Dr. Nat Strand is an anesthesiologist who lives with type 1 and a mom of two young children. She just contributed to a paper all about pain management guidelines in this difficult time, when many people can't see their doctors to face to face. You also may know her as the winner The Amazing Race in 2010. Of course we also talk about having T1D and that crazy travel show!

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Episode Transcription:

Stacey Simms 0:00

Diabetes Connections is brought to you by One Drop created for people with diabetes by people who have diabetes by Real Good Foods real food you feel good about eating and by Dexcom take control of your diabetes and live life to the fullest with Dexcom.

Announcer 0:20

This is Diabetes Connections with Stacey Simms.

Stacey Simms 0:25

This week, Dr. Natalie Strand is an anesthesiologist who was diagnosed with type one as a teen. And she says people who live with chronic pain and people who live with diabetes have a lot in common.

Dr. Nat Strand 0:39

and we may think the person who lives with it is thinking about all day long with every activity you know before they go to bed when they wake up in the morning, but the people around them even loved ones, you know and household. kind of forget because you look healthy.

Stacey Simms 0:53

Dr. Strand just contributed to a paper all about pain management guidelines in this difficult time when many people Can't see their doctors face to face. You may also know her as the winner of The Amazing Race in 2010. Of course, we talked about having type one and that crazy travel Show. I'm a huge fan By the way.

In Tell me something good: virtual events, firefighters and a Lego master. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider.

Welcome to another week of the show. I'm so glad to have you along. I know Stacey Simms. We aim to educate and inspire about type 1 diabetes by sharing stories of connection. And I am so excited to finally talk to Nat Strand. I can't believe that we haven't crossed paths before. I'm a huge fan of the amazing races. I mentioned I started watching it in 2001 when I was pregnant with my daughter, and I actually remember the commercials when it was like coming soon. And then of course September 11 happened and how are they going to be able to do this they thought the show might not have a second Season. So, gosh, that was such a long time ago. But it is amazing to see that even with COVID-19, which stopped the show again, they're going to be continuing that in the future.

But that's neither here nor there. I mean, we're talking to Dr. Strand about pain management her life with type one. And of course, we'll talk about the amazing race as well, but she wanted with her partner and fellow doctor in 2010. So taking a look back, I want to bring you up to date before we get to the interview about something new that I just announced really a couple of days ago on social media, and that is my book to clinic program. Of course, the book is the world's worst diabetes mom. And one of the things that I have found really fascinating is that although I am obviously a lay person who wrote an advice book for parents of kids with Type One Diabetes, I've been really fascinated by two things. One is that adults with type one are buying and reading the book and then giving it to their parents to talk about, you know, their childhood if they were diagnosed as a kid or wants to learn Learn more about the parent perspective, which I thought was fascinating. But I'm also hearing from diabetes educators and endocrinologists who have told me and I know I sound surprised here and this is genuine. I'm not trying to make this silly. They have told me that they have learned things from the book. And you know, when you think about it, it really isn't a surprise, because it's the layperson perspective. These are things you do not learn in medical school, right? These are things you learn when you mess up diabetes, when you're at the beach, you're in the car. It's the middle of the night, you're macgyvering stuff together. This is stuff you've learned when you live with type one.

And to that end, a few clinics reached out and said, Can we have copies of the book to give away and so I started a new program, it is called book to clinic. Bottom line, I'm looking for sponsors to pay for these books, so we can get them to people who need them. It's very reasonable. It's a very easy system. I will put more in the show notes and there's a video that's on social media you can see the whole thing and how it works. big thank you to my first two sponsors because the books have already gone to clinic. Thanks to T one d 3d year, and Big thanks to frio so you know I really appreciate the faith that they have shown and if you have a product or a blog or another podcast and you're looking for some very reasonable advertising that is targeted to an audience that is looking for you, please let me know and you can reach out to Stacey at Diabetes connections.com. I'm really excited about it. It's one of those things that you just don't expect to happen. But you know what, we'll see where it goes.

Diabetes Connections is brought to you by Real Good Foods, and they have already new ice cream flavors. We love their ice cream and they're kind of hard to get right now. they've they've silted up a couple of flavors. But man they are so yummy. I cannot wait to try the mocha Java chip ice cream. I'm a huge fan of coffee and chocolate and their original flavors that we tried way back when beginning of March. I think we did that Facebook Live where Benny and I tried the ice creams. They were so delicious. We really liked them in chocolate chip, everybody in my household Loved the peanut butter chocolate chip ice cream or big peanut butter people. The new flavor sound amazing. I mentioned the mocha Java chip, the cake better ice cream. My kids love that. And something called super premium almond charcoal ice cream. That sounds amazing. So let me know what you think if you've sampled the new flavors, we haven't been able to try them yet, but I'm really excited and of course Real Good Foods has real good food. They have a whole line of high protein, low carb grain free gluten free. Good for a keto diet if that's your thing. Everything from cauliflower crust pizza to stuffed chicken and breakfast sandwiches, find out more Just go to Diabetes connections.com and click on the Real Good Foods logo.

