Clipper Round The World

[dwatkin]

Calling all sailors !

I've signed up to one Leg, the Atlantic of the Clipper Round the World Race. I could do with some advice regarding offshore sailing and managing Type 1 diabetes.

Although I've done half of the training I had some specific questions what, most likely other sailors have considered and answered. Specifically:

1) How have you coped with the sudden and unpredictable surges in energy consumption required by, for example a mainsail reef or changing a foresail? In the heat of racing it is easy to forget to pre-load with carbs and weight limits are scarce but handy to know what carb supplements are light weight, water proof and fast acting.

2) Has anyone any experience of coping following an abandon ship into a life raft when resources are scarce including carbs needs to prevent low blood sugars.

3) Sea sickness appears to be the biggest danger. Fortunately I've never suffered but it is inevitable in a life raft. How does one cope with losing the vital carbs.

4) Waterproof covers for freestyle libre readers would be handy !

I'm sure there are plenty of other questions I would have but I would really appreciate advice from others who may have done the same or similar races.

David

 

[Guzzler]

@Antje77 may have some pointers for you though I can't remember if it is a full sail vessel he sails on.

Good Luck, what an adventure!

 

[Scott-C]

Wow, that's going to be an amazing adventure @dwatkin !

Raced around in Graduates, Lasers and 470s in my younger years, and some keelboat stuff too, but never too far offshore - there's no pubs out there!

I'd get a few bottles of Glucojuice in, about £1.50 from Boots, quite expensive so I just use them for emergency hard drops. 15g of veeery fast acting neat glucose, a small bottle so easy to tuck a few away in pockets.

Not sure how to deal with the liferaft situation - most of them are prepacked, so maybe worth checking if you can have access to pre-store kit in it. If not, maybe do a Heath Robinson gig, and tie some kit on to the outside in a waterproof grab bag or just make sure you've got a grab bag on yr person at all times. Provided it's undercover out of direct sunlight, it'll be fine.

Not sure if you're pump or mdi? With pumps, the obvious danger is that as you're not using a separate basal, you'll go dka very quickly if on a raft if the pump is detached/breaks, so I'd definitely have a lantus or whatever pen on the raft and some fast acting too.

I prefer to run at around 5 most of the time, but I was in your shoes, I'd maybe be tempted to stay closer to 8. For the couple of weeks it'll take, that's not too high to cause any real damage neuropathy-wise.and gives a comfort zone well away from hypos.

I'd also be seriously tailing back my doses - even during quiet spells, the rocking of the boat will mean your muscles are tensing to maintain balance, and that alone will get the glut4 - glucose transporter 4 - in your muscles working to use glucose independenly of insulin, so that'll have an impact on how much insulin to use.

Good luck, mate, just goes to show what T1s can do when we put our minds to it!

 

[DCUKMod]

Calling all sailors !

I've signed up to one Leg, the Atlantic of the Clipper Round the World Race. I could do with some advice regarding offshore sailing and managing Type 1 diabetes.

Although I've done half of the training I had some specific questions what, most likely other sailors have considered and answered. Specifically:

1) How have you coped with the sudden and unpredictable surges in energy consumption required by, for example a mainsail reef or changing a foresail? In the heat of racing it is easy to forget to pre-load with carbs and weight limits are scarce but handy to know what carb supplements are light weight, water proof and fast acting.

2) Has anyone any experience of coping following an abandon ship into a life raft when resources are scarce including carbs needs to prevent low blood sugars.

3) Sea sickness appears to be the biggest danger. Fortunately I've never suffered but it is inevitable in a life raft. How does one cope with losing the vital carbs.

4) Waterproof covers for freestyle libre readers would be handy !

I'm sure there are plenty of other questions I would have but I would really appreciate advice from others who may have done the same or similar races.

David

Oooooh,......... What a great adventure. I'm not T1, so my experiences don't include insulin or hypos.

How much sailing have you done in the past? To be honest, whilst you cite seasickness as your greatest danger, I assume you mean for yourself and your wellbeing, as opposed to in general terms ?

I imagine you will want your crewmates to understand a little about your diabetes and what to do in a crisis situation. In your shoes,I'd consider making laminated cards of instructions for simple hypo treatments and what you routinely use, and where it is stored. In tense situations minds go blank, and although I'm sure there will be efficient medcial support, it's best to make things easy.

