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Living with Diabetes

Pushing boundaries with April Blackwell from NASA

8/5/2019 by Scott Johnson

Pushing boundaries with April Blackwell from NASA

Getting a diabetes diagnosis doesn’t mean you have to give up on your dreams. In fact, as this episode’s guest shows, we can be tough and pursue our dreams no matter what life throws our way!

April is a very inspiring person. She flies the International Space Station at Mission Control, and she’s also been living with type 1 diabetes since 6th grade.

How had she been able to get into so many exciting programs, even though so many military and NASA doctors don’t understand diabetes? What is it like flying a space station for NASA? What is the future of NASA and diabetes?

Find out in this week’s "Live, with Scott!"

In this episode, Scott and April talk about:

  • April’s unique and inspiring story

  • The history and future of NASA

  • The new opportunities for people living with diabetes

Resources:

Transcript

Scott Johnson: Have you ever felt like you can't find your footing or that you're floating around in space when it comes to your diabetes? Well, stay tuned because I have a special treat for you today. Oh, let me turn the gravity back on in here.

All right. What's up Monster Tamers. Welcome to another episode of Live with Scott. Thanks so much for tuning in. My name is Scott Johnson. I've been living with diabetes since I was five years old, and the diabetes social media space, that's you, by the way, has been an important part of my wellbeing for a long, long time. Thanks so much for helping me along.

As your host today, I am thrilled to connect you with my friend, April, who literally flies spaceships for a living. Now, while we get going, please share a quick hello in the comments. Let me know where you're watching from.

Today's episode is sponsored by mySugr. Head to your favorite app store to download the mySugr app. It's completely free and might be just what you need to get a leg up on your diabetes management routine. If you pair and synchronize with the supported Accu-Chek meter, like the Accu-Chek Guide or Guide Me, you'll automatically unlock all of the pro features, which is pretty sweet, pun totally intended.

Now, before we get going, I've got another fun bike training video to share. Somehow I've gotten myself talked into this huge 100-mile bike ride this fall for JDRF in Death Valley. Over the weekend, I caught up with my friend Sara to hear more about why she rides.

Sara: I was diagnosed with type 1 diabetes when I was 21 years old, and I was in college. My friends at the time were really on board with like, "Let's all do this together. So we're going to eat the same meals together. We're going to exercise together. We're just going to take on this whole challenge together." So that started a couple of days after I got out of the hospital, and we decided to go on a bike ride around the college. It started out fine, but I quickly realized that I wasn't prepared. I had been sick for a very long time, and so I had lost a lot of muscle tone. So it was hard to pedal the bike, and then blood sugar-wise, I just really didn't know how exercise affected my blood sugar.

I mean, this was the 16 years ago now, 16 and a half years ago, and I have not felt as bad as I felt on that ride to this day. So, to me, that meant, if you have diabetes, you can't ride a bike. So I sold my bike, stopped riding. Probably about four or five years ago, I started hearing about the JDRF Rides. It kind of piqued my curiosity just a little bit like, "Is that something I could do?" There were a couple of people from my chapter. I'm going to one that was drivable. So I drove out to it and saw all the people with diabetes doing it. So I actually left that ride, and before I get got home, went to a bike store and bought a bike.

So, for my 13th diaversary, my goal was to ride 13 miles. So, on my 13th diaversary, I rode 13 miles. I've done three JDRF rides since then. My biggest one was 76 miles in Tucson. It's exciting to see all the people out there with type 1 and knowing for myself that having type 1 doesn't stop you from doing anything that you want to do.

Scott Johnson: All right. So we have been on our bikes for a very long time today.

Sara: Very long time.

Scott Johnson: We rode the Santa Ana Trail out.

Sara: Yes. Santa Ana River Trail.

Scott Johnson: Santa Ana River Trail. We parked the cars at a park. We rode 18 miles to the beach, Huntington Beach, and then another five-ish mile over to meet Vanie, Sarah's mom and had a delicious lunch and-

Sara: In Balboa, just to give then perspective.

Scott Johnson: In Balboa. I was feeling ambitious, and I said, "You know what? I think I'm going to... I'd like that. I enjoyed that so much that I think I'm going to ride the whole trail back again."

Sara: We had a way of getting back without getting back on our bike.

Scott Johnson: We could've just gotten in the car-

Sara: Got in a car.

Scott Johnson: ... at lunch, but we made a decision to keep going to push. I'm proud of Sarah for jumping on my crazy bandwagon to come with. She didn't have to do that. So thank you for joining me-

Sara: No problem.

Scott Johnson: Pushing yourself, and let's go knock out the last part.

Sara: We can do it.

