In Conversation: Dr. Michael Natter & World Diabetes Day

Welcome to The Sidebar, Dr. Mike! Could you tell us a bit about yourself?

Hi and thank you for inviting me! I’m Michael Natter, a current Endocrinology Fellow in New York City. I identify as an artist, patient, humanist, and doctor. I was born and raised in NYC, which shaped much of who I am today. Growing up, I was an “art kid” who spent most of my free time drawing and painting. I never considered myself much of a math or science person, nor did I excel in those fields.

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But then something happened to me when I turned 9 years old that changed the trajectory of my life: I was diagnosed with Type 1 diabetes. This meant I would inherit the full time job of being my very own pancreas, while also trying to navigate childhood and beyond. Yet, what this heavy burden of a diagnosis also did for me, was open a magical window into medical physiology that led me to my calling in life: helping others through the art of healing.

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I studied art in undergrad, completed a post-baccalaureate pre-medical program in NYC, and then enrolled in medical school at Jefferson Medical College in Philadelphia. I graduated with my MD degree in 2017, completed my Internal Medicine Residency in 2020 at a major academic hospital in NYC, and then stayed on to do my Endocrinology Fellowship, which I will complete in June 2022.

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Throughout these long years of medical training, I have been using my artistic background to guide me — drawing my medical school notes into digestible visuals that helped me learn but then also illustrating difficult-to-understand medical topics for my peers (and my patients) to learn from as well. I believe it is my background as an artist and a Type 1 diabetic that informs my therapeutic bond with my patients and my art of practicing medicine.

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How does living with Type 1 Diabetes influence your day-to-day life? Similarly, how has diabetes impacted you during your medical training and/or your career as an Endocrinologist?

Type 1 Diabetes is a full-time job that does not take any days off. It can be mentally, physically, and emotionally draining. That said, as anyone living with a chronic condition knows, you do your best to adapt and attenuate, to where it hopefully becomes an unconscious part of your day. It was once described to me as an annoying pet that is in need of being fed, walked, and groomed and at times will act up for no clear reason, keeping you from sleep or other more pressing activities.

The advent of diabetes technology has grown exponentially since my childhood diagnosis. This has made management less burdensome. For example, the continuous glucose monitoring (CGM) technology that exists now not only means I no longer have to prick my finger to test my blood glucose, but it also allows insight into the trajectory of my blood glucose in real time. I equate the older fingerstick glucose management to flying an airplane with a blindfold on, knowing approximate altitude but with no idea if you are heading up or down and at what velocity. CGMs remove that blindfold.

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The CGM technology is truly a revolutionary technology, as before this, I had pricked my finger approximately 56,940 times over the course of 26 years.

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On the professional side of things, medical training is difficult for everyone but it can be especially complicated for those of us dealing with Type 1. This meant I needed to take extra care to plan ahead, keeping extra supplies, snacks, batteries, and backups on me at all times. Glucose tabs in my white coat pocket. Insulin pens in my backpack. You name it.

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But as mentioned above, the aid of new diabetes technologies like the CGM and insulin pumps was a massive help. There are always factors that are out of our control, of course, like stress and cortisol spikes which can be quite common during a 24-hour shift or during medical emergencies in the hospital (or maybe even a global pandemic?!), but you do the best you can. What has also always been poignant for me is that my diabetes keeps me anchored to the patient’s perspective and experience. It keeps me grounded.

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What’s a piece of advice you would give to someone who has recently been diagnosed with diabetes?

You are not alone. Yes, Type 1 diabetes can be frustrating and difficult but it can — and will — get better. Also, the Type 1 community is robust, warm, and supportive.

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As a physician, what have you found to be effective ways to empower people to self-manage their chronic illnesses?

As a physician, I believe it is imperative to come from a place of understanding and empathy, first and foremost. This does not mean you have to share your own personal chronic condition with a patient, as I do; any health care professional can practice empathic, patient-centered medicine. You just need to listen. This includes meeting the patient halfway and recognizing that an individual approach is key. It can often feel like you are going to “get your report card from grade school” when going to the endocrinologist for your hbA1c, and it should not feel that way.

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A team approach with a shared end goal is everything.

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What is your experience with utilizing digital healthcare as a tool for managing chronic illness, and how do you foresee it being further implemented in the US healthcare system?

Due to the pandemic, most of our outpatient endocrinology visits were conducted virtually by both phone and video encounters. This pivot exposed some key learnings. For example, for certain follow-up visits or quick lab result appointments, a virtual visit can be more efficient and accessible for both parties, which can help overcome certain barriers.

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I would note, however, that I do not believe that telemedicine alone can fully replace the traditional doctor’s office visit — but rather, used as a supplement or additional option. A big reason why I went into medicine is because of the human connection, and there are so many subtle interactions that take place in a face-to-face visit that I believe are vital in medicine. There will never be a true substitute for that.

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What’s one thing you wish more people knew about diabetes?

Given that the overwhelming majority of diabetes in the world is predominantly Type 2, Type 1 often gets lumped in as if they were one in the same. Each of these conditions are unique and deserve recognition as such. It also worries me that some may falsely believe that having Type 1 diabetes can “limit” you. I hope to dispel that myth.

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Thanks so much for speaking with The Sidebar, Mike!

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Michael Natter, MD, is an artist, a humanist, and a doctor. He is a board certified Internal Medicine physician and current Endocrinology Fellow at a NYC academic hospital. He uses his background in studio art to illustrate complex medical topics by bringing them to life through his drawings. His work has been featured in the Annals of Internal Medicine, Medscape, Buzzfeed, and the Philadelphia Inquirer Newspaper. You can find more about his art and adventures in medicine on Instagram and Twitter.

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