If you have ever had the unusual pleasure of having a meal with a diabetic you might have noticed that moment when they look off to the left, appearing deep in thoughts somehow not entirely related to the current conversation. If you have ever wondered what it was running around in their head, here is a small glimpse into the things they have to think about on an almost constant basis.
A little background, last weekend I went on a sailing trip to Catalina with 4 fellow sailors. It is an entirely new situation for me as far as dealing with diabetes goes. Most of my adventures since acquiring this "medical challenge," as my mom puts it, have been very active, hiking the grand canyon, running triathlons, surfing for hours on end. This one would involve sitting or standing for hours on end which can be a total disaster with diabetes. I, also, would be stuck on a boat if anything went south.
Friday morning I wake up high, 241 at 5:30. Correct with 1 unit for every 50 points above 100. 240-100=140/50=Push 2.8 units. I'd been battling bronchitis for 5 days, the extra bacteria will send my sugars
higher than usual. I haven't worked out in 5 days so my body will not be as sensitive to insulin until I get in two to three good workouts. Driving in the morning will also send my blood sugars higher than if I drove in the afternoon. All of this means I will need more insulin. My basal rate, the amount of insulin constantly dripping into my system from my pump to closely mimic what your pancreas does naturally and so much more accurately, needs to be raised. I would have gone 120% of normal for just the sickness, probably another 15-20 % for the car ride, so I decided on a 145%. If I go too high my blood sugar will crash, so I am always afraid of going too high with a higher basal rate, but being high on a trip doesn't sound too good either.
I got to my parents house in Seal Beach, dropped the kids, had a few moments to get a bite and clear my head. I hit Jack in the Box for a soda and went across the street to Starbucks for a breakfast sandwhich (caffeine blasphemy, I know, to bring soda to Starbucks, but I just can't get into the whole coffee thing.) Check my blood sugars, 271. My correction was an hour and a half ago so its halfway done with its job, which should have put me at 160. So 271-160=171 more to correct for. 171/50=3.2 but I don't want to overdo it so I pump in 2 more units to correct and 1.5 for the breakfast sandwich, skip the Symlin because it can make me nauseated and no one needs that kind of help when their about to get on a boat. Get on the boat and take off at 10. Check sugars again. Now I'm 361. That's pretty crappy. Correct again. (361-100)/50 gives me 5.2 units. Sitting on this boat motionless is going to add to the crappyness so I up my temporary basal to 155%. Try to sail.
I spent most of the morning trying to get my sugars down. Eventually I upped my basal again and corrected a lot. I managed to bring it down to the 200's by lunch, but it didn't get much better than that. We anchored that afternoon and, after a quick swim in the surprisingly warm water, we hiked across the island (only about a mile) to watch the sunset over the pacific side of the island. That walk couldn't have been more welcome. A chance to stretch my legs and get my body a little more sensitive to the insulin. On that walk I got into the good zone, actually I kind of overshot it, but was brought quickly back in thanks to the PowerGels I always have in my pocket while sailing.
The rest of the days went just like the first, 300's in the morning, even with high basal rates and lots of correction, and afternoons that were good once I got on land. It was odd to see the immediate difference in my blood sugars on land and on sea. While on the boat my sugars were very obstinate, they dug in their heels and did not want to come down. Once on land they became perfect, that level line between 80 and 120. As I start to plan my insulin regimen for my upcoming trip I start to wonder, was that a morning thing versus an afternoon thing (there are different hormones circulating around your body depending on the time of day that can make your body more resistant to insulin) or was it a land versus sea thing? Or maybe a little of both? Looks like I will have to go back into the lab and do some experimenting, change some variables and then analyze the data. Maybe a morning sail and then an afternoon sail and then check the sugars? Will a run in the morning before I take off fix the problem? I can sit on the couch all day on Sunday watching football with perfect blood sugars as long as I've had a long run in the morning, this might be similar. Maybe some sort of exercise on board? I thought about doing some squats while at the wheel last weekend but I didn't have the guts to start aerobicizing in front of everyone. I was already the weird one who had to draw blood on an hourly basis, and gladly swam half a mile to get to shore to buy a soda to get my caffeine fix . I didn't need to add to that impression by doing squats while on watch. While I'm alone I would have no problem, but can you do squats safely while on a 25' boat as opposed to the 31' that we were on? Maybe some pushups wheile I anchor? Maybe some dancing wildly to loud music might do the trick.
Will my activity level change on a smaller boat, will it rock more, will I have to balance more? We had 5 people to manage the boat last weekend, sailing alone will certainly mean more work. Will the increased work load help with my blood sugars, and if so how much? Will stronger winds make a difference? We motored most of the way out and back so there was very little scurrying about the deck to adjust the sails. The stronger trade winds in the Keys will definitely change that.
While down below in the tight quarters I bumped into a corner and ripped out the sensor in my leg that measures my blood sugars every 5 minutes and then reports it to my pump. I yelled at Johnny for not holding on tighter to my leg (if boys can name their cars that just get them from Point A to Point B, I can certainly name the Continuous Glucose Monitor that has already added years to my life). So next time I should probably move it to a safer spot, one that won't be as likely to hit a counter (not that I need to explain where exactly that might be) and probably bring an extra couple of sensors. I only brought one on this trip because I had no idea how I would shoot a 2-inch long, way-too-thick needle into my thigh on a rocking boat when I can hardly bring myself to do it while on land. In July, I can just go ashore, I suppose, and do it in a bathroom stall in some run-down Florida restaurant (note to self: bring lots of rubbing alcohol).
Things like this ran around my head during the whole weekend. My brain was wracked with math and strategies and analyzing every variable to make a sad attempt to keep my blood sugars stable, while the others simply enjoyed the sea and the sun and let their pancreas do all that hard work for them. So next time you see your diabetic friend start to go to that place when they stop listening to you just for a brief moment, pause, just for a second, to give them a chance to zip through the math, and then go ahead and finish that story about that time when you were just 18 and could still stay out all night and not feel it in the morning. They'll appreciate the gesture.