If you've already heard of my guest this week, chances are you're a big fan of The Amazing Race TV show. Dr. Nat Strand won the whole thing in 2010, part of the first all female team to cross the finish line first, along with her friend and race partner, Dr. Cat Chang. Dr. Strand is also the first winner with diabetes and she might really think We'll be the only contestant to compete with type one. I started watching The Amazing Race. As I mentioned when I was pregnant with my daughter and I have been meaning to talk to that for a long time. I'm so thrilled we finally worked it out. She's an anesthesiologist and a pain medicine specialist working at the Mayo Clinic in Scottsdale, Arizona. Recently, she contributed to a paper on caring for patients with pain. During the COVID-19 pandemic. She was diagnosed with type one at age 12. So we have a lot to talk about. Here is my interview with Dr. Nat Strand.

Dr. Strand, thank you so much for joining me. I am excited to learn from you and to hear your story. I followed you for years on social media. So thanks for coming on.

Dr. Nat Strand 6:42

Oh, well, thank you so much for having me. It's an absolute pleasure,

Stacey Simms 6:45

so much to talk about. We will get to the stories and living with diabetes and your diagnosis story. I want to start out and just jump right in with what caught my eye recently, which is a study to what you contributed about caring for Patients with pain during this pandemic. I don't know that you can really share too much about the study. But I'm curious like, you know, your anesthesiologist, let me start with asking you what are you seeing right now? What's going on in your world,

Dr. Nat Strand 7:14

where I'm located in Phoenix, Arizona, we are thankfully not experiencing the surge that we thought we were going to have. So four to six weeks ago, there was a lot of work as far as preparing on a community level. All the hospitals governor mandates to increase capacity of hospital beds, things of that nature. So we were certainly preparing for a surge. But I think a lot of people in our community have made personal sacrifices with the social distancing and the stay at home. And I think that that has helped us flatten the curve, as I say, not quite bend the curve because we're still increasing cases here but flattened the curves. Right now. What I do is practice pain medicine, we largely transition to telemedicine to avoid face to face visits and allow patients to access health care. While they stayed safe at home, so predominantly in the last few weeks, I have been treating my patients with telemedicine.

Stacey Simms 8:08

And how does that work? Because I would imagine that pain management is already a very delicate balance. You know, we hear about, Oh, you don't want to take too much of this medication or you can get addicted. And then when people are concerned about not seeing their doctor face to face, you've got to be worried about well, are they even managing their pain? Or are they suffering? Can you share a little bit about how it's been going?

Unknown Speaker 8:27

You know, I think for the most part, it's been excellent. With two way real time, audio and visual, I think you can get a good sense of how patients are doing. And as far as managing medications, you know, certainly the opioid crisis was there before we call the pandemic that the word crisis is still there during the COVID pandemic. So, you know, it's not the answer isn't just to prescribe a bunch of opioids. Now, some people benefit from it, but a lot of people can do manage with other texts. Consider that the anti inflammatories, neuropathic pain medications, lifestyle alterations, weight loss therapy and even with you know, the social distancing and stay at home, there's a lot of physical therapy that you can do from home too. So I think this challenge in medicine is really forcing our hand taking advantage of telemedicine and taking advantage of remote care and certainly providing access without being face to face now we are now open for elective procedures in Arizona so we are able to keep patients face to face but for a period of time there we really were forced to jump on the telemedicine bandwagon, maybe a little sooner than most of us were prepared to do that. I've been very pleased with the ability to offer access to patients, especially patients who are at higher risk, whether that be due to health concerns or age or even for patients that have to travel long distances to see a physician. So I think easing the burden on those patients and their situations to allow a little bit lower barrier to entry. healthcare access has

Stacey Simms 10:01

pardon my ignorance on this question, but when I think of seeing a doctor for pain management, and fortunately, I haven't had to have a lot of that in my life. So again, I'm ignorant on this. I don't think of an anesthesiologist. Right as the person that I would see I think of you all in the operating room.

Dr. Nat Strand 10:18

You're not alone. You know, when you do a residency in anesthesiology, you basically spend three years after your internship focusing on ICU level care, operative care, regional anesthesia, select nerve boss, epidural catheters, those kinds of things. So you become an expert at acute pain management, both with medication bandwidth intervention, so there's a fellowship option afterwards. And one of those planners either you can go into ob anesthesia, you can go into cardiac anesthesia, you can go into intensive care, you can also go into interventional pain medicine, so you kind of utilize that and there's a small skill set you developed during the anesthesia residency to further hone that Then focus on mega spinal injections, radiofrequency ablation of the spine or large joints, implantation of spinal cord stimulators or implantable pain pumps. So, you know, it doesn't seem like a natural progression at first glance, definitely. But when we kind of think about what we do in the bar and how that can translate to an office setting for chronic pain patients who kind of come to the bridge to the specialty,

Stacey Simms 11:27

yeah, yeah, of course, that makes sense. So tell me about this study. Because this is all about caring for patients with pain during the pandemic, not necessarily patients with COVID-19. This is something that is more of a guide for physicians,

Dr. Nat Strand 11:42

who's our recommendation, we worked with the American Society of we China presenting medicine to put out recommendations and then we also the paper you're referencing with that International Paper with the European society, of regional anesthesia also, and we just kind of want a different side provides some guidance during this pandemic early on, know how to handle urgent procedures, semi urgent procedures, you know, what was the risk of using steroids? You know, what can we do to manage our patients that were on chronic opioid therapy. So they really was sort of a set of guidelines after discussion of a panel of international pain medicine experts.

