02 December 2013

Dream Big

Exploring Iceland. Surfing in Nicaragua. Hiking in Machu Piccu. Visiting the Great Wall of China. The Cherry Blossom Festival in Maryland.

     
Last weekend I took a poll at the Taking Care of Your Diabetes Conference in San Diego and asked people where their next adventure was. Some people knew immediately. They were planning something big. Others took a minute to think about it. There was someplace they had always wanted to go. For some though, their lives were a struggle and they barely had time to take care of the necessities let alone dream big. 

     But when I pressed these people to come up with something, you could see them start to smile. It was as if I needed to give them permission to day dream. And I think that for these people, the ones for whom diabetes management has hit the difficult spot, those who are hurting, that dreaming is even more important. 

     It is those dreams that get us through the rough patches in life, that keep us moving forward knowing that one day, off in the future, things might be better and there might be a way to make those dreams happen.

     I know that it is in my darkest times that I relied most heavily on my dreams to give me a moment of escape. So if you don't have a big adventure dreamed up already, start today. 

     Where is the one place you want to see? The one adventure you want to take? The mountain to climb, or sea to sail, or island to swim around? Find it and escape for a moment in the thought of doing something big and fun some day soon.

     So where is your next big adventure? Leave it in the comments below. Who knows, maybe your adventure will be the catalyst for someone else's new dream.

22 October 2013

Swimming The Keys


There are those runs every so often, when you feel like you can run forever without even a hint of fatigue. Where your mind drifts off into that happy place and your body just relaxes. I’ve gone to that place a few times while running but never when swimming. 

It's kind of hard to get into a groove when every eighteen strokes a huge wall looms and forces you to break stride to turn yourself upside down in some elementary school style pool trick just to put in another eighteen strokes and hit the other wall.

I've been in the pool for fifteen years, taking it twenty-five yards at a time, and never found that happy place. That is until last week when I took my Christmas gift to the deck.  I had my eye on it for over a year when my parents found out and gave me a waterproof case for my iPod, an H2O Audio case for my third generation Nano and the Laird Hamilton earphones to match.

I figured if I was going to meet my goal at Wildflower this year, I needed to put in some major yardage at the YMCA pool. So I situated my Nano inside the case, locked it down, slipped the neoprene belt around my waist and fiddled with the earphones for a bit. 

The first few laps were less than enjoyable trying to get the volume adjusted, the earbuds set just right and the pressure fixed in my ears from the watertight fit. But once I got set up, I was immediately in another world.

The experience of counting my strokes in my head, "1,2,3-  2,2,3- 3,2,3- 4,2,3- flip" was instantly replaced by the feel of the tepid water gliding across my skin. With a little Jimmy playing in my ears, I could see the sun streaming in from the open roof as if it were shining down from a tropical sky. 

The water suddenly was the clearest ocean water I had ever seen. I was swimming around some tidal island in the Keys just a few feet from shore. No more stroke counting and flips, just a constant revolution around the island. 

When I pop my head out of the water for a moment to breathe, I catch a glimpse of a Key deer nibbling some grass just below a patch of palm trees moving ever so slightly with the Prevailing Westerlies. 

My 22’ Catalina sailboat anchored offshore is still visible to my left where I left her to have the coolness of the sea wake me up and to get in some exercise before lounging the rest of the day away in my topside hammock, writing and enjoying being in one of the coolest places that God has made.

If only I could make this feeling last...

I'd love to hear a story of how you slipped into the zone while running, or hiking or doing some other amazing activity. Leave me a comment below.

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13 October 2013

Take a peek inside my writer's studio

TuDiabetes is a terrific site for social networking amongst diabetics. They also run several outreach projects including the Big Blue Test coming up in November. Emily Coles also does live interview with some pretty cool people in the diabetes community.

I had the great opportunity to sit down with her (me in my studio, her in her office) and chat a little about my background in sailing and the beginnings of my book, Islands and Insulin.



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12 July 2013

Are You a Genius?