Scott Johnson: All right. You work for JDRF, which is awesome. You gave me some awesome socks today. Yeah. I love it. Thank you. There they are, which are cool. Tell me a little bit about the socks.

Sara: So we have a person in our chapter, who she used to coach our team, but her and her husband own a soccer company. So when we're looking for ways to fundraise for our team, it was a great fit. 100% of the proceeds go to fundraising for Nevada Chapter Team.

Scott Johnson: Very, very nice.

Sara: Yes. If you go to Gizmo, G-I-Z-M-O, gizmosocks.com, and then just type in JDRF.

Scott Johnson: We did do it, didn't we? First of all, thank you for getting me out on a ride today. We went the distance-

Sara: Double the length that we anticipated.

Scott Johnson: ... double the length. That's right. Advice for me as I train. Keep training for Scott's Death Ride.

Sara: Don't die.

Scott Johnson: Thank you.

Sara: Just-

Scott Johnson: Keep spinning.

Sarah: ... pedaling.

Scott Johnson: Thank you for a great ride today.

Sara: No problem.

Scott Johnson: Thanks for doing all you do at JDRF.

Sara: I want a cure just as bad as everyone else.

Scott Johnson: All right. Now, I'm going to be doing a lot more cycling over the next few months to get ready for this big ride in the fall. Let me know if you enjoyed that video, and I'll be sure to do more and include them in upcoming shows. So let me know what you'd like me to do there.

Now, for more on today's guest, April Blackwell is an aerospace engineer and lifelong astronaut hopeful who flies the International Space Station from NASA Mission Control. April has worked at NASA for six years but has been obsessed with space since kindergarten when she made up her mind to become an astronaut.

But a diagnosis of type 1 diabetes at the age of 11 seems like an insurmountable roadblock. It's an automatic disqualification on the astronaut application. But instead of giving up, she doubled down – learning Russian in high school, studying hard in math and receiving a full-ride scholarship to attain an aerospace engineering degree. In her aerospace career, April has flown more than 250 hours in experimental army aircraft and passed qualifications in the Army Special Operations Helicopter Dunker Program, Altitude Chamber and Parachute Course, all of which normally preclude participants with type 1 diabetes.

Since NASA flight controllers certification, she's acquired almost 2,000 console hours in mission control, where she's responsible for piloting the International Space Station. I know, no big deal, right? April hasn't given up on her ultimate dream of becoming an astronaut. But she has added an extra challenge to be the first person with type 1 diabetes in space. She's passionate about sharing her experiences on her blog called Nerdy April. I love that. To inspire fellow people with diabetes, to push boundaries in pursuit of their dreams. Let's dive right in.

Hi April. So good to connect with you. Thanks for joining.

April Blackwell: Thanks for having me. I'm really excited to talk to you today.

Scott Johnson: Me Too. Me Too. It's not every day I get to spend time with a story as interesting as yours. I was trying to figure out, how do I convey my excitement without spoiling the story, right? So maybe the observant folks in the audience will notice all the cool space stuff you have in the background. But for those who may not know much about you or want to learn a little bit more, can we start off by just telling folks a little bit about yourself?

April Blackwell: Sure. So, as you said, my name is April. My job right now is very, in technical terms, the attitude, determination, and control officer for the International Space Station. But in a little bit more relevant terms, it means I get to fly the ISS from mission control. So it's definitely a dream come true for me. I've been interested in space since about five years old. I decided I wanted to be an astronaut, I think like many five-year-olds. I guess the difference for me is it just stuck around. I just couldn't get it out of my head. I ate all the books in the library related to space, and I remember asking the librarian to order more books because we didn't have the internet back then, maybe showing my age here. So that bug just kept with me.

I was diagnosed with type 1 diabetes in, sixth grade, so I was 11, and kind of doing some research, found out that type 1 diabetes is an automatic disqualification on the astronaut application. Of course, to be an astronaut, you have to be in peak physical health among tons of other things. So it was a little bit of a bump in the road for me, I guess. I started thinking about, maybe is there's something else that would be interesting to me? I just couldn't think of something else that was so interesting. So I decided to keep at it, and even if I couldn't be an astronaut, getting to work with rockets, getting to talk with astronauts and design repulsion systems, like I'm doing now. I get to fly, just from mission control.

These are all things that would be absolutely satisfying to me even if I could never be an astronaut. So went through high school and went to college, got an aerospace engineering degree, ended up working for the army for about three and a half years. The time I was getting out of college was a little bit of a downturn in the aerospace industry as the space shuttle was retiring. So it was a little uncertain. So I worked for the army, which actually turned out to be a blessing in disguise. I was a little nervous at first, but I ended up being able to fly on experimental army helicopters and boss pilots around and tell them what to do. I got a lot of unique experiences and kind of meshed them with type 1 diabetes to sort of break down some barriers in that job.