Stacey Simms 12:22

It does seem that chronic pain as I read through a little bit of the study, you know, just the introduction, things like that. It seems like chronic pain is so debilitating, especially for older people. I know we're a diabetes podcast, we're going to talk about diabetes in just a moment.

Unknown Speaker 12:37

But is there

Stacey Simms 12:38

you know, any advice that you would give someone who is suffering who feels like I don't think there's something for me? I've had this pain for so long. I'm afraid of being addicted. You know, we hear all those stories. Any reassurance?

Dr. Nat Strand 12:48

Absolutely. And one thing I want to say, You reminded me we talked about the food diary podcast. I think we're a lot of similarities between living with chronic pain and dealing with diabetes. I mean, they're totally different disease states. But if you talk about an invisible disease, that the person who lives with it is thinking about all day long with every activity, you know, before they go to bed when they wake up in the morning, but the people around them even loved ones, you know, a thing household, kind of forget because you look healthy or you look okay, you know, so yeah, that experience of living with diabetes is very similar to the experience of living with chronic pain.

Stacey Simms 13:27

That's really interesting, especially and even to my question of people are almost afraid to speak out because they're afraid they won't be taken seriously, or they'll be blamed. I didn't even think about that.

Dr. Nat Strand 13:38

Yeah, I mean, and, you know, you don't want to be a complainer or you want to put on a happy face. You feel like it's not interesting to other people, because it's the same thing it was yesterday and so, you know, I think living with diabetes myself, I bring a lot of that to counseling people who live with chronic pain because I get it, you know, and a lot of times they feel really, you can tell they can feel like, Oh my God, that's the first time anybody's really related to me on that way, you know more than just diagnosing the underlying cause of their pain, but actually, what it means to them to live with a condition like that. So I think that actually me having my experience of living with diabetes helps me relate to patients who live with chronic pain.

Stacey Simms 14:16

So let's talk about type one. Let's talk about your experiences. You were diagnosed as a young teenager, really, pre teenage 12 to remember your diagnosis story.

Right back in just a moment and telling your story there, but first, diabetes Connections is brought to you by One Drop, and I spoke to the people at One Drop, and I was really impressed how much they get diabetes. It really does make sense their CEO, Jeff was diagnosed with type one as an adult. In fact, I just talked to him last week about something else. It's always so good to talk to him because he gets it. He knows what this is like. Right? One Drop is for people with diabetes by people with diabetes. The people at One Drop work relentlessly. To remove all barriers between you and the care you need get 24 seven coaching support in your app and unlimited supplies delivered. No prescriptions or insurance required. Their beautiful sleek meter fits in perfectly with the rest of your life. They'll also send you test strips with a strip plan that actually makes sense for how much you actually check. One Drop diabetes care delivered, learn more, go to Diabetes connections.com and click on the One Drop logo. Now back to Nat and I had asked her if she remembered her diagnosis story.

Dr. Nat Strand 15:34

Do I remember that summer being really annoying and my family's road trips I remember going up to Northern Arizona and having to stop use the restroom all the time and it's a short like two hour drive. So I do remember my parents saying we'll stop drinking so much. You know of course now we know that the opposite. And then I went to like a three day sleepaway camp and at camp I was getting some notoriety for how many cans of soda I was drinking, I was going to the vending machine. And I was drinking so much that point I'd like built a pyramid of all the cans. I think, obviously I was going into either some decay or you know, just hypoglycemic diarrhea. So, I came home, my dad is a radiologist, he started to suspect that I might have diabetes. And I think he brought home some like urine ketone strips or something and tested them. And I remember it was like black. So he actually took me into the hospital. And I remember him telling me I was going to the hospital. And I had this bag of gummy bears in my room. And I vividly remember looking at those gummy bears. And you know, in a typical kid, that was what I was sad about was like, Oh, I'm not going to believe me. There's I had no idea what the rest of the diagnosis meant. But at that time, you know, you were admitted. I think I stayed in the hospital for 10 or 12 days and learned how to give myself injections and carb counts and there you have it. That was kind of my guide. It was truly not traumatic in a way. I mean, I didn't have some big bad events that veiled the diagnosis. It was kind of suspicion. Then that was the summer before I went into middle school. So I got to carry a purse everywhere. So the diabetes supplies I thought that was pretty cool.

Stacey Simms 17:17

Did you know you wanted to go into a medical field when you were that age?

Dr. Nat Strand 17:20

No, I don't think so. I had dreams of being like an oceanographer or a National Geographic photographer, kind of more creative, worldly, growing, no roots type of careers. But it wasn't until later. I think I had an interest in medicine through diabetes and my you know, you get a lot of exposure to physicians and hospitals at a young age. But it wasn't until I was in college that I really solidified my desire to go into medicine.

