The End of Diabetes: The Eat to Live Plan to Prevent and Reverse Diabetes

Dr. Mike Natter provided us with this interview centering around his experiences as a type 1 physician amidst the COVID-19 pandemic. Thank you, Dr. Natter,  for your time and for what you do to facilitate so many.

How long have you been type 1?

I was diagnosed with Type 1 in 1994, two weeks after my 9th birthday.

Did that play into your decision to become a doctor? 

Yes. I believe being diagnosed opened this window into the delicate physiology that was happening in my body — it’s a beautiful orchestra on a microscopic scale. The pancreas is the conductor, diligently balancing the hectic homeostasis of blood sugar and then BOOM, now as a nine-year-old kid I had to shoulder that balancing act — it left me with a feeling of awe in our own complex biology.

When you heard about COVID-19 heading our way, were you nervous? For your family? And for your work as a doctor during this pandemic? Did you feel your hospital was prepared for the outbreak?

I was paying close attention to what was unfolding in China and it worried me a lot, but nothing could have prepared me for what came next. As a doctor, I knew this was going to be bad for my patients but this was the 1st time that going to work meant I was also putting myself at serious risk, on the front lines with a potentially deadly pandemic… and as a type 1 diabetic.

I don’t think any of us were truly prepared and I think all of us were quite frightened. That said, with that fear came a sense of purpose and calling. Seeing my colleagues – co-residents, attendings, nurses, house cleaning staff, respiratory therapists, etc. stepping up and doing their jobs… it just really inspires me and continues to do so today.

How did you personally prepare for this crisis? Did you stock up on any foods? Medications? Toilet paper?  

First, I tried my best to stay calm. Knowing I would likely be working crazy hours, I stocked up on granola bars, protein bars, coffee, and frozen meals. I did a quick laundry and made sure I had enough clean scrubs. Most importantly, I made sure to secure a three-month supply of all my diabetes gear (insulin, pump supplies, strips, etc). I also wanted to prepare in case I needed to quarantine if I get sick (Tylenol, Gatorade, thermometer, and a pulse oximeter).

Next for me as a type 1 diabetic and a senior medical resident who will be confronted with an invisible enemy that is ravaging my patients, my colleagues and potentially myself – I needed to mentally prepare myself. I was and I am scared. Fear, as we know, also causes a stress response in our bodies which spikes our blood sugar. For these reasons and more, I am doing my best to stay calm, manage my glucose as best as possible – eating well and also doing home workouts, and doing mindfulness activities like meditation when time allows.

Photo credit: Dr. Mike Natter

What is the main concern you have as a doctor for you, your family and your patients if they contract COVID-19?

I am frightened. What has been keeping me up at night is less fear about myself falling ill, but rather if my family members, loved ones, or my colleagues ended up in a hospital bed. I don’t think that is something I could handle. As a type 1 diabetic, I do sometimes think about my course may be complicated but if given the choice, I’d much prefer I get it than any of my loved ones. There is an emotional and mental toll to all of this in addition to the physical exhaustion.

If your patients are nervous that they have COVID-19, what is your advice? What symptoms ought to they look for and who should they call? 

While many of us will potentially get the virus, that is OK.  The reassuring thing is that MOST of us will have a mild course that will not require any type of hospitalization (approximately 80% have mild courses, although the true percentage is likely higher since some will be asymptomatic and therefore not even be aware they have anything).

What we are hearing from the main diabetes centers is that well-controlled type 1 diabetics are not necessarily at any higher risk of getting the virus or faring any worse than the non-diabetic population. There is not enough data to realize for sure, but theoretically, if we keep our glucose under control, then the negative effects of diabetes on the immune system should be mitigated.

All that said, we must take precautions. The best way to not get sick is stay home. Wash your hands with soap and water or alcohol-based hand sanitizer frequently. Socially distance, keep at least six feet apart and as of recently, New York City is recommending when going out in public to wear a mask regardless of symptoms or not (that said, please do not hoard masks or use N95s as those are desperately needed for health care professionals).

At the first sign of any symptoms (cough, malaise, fatigue, fever, chills, diarrhea, nausea, vomiting, etc), call your doctor right away. If you should experience significant shortness of breath/difficulty breathing you should present to the emergency room.

Is there anything to have on hand that you would suggest for people living with diabetes? 

I would recommend having a 3-month supply of all your diabetes-related medications if possible (insulin, strips, pens, pump supplies, batteries, CGM supplies, back up glucometer, ketone strips, glucose tabs, glucagon, syringes, pen needles, alcohol swabs, etc) as well as plenty of food, Tylenol, thermometer, and drinks (both sugar and non-sugar beverages).

