Plan B Book

I have two sides to my personality, one that likes to fly free, moving on every whim of desire and taking every opportunity as soon as it presents itself, and the other, which is my practical side. It’s my practical side that likes to prepare and research and plan for every possible obstacle.

Single-handed sailing through the Florida Keys this February will provide a place for both sides of my personality to work together as one unit. While at sea all alone, I will be free to change course, to get a closer look at an island that catches my eye, to slow down and follow a manatee eating lunch, to find the craziest, out-of-the-way dive bar to grab some hot food and recharge my batteries (both my actual batteries- cell phone, laptop, GPS, and my more figurative batteries-, a friendly face, stable ground, and a warm meal). But because of my diabetes, I will need to do a great deal of behind the scenes planning and preparation before I ever set foot on that boat.

One of my latest preparations is writing my own emergency manual, my Plan B Book. For the non-diabetic world this might consist of a first aid manual and the number of the Coast Guard.

For me, it is a thirty page book organized from the most extreme emergency to the least. If I need major medical care (short of a call to the Coast Guard to bring in the helicopters and rescue divers), I will need to get myself to a hospital, which is easier said than done. If I were on a typical road trip, I wouldn’t even bother to find the names of any hospitals along the way. The amazing 911 system takes the hard work out of it. Simply call, tell them where you are and in a few minutes you’re safe.

On a boat, it is a whole new game. You can’t exactly pull the boat up into the hospital parking lot and jump out to find a nice orderly waiting with a wheelchair. Thus, my creation of the Plan B Book. The first pages are for every hospital and emergency medical center in the Florida Keys. Each page includes a map of the hospital and at least three docks nearby.

For each dock, I need the longitude and latitude, address to give to the ambulance driver, the phone number of the dock master so he knows why I am crashing at his dock, and in case I can’t contact an ambulance, the path I would walk to get to the hospital.

After that, follows the plans for the mishaps. The “I forgot to pack my Symlin,” or the “Oh crap. I just dumped all of my test strips into the ocean,” or the “I never even thought of what the Florida heat would do to my insulin” mumbled as I roll the insulin bottle around in my hands and notice that the once clear liquid is now chunky and white.

So in the next few pages are the addresses and phone numbers of every pharmacy in the Keys, all five pages of them, divided by region. And just in case there is not a single one who will transfer my prescription (which of course I have every one listed with the prescription number and phone number of each pharmacy who holds the prescription), I have the number of the only endocrinologist in the Keys in case she might take pity on me and give me one of those free samples of insulin or strips or whatever it was that I ruined, or lost, or forgot.

My preparation goes far beyond the Plan B Book, too. It covers knowing that things happen: airlines lose luggage, I lose my mind and forget to pack things, electrical systems on a boat can break and leave my fridge as nothing more than a cheap cooler without any ice packs to keep it cool. So I pack multiples of everything I need and I pack them in multiple locations and in multiple contraptions.

I pack four blood glucose meters, one in each backpack, one in a waterproof Otterbox below deck and one in my ditch bag, just in case. I bring six vials of insulin, enough to keep me alive for five months, and hide it in all of the same spots as the meters and two more in the fridge.

I pack my insulin pump, my old insulin pump, a loaner insulin pump from Minimed, and even needles (which I have not used to inject insulin in the thirteen years I’ve been pumping) in case all three pumps break. I bring Nick, my preferred Dexcom CGMS with his extra sensors, and Johnny, my back up CGMS system, with his extra sensors.

My bags will be so full with back up diabetes supplies, I will only be able to fit one swimsuit and one pair of shorts into the remaining spaces. Looks like shirts will have to wait for another trip.

After spending countless hours thinking of everything that can go wrong, and five ways to fix each problem, after packing and repacking to get all the extra equipment, equipment that I will probably never even use, to fit into my two bags, and after spending time typing up and printing my Plan B Book, I can shut down the practical side to my personality and fully embrace my footloose and fancy free side because I know all of my bases have been covered, and a few extra ones at that. I will be able to fully focus on the beauty in front of me, the one hundred miles I have to cover, and the diabetes that I will be conquering by not letting it stop me from living my dreams.

Out the Window: Preparing to Sail Solo

I have thirty-four red marks on my outer thighs from the insulin infusion sets and continuous glucose monitor sensors that make their home beneath my epidermis for up to a week at a time. The tissue in my upper buttocks is currently too scarred up to even use to inject insulin.

I have a nice long scar at the base of my abdomen from having two c-sections to free children who grew very fat in utero from the excess sugar in my bloodstream. I currently have one penny-sized bruise on my stomach from the Symlin I inject there two to three times daily.

I don’t even want to think about what my kidney tissue or the back of my eyes look like, not to mention the inside of my vascular system after fourteen years of being ripped up by red blood cells that are strapped down with too many glucose molecules stuck to them because I couldn’t figure out how to perfectly mimic my own dumb pancreas. But, my feet- my feet still have their flip-flop tan well into December.

