a busy world and to be a 'good' diabetic," says Strand, who is now 20 years into her type 1 diagnosis. She leads an incredibly active life filled with running, biking, hiking, the occasional yoga class, and working long hours as an interventional pain management specialist in Newport Beach, Calif. "But now I'm at a place where I realize that there's always balance. . . . Once you accept that, you do the best you can and give yourself credit for the strides you do make and the goals you do meet, but don't beat yourself up if you're not perfect."

Being back home certainly helps. "I loved the experience of being on the Race—it was so much fun, and truly life-changing—but there were certain things that were just hard," Strand admits. "I am definitely happy to have control back in my life, over when I'm going to eat, what I'm going to eat, when I'm going to exercise and what kind of exercise, and how much I get to sleep—all of those factors."

Not surprisingly, now that the cameras are off and the doctor has settled back into normal life, her day job, and a semi-regular routine, her blood glucose has come down to the 120-to-160 range. "I'm happier with my control than I have been in a long time," she says. "I realize that not every other diabetic is perfect, and neither am I. My control is good—it's not the best in the entire world, but I do everything I want to do and I'm healthy—so I'm very, very happy with that."

The Amazing Race champ is also ready to use her newfound celebrity—and at least part of her share of the million-dollar prize—to help further diabetes advocacy, which she's extremely passionate about. "I think type 1 diabetes is very misunderstood . . . so any opportunity to educate people, to raise awareness, and to raise money is important, and hopefully all of that will translate into increasing the amount of research and getting to a cure faster," says Strand. She has been giving speeches about her experiences and meeting with different diabetes organizations, and in June she will lobby members of Congress, with the Juvenile Diabetes Research Foundation.

In addition to pushing for a cure, Strand hopes to serve as an example to the parents of newly diagnosed children. "I really just want them to know that diabetes is a challenge, not a limitation," she says, sharing the personal mantra that initially inspired her to sign up for The Amazing Race. "I'm never going to say diabetes is easy—I'm never going to say it's something I would choose if I had a choice—but it's not a limitation. It's a challenge that we can all rise to and meet and overcome."



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