Sailing With Diabetes

This is a reprint of an article I wrote for Multihulls Magazine Jan/Feb 2013. It was geared towards sailors and crew members who are not familiar with diabetes. As a person with diabetes, it would be a great primer for anyone you may sail with to be followed up with a discussion of a more detailed plan of action.

Insulin on Board- How to prepare for and respond to a diabetic emergency on your boat

What Would You Do?

Suppose you are out on an overnight cruise with some friends and family. Your brother's friend, Jimmy, starts to get a little sweaty and shaky. He seems confused and can only answer your questions with, "Uhh. Wait. What?" You know something is off, but will you know what to do?

It just may be that Jimmy is a diabetic and is having an episode of hypoglycemia. Without the right help, your cruise may go from pleasant to scary in the next few minutes.

What is Diabetes?

Diabetes is a group of diseases that all result in an excess amount of sugar in the blood. Diabetes can be a deadly disease, but with proper management it can be moderated so that a person may participate in any and all activities.

There are two main types of diabetes, Type 1 and Type 2. A fundamental explanation of the difference is that they both occur from a malfunction of insulin. Insulin helps cells gain access to sugar in the blood that is a necessary energy source for all body activities. Type 1 is from a pancreas that no longer makes insulin. Type 2 is when the body's cells do not respond to insulin. Type 2 is vastly more common.

How Diabetes Affects You as Captain

One in twelve people in the U.S. is affected by diabetes. At that rate, chances are high you have already sailed with a diabetic or will in the near future. As captain of your vessel, you are responsible for the safety of your crew and passengers. You have safety gear, radios, and the knowledge about what to do for your boat in an emergency. You have prepared well.

This preparation also needs to extend to your passengers and should include the sometimes uncomfortable task of asking if your passengers have any medical conditions that may present a problem while on the water.

Diabetics can be very self-sufficient people, so one of the best resources for preparation is the crew member himself. Ask what his plan is for taking care of himself during your trip. Ask about supplies he will be bringing and the proper protocol for an emergency. If you know ahead of time that you will be sailing with a diabetic, do a little research online about proper protocol and precautions.

So what are the kinds of scenarios you might encounter while sailing?

Diabetes Basics

Diabetes management is all about balancing the amount of sugar in the blood. This is done with insulin, oral medications, diet and exercise. A diabetic will try to coordinate the activities that raise blood sugar (food, stress, illness) with those that lower it (insulin, medications, exercise). Unfortunately, life is not always predictable and sometimes blood sugar levels will be out of balance. In these rare cases, it is advisable to know a little about what to be on the lookout for.

Lows or Hypoglycemia

If a person has too much insulin, not enough food or increased physical activity, his blood sugar will drop below a safe amount. Some of the symptoms of low blood sugar are shakiness, confusion, sweating, hunger, or sudden moodiness, such as crying for no apparent reason. Low blood sugar must be addressed immediately before it becomes a life-threatening emergency. If addressed quickly, blood sugars will rise and no further assistance is needed. If not, blood sugar can continue to drop rapidly and may lead to fainting, seizures and death.

What to do for Hypoglycemia

If a diabetic has any symptoms of a low, ask them to test their blood sugars. If they are low or they are unable to test, get them some sugar fast. Good sources of sugar are candy, juice, regular (non-diet) soda, or an energy gel such as Gu or Powergel. Most diabetics carry these with them at all times and will be able to take them on their own. If not, you may need to help them get the sugar. If you have a diabetic on board, do not leave port without a fast-acting sugar on board. No sugar, no sail.

It is a good idea for a diabetic on a boat to bring a Glucagon kit. This is a small package containing a syringe and vial of the hormone glucagon, which will raise blood sugar levels in a diabetic who has passed out. It does involve a few steps and a syringe, so it would be advisable to run through the steps before launch.

Highs or Hyperglycemia

On the other end of the spectrum is the situation when there is too much sugar in the blood. This is called hyperglycemia or a high. This is less time sensitive, but still needs to be addressed quickly.

What to do for a Hyperglycemia

Each diabetic will have a different protocol for dealing with high blood sugar. For most Type 1 diabetics, this includes additional insulin. Both Type 1's and Type 2's will need continued testing until blood sugar levels become normal again. It is also important to drink plenty of sugar-free liquids to fight dehydration.

If hyperglycemia continues, it can produce ketoacidosis, which can be a life-threatening condition. Ketoacidosis will produce shortness of breath, breath that smells fruity, nausea and vomiting and a very dry mouth. If a person has these symptoms it is time to get medical attention.

A Special Consideration

Watch out for seasickness in a diabetic. It is very easy to overlook vomiting as a symptom of high blood sugar, instead writing it off as the usual seasickness. If it is in fact seasickness, special care is needed. Since much of diabetes is regulated by food and drinks, if a person is unable to keep food down, they are in more danger of not being able to correct a low. A good anti-nausea remedy would be helpful in these situations.