Stacey Simms 17:46

And what made you choose anesthesiology? Do you remember having a process

Dr. Nat Strand 17:49

for that? Well, it's certainly you know, matters a lot about what rotations you get. And if you have a great attending on a certain rotation that makes you know just kind of lights it up for you and that kind It happened to me for anesthesiology, bad reputation as a third year medical student and I just had a series of phenomenal attending physician to let me you know, place IVs Let me place lines, I intubated patients, I was in on some bigger cases. And I remember at the time, which of course you you changed your mind on this as you get older, but at the time, I wanted to be, you know, really where the emergencies happened. I wanted to be, you know, a first responder I wanted to be someone went down and had an emergency, I wanted to be there to be part of it, you know, traumatic, and now that I'm older, I kind of like No, I'd like something with Office Hours. You know, nobody needs you in the morning. But at the time, I wanted to be right in the heart of the action and there's nowhere better for that than being you know, in an operating room every single day and you get to help people. That's often the most terrifying thing they've ever done. And you have just moments for them to establish trust with you. Even if it was pediatric cases or you know, even on babies, you know, a parent literally can do their baby. And then you take it down the hallway. And so there's this intense trust that needs to develop over a very short period of time. And I always felt like that was something I really helped sacred as that amount of trust that someone had any for their loved one or for themselves.

Stacey Simms 19:22

We have had to have, you know, anesthesiologists, we've had surgery, both of my children over the years, and I always in the consultations, or when they come in, I always say to the anesthesiologist, you are the most important person in this room. And I try to say it when the search is not around, but I don't care. Because to me, that's the one and I, you know, it is such a huge responsibility. And I have such respect almost all and when you said, you know, you take your child down the hallway, if you've been there like I have, you know, your heart is in your throat for the entire time, and it must be such intense, not only the training, but just the experiences that you go through. Do you all Good, this is kind of a personal question, do you will have a community? Do you help each other out? Do you think there's Okay, mental health among anesthesiologists, because that's gonna be so difficult. So that's a huge weight to bear.

Dr. Nat Strand 20:11

It's a huge weight to bear. And I think, you know, I don't want to pretend like I'm on the frontlines right now, because again, I do outpatient pain medicine for the majority of my practice, but especially some of the anesthesiologists that have been called to intensive care units, and that are on COVID airway teams. And some of my best friends from training are in hospitals that are saturated with cases and other states. And so I think that mental health is a huge issue, the amount of stress, the amount of burnout, the amount of anxiety, the amount of fear even about you know, PBE and that kind of thing, especially in the beginning, when some of the supply chains weren't, you know, as mature again, I'm not talking about my personal experience, but people at other hospitals. So, you know, I think in general, it's an issue and I think acutely, it's even a bigger issue. I do see resources. I think people do In the pandemic are very aware, I even read a story about a physician suicide in New York for an emergency medicine physician, you know, so people are aware, and I think there are resources available now, especially that are free for physicians. But in general, I think mental health is unfortunately still kind of has a stigma where in medicine, I think self care is often last care. You know, people go to work when they're sick. For the most part, people go to work when they're tired. People work long hours overnight, you know, into the next morning, so I think mental health kind of goes along with physical health and, you know, you just kind of do what needs to be done and the needs of the patient come first. And so for a lot of physicians and all specialties, I think self care, including mental health really is a challenge.

Stacey Simms 21:42

I have to ask well, I have an anesthesiologist who also has type one and I mentioned you know, my kids, one has type one and one does not have both had surgeries where they required hospitalization and anesthesia. Are there any best practices or any bits of advice that you can share with the diabetes community to help us make the hospital stays, you know, we're not talking about COVID-19, obviously, but you know more routine stuff. Is there anything that we can do or better prepare, so that when we go to the hospital, if it's an adult or child with type one, that we can kind of help the healthcare teams take better care of us.

Dr. Nat Strand 22:16

So I think one of the things is to try to speak with your anesthesiologist ahead of time if possible. So if you're having a plan surgery, and you know who the group is going to be, you may find people within that group that have a little bit more experience and interest in managing type one, that would be number one is to really see if you can identify someone, even if there's not someone who has specialized experience just so you can come up with a plan. I would definitely suggest having a plan with your endocrinologist written out that can be given to the anesthesiologists. You know, I'm thinking of when I've had surgery or when I you know, had my C sections with my kiddos. I think that having the endocrinologist involved so they can, you know, give their support and of course, the You're going to do what they're comfortable with and what they know how to do. And sometimes that's changing, you know, insulin pump to IV insulin. And you also have to balance that with if someone's not familiar with it, and they don't have trust in it, they have to administer the care that they have trusted. So there might be some education involved. Of course, it depends on you what the case is the length of the case, the intensity of the case, those kinds of things. So I think if you're able to, if it's a short case, if the anesthesiologist is comfortable with the plan, I would love to always keep my insulin pump on and my guests come on, but I do know that sometimes, that's just not possible and you have to switch to, you know, other types of influence. So it's kind of uncomfortable for everybody. But I think if you can communicate ahead of time and create a plan that's most comfortable for everybody involved. That's important. And of course, you know, whatever is going to keep anybody safe. You know, avoiding any hypoglycemia, avoiding any severe hyperglycemia. And of course, just getting you to the other side when you can take over management yourself again.

