Sailing with Diabetes

Recently diagnosed with Diabetes and placed on insulin. Curious to hear from others in this situation. Do you have significant worries about being alone on the water and having an insulin reaction. I sail offshore a lot but worry about doing so now, especially alone.

Can you eat just before setting sail and typically feel safe?

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Greg

2016 AI - Spinn & Jib

“Out of sight of land the sailor feels safe. It is the beach that worries him.”
– Charles G. Davis

Greg, I have type 2 diabetes, I only take a small amount of insulin (4 in the morning, 10 in the evening of Lantis), so your situation could be completely different. Best to talk to a GP or the pharmacist, and get some commonsense advice. It may be as simple as taking a bag of lollies out with you.

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Tony Stott
2012 Tandem Island "SIC EM" with Hobie spinnaker

Hoping you would respond Tony. I'm Type I , adult onset. At this point I am taking just a basal insulin too. Being a veterinarian, I understand the medical side of this disease well. But I was curious what real world precautions others with Diabetes take when sailing. My doctor said I could reduce my insulin dose the days I sail offshore. I think I need to do that to play it safe. I need to sail with buddies, eat before going out as well as periodically while sailing. I hate to give up something I enjoy so much. Just don't want to drift out to sea, slumped over in my boat. But hey, what a way to go!

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Greg

2016 AI - Spinn & Jib

“Out of sight of land the sailor feels safe. It is the beach that worries him.”
– Charles G. Davis

Gregg have you considered carrying some oral glucose gel ? It's a simple, reliable dose of glucose that's more convenient to keep close by on the boat than food for an emergency. It's a lot easier for someone to administer and for you to take if you are semi conscious.
It's what Firefighters carry on their trucks and administer as EMTs. It survives the harsh environment of a fire truck in Texas and would be fine in the hatch. Also, I just wanted to suggest that you have a medical alert tag somewhere easy to find. If you are found unconscious Fire\EMS will check your blood sugar but it's helpful if they have a heads up that you are diabetic. And tell whoever is sailing with you that you are diabetic and what to do if you become hypoglycemic. Be extra vigilant about heat exhaustion and your potential increased sensitivity. I really like taking frozen 16 oz water bottles during our hot summers.

Chris

I love this forum!

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Tony Stott
2012 Tandem Island "SIC EM" with Hobie spinnaker

Thanks Chris. Ordered some medical tags and glucose gel today. Just started on insulin 3 days ago and not really sure what an insulin reaction is going to feel like. Most importantly, will I be aware that it is happening and have a clear enough head to do something about it.

Still planning to do the Texas 200 unless I have trouble regulating. I have some concerns about the heat. Plan to stay well hydrated and eat at regular intervals. When several of us first agreed to do this, I suggested we stay close by each other. My intent was to provide safety for them. Now it looks like I need the protection. Funny how things work out.

Tony, have you ever had a reaction while sailing? Do you have time to react to it?

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Greg

2016 AI - Spinn & Jib

“Out of sight of land the sailor feels safe. It is the beach that worries him.”
– Charles G. Davis

Greg there are warning signs, I think people get into trouble when they don't pay attention to what their body is telling them and proceed past the point of being able to make the right decisions. It's also possible to have rapid onset hypoglycemia that is exercise induced but I don't think of sailing my boat as intense exercise.
Early onset you can expect shakiness, irritability,anxiety,fatigue, dizziness, sweating, hunger, tachycardia followed by confusion, headache and inability to concentrate or lack of coordination. So it's a gradual process in the sense that if you are paying attention to the early signs/symptoms you can avoid the later ones.
I was a Medic and Volunteer Firefighter/EMT before that. As an EMT we could only give oral glucose and sometimes it was a challenge because some mild to moderately hypoglycemic patients were irritable and didn't want to take the not so great tasting glucose. It's helpful to just get some glucose in the mouth to be absorbed through the mucosa, useful for your sailing companions to know. But I would think of the glucose as a backup safety device and use food to keep your sugar stable.
Your primary doc should be able to give you a lot more extensive advice than I can with my limited medical training but if it were me I would get acclimated to taking insulin along with a low risk physical activity just to see what I could tolerate. And it's very beneficial to do aerobic and weight bearing exercise if you are diabetic.
There are plenty of elite athletes that are diabetic and manage just fine.
Chris

Great advice. I'm glad you brought this up. Personally, I would keep close to shore for a few weeks. At least until your body adapts and your doc has you stable with the right med and doses. It can takes weeks or months to figure that out.

The med Alert id tags are a must, as is REAL float plan. And a leash-at all times.

Out on the water, watch for vision changes and nausea, among the other symptoms. You can advise the coast guard of your location, course and condition whenever you start to feel sustained symptoms offshore. Do 15 minute updates till you're out of the woods. There's no harm in that. If you start to have trouble communicating, they will pick up on it.

One thing is sure, you'll have a hard time checking your actual sugars out there, so self awareness and prep are important. As a doctor, and a good sailor, you know that even on a good day, being offshore in our boats is more stressful than it appears. Our bodies are regulating temperature, vision, equilibrium and other systems to deal with harsh conditions. Meanwhile, our monkey brains are screaming at us to "find land, dammit! Find land!"

So extra rest and hydration are needed before launching, even when you aren't competing.

Another certainty is that it's exceedingly difficult to help a disabled sailor or stop a runaway boat from another sailboat. It's best done by a powerboat crew with extra hands on board. (Although a TI pilot with a good mate can manage it at times). Done wrong, it can easily lead to a capsize and trouble for both boats.

I really like your awareness, your boat mods and your attitude about this. Thanks for posting this subject to the group, so all of us, with or without serious medical conditions, can think about it.

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The Wind Is Your Friend...

Hi Vetgan, I'm type 1, adult onset and have continued to sail for more than 15 years--offshore including single handing races to islands in 30 kt breeze.

I've used both multiple shots (basal and bolus) and currently use a pump which (IMO) offers the best solution for insulin dependent diabetics as you can change your basal rate while sailing. While my current pump is not waterproof, I put it into a drybag and hang it around my neck.

I carry sugar with and on me. It is best to use the sugar even if you aren't sure you are hypo...hypo is sometimes disguised while on the water since you are excited. My sugar of choice are those chewable tablets or "smarties".

I do not check bg while sailing unless I'm going to be out for more than 4 hours. I don't typically carry my meter unless it will be an extended trip. I do check bg prior to leaving shore and use that reading to determine whether or not to eat right away.

For me (and diabetes is definitely one of those conditions that is personal) I usually eat a small meal and have a couple beers while out--not light beer--the beer has carbs. The small meal is usually something like a half sandwich and apple and I eat it at my normal lunchtime. Recently I have been eating an aussie bite or half of a "meal to go" (meal to go is a recent product that offers a balanced (carbs, protein and fat) and good tasting quick food). I do not bolus for this meal and check my bg as soon as possible after the sail to bring my bg back down.

I've been type 1 for 22 years now...contact me off-forum if you have questions, concerns or just want to converse with someone in the same boat.

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R/Thom
SeaRail 19
Triak
BMW C600
Formerly Getaway with Custom Spinnakers
Formerly raced F24 Mk II

I'm type 2 insulin dependent, and have had some crash episodes, the paramedics just had me drink a coke.
I do carry those little carb packs with me, I also typically also just pack a can of coke in my cooler along with the normal 4 bottles of water just in case. Being diabetic we typically lead a pretty steady life style mostly eating the same foods and try to stay safe. The monkeywrench in the mix is heavy exertion (like sailing and pedaling my ti all day), this throws all my numbers off (out of my norm).
For me anyway this puts any multiday adventures involving any type of primitive camping out of the question for me anyway.
However this doesn't mean I can't do 50-60 milers (we do them often), the whole key to that is having your boat rigged to be capable at more than the 3mph typical speeds the stock boat was capable of in the typical conditions we encounter around here. Basically If I can get someplace and back in a day I'll go for it. As long as we have our RV or a hotel to get myself back on track, and a good nights sleep, I can do it all again the next day (what we typically do).
Just call me daysailer Bob (lol).
Even with all my health restrictions I still have a blast everytime out.
FE

I can't thank all of you enough.

FE, when you had your reactions, could you not feel them coming on and did you not have something available to take? What I want to understand is what keeps us from taking something on our own accord and self treating? I'm sure I'll understand this soon enough. Do we go into a kind of denial or do we loose the ability to reason and react so fast (within minutes?, seconds?) that we just don't? Or is this a situation where you react and take a sugar product but it takes too long to improve your blood sugar?

Sorry with all the questions, my dad had diabetes and he had many reactions in his lifetime. This is why I seem a bit overly concerned.