For the Diabetic

Let's show the world that we are responsible, well-managed people who happen to deal with a disease. Be prepared with more supplies than you think you will use. You never know when a three-hour cruise will become much longer. Keep your supplies in a place that will not be compromised by the wet marine environment. Consider dry bags, and dehumidifier packets. Have a method for keeping insulin cool. Have a back up for any electronics you use in case you or they go overboard. Bring a glucagon kit and teach others on board how and when to use it.

Be open with your fellow crew. Teach them what to look for. Teach them what to do in an emergency. Reassure them that you are a competent diabetic and that most likely they won't ever have to respond to a diabetic emergency.

And let's push the boundaries of what we think is possible. Let's follow in the footsteps of those who have gone before us and look to them for information about how they did it. There are plenty of diabetics to fill this role.

EddieCrane is a Type 2 diabetic who is preparing to join the crew for the Clipper Round the world race and become the first Type 2 to circumnavigate the globe. Or there's Keegan Taberner, the 18-year-old Type 1 who covered 800 miles circumnavigating Vancouver Island to raise money for a diabetes research group. Then there's Sara who has led the way for long-distance cruising for diabetics aboard Wondertime with her husband and two daughters, cruising from British Colombia to Mexico and then crossing the Pacific.

None of these people have let diabetes stop them. Sure, there are extra preparations, but a good sailor always prepares well for a voyage. And people with diabetes are no different.

An Excerpt from Islands and Insulin- Second Installment

10 February 2009

Carlsbad, CA

My fifteen-year high school reunion is quickly closing in and the only thing I have done since high school is to spend the last decade or so being ordinary. I now drive a minivan, have two kids, spend my days as a teacher and live in a small house by the beach.

Not that any of those things are bad; I really am enjoying my life. But my life was supposed to be something bigger, filled with great adventures and travel. It should have great moments of glory, like climbing a mountain or sailing the Seven Seas. Maybe even a little professional surfing.

I should have studied sharks and lived for months at a time on a research vessel. I might have my PhD. and teach at a major university. I would have done some great things. Instead I have become overwhelmingly average.

Anytime the reunion comes up, this scene keeps playing over and over in my mind. I run into old friends and time and time again have to answer the inevitable, "So what have you been doing for the last fifteen years?" Surrounded by doctors and lawyers, UN representatives and CIA agents, I will have nothing to tell.

My life is unremarkable. Nothing more or less than every other average American has accomplished. A few tables over a few guys from one of my classes will begin to chat. "Do you remember that girl who used to study with us in AP Chem?" the music manager will ask.

"The one who never actually studied and barely stayed awake in class if she decided to get out of the water long enough to show up?" the C.E.O. will reply.

“You know, I think she only came to study group to get us to do her work for her."

"Karen or Mary or something—”

"Erin. Erin Roberts." He takes a long draw from his beer. “Wasn’t she going to be a shark biologist or something?"

“I think that was Plan B, behind pro surfer.”

"She here tonight?"

"Nah. Probably still out surfing somewhere."

"What ever happened to her?"

"Oh, she did the usual; grew up, got married, had some kids. She probably won’t show her face here tonight."

That image has to change. I can't go out like that. I need to do something to make those guys finish their conversation with, "But she woke up one day, looked at the cards she had been dealt and stepped up to the table to bet."

I have to find something big. And quick. Far too many years were spent muddling through the ordinary. Now is the time to do something grandiose. Or at least somewhere closer to grandiose than where I am right now. And I have to start planning it today.

Saturday gives me a few hours off from Tony and the kids to find my favorite table in the courtyard of a market near the water in Cardiff by the Sea. On the table lies a book that I’ve been meaning to pour through, but I just can’t concentrate. My mind repeatedly wanders off into thoughts of what I can do to feel alive again, to leave behind the stone tied to my leg threatening to drown me.

Diabetes has been holding me under for the last few years. In the beginning, diabetes was a minor nuisance. It was nothing. My self-care had become, just like the doctors and nurses told me it would, like brushing my teeth. But thirteen years in, it overwhelms me with responsibility and fear and depression and I need to do something about it.

Growing up, I was always up for any sort of challenge. But now I am tempered, not wanting to push too hard. The fear and frustration of diabetes fences me in. It has slowly worn me out. I have to get back to the girl I was before all this diabetes shit started. The girl who feared nothing, except being weak. The girl who always accepted a challenge and was ready at any time to go on any journey that presented itself.