Stacey Simms 23:59

Yeah, what We did the last time but he had surgery because the first the first time he had surgery, he was teeny tiny, I think had been diagnosed for, I think he was seven or eight months in. So he was about he was still two. And he had no, he had no decks. And he did have an insulin pump when this was like 13 years ago. So everybody was all excited to see the pump. It was very interesting. But he did great. And then this last time, he needed surgery, he had knee surgery late last year, and they were amazing. But we decided that it would be easier for the anesthesiologist to just look at his Dexcom numbers on his pump, not his phone, because the pump you unlock 123 right, the tandem pump is super simple. We figured the phone could lose signal, the phone could be harder to unlock, you know, just he's got like an, you know, a six digit code, and why would I remote monitor from the waiting room? What the heck was I gonna do? You know, they would know, they would know I had faith. They were great, and it really worked out well. So it was a really positive experience. And interestingly in the 1213 years that had come by that hospital Steph was really well educated about pumps and CGM, which was a really pleasant surprise for us. So that was good.

Dr. Nat Strand 25:06

Yeah, that's awesome.

Stacey Simms 25:08

All right. So I think I'm not alone in that the way many of us were introduced to you was on national television was on The Amazing Race, which is, it is the best reality show. It's my favorite of all time. I started watching it. I looked this up the other day that I couldn't believe it. I started watching it in 2001, because I was pregnant with my daughter and I couldn't sleep. And I used to watch it all the time. And I adored it.

Unknown Speaker 25:31

And you guys

Unknown Speaker 25:32

want it?

Stacey Simms 25:34

I know a lot has been said a lot has been written over the years about this. What was that? Like? I mean, what do you most remember about it?

Dr. Nat Strand 25:41

Yeah, that was 10 years ago now it's really crazy. But you know, there's there's the experience of doing amazing race of traveling around the world was nothing. I mean, you have a backpack but you know, you're going to the Arctic Circle, you know, you're going to go to sub Saharan Africa, you know, you're going to go we we didn't know exactly where we're going. Go back, watch the show myself enough time to know I'd be really cold, really hot, really dirty. But you have a backpack, you have no money, you have no maps, you have no cell phone, you have nothing. And so just being stripped down to sort of your just immediate resources to figure things out like that, because that was as interesting as it was to see the world. I mean, I had never been so stripped down of things I had access to, you know, being a study or I would have references for everything I kind of just get thrown into the world and open a clue and say, make your way to Stonehenge, you know what I mean? It's not like you get direction. So it was while that I did it with one of my very best friends, who's another anesthesiologist, Dr. Catching and we we had a blast. We went around the entire globe and I think it took us 21 days total. And then I came home and slept for like six. And after that, you know, the show starts airing in the fall and it airs. I think it aired from September to December or did at the time. So what sticking it was a whole nother like phase two.

Unknown Speaker 27:03

Oh yeah, with all the

Dr. Nat Strand 27:04

editing and the production that they do to their production, what the other teams were doing, you know, you see a lot of backstory or parallel stories that you didn't see at the time, right? Because you were just with your team, so very interesting to watch it after having lived it. And then I think phase three of it is getting to be like a C list celebrity for a year or two, which was also very weird. So there's like three phases of The Amazing Race that totally kind of changed my life. But overall, I was so positive, I have nothing but fond memories of doing it and the people that I met and, and I also remember thinking the world is a lot safer and friendlier than I would have thought, you know, if you just drop off to Bangladesh for 48 hours, with no plans, you know, people just kind of help and you and you're frenetic and you're tired and you're racing and you run up to strangers and you asked them questions really quick and, you know, now I would never go to Bangladesh for the weekend. You know what I mean? Like work to go somewhere for a weekend. But it was worth it, you know, you You definitely got to see things and get a taste of it. So afterwards I tried to tell myself, you know, even if you don't have a huge chunk of time to go somewhere still go, if you can, and, you know, to see the world and everybody was friendly, I don't think I had one time where I felt like somebody that's, you know, rude or aggressive or unwelcoming. And I think that was a very wonderful experience too. Because sometimes I think we can kind of become afraid of going places or being with other cultures and being there in person in so many different cultures. And having everybody be so warm was was phenomenal.

Stacey Simms 28:34

Did you learn anything at that time about managing diabetes? Because you you I mean, I know you're stripped down, but you had your diabetes supplies, but I saw the show you're testing while you're driving. I mean, you know, to some extent, you don't have all the stuff you know, you don't you're not sleeping, right, you're not eating right. And I'm just curious, I think sometimes with my son, he'll go and forget something and muddle through when he learns from that. And even though we have all this wonderful technology, he kind of has learned that he can make it work. You can always MacGyver something. I'm curious if you had that experience.