What I Don't Know

During a recent Google Hangout with Emily Coles from TuDiabetes, I was asked a couple of questions about how I prepare supplies for long journeys and what I would do if all of my supplies went overboard. I had a few suggestions for the latter but had nothing to share on the former.

But I know there are so many diabetic sailors out there who are screaming the answer to both questions as they read them. When we come together and share our wisdom, we are so much stronger as a community. So here's you chance to let your voices be heard.

In my classroom, when a student comes up with a creative answer I bestow upon them the title "Class Genius of the Day". 

What Do You Know?

What systems have you come up with from getting diabetes supplies for a year long journey, to keeping strips dry? 

How do you keep insulin cold? 

How do you start a discussion with your crew about diabetes? 

How do you deal with the days on the sand or near the water? 

Do you ever go Untethered and how?

So are you the Genius of the Day? 

Let me know in the comments below and I will compile and organize them into a searchable database to help those just starting out. Let's give help to the sailor who just found out they're diabetic, or the diabetic who just decided to give this sailing thing a go.

Are you Genius of the Day??


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17 June 2013

Sailing with Diabetics


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.


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07 May 2013

John Lancaster and His Son Dylan- Winners of the I&I and YOU Contest



Well, the I&I and YOU Contest is officially over. John Lancaster and his Type 1 Diabetic son, Dylan have won! And it couldn't have gone to a greater pair. 
 
 
Dylan is taking on the Appalachian trail to raise money to provide 3 diabetic service dogs for himself and two other local diabetic kids in his town. Check out his adventure at D Cubed Dylan's Dogs for Diabetes  and help support his goal.  

 
 
Dylan and his dad will be receiving the eBook version of Islands and Insulin, a paperback version, a GlucoLift bundle, as well as other goodies.




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30 April 2013

Wildflower Here We Come

After a five year hiatus from tri due to hyperthyroidism, I am back and ready to race. Tonight was bike maintenance.
The Wildflower triathlon is a mountain bike sprint so I have dragged out the fifteen year old mountain bike that I bought for Tony before we got married.



I love that in our house it is perfectly acceptable to do bike maintenance in the kitchen. In fact our eat in kitchen nook has become the permanent home of Tony's new Franco bike.

The tops to the PowerGel's I used to keep my blood sugars stable on my last Wildflower Triathlon. I didn't know it at the time, but I was already sick then. I am going to keep them on there as a reminder of how far I have come in getting healthy again.


I think I used about the whole can of lube to get this bike back in shape.


And of course, after a day battling highs, the second I start this project I go low and have to stop to correct.  Can you see this morning where I took the steroids to help my asthma? Steroids and insulin don't play nicely together.

Marks left over from the tape I used to secure my glucose meter, lancet, and test strips to my handle bars so I could test on the bike. Now I throw my Dexcom in my back pocket and ride. Got to love technological advances, they are definitely cutting down on my transition times. (No more waiting 45 seconds to get a meter result.)



Correcting with some apple juice while I continue to work.

The finished product. Forgive the colors, I had to get some spare parts from the bike shop that has taken up residence in our garage. It is not color coordinated, yet.

28 April 2013

14 Tips for Bringing Diabetes on the Trail


     The date has been set. The packing list has begun. The companions have been chosen. I am off into the planning stages of my next adventure. Tony, Michelle, Brian and I will be hiking from one end of Catalina to the other over two-ish days. In addition to the usual hiking/backpacking preparations, I also need to make the diabetes preparations. And there are quite a few. 
Dylan treating a low before his training hike

     I recently came into contact with another diabetic hiker, Dylan, looking for tips. He is a ten year old who is hiking the Appalachian Trail this summer (a much bigger adventure than I can imagine) to raise money to purchase three Diabetic Service dogs, one for himself and two for fellow diabetic kids in his town. You can check him out at www.dcubed.org.

     I'm always looking for cool new ways to solve diabetic problems on the trail and thought I'd share some that I have found along the way. I have a feeling there are thousands more tips out there just waiting to be shared. So your job is to add them at the bottom of this post, for Dylan and for Michelle and I. 