I don't know what your storage limitations are, but they will be limited, for sure, but I imagine you would want to ensure you always have your supplies on hand.

There are load of gadgets and waterproof stuff out there. For example, a simple phone pouch could work for your Librre reader. Something like this: https://www.amazon.co.uk/YOSH-Water...d=1555863434&s=electronics&sr=1-2-spons&psc=1

Once you start looking you'll be surprised about your options.

I adore passagemaking, but I adore passagemaking at night even more!

 

[Antje77]

Thanks for the tag, @Guzzler
I do have a couple ideas for you, @dwatkin , although I don't have ocean experience. But I just came home after 3 days of sailing with 20 people and I'm so tired my brain doesn't work right now. I'll come back tomorow!

 

[Antje77]

Brain is much better today, so here are my thoughts. Your plan sounds like a wonderful adventure! Here's what I do, to show you the differences and similarities of our situations:
I sail the lakes and coastal waters of the Netherlands on historical sailing ships with 10 to 30 tourists. We usually visit a harbour or throw anchor every night. We are with only 2 experienced people, the captain and the mate, the rest are expected to help with the sailing but don't know anything about it so all activities are guided by us, no room for skipping due to a hypo when something has to be done NOW. I use Libre.

1) How have you coped with the sudden and unpredictable surges in energy consumption required by, for example a mainsail reef or changing a foresail? In the heat of racing it is easy to forget to pre-load with carbs and weight limits are scarce but handy to know what carb supplements are light weight, water proof and fast acting.

I prefer sweets I actually like to eat for hypo's, but with everything wet that doesn't work. Fluids are easier because they are in a bottle. I'd go for undiluted lemonade, way more carbs than coke or juice so you need much less of it and you can keep a small (plastic is lightweight) bottle in your pocket and refill from the big plastic bottle you keep below deck. You can even use it when water is pouring over you during a foresail change, a little dilution by seawater won't hurt you and as it tasted horrible to begin with it doesn't matter that it now tastes a bit salty as well
Bananas are great for keeping you going a bit longer, and again easy to eat or keep in your pocket when there's no possibility to cook. And yes, they're heavy but also nutrient dense so no different from other foods on board.
Scan every time you're wanted to do something and pop something in your mouth on your way to the job if on the low side. That's how I deal with the unexpected surges. This only works if you have something in your pocket to use of course!

2) Has anyone any experience of coping following an abandon ship into a life raft when resources are scarce including carbs needs to prevent low blood sugars.

3) Sea sickness appears to be the biggest danger. Fortunately I've never suffered but it is inevitable in a life raft. How does one cope with losing the vital carbs.

This one is really difficult. Fortunately you run more risk of having a car accident on your way to the airport than of having to abandon ship. Still, it's good to be prepared.
Undiluted lemonade again. Small sips are more likely to stay down than a whole bottle of lucozade. Only keeping it in your mouth helps as well, as the lining of your mouth absorbs glucose.
When being seasick, really seasick, people can get very close to wanting to die and very apathetic. Last year a Dutch sailor died from DKA following seasickness because he didn't take insulin because he couldn't eat and couldn't bring himself to test his bg (which would've told him his bg was dangerously high). Somehow he didn't know or forgot that he still needed his long acting, and he hadn't told his partner much about his diabetes.
So even when you only want to curl up and not think, you need to test and inject. Make sure you show others how to work your libre reader and bg meter.

4) Waterproof covers for freestyle libre readers would be handy !

I scan with my phone and I use a cheap waterproof cover, scans right through it. I've used freezer bags as well. Should work the same for the reader.

- Spares: Take double everything. Insulin (maybe triple), bg meters, activated(!) phone app in addition to your reader, spare sensors. If on a pump, take pens as well and make a plan for how much long and short acting you think you need.
- Grab bag: There will be a grab bag on board in case of abandoning ship. See if you can add insulin, meter, glucose and glucagon to it. You might not have time to get your own stuff. If not, keep your own grab bag with the central grab bag and make sure they know you'll die without it.
- Glucagon: teach someone how to use it.
- Sensor: I'd start a new sensor 2 days before leaving. A faulty sensor is not something you can use on board. When hands have been wet for hours it's impossible to do a fingerprick, you'll want to know you have a working sensor before getting wet.
Use Tegaderm over your sensor.
They won't like you washing hands with drinking water before testing. That's fine, the salt won't affect the reading (I tested that this weekend) and there's no need to wash hands when having handled sail and ropes, they'll be very clean
- If expecting warm weather, use frio bags or such for your insulin.

Have a wonderful trip, and expect none of your precautions to prove needed

Bonus: I found the best place to inject when wearing sailing gear the very top of my stomach. Use clothes with zippers, unzip coat and pullovers just a little, stick pen in the resulting hole and inject through shirt.

 

[Deleted Account]

@dwatkin Clipper sounds amazing. I have a friend who did a few legs about 10 years ago. She hadn't sailed before and now it is nearly impossible to keep her off a boat. That may also be because she made some great friends during her Clipper.

I have little experience of sailing having only sailed across the Channel and around some of the Croatian Islands on much smaller boats than you will be on (I sailed in 6 berths).
However, I did experience seasickness during my force 8 crossing of the Channel. I made the mistake of eating a carb heavy meal before I boarded the boat when I knew it was going to be rough. As a result, I had taken a lot of insulin and then didn't digest the carbs which lead to hypo on top of seasickness and difficulty in keeping anything down. Another consequence of the rough seas was I was unable to balance to safely inject my basal. The high unused bolus and lack of basal for a night are not something I would recommend but they seemed to balance each other out during the 6 hour crossing (not only was it rough but the tide and winds kept blowing us off course making it a long night).
The lesson I learnt from that was to never eat a heavy carb meal if I am going sailing, especially if I expect rough seas. I don't know if lower carbs is possible on your boat or whether pasta is so convenient that it will be the main ingredient for most of your meals.
The other thing I now know is that it is much easier to bolus with a pump when you are bouncing up and down.

 

[DCUKMod]

In my experience of passage making, there should be lots of pasta around as it keeps for an age and can be well disguised in a multitude of sauces and combos.

If you are doing the TransAt, first leg, you'll likely have alimited amount of fresh produce onboard, so there'll come a point when things like fruit are just nit likely to be available. Having spent lots of time in the Windward Islands, which are often the land point from TransAts (St Lucia usually lands the ARC), those coming off a long passage will often just want lots of fruit and anything fresh!

With your timing you might well spend a bit of time in foul weather gear, which you may or maay not have done any training in. I detest foul weather gear, and when we sold our boats last year, I was very happy to put those babies on eBay. To be fair, I'd not needed to wear them "in anger" for years, having concentrated on the Tropics.

Hypo treatments are your own choice, but as well as @Antje77 's suggestions, I'd consider something in tubes you can just bite the end off. Cold, wet hands might make taking caps off bottles harder.

I don't know if you will be taking a form of first aid kit for yourself, but I would probably suggest you have some stuff in the yacht's first aid kit, with specific instructions. Personally, I'd have "my" stuff in a sealed bag, so that they don't get lost while someone's rummaging for an Elasoplast.

Exciting times!

 

[membrew]

Wow, that's going to be an amazing adventure @dwatkin !

Raced around in Graduates, Lasers and 470s in my younger years, and some keelboat stuff too, but never too far offshore - there's no pubs out there!

I'd get a few bottles of Glucojuice in, about £1.50 from Boots, quite expensive so I just use them for emergency hard drops. 15g of veeery fast acting neat glucose, a small bottle so easy to tuck a few away in pockets.

Not sure how to deal with the liferaft situation - most of them are prepacked, so maybe worth checking if you can have access to pre-store kit in it. If not, maybe do a Heath Robinson gig, and tie some kit on to the outside in a waterproof grab bag or just make sure you've got a grab bag on yr person at all times. Provided it's undercover out of direct sunlight, it'll be fine.

Not sure if you're pump or mdi? With pumps, the obvious danger is that as you're not using a separate basal, you'll go dka very quickly if on a raft if the pump is detached/breaks, so I'd definitely have a lantus or whatever pen on the raft and some fast acting too.

I prefer to run at around 5 most of the time, but I was in your shoes, I'd maybe be tempted to stay closer to 8. For the couple of weeks it'll take, that's not too high to cause any real damage neuropathy-wise.and gives a comfort zone well away from hypos.

I'd also be seriously tailing back my doses - even during quiet spells, the rocking of the boat will mean your muscles are tensing to maintain balance, and that alone will get the glut4 - glucose transporter 4 - in your muscles working to use glucose independenly of insulin, so that'll have an impact on how much insulin to use.

Good luck, mate, just goes to show what T1s can do when we put our minds to it!

 

[membrew]

David

I asked my neice Caroline for some information seeing as she did the whole race on a Clipper a couple of years ago. This is what she said.

I would tell him not to worry about the weight as he has the perfect excuse to bring additional bits onboard. The boats weigh a ton so a few extra snacks won’t make that much difference. My advice is to get involved in the victualling as otherwise he’s unlikely to be catered for. Remember he will be at sea for 4 plus weeks on the first leg or maybe only 2.5 weeks if doing leg 2 and needs to bring enough for the whole time.
Also if he is involved with the victualling he has something to put in the grab bag for a life raft. I would like to point out that in 22 years no one has had to get into a life raft!
He can also use the race Facebook page that they will be on or the alumni page, Clipper Race Yacht Clipper to ask the question about seasickness as I’m sure someone has come up against it on Clipper in previous races. Maybe even his doctor can provide some advice?

It was also suggested that you ask ther Personnel Officer
Hope this helps. Have a safe trip. membrew. 24/04/2019

 

[Robinredbreast]

Wow that's amazing and very exciting too. I just wanted to wish you all the very best and good luck

 

[dwatkin]

Dear all. Firstly an apology. I foolishly assumed I would get a notification of some kind when someone kindly sent me an email and I didn't see the great advice given here.

Thanks so much to everyone for spending time to help me. I will certainly be taking advantage of others experience and it's great timing with 28 days to go I'm putting the final touches to my packing list including a grab bag, glucojuce, dextrose, anti nausea tablets and patches and of course insulin in a frio pouch.

 

[dwatkin]

Wow, that's going to be an amazing adventure @dwatkin !

Raced around in Graduates, Lasers and 470s in my younger years, and some keelboat stuff too, but never too far offshore - there's no pubs out there!

I'd get a few bottles of Glucojuice in, about £1.50 from Boots, quite expensive so I just use them for emergency hard drops. 15g of veeery fast acting neat glucose, a small bottle so easy to tuck a few away in pockets.

Not sure how to deal with the liferaft situation - most of them are prepacked, so maybe worth checking if you can have access to pre-store kit in it. If not, maybe do a Heath Robinson gig, and tie some kit on to the outside in a waterproof grab bag or just make sure you've got a grab bag on yr person at all times. Provided it's undercover out of direct sunlight, it'll be fine.

Not sure if you're pump or mdi? With pumps, the obvious danger is that as you're not using a separate basal, you'll go dka very quickly if on a raft if the pump is detached/breaks, so I'd definitely have a lantus or whatever pen on the raft and some fast acting too.

I prefer to run at around 5 most of the time, but I was in your shoes, I'd maybe be tempted to stay closer to 8. For the couple of weeks it'll take, that's not too high to cause any real damage neuropathy-wise.and gives a comfort zone well away from hypos.

I'd also be seriously tailing back my doses - even during quiet spells, the rocking of the boat will mean your muscles are tensing to maintain balance, and that alone will get the glut4 - glucose transporter 4 - in your muscles working to use glucose independenly of insulin, so that'll have an impact on how much insulin to use.

Good luck, mate, just goes to show what T1s can do when we put our minds to it!

Scott, many thanks. I'm using penfill injections and so on my person I will always have Fiasp rapid acting and my grab bag with have my 'next' set of pens so I'll.always have a weeks worth in them. Definitely going to run high, over the 5-6 weeka sit won't cause me harm. Thanks again.

 

[dwatkin]

Oooooh,......... What a great adventure. I'm not T1, so my experiences don't include insulin or hypos.

How much sailing have you done in the past? To be honest, whilst you cite seasickness as your greatest danger, I assume you mean for yourself and your wellbeing, as opposed to in general terms ?

I imagine you will want your crewmates to understand a little about your diabetes and what to do in a crisis situation. In your shoes,I'd consider making laminated cards of instructions for simple hypo treatments and what you routinely use, and where it is stored. In tense situations minds go blank, and although I'm sure there will be efficient medcial support, it's best to make things easy.

I don't know what your storage limitations are, but they will be limited, for sure, but I imagine you would want to ensure you always have your supplies on hand.

There are load of gadgets and waterproof stuff out there. For example, a simple phone pouch could work for your Librre reader. Something like this: https://www.amazon.co.uk/YOSH-Water...d=1555863434&s=electronics&sr=1-2-spons&psc=1

Once you start looking you'll be surprised about your options.

I adore passagemaking, but I adore passagemaking at night even more!

Many thanks for the advice. I've been sailing dinghies since I was a kid and yachts for the past 15 years and I've never felt sea sickness. However pride comes before a fall so at race start on September 1st I will use Scopaderm patches to make sure.

I intend to take your advice regarding laminated sheets for the crew as well as briefing key individuals. I've also got my own Glucagon as the yacht doesn't carry them so I'll train the skipper and medical assistant although there are 3 consultants on board as well.

I was going to use a plastic freezer bag for the reader but given the problems losing my Libre reader would cause I'll invest in a waterproof case.

Thanks again and happy sailing.

 

[dwatkin]

Brain is much better today, so here are my thoughts. Your plan sounds like a wonderful adventure! Here's what I do, to show you the differences and similarities of our situations:
I sail the lakes and coastal waters of the Netherlands on historical sailing ships with 10 to 30 tourists. We usually visit a harbour or throw anchor every night. We are with only 2 experienced people, the captain and the mate, the rest are expected to help with the sailing but don't know anything about it so all activities are guided by us, no room for skipping due to a hypo when something has to be done NOW. I use Libre.


I prefer sweets I actually like to eat for hypo's, but with everything wet that doesn't work. Fluids are easier because they are in a bottle. I'd go for undiluted lemonade, way more carbs than coke or juice so you need much less of it and you can keep a small (plastic is lightweight) bottle in your pocket and refill from the big plastic bottle you keep below deck. You can even use it when water is pouring over you during a foresail change, a little dilution by seawater won't hurt you and as it tasted horrible to begin with it doesn't matter that it now tastes a bit salty as well
Bananas are great for keeping you going a bit longer, and again easy to eat or keep in your pocket when there's no possibility to cook. And yes, they're heavy but also nutrient dense so no different from other foods on board.
Scan every time you're wanted to do something and pop something in your mouth on your way to the job if on the low side. That's how I deal with the unexpected surges. This only works if you have something in your pocket to use of course!


This one is really difficult. Fortunately you run more risk of having a car accident on your way to the airport than of having to abandon ship. Still, it's good to be prepared.
Undiluted lemonade again. Small sips are more likely to stay down than a whole bottle of lucozade. Only keeping it in your mouth helps as well, as the lining of your mouth absorbs glucose.
When being seasick, really seasick, people can get very close to wanting to die and very apathetic. Last year a Dutch sailor died from DKA following seasickness because he didn't take insulin because he couldn't eat and couldn't bring himself to test his bg (which would've told him his bg was dangerously high). Somehow he didn't know or forgot that he still needed his long acting, and he hadn't told his partner much about his diabetes.
So even when you only want to curl up and not think, you need to test and inject. Make sure you show others how to work your libre reader and bg meter.

I scan with my phone and I use a cheap waterproof cover, scans right through it. I've used freezer bags as well. Should work the same for the reader.

- Spares: Take double everything. Insulin (maybe triple), bg meters, activated(!) phone app in addition to your reader, spare sensors. If on a pump, take pens as well and make a plan for how much long and short acting you think you need.
- Grab bag: There will be a grab bag on board in case of abandoning ship. See if you can add insulin, meter, glucose and glucagon to it. You might not have time to get your own stuff. If not, keep your own grab bag with the central grab bag and make sure they know you'll die without it.
- Glucagon: teach someone how to use it.
- Sensor: I'd start a new sensor 2 days before leaving. A faulty sensor is not something you can use on board. When hands have been wet for hours it's impossible to do a fingerprick, you'll want to know you have a working sensor before getting wet.
Use Tegaderm over your sensor.
They won't like you washing hands with drinking water before testing. That's fine, the salt won't affect the reading (I tested that this weekend) and there's no need to wash hands when having handled sail and ropes, they'll be very clean
- If expecting warm weather, use frio bags or such for your insulin.

Have a wonderful trip, and expect none of your precautions to prove needed

Bonus: I found the best place to inject when wearing sailing gear the very top of my stomach. Use clothes with zippers, unzip coat and pullovers just a little, stick pen in the resulting hole and inject through shirt.

Thank you so much for taking the time to comprehensively answer my points. I'm sorry it's taken so long for me to reply.

As I've been stressing to the skipper I'm preparing well but I don't expect to have to resort to anything other than the usual maintenance of my disease. In the 4 weeks of training including 6 days at sea I've learnt quite a lot including that I need to;

Run high during watches, maybe ten.

Always have a bottle of glucojuce on my TOP layer... fighting through to my dextrose buried beneath 3 layers of clothing whilst on the pulpit changing a headsail isn't fun.

Tell people to look out for you and teach them how to read blood sugars.

In foul weather gear even finding top of tummy is tricky indeed.

So I'm definitely taking 2 glucagon, one in mygrab bag and one for the yachts medical box and will teach the assigned medical team how to use.

Good tip on the sensor and tagaderm. I've lost so many onboard already. I'm taking 5 for 5 weeks sailing so I have spares but also enough test strips in case all of them fall off.

Thanks again.

 

[dwatkin]

David

I asked my neice Caroline for some information seeing as she did the whole race on a Clipper a couple of years ago. This is what she said.

I would tell him not to worry about the weight as he has the perfect excuse to bring additional bits onboard. The boats weigh a ton so a few extra snacks won’t make that much difference. My advice is to get involved in the victualling as otherwise he’s unlikely to be catered for. Remember he will be at sea for 4 plus weeks on the first leg or maybe only 2.5 weeks if doing leg 2 and needs to bring enough for the whole time.
Also if he is involved with the victualling he has something to put in the grab bag for a life raft. I would like to point out that in 22 years no one has had to get into a life raft!
He can also use the race Facebook page that they will be on or the alumni page, Clipper Race Yacht Clipper to ask the question about seasickness as I’m sure someone has come up against it on Clipper in previous races. Maybe even his doctor can provide some advice?

It was also suggested that you ask ther Personnel Officer
Hope this helps. Have a safe trip. membrew. 24/04/2019

Thanks so much for asking Caroline. Her advice is particularly valuable as she understands Clipper. I've taken her advice and am working with the victualler to ensure any specific needs I may have are catered for.

I'm doing Leg 1 which for this year stops in Portugal so I've got 10 days sailing and then 28 days across to Uruguay.

With respect to abandoning ship whilst rare it's more a case of asking the what if question. In the last race 2 people were lost overboard, one boat ran aground and crew had to abandon ship and in a separate incident the only Type 1 doing the race had to be taken ashore with DKA ending the race for that yacht.

Thanks again!

 

[dwatkin]

@Antje77 may have some pointers for you though I can't remember if it is a full sail vessel he sails on.

Good Luck, what an adventure!

Many thanks for your good wishes and recommending Antje77.

 

[Antje77]

Dear all. Firstly an apology. I foolishly assumed I would get a notification of some kind when someone kindly sent me an email and I didn't see the great advice given here.

No worries, you're still in time before your trip
Took me some time to figure that one out too. At the top of each thread is a 'watch thread' button. You'll get notifications as a little green button on the top right of the screen. You should also get them when someone has tagged you, which 3 of us have done in our answers. You could have a look in your profile to check what boxes are ticked for alert preferences.

I was going to use a plastic freezer bag for the reader but given the problems losing my Libre reader would cause I'll invest in a waterproof case.

Don't forget to use your phone as a back up reader! You need to first activate with the reader and then with your phone within the hour. If your phone doesn't have NFC ask your friends if someone has a shabby old Samsung laying around somewhere you can take with you.