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.
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 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.
What to Do
Low or Hypoglycemia
· Pale skin color
· Sudden moodiness or behavior changes, such as crying for no apparent reason
· Clumsy or jerky movements
· Difficulty paying attention, or confusion
· Tingling sensations around the mouth
They should test their blood sugars
Give them 15 g of fast acting carbohydrate (read: simple sugars)
· regular (non-diet) soda
· energy gel such as Gu or Powergel
High or Hyperglycemia
· High blood glucose
· High levels of sugar in the urine
· Frequent urination
· Increased thirst
· Shortness of breath
· Breath that smells fruity
· Nausea and vomiting
· Very dry mouth
Every diabetic will have a different plan for addressing this. Most Type1's will administer extra insulin and continue to check their blood sugars.