   So here are my tips, in complete random order, and probably useful only to some... (and they are just things that work for me, not in any way to be confused with medical advice or something I would advise you to do.)

FOOD, BASALS, and BOLUSES
1. I like my pump to be turned down to 45-55% for long hikes. I start it usually about an hour before the hike.

2. I cut back on boluses for food to the same percent.

3. I bring two bladders for fluids. One with just water for when I am higher than I would like, and one with what I call GatorPel. It's half Gatorade and half Propel. It gives me enough sugar to keep hiking and extra electrolytes (super important on a hike) from the Propel. When it runs out, I refill the bladder with water from the trail and pour in a pre-measured Ziploc with another dose of the GatorPel powder.

4. I never under-eat on a hike, even when I am higher than I'd like to be. I have found I burn at least 100 calories an hour on top of my usual daily calorie burn. Food early and often is very important.

5. I love to bring pre-measured trailmix in Ziplocs in an outside pouch so I can grab them easily without having to stop to get them out and slow everyone down. I make them with 240 calories of raisins, chocolate chips and Annie's cheddar bunnies (an organic version of Goldfish). For me that's a 2.0 unit bolus, or on the trail a 1.0 unit bolus. 

6. Watch out for the overnight lows after a big hike. I have had to go to a 15% bolus at times. Other times if the day's hike was too strenuous my sugars would spike and become very obstinate. It really depends on the nature of the hike. After a few days on the trail, those results may also change. 


GENERAL HIKING TIPS
7. Fresh socks, halfway through the day are AMAZING!!!!!

8. Dehydration is a really big concern on a hike, especially with diabetes. On my last hike, I ran out of water between stops in the hottest part of the canyon and could't take in calories because my stomach got so out of whack. And that's not a place I want to get again.

PACKING
9. Bring enough food, quick acting sugars, and insulin supplies to last more days than you expect to be out there in case you get lost or stuck.

10. Find a way to refrigerate your insulin if it gets hot, or warm it if it gets cold. No one wants frozen insulin. Consider the moisture of the air also can ruin test strips.

11. Having a favorite food for a mid-day meal will do wonders for morale. Even if it seems like it's a pain to pack. Last hike it was a soda and a chocolate candy. So worth it!! It gave me something to look forward to before and something to revel in afterwards. 

CGM's
12. I have hiked the Grand Canyon with a glucose meter, and I have hiked it with a CGM. Let me just say, CGM's RULE!! If you don't have one, find a way to get one, even if it is just for the duration of the trip. With only a meter, I had to stop my group sometimes every 30 minutes to test. They hated it and we never got into a groove. With the Dexcom, I kept it in my pocket and pulled it out about every 30 minutes to check. It also alerted me if I was dropping fast BEFORE I got low and had to stop hiking to correct and then wait for the sugar to hit before continuing on. But always keep a backup. On my last hike, my fellow Type per Michelle had her Dexcom go out within the first 30 minutes. 

13. I've had a sensor pull out on other trips as well. You may want to consider additional measures to keep the CGM sensor on. I use SkinTac and have had excellent success (Just an FYI. This is not FDA approved or Dexcom approved) but those sensors stay on like no other.

14. Start your CGM an few days before your trip. I've found the first two days on a new sensor can be a little more off than later int he sensor's lifetime.

So what are your tried and true tips for taking diabetes on the trail?

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05 April 2013

Cast of Islands and Insulin- The Sea

Enough said.

You can pick up your own copy of Islands and Insulin at Amazon.com today.

25 March 2013

The Cast of Islands and Insulin- My Mom


When I first was in the hospital with diabetes, I was told to be as active as I would be normally so that they could figure out the correct insulin doses. I was a pretty active girl. I couldn't figure out how to surf while indoors, playing basketball might interrupt other patients, and I didn't have an indoor bicycle trainer to spin on in my room at the time. The only thing I could think to do was to run up and down the eight flights of stairs in the hospital. Luckily my mom was right there beside me to keep me company.

You can pick up your own copy of Islands and Insulin at Amazon.com today.




15 March 2013

The Cast of Islands and Insulin- Hank


Parting words from Hank. We weren't that good at communicating back then. Mine weren't much better, "Ok."

You can pick up your own copy of Islands and Insulin at Amazon.com today.

11 March 2013

The Cast of Islands and Insulin- My Dad


The reason I have a need to travel. And the source of my writing habit. Thank God my journey to Florida was much better than his first and only trip there.

You can pick up your own copy of Islands and Insulin at Amazon.com today.

08 March 2013

The Cast of Islands and Insulin- Tony

The first time I mentioned that diabetes was getting the best of me, Tony made sure I could count on him.  He insisted that I call him anytime I needed to talk. He was the first person I met who expected more out of me than I had been giving to other people.

You can pick up your own copy of Islands and Insulin at Amazon.com today.

01 February 2013

An Excerpt from Islands and Insulin- The Final Installment


13 April 1996
La Jolla, CA

     The week after the struggle on the bike, I came down with another cold. One bad enough to really knock me on my ass. I had lived in La Jolla for three years and I suppose I should have had a doctor down there, but I was never sick so I never bothered.
     This cold however wasn’t leaving and I was frustrated with missing class just to sit on the couch and stare at the ceiling of our television-deprived living room. I had no problem missing class to surf or lay in the sun, but to miss class in order to do nothing was starting to wear on me.
     My roommate Christina was going up to Orange County to check out a grad school close to my parents house, so I thought it might be a good idea to catch a ride with her and grab some antibiotics from my doc back home to kick this stupid infection. My mom scheduled an appointment for the afternoon so she could take me in after she finished teaching her classes.
     We sat down in the small waiting room and waited.
     And waited.
     And waited.
     After about forty-five minutes, I approached the receptionist desk.
     “How long do you think it will be until I can see the doc?”
     “What’s your name?”
     “Erin Roberts.”
     “Umm. Let me see.” She flipped through her appointment book as a puzzled expression spread across her face. “It looks like we just brought a family of three back. They were actually in back of you.”
     “Really? So how long is it going to be now?”
     “Probably another thirty minutes?”
     “Thanks.” Back to my uncomfortable waiting room chair.
    When I finally did get to see the doctor, he was rushed and barely looked at me. He performed the usual checks for a cold, looked in my ears and nose, stuck a stick down my throat and persuaded me to say "Ahhhh." He concluded that with some antibiotics I would be fine. My mom then spoke up.
     She turned on her assertive mode, listing off symptoms. Thirst, lethargy, weight loss. It was the first time I had heard of my weight loss. It turns out I had lost fifteen pounds over the last month without even noticing.
     "I don't know how that's possible. I am eating all the time." I added.
     “You need to run some tests. It’s not just a cold,” she said.
    The doctor agreed to run a blood test to see if there was anything he was missing - mostly to assuage my mom and possibly cover his own butt by warding off a lawsuit. He said he’d call if anything showed up. 
     Christina came by late that night to pick me up for the long drive home. I took my first antibiotic and didn't give the doctor's visit another thought. I was feeling good enough to go to class the next morning. I even stayed awake through the whole thing. It was the first week of classes, so as was my custom, I tried to make a fresh start and show up to all of my classes for the whole week, a rarity for me at other times during the semester.
     I thought it was a bit unusual when my dad called two days later. My mom, the chatty one, would usually call. My dad only called when things were serious. “We got your blood work back,” he said.
  Based on my symptoms, the doctor suspected three diseases: diabetes, cancer or leukemia. My blood work proved it was diabetes. Given those three, I’d take diabetes every single day of the week. Please. No problem. Whatever I had to do, it would not be a problem. Not a single complaint would be heard.
     I was a proud girl, never one to show my weaknesses, hiding every crack in the facade. I was invincible, or at least that was the side of me I was willing to let show through. And that’s the face I chose to put on when the news came. It was the only face I was willing to let myself own at that point.
     It would take my parents a little over an hour to make the drive from Seal Beach down to La Jolla to pick me up and bring me back to the doctor. I wandered upstairs and packed a few clothes, my toothbrush and stuffed my biology books in my backpack.
    My roommates would have started a cry-fest if I gave them a moment, and I was in no mood for tears. So, I walked over to the boys’ condo on the other side of our complex to kill time. I knew they would be good for a few laughs and boy was I right.
    After about forty minutes, knowing my dad would probably be even more prompt than usual and not wanting to keep them waiting, I cruised back home and sat down on the couch waiting for my new life to begin.
    The first doctor’s appointment was a blur. The only words I remember were, “You have diabetes. Go make an appointment with an endocrinologist.” Why he couldn't tell me this over the phone is beyond me.
    We went straight from that appointment to one with Dr. Perley. His waiting room was full to the brim. And so once again we waited. I had no idea it would be the beginning of a lifetime of waiting hours on end to see doctors.
    My definition of a good day: Wake up and put on a bathing suit and shorts. If you can make it through the day without having to put on shoes or a shirt, it has been a good day.
So when I first saw Dr. Perley late that night in his white orthopedic shoes, I wondered how long it had been since he had had a good day. He talked slowly with my parents and gave me the Intro to Diabetes lecture. He had me practice giving insulin injections to an orange and then he handed me my own kind of death sentence.
    It was one of the only things that impacted me from that appointment. Maybe it was all the extra sugar circulating in my blood that was making me groggy or the whirlwind of appointments and information that come with a new diagnosis or maybe because the thought just shattered my concept of the world and my place in it.
    He told me that now that I was a diabetic I could never walk barefoot again. Flip-flops were definitely out of the question. From the moment I got out of bed in the morning my bare feet were never to touch the ground. Gone was the slightly gritty feeling of the deck of a sailboat beneath my feet and the feeling of sand sifting through my toes. No more hopping from white line to white line in the parking lot in the middle of summer to avoid burning my feet.
    My happy-go-lucky future was now strapped down and buried beneath my summertime nemesis, the dreaded shoe. I couldn’t even get away with going to my Plan B when society demanded some sort of footwear, the go-ahead, as Captain Jack calls them.
Lucky for me, I have a streak of rebellion running strong and wide. That one piece of advice I ignore. I ignore it just about every morning when I get up in the morning to feel the cold, always somewhat sandy, hardwood floor beneath my bed.
    I ignore it before every surf session while making my way across the parking lot and later on the sand with all its hidden glass-shard land mines. And I ignore it every time I throw on a pair of heels when I go out with Tony. Heels were also outlawed by Doc Killjoy because they might hurt my feet. How a man could outlaw heels is beyond me. Weren’t they invented and propagated by man after man after man?
    In this fight against diabetes you have to filter your advice carefully. You do your best and forget the rest. For me that was refusing to condemn my feet to the confining dark holes that we all call shoes.
    After shattering my world and making me assault a piece of fruit with a hypodermic needle, Dr. Perley sent me home with the instructions to shoot up with three units of regular insulin and three units of NPH, or neutral protamine Hagedom, a long-acting insulin. It didn't matter how much or little I ate for dinner or how high my blood sugars were at dinner, I was to take three and three.
    In the normal human body, the pancreas perfectly matches the amount of insulin it releases to the amount of food you have consumed. Diabetics try to do the same thing by reading food labels and estimating or measuring our food. We then run those numbers through a calculator in our brains or our insulin pumps and come up with a pretty good estimate of what we need to counter the food we eat.
    I suppose Dr. Perley thought this far too complicated to tell me before I left for the night. Even if he didn't trust me enough with that new calculation, maybe he could have instructed me to eat a certain amount of food so that he could have done the math ahead of time and told me to eat a turkey sandwich and an apple, for example.
    But instead he only told me to shoot up with three and three at dinner and then test before bed and call him with the results. He also gave me no indication that I should be taking more insulin if there was already too much sugar in my blood. Extra insulin is needed to tuck the sugar away into muscle cells.
    Most diabetics develop a sliding scale for this calculation. For me it is an extra unit of insulin for every fifty points above one hundred. So, if I am one hundred fifty, that's one unit. Two hundred gives me two extra units. There was no allowance for either of these most basic diabetes management tools.
    My parents thought it would be nice to go out for a little dinner, since we had all had a long day, and none of us had thought about eating through this whole process, one luxury I would not have again for a few years. We went out to the little Italian place near our house and sat to digest all of this new information.
    Lasagna and a hot fudge sundae were on the menu, and then we went home and fumbled through my first blood glucose test on my own. My dad and I had figured out enough in that small amount of time with the doctor to realize 533 wasn't a good thing. I was only 423 earlier in the doctor's office and they seemed concerned about that.
    My dad wrote it into my log and called Dr. Perley. He asked for my latest reading. My dad relayed the information and hung up. My mom asked, "What did he say?"
    "He said he would meet us at the hospital in fifteen minutes.”