Then I finally applied for and got this dream job of working in mission control, which sounds, I don't know, like a big deal. It is a big deal to me.

Scott Johnson: Big deal. Yes.

April Blackwell: But it wasn't about another two years of I would call like master's level learning. So I feel like I essentially have a master's degree in flying the space station. But it took about two years to become certified, and now I get to work all sorts of dynamic operations. So, just this week, I got to undock the astronauts that came home on Monday, which means I control the mothership, as I like to call her, getting her in position so that the astronauts can safely undock. But I get to do that stuff. I get to capture the Cargo Dragon vehicle if anyone's heard of SpaceX. We have lots of cargo vehicles coming up nowadays, and pretty soon we're going to have new American crewed vehicles coming up, which we're all really excited for. I get to do all of this. I get to fly the mother ship while all of these things are happening. So it's really exciting.

Scott Johnson: It's so amazing. I think that there's so much that I appreciated about you and your journey that you share on your blog, and we'll put your blog address and everything on the screen for viewers. But I think your approach to this dream of yours, so you mentioned learning that type 1 diabetes or diabetes is a barrier to becoming an astronaut. I love how you called it a speed bump, right? Just a bump in the road. You remember, you couldn't have been that old when you realized this. I think the maturity level, to say, "Okay. Well, this is a barrier and obstacle, but there are things I can do to either kind of work around this or push barriers and break down barriers."

So let's spend a little time talking about that, maybe. Do you remember when you first learned that that was something that was to supposedly prevent you from being an astronaut, and was it just an immediate, well, okay, like I see this rule, and let's dive into this rule and figure out why?

April Blackwell: I would say I definitely had a period of mourning, I guess I could say, where I just thought I had totally lost it, and this just wasn't going to be a reality for me anymore. It was a little heartbreaking. But that's kind of when I just decided that even working adjacent to astronauts would be just as exciting. Then in high school, kind of where the high school timeframe, sort of preparing for college and stuff, just researching what was going on in the aerospace industry, there was so much going on, and especially with private companies taking astronauts to space, or at least suborbital flights, like Virgin Galactic and other companies that are coming up. It sort of opens up this new space for people like us, people that maybe aren't perfect because I guarantee you all the people that are paying to go on these space journeys are not perfect, imperfect.

So I think there's opening up a space for people like us. That combined with the increase in diabetes technology and individual diabetes monitoring and certification and medical clearances like that and taking a more individualized approach, instead of just these blanket, no, you can't fly in space because you have diabetes. Well, let's look at how my diabetes is actually managed and what my numbers are and how I can react to curveballs diabetes throws at me, which the diabetes technology has absolutely blown open that sphere. So I think just getting back to your question, I guess, sorry, I'm off on-

Scott Johnson: No worries. I love tangents. Trust me, your brain, you know all this stuff better than I do. So I will follow your lead. You will take me wherever you want to go.

April Blackwell: I would just tell that if your heart is really stuck on something, you may not be able to get that exact dream that you had in mind. But I'm also I guess maybe a little open-minded on this that I sort of take, everything happens for a reason and that I got diabetes for a reason, and working for the army felt weird at first, but it turned into this amazing opportunity. So that absolutely happened for a reason and just seeing this kind of roadblocks or speed bumps as opportunities to dig a little deeper into yourself as a person and just realize that full potential that you have.

Scott Johnson: As I hear you talk about navigating that course, there are a lot of parallels, right? So, when I wake up in the morning, my dream of a perfect diabetes day is my dream, and then I bump into all kinds of obstacles and things that I need to course correct for along the way, some of which you can look back 20/20 hindsight and say, "Okay, I wish I would have done something different." But there are an awful lot of things that we just don't understand about diabetes yet, and there's no good reason for it, but yet we have to kind of react and stay on course as best we can. Do you think that your practice of navigating and living with diabetes helped you kind of navigate that decision or that obstacle as well?

April Blackwell: Absolutely. 100%. There's parallels even if you take it a step further to my job today. It sounds very routine taking astronauts up to the space station. But I guarantee you it is not. We have so many little hiccups and snags and just challenges we have to work through. One challenge maybe people don't really realize is that ISS has actually been flying for 20 years. So it's been flying as long as I've had diabetes. So if you think about, there's 20-year-old hardware on ISS, and it's challenging to work with sometimes. It's degrading, it's getting old, and we have to find new ways to do new operations with very old hardware.

So one thing that sort of teaches you is to be adaptable and flexible, and you're never... We do a lot of simulations and practice on malfunctions that could happen on board. That's part of our certification. But on the real day, when a malfunction happens, it's not going to be something that you've seen in a simulation because that's just how it works. Diabetes is just the same way. You could have this perfect plan laid out. You could be completely ready for, as we like to call it, two failures deep. You can have your backup supplies and everything, and some curveball is going to come. It could be a curveball that you locked your keys in your car or something like that, and now you can't get to your supplies.

