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KERA Health Checkup: Diabetes

Dr. Natalie Strand
Dr. Natalie Strand

By Sam Baker, KERA Morning Edition Host

Dallas, TX –

The American Diabetes Association says nearly 26 million people live with the disease. And another 79 million are at high risk for developing the Type-2 form of diabetes. In our KERA Health Checkup, Sam Baker spoke with Dr. Natalie Strand. She's a Type 1 diabetic who's also an assistant professor of clinical anesthesiology at USC. During a recent visit to Dallas to address the Juvenile Diabetes Research Foundation, Dr. Strand explained the different forms of the disease.

Dr. Strand: Juvenile diabetes is what people traditionally call Type 1 diabetes, being the type of diabetes where your body stops making insulin. Traditionally, it came about while you were an adolescent or a young child, but now we're starting to see some adults diagnosed as Type 1 diabetes.

Sam: And how does Type 1 differ from Type 2?

Dr. Strand: In Type 1, it's more of an autoimmune disease. Your body attacks the cells in your pancreas that make insulin and your body stops making insulin. So Type 1 diabetics have to take insulin to survive. In Type 2 diabetes, it's more of a metabolic disorder, where your body still makes insulin, but you are not able to make it efficiently. Type 2 diabetes is the type most people think of when they think of diabetes that is improved by diet and exercise and can be prevented by leading a really healthy lifestyle.

Sam: It's also the form of the disease that's easier to miss?

Dr. Strand: It does take longer sometimes for people with Type 2 diabetes because with Type 1 diabetes you get very ill and it is imperative that you go to a physician and get diagnosed. With Type 2 diabetes, it may be subclinical, meaning it may take people a while. They may realize they don't feel very good or their hands and feet may be bothering them or they're noticing some subtle changes, but it's not as dramatic as when people have Type 1 diabetes, so it can take a while for them to get themselves to the physician and get diagnosed.

Sam: And those sound like the kind of symptoms you could mistake for almost anything else.

Dr. Strand: Certainly. When your blood sugar gets high, you'll find that you're thirsty a lot of the time, that you're urinating a lot. You may have leg cramps, low energy, a sense of malaise, fatigue. You may know something's wrong, but you may not know what.

Sam: If you go undiagnosed for too long, what kind of a situation are we talking about here?

Dr. Strand: More people die from diabetes every year than from breast cancer and H.I.V. combined. I believe here in Texas, it's the sixth leading cause of death in the entire state. So diabetes affects multiple organs, it's a leading cause of blindness and kidney failure, stroke, heart disease. So undiagnosed diabetes - even diabetes that's diagnosed but poorly treated - puts you at risk for several serious health problems.

Sam: Is there a problem in this country with getting that disease diagnosed?

Dr. Strand: The estimates are that, right now, approximately ten percent of the population in Texas is struggling with diabetes and of those, a large amount are undiagnosed. Certainly, as the obesity crisis continues, the Type 2 crisis will also continue to rise.

Sam: But it's the kind of disease, once you are diagnosed, you can manage?

Dr. Strand: Well, they're quite different in the management. Type 1 diabetes, yes, insulin has been a life saver, but still a disease that requires multiple daily injections, testing glucose four to six, even eight times a day. It affects the ability to exercise, the way you travel, the way you sleep, so it's by no means cured. Type 2 diabetes oftentimes can be reversed or treated when people are vigilant about their diet and increase their exercise. So, being that Type 2 diabetes is the more prevalent one - about 85-percent of people with diabetes are Type 2 - that's really good news because, basically, if you start eating well and exercising, a lot of those people can have long life spans, a wonderful quality of life and can really prevent some of the complications that diabetes can bring upon them.

Sam: There's no cure for diabetes, but are there promising new treatments at this point?

Dr. Strand: There are promising new technologies on the horizon. Anything from an automatic pancreas or an insulin pump that can work with a continuous glucose monitor to islet cell transplantation to the idea of using whole new hormones that may work with insulin, such as leptin. There are a lot of exciting new ideas on the horizon and I can't wait for one to come to fruition.

Sam: You're a co-winner of The Amazing Race. Season 17, I think it is. It's a race that goes on over 22 days at a very fast pace. So how do you manage your disease under such conditions?

Dr. Strand: Well, it was a pretty grueling situation. We covered 32,000 miles in 22 days, traveling everywhere from Ghana to the Arctic Circle with nothing but a backpack. So it was definitely not normal daily life for me. But in a lot of ways, every day with diabetes is like an amazing race. You never know what kind of obstacles will come up. You have to be vigilant and take time to plan ahead. So, for me, The Amazing Race was a more extreme version of what living day to day life is with diabetes.

Sam: It's the planning I'm curious about because you take insulin...

Dr. Strand: Yes.

Sam: What was in that bag? And do you refrigerate insulin or no?

Dr. Strand: Normally, I do. Unfortunately, I did have a refrigerator with me (laughs). I had to creative about finding ways to keep it cool. I had a little FRIO pouch with me, which is a water activated cooling system that I use. That's how I kept my insulin cool on the road.

Sam: So the series doesn't work with you in maintaining this. You're on your own?

Dr. Strand: You're on your own. They're very adamant that they are not allowed to intervene at all. So they wouldn't carry any extra supplies for me. They didn't give me any refills. They didn't refrigerate my insulin. I had to do everything on my own with my teammate.

Sam: That's potentially dangerous. Why did you want to do this?

Dr. Strand: Well, I didn't feel it would be dangerous. I felt that myself being a physician, and my teammate was also a physician, and I knew that if anything serious happened to me, they would intervene. It would just mean I was off the show. So, at the end of the day, if anything serious came about, I felt that I was in good hands. And I felt confident I would be able to handle anything that came my way. This is where the planning comes into place. I had several insulin vials. I had syringes. I had insulin pumps. I had lots of glucose and snacks with me, so I tried to imagine every single disaster and have a plan for each one.

Sam: Was it an attempt on your part to make a statement about living with diabetes?

Dr. Strand: Oh, it definitely was. I definitely want people who have diabetes to know they can live whatever kind of a life they want. That being active is not only doable, but necessary. So I really wanted to put that message out there. I had a lot of people write letters to me during the show. One woman said that her father was living with Type 2 diabetes and he used his diabetes as an excuse not to exercise. He would say "Oh, you know, my diabetes, I can't, it's so much harder for me, you don't understand." She said they were having this argument as the first episode of The Amazing Race was airing, and they showed that I was a Type 1 diabetic, and he looked at her and said, "Well, I guess my excuse just went away." (laughs) And I was really happy reading that letter. It was a funny letter, a little tongue-in-cheek, but I was happy to hear it was impacting people positively.

More about diabetes:

To see Dr. Strand on The Amazing Race: