Studying At Sea with T1D

February 13, 2018
Rachel Hemond
Middlebury College
Rachel attends Middlebury College in Vermont, where she studies molecular biology and biochemistry on a pre-medical track. Her goal is to find a balance between a passion for the rough edges of the outdoors and the smooth cleanliness of a lab bench, blending the wonder of summit views and an understanding of the mechanisms of a complex chemical reaction. She is preparing to solo hike the entire Appalachian Trail, from Georgia to Maine.

Thirty-five glucagon. Thirty-five. I’d heard the hesitation in my endocrinologist’s voice as she prescribed them, wondering what sort of mess I was getting myself into this time around. I’d seen the skepticism on the face of the pharmacist who handed over the bag full of the red containers and the unasked questions.

I didn’t care. If carrying around an extra backpack stuffed with syringes, Omnipods, CGM kits, and test strips was the cost for my impending adventure, I would gladly pay it. After all, how many people get to spend a month sailing across the deep, open waters of the Atlantic? How many people get to experience the boundless joy of hanging from the rigging of a tall ship, or of swimming a thousand miles from the nearest land?

And among those limited few, how many of these were a type one diabetic?

Well, judging by the worry of my parents, endocrinologist, and the medical board of my study abroad program, not many. Now, my family and doctors are used to this sort of thing; I have a (in my opinion, wonderful, in their opinion, stress-inducing) habit of running off to the remote corners of our world, out of contact and certainly out of range of a quick hospital visit. So, in addition to being pretty good at finding these adventures, I’ve also gotten really, really good at planning.

Before I left on SEA Semester, I made lists. I made lists of supplies I needed, of people to call, of paperwork to fill out; I made lists of the lists I needed to make. I counted and recounted, packed and repacked, making sure that I had total redundancy of everything I could possibly need. I revived prescriptions for insulin syringes, since I’ve used a pump for the past six years. Did I remember how to give myself a shot? I hoped I wouldn’t have to find out – the irony of a diabetic who’s scared of needles.

“So when the time came, I put all my supplies into a watertight bag, took a few steadying breaths, and boarded the beautiful SSV Corwith Cramer.”

When it comes down to it, there’s only so much preparation you can do. The best laid plans of mice and men, and all that jazz. So when the time came, I put all my supplies into a watertight bag, took a few steadying breaths, and boarded the beautiful SSV Corwith Cramer. Only to realize an hour or so later that I’d left all my insulin on shore. Yikes? Fortunately for me, we hadn’t gotten underway yet, and a few slightly panicked phone calls brought my insulin back to me. Somewhat chagrined (wasn’t I supposed to be on top of all this?) I decided to do better, to have perfect control, and to be a model diabetic.

I’m sure all you type ones out there know exactly how well those resolutions tend to go.

To start off, life at sea isn’t easy, even if you don’t have to fill in for your malfunctioning pancreas. You rotate through being on watch; after six hours of setting and striking sails, steering, checking the engine, keeping lookout on the bow, and generally taking care of the ship, you get twelve hours off to take care of yourself. So you may be awake from 1am to 7am one day, eat breakfast, sleep until lunch, go back to sleep for the rest of the day, then be woken up for watch at 7pm. By the time you are relieved (at 1 AM , of course) there is little room in your confused mind for anything other than rolling into your bunk… until your next watch begins. So while meals are served three times a day, with snacks between each, there’s no guarantee you’ll be awake for them; I got into the habit of sleeping through meals just to get a full night’s sleep.

Fortunately, in addition to the hoard of gummies that I’d brought on board, snacks of ramen, cereal, and leftovers were always available. But while this set up was ideal for those whose pancreases could keep track of such an odd schedule, my pump system didn’t stand a chance. Add to that the seasickness of the first week, a rockin’ three day storm, the stress of doing schoolwork in the midst of all of this, and some roller-coaster blood sugar days felt pretty justifiable. For a week, I was just going with whatever came my way, wondering what on earth had driven me to choose this as a semester abroad while my friends were off enjoying Oktoberfest. but one day, I woke up with my blood sugar perfectly at 100; a check of my CGM showed me it’d been stable overnight. I ate breakfast and went on deck, greeted by the first blue skies we’d seen in days. Cheesy as it might seem, the literal storm passed as my roughest blood sugars did. Fair winds and following seas, as the saying goes, had found us at last.

Of course, I still wasn’t perfect. There were a few watches where I put myself on lookout, standing alone in the bow of the ship with my eyes on the horizon, grouchy from a sky-high blood sugar and not wanting to snap at my shipmates. Once, in the middle of striking a sail before an oncoming squall, my blood sugar plummeted and I found myself stuffing gummy bears into my mouth with one hand while coiling a line with the other. Temp basals were set, ratios adjusted, and countless Skittles were eaten -but at the end of the 3,100 mile journey, deep in the corner of my bunk, the thirty-five glucagon remained, completely untouched.

So if you hear the ocean calling, don’t be afraid to answer. Fill your bags with twice as many supplies as you could possibly use (including tech-free options like syringes and vials of insulin), stuff gummies or sugar tabs or Skittles into every inch of free space you have left, and bring as many glucagons as your endo tells you to – but leave space for less tangible things as well. You’ll need to be flexible and adapt to ever-changing circumstances. Be willing to be patient with blood sugars that simply cannot be as well-controlled as they were ashore. Don’t panic at every low, or spend the hours following a high blood sugar angry and frustrated; they happen, and they’re always so inconveniently timed, but you can learn from each one. See if serious sail-handling caused that low, or if the midnight snack of ramen and peanut butter shot your blood sugars through the roof. Then, the next time you’re scavenging for a late-night-meal, adjust your bolus accordingly.

“Don’t panic at every low, or spend the hours following a high blood sugar angry and frustrated; they happen, and they’re always so inconveniently timed, but you can learn from each one.”

But as the rocking of the ship and the cycles of watch become a routine, the temporary basal increases and decreases become just as natural, and you can fend off a low because, well, they always tend to sneak up around 3AM on dawn watch. And while I’m not saying you should forget about your blood sugars, remember that while you’re on board, you are first and foremost a sailor, charged by the wind and the waves and the stars to keep on track in a trackless sea. There’s a metaphor about managing your diabetes in there somewhere, but you might just have to set sail yourself to find out what it is. Fair winds and following seas to you all!

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