Recently, I was put on a medication that just really affected by numbers out of nowhere. I mean, it can be just there's such a breadth of different things that can affect diabetes, and none of it can necessarily be planned for all the time. So I think the parallels to my job today are just... I mean, they are on point, and diabetes has definitely played a part in me being adaptable and flexible and just thinking outside the box that how am I going to solve this problem? Because there is a solution or work around this, we like to call it, and you just have to be creative. So I think diabetics are adaptable, flexible, and creative.

Scott Johnson: Absolutely. I would agree with you 100%. In fact, I think that almost gives you a leg up on those around you who don't have that practice and mindset of dealing with diabetes. So I very much agree with you. It's marvelous to think about the age of the space station and another... So I'd like to kind of... There are two tracks I want to follow here, right? So, this July, you shared with me is the 50th anniversary of the first moon landing, right?

April Blackwell: Correct. Yeah. Yeah. We've got... Back here.

Scott Johnson: Amazing. I love it. So that's a big deal coming up. That's amazing. But I love that the space station has been flying as long as you've had diabetes. You mentioned the technology changing and the practices changing and having to adapt to some of that stuff. Let's kind of dive into that topic a little bit, right? So what have you seen in the diabetes space and in your 20 years, and how do you see the parallels in the space field over that time too? I mean, well, if we look at even just 20 years, much less 50 years, holy cow, right?

April Blackwell: Yeah. Yeah. So I was thinking about this topic a little bit, and there's actually a really concrete example. Maybe this will help people even connect a little bit to space if you don't know much about space. But in the Apollo era, if you've seen maybe the movie Apollo 13 and the Mission Controllers there, in the Apollo era, the astronauts were really trained on how to control their spaceship. It was really a test flight of these spacecraft. So they really knew every switch inside the capsule and all the procedures and exactly how to move the hand controllers and fly down to the surface of the moon and dock and rendezvous and all that stuff. Mission control sort of just acted as this sanity double-check.

They were getting the data down, but they really couldn't influence anything onboard the spacecraft. If you look at diabetes, even 20 years ago when I was diagnosed, it's very similar. Your endocrinologist or diabetes educators sort of says, "This is how you take care of yourself, and now you go and do it, and we'll be here if you need to call us or fax us your logs back in the day. We'll take a sanity check on it, but really it's you at the controls." Today how we fly the space station is we really try to have the astronauts focus on science. That's the main purpose of ISS. It's an orbiting laboratory.

So all of the systems type stuff, the life support and my job, making sure the attitude is correct and flying and power generation and all that stuff is taken care of almost completely by the ground. We send commands up to the vehicle, and we maneuver it to the different positions that needs to be at and all this stuff. I think diabetes is kind of shifting to that mindset too. We have all these apps on our phones, and we can share our data in real-time basically with our endocrinologists or family or friends that are kind of helping watch over us.

Maybe they can't quite send a command to our pumps yet or influence us quite like that. But some of these new technologies, like the looping and I think some more of these artificial pancreas-type projects are kind of moving in that direction, where they're taking the burden of the physics of the disease, the commanding and counting carbs and all of this stuff. They're taking it off the patient and putting it into some technology. Of course, it's just a really concrete example of how the technology itself has transitioned. We use it in both spheres. We use it medically and in space, so...

Scott Johnson: Yeah, I love that example. I think it's perfect because I... so I'm one of these people who... I'm generally an early adapter when it comes to... an early adopter when it comes to technology and even medicines, things like this. So I have been looping for a while, and-

April Blackwell: Oh, cool.

Scott Johnson: ... I think that it's like I'm outsourcing this piece of my diabetes to somewhere else, a device, a set of devices that kind of frees my brain up and my resources up to do other things, as you described, as the astronauts are able to do their science work instead of having to pause very important experiments in order to correct the attitude of a spaceship. I think that's amazing. That's amazing. Can you talk a little bit about where NASA is headed in the next number of decades? Then let's dream a little bit about where diabetes is headed in the next decades.

April Blackwell: Sure. So NASA's objective has sort of been evolving over the last few years, and unfortunately, sometimes it's connected to politics, as we all know. But right now, we just sort of had this goal set forth to go back to the moon by 2024. So we're calling it Boots on the Moon 2024, which is only five years away. In space flight, that's really fast. So we are definitely working towards that goal and trying to figure out how we can leverage the information and lessons learned that we have from the space station and transfer that to whatever sort of new vehicles or space station in lunar orbit that we're trying to come up with and make it as safe as possible for the new astronauts going that way.