31 January 2013

An Excerpt from Islands and Insulin- Second Installment


 10 February 2009
Carlsbad, CA

     My fifteen-year high school reunion is quickly closing in and the only thing I have done since high school is to spend the last decade or so being ordinary. I now drive a minivan, have two kids, spend my days as a teacher and live in a small house by the beach.
Not that any of those things are bad; I really am enjoying my life. But my life was supposed to be something bigger, filled with great adventures and travel. It should have great moments of glory, like climbing a mountain or sailing the Seven Seas. Maybe even a little professional surfing.
     I should have studied sharks and lived for months at a time on a research vessel. I might have my PhD. and teach at a major university. I would have done some great things. Instead I have become overwhelmingly average.
     Anytime the reunion comes up, this scene keeps playing over and over in my mind. I run into old friends and time and time again have to answer the inevitable, "So what have you been doing for the last fifteen years?" Surrounded by doctors and lawyers, UN representatives and CIA agents, I will have nothing to tell.
      My life is unremarkable. Nothing more or less than every other average American has accomplished. A few tables over a few guys from one of my classes will begin to chat. "Do you remember that girl who used to study with us in AP Chem?" the music manager will ask.
      "The one who never actually studied and barely stayed awake in class if she decided to get out of the water long enough to show up?" the C.E.O. will reply.
      “You know, I think she only came to study group to get us to do her work for her."
      "Karen or Mary or something—”
      "Erin. Erin Roberts." He takes a long draw from his beer. “Wasn’t she going to be a shark biologist or something?"
      “I think that was Plan B, behind pro surfer.”
      "She here tonight?"
      "Nah. Probably still out surfing somewhere."
      "What ever happened to her?"
     "Oh, she did the usual; grew up, got married, had some kids. She probably won’t show her face here tonight."
     That image has to change. I can't go out like that. I need to do something to make those guys finish their conversation with, "But she woke up one day, looked at the cards she had been dealt and stepped up to the table to bet."
    I have to find something big. And quick. Far too many years were spent muddling through the ordinary. Now is the time to do something grandiose. Or at least somewhere closer to grandiose than where I am right now. And I have to start planning it today.
     Saturday gives me a few hours off from Tony and the kids to find my favorite table in the courtyard of a market near the water in Cardiff by the Sea. On the table lies a book that I’ve been meaning to pour through, but I just can’t concentrate. My mind repeatedly wanders off into thoughts of what I can do to feel alive again, to leave behind the stone tied to my leg threatening to drown me.
     Diabetes has been holding me under for the last few years. In the beginning, diabetes was a minor nuisance. It was nothing. My self-care had become, just like the doctors and nurses told me it would, like brushing my teeth. But thirteen years in, it overwhelms me with responsibility and fear and depression and I need to do something about it.
     Growing up, I was always up for any sort of challenge. But now I am tempered, not wanting to push too hard. The fear and frustration of diabetes fences me in. It has slowly worn me out. I have to get back to the girl I was before all this diabetes shit started. The girl who feared nothing, except being weak. The girl who always accepted a challenge and was ready at any time to go on any journey that presented itself.
     Of all the journeys I could take on, the Australian Aborigine's walkabout intrigued me the most. When a boy is ready to venture into manhood he takes off on a journey to unite with the land of his ancestors, to prove that he has the skills and knowledge necessary to fend for himself. When he returns he has proven that he can be a valuable member of the tribe, one whom others can depend on and trust. He has had a spiritual experience that he can look back on as proof that he can handle whatever life throws his way.