Of all the journeys I could take on, the Australian Aborigine's walkabout intrigued me the most. When a boy is ready to venture into manhood he takes off on a journey to unite with the land of his ancestors, to prove that he has the skills and knowledge necessary to fend for himself. When he returns he has proven that he can be a valuable member of the tribe, one whom others can depend on and trust. He has had a spiritual experience that he can look back on as proof that he can handle whatever life throws his way.

That is the kind of thing that I need. It has been twelve years since the diagnosis. Diabetic adolescence has hit. I have gone through the happy-go-lucky childhood days, when my pancreas was not entirely dead and would at least help to regulate my sugar levels a little bit. It evened out the highs and lows. Those years passed quickly and the next three years taught me more of what diabetes does to a person. I was more responsible and knew the power the disease had.

The following six years brought on the usual teenage depression when everything was wrong and I was overly touchy about the subject. I am ready to move out of the teenage moody years and move on to adulthood when I can have a better outlook, more maturity and a healthy perspective on who I am because of diabetes, not in spite of it.

A walkabout looks like the perfect rite of passage to usher me into this new phase. The only problem is I do not have the Outback at my disposal and I wouldn't know how to survive in it even if I did. What I do know is the ocean. And in all its vastness and danger, it easily rivals the outback.

The aborigine walkabout is done to merge with the land. The boy endures it and enjoys it, and it urges him to extend his capabilities as far as possible. I need something to allow me to become part of the ocean and something that would be just at the end of my grasp. I need a risky goal which calls for a major extension of my talent. A goal that I am not sure I can accomplish. One with an opening for the unknown to step in and test me.

I need to go out to sea.

Beyond the borders of the land, where my feet can no longer touch the shore, I can follow in the footsteps of my grandpa, Captain Jack, and sail into the horizon. I loved hearing his stories as a kid, and it is just about time I start stocking up on my own stories to tell my kids and future grandkids. To do this right, though, I need a long journey. And I need to do it alone.

The stories of solo sailors have always engrossed me. My desire to solo was first stoked by reading Close to the Wind by Pete Goss, and Godforsaken Sea by Derek Lundy. They both tell the same story of the 1996-1997 Vendee Globe race. It is a grueling, four month sailing race that pits solo sailors against each other as they race 24,000 miles around the world. Most races have sailors drop out or lose their boats. Some lose their lives.

In this particular race the competitors encountered a fierce storm in the Roaring Forties and Rolling Fifties, the latitudes around the bottom of the world where waves and winds whip themselves up, unencumbered by land to stop their growth.

Raphael Dinelli was wrecked in the middle of the storm. His boat had sunk and he was holding on to life in his little raft amidst icy air and sixty knot winds that whip the sea into fifty foot waves. His life was being sucked right out of him.

When Pete Goss heard the MAYDAY call he turned his boat around to sail into the hurricane force winds to save his competitor. He risked his life to head directly into the storm that he had spent the last two days trying to outrun. And he made that decision without hesitation. It is the way of the sea. When someone is in trouble you do everything you can to help.

That was a tradition I wanted to be a part of and I wanted to do it alone. Shortly after finishing the book, solo sailing a long distance went on my Someday-I-Will list. Now is the time to take it off the list and place it firmly into reality.

Now that the decision has been made to go sailing, I need to start planning. First on the list is finding a place to sail that is warm and safe. Warm because I absolutely hate to be cold and I love not wearing much more than a bathing suit all day long. Safe because I have a husband and a mother who tend to be scared by my adventures.

I know they will be reassured if I stay in the United States. This leaves San Diego where I currently reside, which doesn't make for much of an adventure, or the southern portion of the Intercoastal Waterway in the Carolinas, Georgia or Florida. Captain Jack had come back from a trip down the Intercoastal Waterway and I loved hearing the stories he told. I would love to follow in his wake.

On the Intercoastal Waterway, I need to find someplace that has natural boundaries so that my starting and stopping points don't feel arbitrary. After a quick glance at the map, I decide on the Florida Keys. One hundred miles of warm water, plenty of islands to navigate by sight, and a very end-of-the-road feel. You can't get much more southerly than Key West.

I need at least a year to prepare for a trip like this. One of the many benefits of being a teacher is three months off in the summer to adventure. Next summer should be a great time to go.

John Lancaster and His Son Dylan- Winners of the I&I and YOU Contest

Well, the I&I and YOU Contest is officially over. John Lancaster and his Type 1 Diabetic son, Dylan have won! And it couldn't have gone to a greater pair.

Dylan is taking on the Appalachian trail to raise money to provide 3 diabetic service dogs for himself and two other local diabetic kids in his town. Check out his adventure at D Cubed Dylan's Dogs for Diabetes and help support his goal.

Dylan and his dad will be receiving the eBook version of Islands and Insulin, a paperback version, a GlucoLift bundle, as well as other goodies.