Longer-term, of course, we're looking at Mars, and this is human space flight-related, but also expanding our presence in the solar system via robots and satellites. Then, of course, in sort of the commercial sphere, you have all of these hopefully passengers going to space soon and a lot more astronauts getting their wings because of this whole opening that they have going on. So diabetes, where's diabetes going? Oh my gosh. I think it's really cool that a lot of patients and groups are getting together and kind of, I don't want to say leapfrogging the FDA or leapfrogging some of the paperwork, but just kind of putting into place their own systems and algorithms and thinking about, what can we do now to make life with diabetes easier, better, more fulfilling?

So that's really, really encouraging. I think that will only continue to pick up steam. As far as me, I mean, I'm still looking for that cure. 20 years ago, it was five or 10 years away, and I still kind of have that little tug in my heart that there's a cure out there, or there's some sort of test or vaccine at birth, so at least new kids won't get it and us old diabetes will just become sort of a relic of a word. That's totally fine with me. So my ultimate hope is still a cure. I think we can do a lot with technology, but there's still going to be interaction with the patient and the technology, or there's going to be side effects, or there's going to be things we haven't thought about. It's still going to, in some way or another, affect that person's life. When you compare that to a cure, it's still a good bit of work even with a lot of technology.

Scott Johnson: Yeah, I agree. I agree with you 100%. I was talking at some meetings the other day about how far we've come, but how much room there is left for improvement. One of the lines that I use over and over again is like, "Why is it okay that I'm still stabbing myself with sharp metal objects and bleeding on things?" We think that's normal, and it's not normal. I'm not okay with that. But let's push further so that we don't have to do these barbaric things that we just think as okay. I love the fact that I... So I wear a Dexcom, and I love that I have that amount of data. But at the end of the day, I'm still wearing a wire in my body, and that's weird.

Also, if I think about the way a nondiabetic body works, it's measuring and adjusting blood sugar all the time, continuously through the day, which is way more often than every five minutes with CGMs, right?

April Blackwell: Yeah.

Scott Johnson: So there's tons of room for improvement. I agree with you 100% that we need to keep pushing both in the technology, the medications, and let's outright find a way to just get rid of diabetes altogether. But I also love the part that you talked about, where there are going to be things that we just haven't thought about yet. It's very much like peeling away layers of an onion, where you solve one mystery to uncover more mysteries. That's I think hard for us as patients and people living with diabetes to appreciate and understand because we want it yesterday.

April Blackwell: Yeah. I was actually talking to my husband about sort of the workload aspect of diabetes and how it's changed over the years. A cursory glance, you would think, "Oh my gosh. We have all this technology. It's way less workload." But I don't think that's necessarily true. Back when I was first diagnosed, I would test my blood sugar three times a day, and that would take two shots, and that's it. Now, I have all this data, but now, I'm like, "It's buzzing in my pocket. I got to look at it. I have to make a correction, or I need to set this temporary basal because I'm about to work out or whatever." So probably, my numbers have been a lot better, and my control has been a lot better, which is not a bad thing. But I would say the workload maybe is even higher than back when it was just three times a day for testing your blood sugar in two shots, so.

Scott Johnson: Yeah, I agree. I agree. There's always some price to pay, and we're definitely, I think, in some ways thinking less about diabetes, but in other ways thinking much, much more about it. The onus of managing all that data and making sense of it is it very much falls on our shoulders alone. I think that's something that a lot of companies and organizations are working hard to change because I'm an advocate for, let's build in a bunch of layers of abstraction in between those numbers. It's not a normal, natural human thing for me to sit down in front of a plate of food and have to think about numbers, right?

April Blackwell: Right.

Scott Johnson: Let's distance ourselves from that as much as we can with the use of tools and technologies and medicines. I am a fan of that. It's interesting, one of the other things that you mentioned, in preparation for our meeting is, do you think that all of this data and visibility has helped kind of break down some of the barriers that existed in the past with regulating organizations that you deal with?

April Blackwell: Absolutely. Yes. I found that to be true in my own sort of roadblocks that I've worked through. When I first started working for the army, I needed to get an FAA, Federal Aviation Administration medical clearance. Class three was the only one that was allowed for type 1 diabetics at the time, which thankfully was all I needed. So that worked out. But I just had no idea going into it how much work it was going to be to get that first certification. I started working at my job in January, and it took until June or July before I had that first clearance. I had been, what was that, I'd been diagnosed maybe 12 or 13 years, and I had recently moved across the country, so I had always gone to the same endocrinologist previously.

