When you have diabetes, facing an unexpected food choice can be a little daunting. But what if daily life included rappelling down canyons, bungee-jumping off cranes, switching time zones and eating extreme cuisine like boiled sheep's head—all while racing across 32,000 miles in 10 countries over 23 days?
Nat Strand, MD, knows all about overcoming challenges as the first contestant with diabetes to compete on CBS's The Amazing Race, the reality-TV scavenger hunt that pits 11 teams in a globe-trotting chase for a $1 million prize. The 32-year-old, diagnosed with type 1 at age 12, says the win was the result of terrific teamwork with best friend and race partner Kat Chang, MD, some smart planning before embarking on the journey and lots of on-her-toes thinking along the way. And Nat, an anesthesiologist in Newport Beach, CA, adds that she owes a lot to a behind-the-scenes partner: her long-term diabetes educator, Carolyn Robertson, RN, CDE, of the University of California, Los Angeles, for giving her the knowledge and skills to not only finish healthy, but bring home the gold. Of course, her insulin pump and continuous glucose monitor were also very helpful!
"The Race really is the perfect storm when it comes to managing diabetes," Carolyn says. "Nat had no idea where she was going—just that she would be in a lot of different countries, would be put in extreme situations and would be subjected to very hot and very cold climates. So we decided to imagine the worst and plan for those scenarios."
The strategy worked—in fact, Nat was thrilled that her diabetes never posed a problem—and the strategy can work for you, too. While you may not be crossing six time zones or dog sledding in the Arctic Circle anytime soon, you can borrow some of Nat and Carolyn's tested techniques to manage your diabetes under almost any circumstances.
Whether you're planning a long vacation or a weekend getaway, creating a checklist of everything you might need—insulin, test strips, glucose tablets and more—will ensure you have a safe and healthy journey and won't need to waste precious time searching for supplies in unfamiliar places. "We tried to think of everything," Nat says. But that was only half the challenge. The other half? "Then we had to figure out how to fit it in my backpack!" One thing that didn't make the cut: her hairbrush!
"If you become dehydrated, you become more insulin resistant," Carolyn says. So she told Nat to drink between six and 12 ounces of fluids per hour, and to down even more during periods of intense activity. Nat would also be flying a lot, and since the air inside airplanes is especially dry, Carolyn reminded her to hydrate while in flight. On the ground, Nat never went anywhere without a water bottle—especially in sunny climes: For people with diabetes, hot and humid weather can impair the body's ability to sweat, causing blood sugar levels to go haywire.
Most of us have experienced flight delays and the occasional white-knuckle turbulence, but the pace and competitive nature of The Amazing Race took travel tensions to new levels. "I'm definitely one of those diabetics who notices a spike in my blood sugar with stressful situations," says Nat, who had to overcome a fear of heights for many of the challenges.
And it's not her imagination: Nail-biting experiences trigger the production of adrenaline and cortisol, fight-or-flight hormones that send blood sugar skyrocketing. To counter on-the-spot tension, Nat turned to deep breathing. But whatever works for you—whether it's taking a walk, punching a pillow or sipping herbal tea—will do the trick.
One of Nat's biggest challenges during the race was not knowing when she'd see her next meal—or what it would be. When on the road, pack a healthy supply of snacks and glucose tablets to combat low blood sugar during long periods between meals. When faced with unexpected meal choices—like that boiled sheep's head—Nat did her best to keep her blood sugar levels in check.
"Usually when I'm traveling, I'll do low-carb or foods that I'm familiar with and, if not, I will test a lot to see if my blood sugar is trending up or down. Having my continuous glucose monitor during the race was very helpful in that sense."
Whether you're on a day trip or an around-the-world adventure, continue to check your blood sugar levels according to your health provider's recommendations to catch problems early and prevent highs and lows. "I made some changes to my insulin pump," Nat says. "I knew I was going to be in a different time zone every day, so my rates of peaking in the early-morning hours and lowering during the day weren't going to work out as well."