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.
Symptoms
|
What to Do
|
|
Low or Hypoglycemia
|
· Shakiness
· Dizziness
· Sweating
· Hunger
· Headache
· Pale skin color
· Sudden moodiness or behavior changes, such as crying for no
apparent reason
· Clumsy or jerky movements
· Seizure
· 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)
Some examples:
·
candy
·
juice
·
regular
(non-diet) soda
·
energy gel
such as Gu or Powergel
·
raisins
·
honey
|
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.
|