So I sent in the paperwork I thought they would require, and then, as all of these government organizations, it sort of goes into this black box, and then all you can do is call this one number, and they'll tell you the status of your application. But you don't get a lot of feedback until you get a letter in the mail that says, "You haven't provided us enough information." But it was all just really frustratingly vague on exactly what they wanted. So, after about three or four rounds like that, I just asked the children's hospital that I had gone to my whole diabetes diagnosis for all of the paperwork, which probably was a stack about that big. Back in the day, it was all paper. It wasn't digital. So my parents went and picked it up and mailed it to me, and I literally made a copy of all of those pages and sent that into Washington, DC to the FAA.

Finally, I got a letter back. All this paperwork, all this work, and it's just that you're accepted. I was like, "Ah." It was like this mountain of a climb. It just kind of blew my mind that I had to go through this much paperwork with... When I had, I would say pretty reasonable control, and I had never had any episodes that I needed help with, even when I was diagnosed, I wasn't in a coma or anything like that, so it kind of shocked me that it required this much paperwork. Sort of talking to the flight doctor who didn't know a lot about type 1 diabetic pilots, I think it's just sort of you hear diabetes, and back in the day, there wasn't all this technology to monitor, and control was probably worse, and I think people were just scared of that. So they sort of had this blanket disqualification for type 1 diabetics.

So even since I applied for that medical license, the FAA and other airline associations around the world have actually made some pretty good progress on allowing type 1 diabetic pilots in the class too and one category, which means they could actually fly a commercial plane if they're accepted, which hasn't been okay for the last 60 years or whatever that the FAA has been around. So that's a pretty exciting advancement. Even when I went to NASA, I think I mentioned to you, my philosophy is sort of about medical transparency, and I've never tried to hide the fact that I'm a type 1 diabetic. I may not be shouting it from the rooftops, but in these kinds of jobs that require medical certification, I mean, if you think about it, it makes sense. I'm sitting at a console in the middle of the night, and I'm the only person that knows about my system and can potentially affect six people's lives on board.

So I don't think a medical requirement is a bad thing. But I think just individualizing it and just looking at the numbers for what they are and having a conversation about that instead of just being scared and just saying absolutely not. So I've been really thankful. My doctors at NASA have been wonderful to work with. The NASA certification is kind of more along the lines of an air traffic controller certification, for their medical, but it's pretty involved. I mean, you get an EKG and your eyes and your ears and a physical and a blood draw and all that fun stuff. So it's not trivial by any means, but they have been awesome to work with.

They work in concert with my endocrinologist and my ophthalmologist to make sure everything is looking okay, and I've never had a problem getting my waiver passed, which I have to have a waiver since I do have this condition, but it's never been a problem. So I think medical transparency in jobs like this is important, but that kind of scares some people. But you just have to have that conversation, be ready to sort of defend yourself, which on another tangent, I was thinking about that and just having to defend yourself and sort of stand up for yourself. It's interesting because we have these foundations of flight operations that we use as mission controllers to sort of guide the characteristics we need to be good mission controllers. All of the characteristics are things that diabetics have just innately because we have to.

So one of them is toughness. I recently wrote about this on my blog, about standing up for yourself, defending yourself, take the hard work in taking care of yourself and keeping your numbers in line with what a normal person's blood sugar would be to prove that you're dedicated to keeping yourself healthy, all of that is toughness, and diabetes forces us to be tough. So I think all of us can be rocket scientists. We all have all these qualities ready to go, and we can do anything, so.

Scott Johnson: Exactly. I love that blog post, by the way.

So I know you have so much free time. But the more you write about it, the more I enjoy it. But I think also being transparent and open and also at the same time showing the qualities, these innate kind of built-in qualities that we have to develop to live well with diabetes that matched the foundations that you work with, all of those tie together to help evolve the knowledge within those regulating organizations. That's a great thing for not only you, but for those people with diabetes coming after you. So your mission is big in helping you live your dream, but it's also laying some important groundwork for the future, which I think is really great.

April Blackwell: Yeah. I would definitely add that there's beauty in community. I know I felt a little bit alone when I first started my blog in trying to overcome some of these obstacles. Since I've started my job here at NASA, we actually have sort of an informal type 1 diabetics club that meets. We all have stories about overcoming these obstacles in our jobs here at NASA. One guy I work with, he is man, he does everything. He's on the volunteer fire department here and the search and rescue, basically the people that go and pick up the astronauts out of the ocean. So he's been working with the navy and search and rescue forces and all that stuff. He's been on navy vessels and had to get the medical clearance to be on a navy vessel with type 1 diabetes performing these pretty high stress, lots of moving parts missions. He's totally done it with flying colors, and he's been transparent about as his medical history. I mean, this guy is just awesome. He's really a cool guy. Another girl-

Scott Johnson: Can I ask you a question because that sounds an awful lot like... So I'm involved with children with diabetes, the organization. Once a year I'll go down and spend a week helping facilitate stuff. There's a cool guy there. Ernie Prado... 