Diabetes has beaten up my body in so many ways over the years. It has done its best to screw with my mind. It has preyed on the fears of those who love me. But there have always been some things I will not let it take from me, the first of which is that flip-flop tan.

When I was diagnosed, my well-meaning doctor told me that I could never walk barefoot again, that from the moment my feet touched the ground in the morning until I retired them in the evening, they were to be strapped into a closed toe, well-fitted shoe so I would not lose them to gangrene. It was the first piece of well meant doctorly advice I chucked.

To a Southern California beach girl who was raised in the water, that new law was worse than the threat of the complications he had just handed down. The flip-flops went on that next morning and have rarely been off except to be replaced by a pair of heels once in a while when going out, or top-siders when on the water.

During my first year with diabetes, I read a few books on my new disease. Most chapters I skipped because they just listed in detail all the horrible complications I was certain I would never get. But there was one precaution I came across that I tucked in the back of my mind, knowing it was one I was going to have to eventually chuck out the window also.

I read in some odd passage that as a diabetic I would never be able to fly a plane alone, drive a big-rig, or sail a boat alone. I was not so upset about not having a career as a long-haul trucker, the hats never really looked that good on me, and flying I have always seen as a way to get to all those amazing places I want to see, not as a pastime in and of itself. But to be told that I wouldn’t be able to sail alone did not sit well with me. I knew it wouldn’t be something I could prove to my doctors the next day, but it was on my list.

As I have lived with this disease, I have learned the many different moods of diabetes and some very effective strategies to try to tame it. I have seen the technology come so far so quickly that things that once seemed scary and risky now seem very attainable with good, solid planning and a lot of attention to detail. Sailing solo is one of those things.

Unfortunately, the old wisdom prevails. People are being told the same old story when they are diagnosed. Here is the list of things you can’t do, you shouldn’t do, you will never be able to accomplish. Their dreams are being crushed at a time when it is so crucial that they be given hope and encouragement. Instead of helping them adjust quickly to a whole new way of living, they are being sucked dry of their hope of leading a normal life.

The time has come.It is now upon us. It is time to chuck outdated proclamations out the window. It is now safe to sail alone with proper planning, with a Plan B and a Plan C and a Plan D for when things don’t go the way you expect.

I’ve had enough conversations with the diabetics already out there sailing, gleaning anything I can from their experiences. I’ve read the horror stories of sailors who had trips where everything went wrong and what made the difference in their survival. I know I can be okay with enough attention to my body, and how it reacts on land, to food and exercise and stress and temperature and lack of sleep and inactivity, and a lot of activity.

In February 2011, I’ll come back with a whole body tan from four days sailing a 22′ Catalina the 100 miles from Key Largo to Key West, having proven to myself and to my doctors and to the world at large that diabetes should not slow us down.

The Two-Story Diabetic

When we chose our house I was thrilled to get one on a cul-de-sac so the kids could run around without having to call off their game of football with a resounding, "CAR!!". The panoramic ocean view from both kids' rooms was a great selling point as was the community pool and jacuzzi to finally teach the kids to swim. The one thing I overlooked was the fact that a diabetic should never live in a two-story house.

When 2 a.m. calls and my blood sugars have plummeted to 38, pausing for a moment just before falling off the cliff that some do not come back from, and I have to locate some sugar in the house, I spring from my bed in a panic and begin the sprint to the kitchen before my eyes are even open.My brain is still asleep and my body has been robbed of the sugar it needs for my muscles to move in any sort of coordinated way. While it's still dark and the stairs seem to be swaying in the wind, I attempt to hobble down those stairs without spraining my knee or falling flat on my face.

Most of the time I make it to the kitchen and force the chocolate milk sludge into my gullet, but I have certainly had some close calls. I have learned to count the seven stairs until the landing halfway down and the other seven to the bottom just so I don't step where there is no step, or forget to step when there is one.

When I finally make my way upstairs later that night with hardly the energy to climb those stairs, I often realize I have left my blood glucose testing kit downstairs on the coffee table. So I have to extricate myself from those warm covers I have just settled myself under to wander back down the stairs.

I climb seven and seven back up and get settled again under the covers to test my sugars before turning in for the night. Hoping to make the correct adjustments to avoid yet another nighttime low, I find that I am still low and am 10 feet too high to reach the fridge from my bed. So back down I go, pounding some choco-sludge and the back up seven and then seven more.

By the time I am upstairs again, Tony is still sound asleep. I shut off the light and hope for a low-less night avoiding a season-ending, blown ACL from only counting to six before turning.

So my advice to the diabetic world out there, go for a single story, maybe a ranch style or a sprawling mansion, but whatever the land-use gurus are promoting and the highly paid real estate agent is pushing, avoid the two story, and by all means, run screaming from a tri-level home. Believe me your knees will thank you for it.