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Greg

2016 AI - Spinn & Jib

“Out of sight of land the sailor feels safe. It is the beach that worries him.”
– Charles G. Davis

You will find out that hypoglycemia will occur suddenly and oft times with no warning. Typically it occurs when your insulin bolus is at its max effect (for my Humalog it is 2 hours after administration). There is a step change in the way you feel. You can be fine and feel normal with your bg at 71 mg/dl; at 69 mg/dl you may feel a little light headed but you might shrug that off as excitement...at 45 you could go into a coma--happened to me as I was reaching for another glucose tablet. Also, some people have hypoglycemia unawareness...those unfortunates are not typical, but they exist and those folks carry glucagon kits (I carry one myself). If you are busy it is easy to miss the early signs of hypoglycemia.

I'm not saying this to scare the wits out of you or make you frightened to leave shore. But it is important to know how your bg is affected by foods and exercise, fresh air and sailing, and especially your insulin intake. If you haven't seen an endocrinologist, see one. Testing your bg is your best friend. You need to know 1) how much insulin bolus drops your bg -- typically it is 1 unit drops your bg by 25 mg/dl unless you have insulin resistance; 2) how much carbs raise your bg (typically it is around 13 grams of carbs raises bg by 25 mg/dl); 3) how 'fast' do sugar carbs raise your bg (sugar raises my bg to get out of hypo in about 15 minutes); 4) what is your basal rate at different times of day and how it changes when you are sailing. Basal rate is how much insulin your body needs and it is related to your metabolic rate. As a type 1, you don't have the "buffer" effect that type 2s have (their pancreas' still work). This is important as your basal insulin is constantly putting insulin into your body, if your metabolic rate increases you will need LESS insulin (counterintuitive, I know) per hour which is why your dr told you to take less insulin for sailing.

If you actually get to know those things, you can have confidence that you will be "OK" while sailing. It takes experience and perseverence, but you can do it. Suggest you test 6 times a day for a week or two. prior to every meal and 2 hours after every bolus. Yah, your fingertips will feel like pincushions.

I'm not an endocrinologist; but I've seen enough of them to know what they'll ask you to do. Suggest you do get an endocrinologist, though. I did work in the medical device field and was COO of a testing company that routinely did effectiveness testing of insulins and glucose monitors so I do know a little more about it than even some endocrinologists (which pisses my endo off, but that is another story).

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R/Thom
SeaRail 19
Triak
BMW C600
Formerly Getaway with Custom Spinnakers
Formerly raced F24 Mk II

As I said above, I love this forum.... we just got our money's worth right here. I never knew any of this stuff, probably because being a type 1 diabetic, nobody bothered to tell me

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Tony Stott
2012 Tandem Island "SIC EM" with Hobie spinnaker

Yeah I would say so. That was just the in formation I needed. Thanks tpdavis473. I'm just on a basal insulin as I start out. So the risk of hypoglycemia for me now is less. I am transitioning from type 2 to type 1 adult onset. Anyway, I feel great now that I'm on insulin and seem to be doing well. Can't say that I am not nervous about being in the Texas 200, I am. I don't want this to stop me though and I'm optimistic that I'll be ready.

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Greg

2016 AI - Spinn & Jib

“Out of sight of land the sailor feels safe. It is the beach that worries him.”
– Charles G. Davis

If you are only taking basal insulin...divide the number of units you are taking by the number of hours between doses (or total number of units per day by 24). That's what your DR is guessing is your basal plus bolus rate. Let's guess 96 units a day (probably too high, but it divides by 24 easily). That's 4 units per hour. That is the "goes in". Let's say you use 20% more energy while sailing than not. So you will only need 3.2 units per hour. Rather than cut back on your basal dose, you might try eating 1 unit per hour which is about 13 grams of carbs or about 3 glucose tablets or one beer. You will probably find your bg is higher a little when you get back to shore, but that's better than going hypo.

Knowledge is power with diabetes. The more you know about how your body reacts (to foods, insulin, exercise) the more confident you can be. Everyone is different so you need to find out stuff...and (unfortunately) you have to keep checking what you find out because as you age, as seasons change, if you get sick, as your emotions change (seriously, having a fight with my wife is life threatening in more than one way )...it is a lifelong study.

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R/Thom
SeaRail 19
Triak
BMW C600
Formerly Getaway with Custom Spinnakers
Formerly raced F24 Mk II