April Blackwell: Oh, yeah. Ernie is another one that's in our little type 1 diabetes club. Yeah.

Scott Johnson: Yeah. They all just sound amazing to me. So I imagined you would've known, but yeah. Cool.

April Blackwell: Yeah. He used to work in facilities, so he got to play with all the mock-ups and stuff like that. Now he works out with the aircraft side of things. So I think he works on the T-38, the astronauts flying in, and the WB and the big GFI that we carry big equipment in. But yeah, he's done tons. It's actually kind of fun. We had lunch just the other day, and he has an intern with him this summer, and she has type 1 diabetes.

Scott Johnson: Amazing.

April Blackwell: So we just got her through all the medical certification process to go scuba diving in the neutral buoyancy laboratory, which is the huge pool the astronauts get to practice space spacewalks in. So we all sort of just rally behind each other, and we give each other tips on, "Well, mine, the doctor said this, and this is how it worked to get my waiver through." There's definitely beauty in community, so.

Scott Johnson: Yeah, absolutely. Also just knowing that you're not alone in the things that you struggle with. I think that there's another great parallel there. That's amazing. I love that. When it comes to your day to day or night to night or whatever shift you're on, can you talk a little bit about how some of the demands of your duties impact your diabetes and how you have to work around that a bit?

April Blackwell: Sure. So I definitely think the hardest shift is overnight. So we do have a shift that goes from 11:30 PM until 8:30 AM. We usually do those in about seven day or night stretches just because once you sleep shift into that shift, it's good to stay on a little bit instead of going back and forth. The weirdest thing for me is I have a few more obstacles, challenges in my life. They're called kids. So working around trying to figure out a good time to sleep. So I usually get home, and they go off to daycare, and that's when I try to sleep during the day. Then I wake up to go get them, and we have dinner and all that stuff, get to put them to bed, and then I go to work.

But it makes for a weird eating situation. I guess I never thought about that before. I was on shift work. But I really ended up only having about two meals a day while I'm on the night shifts. So I'll have dinner with my family, and then I'll usually have a meal, some kind of snack or something in the middle of my shift to kind of keep me awake because I'm hungry and stuff like that. But then when I get home, I don't really want to have a big breakfast or anything right before I try to go to sleep. So that part is a little bit weird, figuring out the meal timing. I can't really think of how I would do that if I was back on just my NPH shots back in the day. So the insulin pump is definitely a lifesaver for skipping meals or weird meal times, which I definitely find happens when I work the night shift.

As far as the job itself, usually, when I'm on console, I like to run my numbers just a little bit higher. So instead of setting my target 80 or 100, I'll set it more like 120. That's just because I've found that when something happens or I start getting a little adrenaline rush, my numbers just tank, and then it sounds like I'm nervous, and I probably am a little bit nervous, but I'm also low and shaky, so it just exacerbates the problem.

Scott Johnson: I'm sure that you don't know... When something is happening, you're not quite sure how long it's going to take to resolve that issue before you can again turn your attention back on... I mean, there's always, of course, a little bit of managing and having attention on your diabetes, but it totally makes sense to me to run your target a little bit higher. It's much like someone doing a workout, and they want to complete their workout or perform in that athletic event, and you are performing in your athletic event of keeping everything where it's supposed to be.

April Blackwell: Yeah. I've talked to some pilots with type 1 diabetes, and it sounds like that's similar to what they try to shoot for as well. Let's see what else/ I do like to keep my... I have the Dexcom app on my phone, so I keep that going, and it goes to my watch. So that'll alert me, and I try to just keep tabs on that periodically. We kind of have this sort of muscle memory when we're on console that we're constantly scanning our system, and your eye just notices things that are out of family. So mine just has one extra little telemetry line, which I think is usually pretty manageable. So that part is really helpful. It's also helpful as women when you're dressed up, as we do on mission control consoles, where you dress up business professional, so that usually means a dress.

So it's nice having something that I can actually take a look at without having to find wherever it is. So that's also really helpful in pockets. Pockets and dresses are so important ladies out there. You know what I mean.

Scott Johnson: Yeah. That's great. I think it's great examples of finding practical ways to fit diabetes into and around the responsibilities that you have in life. So I think that's wonderful. Another thing that I think you're a great example of is not focusing on the barriers. I know we've talked about this a bit already, but I love your approach to it. As we kind of wind down, I think it's a great way to do that. So not focusing on the barriers, but just kind of working harder to get where you need to be, figuring out what you need to do, problem-solving, and just making it all work. I think that's amazing.