     That is the kind of thing that I need. It has been twelve years since the diagnosis. Diabetic adolescence has hit. I have gone through the happy-go-lucky childhood days, when my pancreas was not entirely dead and would at least help to regulate my sugar levels a little bit. It evened out the highs and lows. Those years passed quickly and the next three years taught me more of what diabetes does to a person. I was more responsible and knew the power the disease had.
     The following six years brought on the usual teenage depression when everything was wrong and I was overly touchy about the subject. I am ready to move out of the teenage moody years and move on to adulthood when I can have a better outlook, more maturity and a healthy perspective on who I am because of diabetes, not in spite of it.
A walkabout looks like the perfect rite of passage to usher me into this new phase. The only problem is I do not have the Outback at my disposal and I wouldn't know how to survive in it even if I did. What I do know is the ocean. And in all its vastness and danger, it easily rivals the outback.
     The aborigine walkabout is done to merge with the land. The boy endures it and enjoys it, and it urges him to extend his capabilities as far as possible. I need something to allow me to become part of the ocean and something that would be just at the end of my grasp. I need a risky goal which calls for a major extension of my talent. A goal that I am not sure I can accomplish. One with an opening for the unknown to step in and test me.
     I need to go out to sea.
     Beyond the borders of the land, where my feet can no longer touch the shore, I can follow in the footsteps of my grandpa, Captain Jack, and sail into the horizon. I loved hearing his stories as a kid, and it is just about time I start stocking up on my own stories to tell my kids and future grandkids. To do this right, though, I need a long journey. And I need to do it alone.
     The stories of solo sailors have always engrossed me. My desire to solo was first stoked by reading Close to the Wind by Pete Goss, and Godforsaken Sea by Derek Lundy. They both tell the same story of the 1996-1997 Vendee Globe race. It is a grueling, four month sailing race that pits solo sailors against each other as they race 24,000 miles around the world. Most races have sailors drop out or lose their boats. Some lose their lives.
    In this particular race the competitors encountered a fierce storm in the Roaring Forties and Rolling Fifties, the latitudes around the bottom of the world where waves and winds whip themselves up, unencumbered by land to stop their growth.
    Raphael Dinelli was wrecked in the middle of the storm. His boat had sunk and he was holding on to life in his little raft amidst icy air and sixty knot winds that whip the sea into fifty foot waves. His life was being sucked right out of him.
    When Pete Goss heard the MAYDAY call he turned his boat around to sail into the hurricane force winds to save his competitor. He risked his life to head directly into the storm that he had spent the last two days trying to outrun. And he made that decision without hesitation. It is the way of the sea. When someone is in trouble you do everything you can to help.
     That was a tradition I wanted to be a part of and I wanted to do it alone. Shortly after finishing the book, solo sailing a long distance went on my Someday-I-Will list. Now is the time to take it off the list and place it firmly into reality.
     Now that the decision has been made to go sailing, I need to start planning. First on the list is finding a place to sail that is warm and safe. Warm because I absolutely hate to be cold and I love not wearing much more than a bathing suit all day long. Safe because I have a husband and a mother who tend to be scared by my adventures.
     I know they will be reassured if I stay in the United States. This leaves San Diego where I currently reside, which doesn't make for much of an adventure, or the southern portion of the Intercoastal Waterway in the Carolinas, Georgia or Florida. Captain Jack had come back from a trip down the Intercoastal Waterway and I loved hearing the stories he told. I would love to follow in his wake.
     On the Intercoastal Waterway, I need to find someplace that has natural boundaries so that my starting and stopping points don't feel arbitrary. After a quick glance at the map, I decide on the Florida Keys. One hundred miles of warm water, plenty of islands to navigate by sight, and a very end-of-the-road feel. You can't get much more southerly than Key West.
     I need at least a year to prepare for a trip like this. One of the many benefits of being a teacher is three months off in the summer to adventure. Next summer should be a great time to go.