11 January 2011

Managing Diabetes On Board

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.

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.

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.  

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.

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.

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. 

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. 

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.

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.

06 January 2011

The Growing To Do LIst

One of the hardest things about planning my four-day, single-handed sail through the Florida Keys this February is juggling of all the side projects associated with the trip. Not only do I have to plan normal travel arrangements like airplane tickets, reservations, and meals, but I have to plan for the aspects of the trip that make it more of an event. There are blogs to write and websites to design and maintain. There is fundraising to do, sponsors to court, and thank you letters to write to the people who have really stepped up to help make this dream a reality.  And, of course, there is the book I’m writing, which unfortunately seems to take a backseat sometimes.
It has recently been in the back of my mind to capture this trip in a short documentary, so today I spent four hours researching how to write, plan, and film a documentary. I read books on Amazon.  I checked out video blogs from the sailors currently racing the Velux 5 Oceans race to see the ins and outs of filming on a boat.  And I watched a documentary sponsored by No Limits about three diabetics who go on a kayaking trip to see how to incorporate diabetes into the story as I chronicle my four day journey on the sea. It turns out there is more to making a documentary than just doing something adventurous and turning on the camera while you do it.  A documentary should have a theme and a vision. It should have a plot and pacing. It should have beautiful camera work that does not rock up and down (how I am going to be able to pull that off in a boat, I have still to figure out.) And all of this has to be planned beforehand without actually knowing what is going to take place during the trip.  I have now added the following to my to-do list: interview family members and friends, write the plot, figure out how to upload videos while away from my home computer and how to handle a camera to get the best picture. And the worst part of this entire documentary idea is that for a good portion of the movie, I will be the only person on film. Anyone who knows me will quickly tell you that this is pretty close to my worst nightmare. I hate to be filmed. I am shy and quiet and have a very hard time expressing myself in person. In writing, I have learned to open up and share, but in person I am still slow to speak.  To fix this, I have written out interview questions to ask myself during each portion of the trip hoping that this somehow magically lets me overcome my lifelong severe shyness and makes me into my daughter who could have eight hour conversations with the wall if she needed to.
The thing that this whole trip keeps  teaching me, though, is that I still have plenty of room left to grow as a person. I do not have it all figured out.  I have weaknesses. I have fears from childhood that need to be overcome.  If you were to ask me what my worst fear is about this trip, just after being cast out to sea and set adrift in my life raft for sixty-six days, it would be having to speak in public with a microphone or to speak on camera. Actually that one would probably come first.  As a rational adult, I know it is not a reasonable fear. I know that no harm will come if I happen to let out to the world that I am a total dork, and I know that by challenging myself to get out of my comfort zone and forcing myself to do the things that I would naturally shy away from, I will gain new skills and lead a fuller life and hopefully, as an added bonus, I will provide a little bit of motivation for another person to get out there and lead a more adventurous life in the process, which I suppose makes it worth the risk.