Dr. Nat Strand 29:03

That's the word I was just thinking. I mean, any type one becomes, you know, kind of a MacGyver where you're learning how to, if you need to draw and slip out of an old reservoir for a new wine or you're learning how to reuse parts of an infusion set because one part ripped off if you don't have enough to replace the whole thing, or you're learning how to keep insulin cold or you're learning how to package things. They don't take as much room by taking them out of their packaging and putting them in a Ziploc, you know, all together, I think, you know, I remember even the test strips, you know, opening the test strip bottles and filling one bottle with two bottles worth of strips just to save space. So, you know, you kind of by force have to get very creative with faith and efficiency and also problem solving. So yeah, I learned a lot about traveling with diabetes. And you know, one of the things I did was I typed out a letter that said I have type 1 diabetes. In case of emergency please help me get sugar or please You know, I'm getting 200,000 to a hospital and I printed that out in several languages. So, you know, if I found myself in Russia, for example, and didn't know how to say what I needed, you know, I would have that kind of to give. So I think, you know, just learning how to prepare, you know, anticipate what problems you might have, or where you're going, and then, you know, trying to bring the selections with you as possible. That was definitely a skill set that was honed,

Stacey Simms 30:24

that's a great point. We were in Israel A while back. And, you know, we were on a guided tour, and everyone spoke English. But at one point, a guy wanted to take my son's medical bag to examine it, and he didn't speak English and then he figured out what was going on your tour guide kind of spoke to him and he was like, Oh, you know, kind of funny exasperated, like, come on, make this simple for me. And he wrote out this is a medical bag in Hebrew, and attached it to our bag. He was like, here Now you won't have any other problems like what's wrong with you people? Why couldn't you just do that to me? He was very funny back to us, like, you know, nicely exasperated with us, but I think in the future, that's Something that is just very helpful. You know, this is a medical bagger. I have type one diabetes in different languages. That's great advice. So I mentioned you have two children. Now you have I was gonna say toddlers, but you have preschoolers, right, five and four years old. You mentioned c sections. I'm not going to get all personal about type one pregnancies and that sort of thing. But when you were diagnosed at 12, I doubt you were thinking about children at the time. But you know, as you were getting older with the diabetes diagnosis, did you think about children? Was this something that you thought might be difficult or not possible with type one, or was it always in the plan?

Dr. Nat Strand 31:32

You know, I actually, again, sitting with my adventurous plan for life. I wasn't one of those girls that really thought I would have kids. I never really thought about being a mom and stuff like that. I kind of was more thinking about how I was gonna travel the world. And so, I mean, we had all seen Steel Magnolias. And so I think, you know, I had this awareness but at the time, you know, I think it was more of an awareness that that movie was wrong. I think I thought it would be fine. If I had wanted Kids. And then once I got a little older, I met my husband, we got married and I started, my switch flipped and I was like, I need children. And then I was like, Okay, I started getting into the details of, you know, diabetes and what the control needed to be and what the risks really were. And, you know, that I think was overwhelming. I think, you know, type one pregnancies, it's definitely a full time job. It's not regular diabetes management is like, very, very intensive diabetes management. So I knew that people would type one could have kids, I just didn't know if I could do what it would take to be that strict for that long. You know, so I think I, I pleasantly surprised myself that I could, you know, I think when the stakes are there, you do your best. But you know, I think there are different personalities, obviously, that have type one and my brother also has type one, he was diagnosed in his 30s and he's very mathematical. He's got an engineering mind and I think Not that anybody is well suited for diabetes, but if someone was to be well suited personality wise, he is, you know, he is regimented. He charts everything. He stacks his thing. You know, he's like that, and I'm the opposite. I became like him when I was pregnant.

Stacey Simms 33:14

So speaking of your kids, though, you you know, you've said you've been doing mostly at home consoles for your work. I assume that for the last couple of weeks, at least you've been home with your kids, maybe more than usual. How's that going?

Dr. Nat Strand 33:28

Well, you know, I think that everybody will look back on this time with different different experiences. Some people are bored and they've organized every room in their house and they make all these new recipes and I will look back on this time and remember what I had a three to five year old, who didn't have anywhere to go and any preschool or any day until my house apart all day long every day. My couch cushions haven't stayed in place for more than 20 minutes of full time. I mean, it's just crazy, but it's gonna be exhausting. I mean, they're like feral animal. But it's been cool to see them develop their relationship. You know, they're they're playing together from sunup to sundown. They're imagining things. They're making no jungle. So it's been nice to see them spend some time together, but certainly be at home with two young kids and nowhere to go. That's not for the faint of heart.

Stacey Simms 34:26

I salute you. Before I let you go. I know as you've said, you you're not in the ICU right now you're, you know, you're not seeing patients with COVID-19. But as a person with type one, I assume you're trying to stay on top of the medical literature and, you know, seeing what this may mean for people with type one who who get it who catch it who are at risk. Can you talk a little bit just either you know, your thoughts for yourself advice for the community? I'm just curious what's going through your mind on

Unknown Speaker 34:52

this these days?

