Managing Diabetes On Board

BREAKFAST

As I get closer to launch day for my sailing trip, I have been focusing more on my diabetes management plan. One of the things that I have been concentrating on is my breakfast. It has always been one of the harder meals to get right because of the different hormones that circulate in the body and bring you from a sleeping state to a fully alert state. Most of these hormones make the body less sensitive to insulin. The result is that you usually need more insulin to cover the same amount of food eaten at a later time in the day. The other problem I have is that I love breakfast foods. I would eat them for breakfast, lunch and dinner if I could (and sometimes I do).

I’ve changing the ratios of my breakfast foods and have achieved some degree of success lately by making breakfast a low-carb, high protein meal. This has lowered that morning spike in my blood sugars and also leaves me feeling fuller. After four weeks eating the new protein based breakfast and finding much success with it, not only in better controlled blood sugars, but, also with the bonus of weight loss. SOME RESEARCH

I came across a study published recently. It was a study of type 2 diabetics (different from type 1 diabetes, I know, but interesting all the same). In the study, the researchers gave the patients a high-protein, low-carb breakfast and found that it lowered their morning blood sugars, which should be obvious.

We have all known that carbohydrates have a far greater impact on blood sugars than proteins do. But what they also found out was that the meal caused their body to replenish their glycogen stores with the sugar instead of storing that sugar as fat.

So the way the body reacted to the sugar changed in addition to there being less of it. If the carbs were later added to a morning snack the patients did not see the same blood glucose spike as when they ate the carbs as their first meal of the day.

I always have to laugh when scientists spend thousands of dollars and hundreds of hours of time to figure out the same thing I figured out in two weeks with my own body. It is nice to have real evidence to back me up, though. And, of course, they can publish their work and make safe recommendations to other people based on their science. I can only change what I am doing, knowing that every diabetic is different and may not react in the same way I did to changes in their diet.

PROTEIN IN THE HEAT I want to continue this high-protein breakfast on my trip, but it presents some slight problems. One of my main morning proteins is eggs. Eggs, however, are very hard to eat if you don’t have a stove or any source of heat. I am all about protein, but I am not going to go Rocky-style and down them raw. I tried that once when I was eight and never will again. I could do a protein shake but after consuming those for breakfast and lunch for four weeks, I have found them very hard to swallow without gagging. So, I have settled for a cheese stick wrapped in turkey slices as my plan for now, but I don’t know if that will work in the long run and I’m not sure that sounds too appetizing first thing in the morning. LUNCH AND DINNER My other meals will certainly include carbs. I am in no way opposed to carbs; as an athlete, there is no way I could be. I will just have to include some of those high-carb breakfast foods I love later in the day.

SITTING STILL One of the other morning issues I will be facing is one that I have more experience with in long car trips early in the morning than I do with sailing. Sailing involves a lot of sitting around. Your body becomes more or less sensitive to insulin based on how active you are throughout the day. I have found that if I take a long car trip starting early in the morning, my blood sugars will race up very high and stubbornly stay put no matter how much insulin I give as a correction bolus to bring them back down. Once I get out of the car and start moving around for an hour or two this problem is quickly remedied. To fix this, I simply have to put in a good workout before getting in the car, and stop every two to three hours for a quick five to ten minute burst of exercise.

PLANNING FOR ACTIVITY While in the Keys, I will have to work-out each morning before I take off for the day. Most days I will go for a quick three to five mile run. When I stay at Fiesta Key for the second night, I get to use their Olympic size pool to put in a quick mile swim. One of the rules of the trip is that I won’t stop until I reach port each night, so I will have to find some way of doing those ten minute bursts of exercise on board. I won’t be able to run or even be able to walk around much as the cockpit on a 22’ Catalina is only about 6 feet long and has the boom of the main sail about 4 feet off the deck.

As a result, I am stuck with calisthenic type exercises that can be done in very little space. To maximize the effect of each exercise I will need to use the largest muscle groups and use as many as possible in each exercise, all while holding onto the tiller so the boat does not go spinning in circles or run aground on one of the many sandbars lurking just below the surface of the water. Included in my workouts will be squats and lunges, which recruit a lot of the larger muscles of the body. Adding to the exercise schedule will be calf raises, which will round out the lower half of my body. I may be able to pull off some push-ups on the seat of the cockpit while holding the tiller still with my foot. EVENING WORKOUTS To round out the exercise regimen, I will need to get some activity in after I dock for the night. This shouldn’t be much of a problem since I will be in search of a warm meal and a view of the old Keys, Florida as it used to be.

Even with all of this physical activity, I will still have to make some adjustments to the basal rate of the insulin, constantly supplied by my pump, to take care of normal bodily functions. The first day I will try a bolus increase of 125% and adjust as needed. FINAL ANALYSIS Each night I will go over my blood sugars and my maintenance plan and will reassess for the next day. Hopefully by the end of the trip, I will have developed some sort of protocol that I can use in future sailing trips, so I won’t need to use myself as the living guinea pig. WHAT'S NEXT As you plan your next adventure, you might want to do two things. First, analyze what you do at home and figure out how that will change as you take off to new places. Second, make a plan to keep your activity level and food roughly the same so you can avoid those whoops! moments while adventuring.

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.