April Blackwell: Yeah. Yeah. So breaking down barriers is something that I've been doing the last 20 years. But I think it's really important to... I don't want to give the impression that I'm a rule-breaker because if you ask my husband, I am definitely the opposite. I am a diehard rule-follower. But what I am is a rule-questioner, and why rules are there, why regulations right there, and not being afraid to ask those questions and keep asking because you probably won't get an answer on your first try. Sometimes the rules make sense. As much as we don't like to admit that, sometimes they do make sense. But sometimes you can use your resources. That's another thing we talk about in mission control, use the data you have, use the history you have on the disease.

Even sometimes references can be a good tool in your toolbox to prove that you can manage this disease in X, Y, Z environment or whatever regulation you're trying to overcome. I know one thing, around the time I was getting married, we were thinking about doing our honeymoon somewhere where we wanted to go scuba diving. My husband has been scuba diving his whole life, I think. But diabetes and scuba diving, there's some people who are nervous about that, some dive instructors. So we ended up finding one that she was really cool about it. My husband obviously knows how to take care of me and knows my diabetes signs and symptoms. We came up with our own underwater diabetes sign and stuff like that. So I think being flexible, back to that adaptability, flexibility, creativity, and be a rule-questioner.

Scott Johnson: I love that. I think that's great. Necessary, as our technology evolves, as our knowledge around diabetes evolves along with the rest of the medical field, their knowledge is continually evolving. So the rules and regulations should have some space to evolve along those lines too. Or at least, as you say, take a look at these rules and find out why. Is the reason still applicable now as it was the same whenever that rule was invented or came up with? So I think that's really important and-

April Blackwell: Yeah. I mean, not only do we have to be patients, but sometimes we have to be educators. I know, even my NASA doctors, they don't see diabetes that often. So I'm just thrilled to be able to show them, "Here's my insulin pump, and it gives me insulin, and it also shows me my Dexcom graph, and I get this update every five minutes, and it buzzes in my pocket when it's out of range, and I can set the range to different places. So I can really narrow in on what control I want to have and just all of these things." Sometimes educating even doctors, who may not always work with diabetes patients, can just sort of open their mind up too that these possibilities exist and this medical equipment exists, and maybe this isn't as scary to me as this regulation makes it out to be.

Scott Johnson: Yeah. Yeah. I think that's super important, and thank you for putting in all the work that you do to move that forward. Thank you as well for sharing so much of your story on your blog and social media channels. I personally really enjoy that. So-

April Blackwell: Thank you.

Scott Johnson: ... thank you for that. Is there anything that we haven't talked about that comes to mind that you want to spend a little time on or cover in a little more detail?

April Blackwell: Man, I don't know. I just think if I had this underlying theme obviously, it's just be tough. We're all standing behind you, and some of us are trying to move stuff out of your way so that you can do whatever you want to do when you get there. It's not just me. There are tons of people out there doing these grassroots sort of advocacy, and I think all of them, for the place they got us to before I kind of hit my stride in this arena. I think we have a ways to go, but man, we're awesome. We're the diabetes community. We can do anything. So don't let anything stop you from your dream.

Scott Johnson: I love that. Another, I think, important reminder that we're all standing on the shoulders of the giants who come before us, and we're likewise boosting those who come after that. So-

April Blackwell: That's a great space pun.

Scott Johnson: I totally intended that. I knew it. Yeah.

April Blackwell: Launch your dreams.

Scott Johnson: Well, April, thank you so much for sharing some time with us today. I have really enjoyed it. Let's do this again before too long, maybe a big anniversary party or when you reach another milestone in your career or goals or whatever. Let's get on and talk about it again. I would love that.

April Blackwell: That sounds awesome. I would love doing that.

Scott Johnson: All right, great. Thanks so much.

April Blackwell: Thank you.

Scott Johnson: All right, there you have it. What did you think about that chat with April? Inspiring, right? Once again, today's episode is sponsored by mySugr. Head to your favorite app store to download the mySugr app for free. If you pair it and synchronize with a supported Accu-Chek meter, like the Accu-Chek Guide or Guide Me, you'll automatically unlock all of the mySugr pro features, which will totally step your game up. Then be sure to tune in next week where I'll connect with Alondra to talk about her work advocating for people of color in the diabetes space.

All right. Thank you so much for joining today. I really appreciate it. If you haven't already, please give us a "Like," share this video with any of your friends who might find it interesting or inspiring, and have another amazing day. I'll see you next week.

Scott Johnson

Almost famous for his addiction to Diet Coke, Scott has lived well with diabetes for almost forty years and is currently the Patient Engagement Manager, USA for mySugr. He's been an active pioneer in the diabetes social media space for more than fifteen years and manages his award-winning blog, scottsdiabetes.com when time allows.

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