Dr. Nat Strand 34:54

Well, you know, when they when it first kind of came out, I was reading a lot about what had happened in China. And also in Italy. And when I thought it was I kind of assumed it was type two diabetes, you know, because we were seeing a lot of age related and comorbidities. But you know, we've now seen with position statements from like the a DA and the jdrf, you know that they're not really differentiating type one and type two. So, you know, I know for me that my risk of catching this is not hired because of the diabetes, but my risk of a more negative outcome definitely is higher because I live with diabetes. So, you know, the way I look at that is I'm doing all you know, the recommended social distancing, masking thing at home, those kinds of things. And at the same time, I'm using this as an opportunity to really focus on all other aspects of wellness. You know, I'm kind of re engaging to bring my diabetes control into a tighter range because I know that's helpful. Now, as far as like rest, nutrition, exercise, all of those things are sort of, you know, you can think of it as like prehab instead of rehab, you know, what you can do before you deal with something to make you as resilient as possible. Physically. So I would just say, we know our risk of getting it's not higher, but our risk of complications if we get it is higher. And that's something that I think we should not let us talk on a topic from a place of fear, but rather from a place of preparation, and using that knowledge to just, you know, get our diabetes under the best control possible. Whether that means, you know, changing to a pump, or getting a CGM, or just re engaging with your endocrinologist or CDE. And then I think making sure you consider all other aspects of wellness to this to make you more resilient, which is, you know, nutrition, rest, stress management and exercise. So, I think we can use this knowledge to just put ourselves in the best position possible. A great defensive is really the best offense in this case.

Stacey Simms 36:42

Well, thank you so much for talking to me for sharing your story. And for just giving us a little bit of an insight into the medical community these days. I really appreciate it.

Dr. Nat Strand 36:53

Oh, and thank you so much for having me. I mean, like you said, I followed you on social media for so many years, and it's just an honor to be included on your project. Cast and thanks for everything that you do for our community. We all appreciate it very, very much.

Unknown Speaker 37:10

You're listening to diabetes connections with Stacey Simms.

Stacey Simms 37:16

That was so nice of her to say that at the end, it's funny, isn't it? The diabetes community, you know, we all kind of know each other from social media, or, you know, we've maybe we've met at a conference, but there's a lot of mutual admiration out there. It's always nice when people say that, but you know, as you listen, it makes me think if for some reason you feel like you're not really a part of this community, you know, maybe you listen or you're lurking in the group, and you've never reached out you're wondering if you know, what's it like, it's great. definitely reach out, definitely jump in. I mean, if you if you're fine, and you just want to listen, that's awesome. But we're doing a lot of really fun stuff in the Facebook group with zoom calls and surveys, and I'd really love to see you there and I really want you to know as you listen that your voice is really important too. So I'll link up more about Dr. Strand and her study and other information that we talked about in the show notes there's also always a transcript there at Diabetes connections.com And up next is tell me something good which is all from the Facebook group this week love it. But first diabetes Connections is brought to you by Dexcom. Now we have been using the Dexcom g six I looked this up it is two years now. We did a goofball video two years ago a little bit over Actually, it was the night that Avengers Infinity War came out and that's the night that we slept on the G six for the first time and we did a facebook live in for Benny wanted to do it but he was also really reluctant because he wasn't sure if it would hurt. So I will link up that video but I will tell you when I looked it up where to start because it's like an agonizing 10 minutes before he does it. But you know, the Dexcom g six FDA permitted for no finger six for calibration and diabetes treatment decisions. You do that to our warm up, the number just pops up. And after so many years of the previous dex comes we had to calibrate a couple of times a day you know you wouldn't get any blood sugar readings till you did so. It's amazing. We have been using the Dexcom for almost seven years now and it just keeps getting better. The G six has longer sensor were now 10 days and the new sensor applicator is really easy to use. You'll see on the video he was shocked, you know no pain. Of course we still love the alerts and alarms that we can set how we want. If your glucose alerts and readings from the G six do not match symptoms or expectations. Use a blood glucose meter to make diabetes treatment decisions. To learn more, go to Diabetes connections.com and click on the Dexcom logo.