If possible, it’s always good to have hand soap/hand sanitizer, and a mask if you absolutely require to leave the house for any reason. I would also recommend having a good clear line of communication with your doctor and a family/member friend so people know to check in on you.

I can’t imagine how stressful this time has been for you, how have you been able to rest, take care of your family and your patients?

It’s been extremely troublesome but I feel deeply honored that I am able to aid in some small way. By having clear tasks in the hospital, it keeps my mind busy at the same time as I am there, but I would be lying if I said there haven’t been many tears shed from the emotional stress and horrifying scenes that unfold in front of us daily.

I worry constantly about my parents and loved ones but knowing they are listening to my advice about staying in, socially distancing, washing their hands, and being careful is reassuring. I wish you and your loved ones all the health and well being possible – please stay safe and healthy and let me know if I can ever be of help.

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Last week, on a 28hr call, I went to steal away for a nap in the early morning hours. Less than an hour later my diligent intern knocked on the call room door “mike I’m concerned about bed 2, his BP is getting soft.” Bed 2 happened to be a patient we were concerned may have COVID but with his test pending. I was still deep in a REM cycle when I got to the patient room. I looked at the vitals from the door. “Yup, those are soft all right.” As I sorted through the gowns and gloves and dug through the cart in search of an N95, the nurse asked me “what do you desire to do?” I mumbled something about pressors and realized I needed more data to sort out what was going on. My brain still foggy with the remnants of dismantled sleep, and as I was about to enter the room, I felt someone next to me. “Hey Mike I’ll come help you grab an ABG.” It was Jack, my co resident who was on his own 28hr shift in a different unit. “I’ll put money on it this guy has COVID,” he said as he threw on his flimsy yellow gown and dove into the room. No hesitation. Together we got our labs, assessed the patient and treated him as we would any other. BPs improved as did mental status the next day. ?? Jack and all of my coworkers are heroes. When I tell them this, they recoil. “Hero” doesn’t sit well with them. None of us asked for this. Many of us are fearful. And yet, they show up. every single day. The nurses, ER staff, techs, transporters, housekeeping staff, PTs/OTs, RTs, NPs, PAs,SLPs, EMS/EMTs, security guards, dietitians. EVERYONE. It is in these uncertain instances when fear can set in. But there is a difference between fear and panic. Fear mobilizes us and allows us to listen the call to arms. Panic paralyzes us and seeps into the air paralyzing others. I have fear. We all have fear. But we will not panic because we are all in this together and together we can and we will beat this.

A post shared by Mike Natter, MD (@mike.natter) on Mar 27, 2020 at 8:57am PDT

I follow you on Instagram and recently you said that there was a difference between fear and panic. And that you are fearful, but you will not panic because of the wonderful team you are working with. What do you want to say to them as it seems the comrade has really helped get you through this?

My co-workers (co-residents, nurses, attendings, janitors, RTs, NPs, literally everyone in the hospital) are the reason I have not broken down yet or fallen apart. To say “thank you” to them does not come close to the enormity of my gratitude I possess for them. They are my family and I feel a bond to them as we are stuck in this mud together, fighting for our patients but also each other. The depth of my gratitude to them knows no bounds.

I absolutely really like a lot the your artwork that you post on social media. I have seen your latest COVID-19 related illustrations. They are amazing. I would imagine art can be a powerful form of therapy. Is drawing your way of expressing your emotions? 

Yes. Art has always been my first really like a lot and is a natural outlet for me. It helped me learn in medical school. It has helped me teach my patients and my medical students as a resident. And it helped me cope in difficult times. I would recommend art for anyone and everyone, as its the process one takes when creating art and not necessarily the product that the benefit is derived from.

Self-care is so important, how has working on the front lines affected your mental and emotional health right now? What are you doing to make sure you take care of yourself?

I anticipate there will be emotional scars that I will bare from this for the rest of my life. As I said earlier, I think doing the work, while scary, is also cathartic as I feel a deep call to arms and I am honored to answer that call. My loved ones, my colleagues, and my art have also been a beacon in these dark times that have kept me sane. I also try to not watch too much news, as that can trigger a spiral of negative thoughts. I try to find peace and detach by watching other shows, spending time with my girlfriend, making art and keeping busy.

It is an respect to speak with you about these topics and I hope I can provide some solace and light in these difficult and dark times. Please be well!

Thanks so much for taking the time to talk to me, Dr. Natter! And from all of us here at Diabetes Daily, thank you for all you do!

Diabetes Daily

The End of Diabetes: The Eat to Live Plan to Prevent and Reverse Diabetes