Tell me something good this week a bunch of great I'll call them little stories from our Facebook group. Last week I talked with these big athletic accomplishments, right, the Appalachian Trail marathons, but this week was a little different and I think these are worth celebrating as well. James said AP exams were easy on accommodations this time simply allowing students with type one, double the time so they could test treat etc during what was already A weird testing cycle. That is good news. Samantha says we sent out birthday cards to any kid among our friends that had a birthday this month since they can't have a party. And that was really fun. Her husband and her son are training for the new virtual jdrf ride. And they all just signed up for the Disney run again in January. She also wrote we are all alive. I see you, Samantha, that sense of humor. And speaking of the ride, Elizabeth wrote in that the reimagine jdrf my ride is good news. And she'd like to see me talk about the new program with one of the managers we have that in the works. I'm going to be talking about that. So the jdrf rides in person for the fall, unfortunately, were canceled, which I think was the right thing to do. But you know, there were a lot of people who really enjoy that and we're banking on it, and we're already fundraising. So jdrf my ride is a way for people to participate, even though they can't travel to these locations. I will put more in the show notes on this, but I will also be doing hopefully, a whole podcast on it soon. You're off Emil Altman, who is part of the Facebook group wrote in I don't know if this is what you're looking for, but I will be hitting 39 years of pumping the second week in June, and I hit 23 years of CGM use in March, he will mark 59 years with type one in November. I had him on the show a while back. He was an early adopter of diabetes technology. In fact, he worked in the industry for a while. So really great stories from him. Perry who lives with type two and is in the group. I'm always happy to see him. He said that his dad survived heart surgery that he is needed since March and finally had the valve repair last week, which would have been early May. Perry works with the fire department in South Carolina and he says good news. My crew has not liked masks gloves or hand sanitizer. And I gotta say, this is my favorite of the week. My dear friend and Sutton who is also the Outreach Manager for our jdrf is so creative, trying to keep people connected online. And she created two events for children who you know aren't able to meet up right now because we do a lot of that in our area. So she created And this isn't just for girls. And it isn't just for boys, anybody could go to anything. She created a tea party, a virtual Tea Party, and she created a virtual Lego build. And I'm going to share the photo of one of the kids built a meter out of Legos. And it's unbelievable. It looks so good. So I'll be sharing that and I hope you check it out really good and creative stuff. Do you have a Tell me something good story it can be. I think this is a great example of what I would call you know, these smaller stories, but still big accomplishments. Good news in our community. I mean, if you running a marathon or you're celebrating 59 years with type one, we want to share that too. But I just love this segment because it gives us a glimpse into the good stuff that's happening. You can share it in the Facebook group or you can ping me Stacey at Diabetes connections.com and tell me something good.

Before I let you go tell you a story about something bananas that happened in my house recently and I think this might be the first chapter in my novel Next, The World's Worst Diabetes Mombecause that book stops really right in the middle of middle school. And it's not as though we haven't continued to make mistakes. So I will tell you the punch line first in that everything is fine. Benny is fine. It's all good. But what happened was, he had had a day, just one of those Perfect Storm days where the decks calm had expired, I accidentally left his pump off. And of course, a few hours later, he was a very, very high now I since COVID-19, and we've been around each other so much. I've actually been less on him than I think I have been any time in recent memory. his bedroom in our new house is upstairs. Mine is downstairs, which is totally new for us. We have control IQ with the tanta pump, which has been a dream and he's doing really really well. But you know, things happen. So it's about six or seven o'clock at night. He realizes he's having the pump issue. Of course he didn't have the decks calm. So you know, we didn't know that there was an issue for a lot Longer than we would have otherwise, we did a blood sugar check and it just gives you that high, you know, there's no number associated with it. And, of course, we did all the protocol you're supposed to do. Huge shot, you know, gave him the correction by injection, change the pump inset slapped on the dex calm, drank a ton of water and checked for ketones. And I went downstairs because Ben he never has large ketones. I mean, in all of his years, he's had medium once I'm not would not get anything I can get. But you know, he's been high for a sustained amount of time through illness or just wackiness or you know, dumb stuff with diabetes, and he's never had large ketones, but we still do check because I just don't want to get lulled into complacency, right, people change things go I just I don't want it to slip. So he texted me and he said, Mom, the keto stick is black, which we've never seen before. So of course, I run upstairs and they look at it and it is it's super dark purple. So I'm like, Alright, well, you just had the injection because it's a urine stick. It's probably a couple hours behind. Drink a ton of water. We'll monitor From here, if in two hours, we still get a really dark, large ketone reading, we'll call the endo and he'll walk us through what to do next. Okay, so I'm freaking out, right? I'm thinking to myself, why don't I have a blood ketone meter? What's wrong with me? I'm the worst. Why don't I have so I'm online, I'm looking for blood ketone meters, you know, like, How fast can I get one and we just, you know, we, we've never had the need, so don't yell at me. Then two hours later, blood sugar is coming down nicely, he's feeling a little bit better, right? Things are gonna be fine. And I sit in his room and he goes to the bathroom and it comes out and he's like, wow, it's still really dark. And I look at the strip

Unknown Speaker 45:33

and I noticed it looks really weird. We use the regular old keto sticks that have little square at the end, and it just has one square.

Unknown Speaker 45:41

this stick

Unknown Speaker 45:42

has two squares, and one is dark purple, and one is light pink. I thought

Unknown Speaker 45:47

to myself, what

Stacey Simms 45:48

the heck is this? So I look at the bottle. And if you know you've already know what happened, I had purchased diagnostics. These are sticks that measure glucose and ketones and The dark purple was the glucose hidden of large ketones. He had small ketones, maybe medium, maybe. So for, you know, big sigh of relief, and that was it. But oh my gosh, I was flipping out before that. So now we know now we have to be more careful. But that's the next chapter. I've already got The World's Worst Diabetes Momstuff ready to go? Never a dull moment. All right, a big thank you to my editor john Lucas from audio editing solutions as always, for helping make sense of a lot of my nonsense. Thank you to you so much for listening. Don't forget about the book to clinic program. If you want to jump in on that or you know, a clinic that would like to get on the list to receive books. I'd love to hear from you as well. I'm Stacey Simms. I'll see you back here next week. Until then, be kind to yourself.

Unknown Speaker 46:52

Diabetes Connections is a production of Stacey Simms media.

Unknown Speaker 46:56

Transcribed by https://otter.ai

Chronic Pain