By Paddy Turner
This uniquely British sporting feat is a monumental challenge, and we have someone with T1DM stepping up for it. Paddy Turner from Hampton, swam the Channel in August. Paddy was diagnosed as having type 1 diabetes 2 years ago. He has been appropriately managed on Glargine and Novorapid and seems to be doing well on this. He has good control and very few hypos. He has a long history in open water swimming, swimming from pier to pier in the sea and Lake Windermere (10½ miles) in the past. He now plans to swim the Channel on the 14 August 2005.
Advice Prior to Swim
- He is training in the morning for 1½ - 3 hours 4 times a week in the early morning.
- This training will increase steadily over the next few months to 10 hours per day over the weekends. He brought his home blood glucose monitoring with him, which shows substantial falls in blood sugars from mid-teens down to 8.
- On several occasions he has been relatively hypoglycaemic. He has been taking a commercial glucose polymer drink containing isodextran with vitamins and salts and he is taking this at 30 grams per hour.
- Given the endurance level of the training, he needs to be careful that we do not paralyse his intermediary metabolism with Glargine. He will need his free fatty acids and ketone bodies to sustain long distance efforts when his liver glycogen levels drop.
- Glargine may cause him excessive falls in blood sugar.
- He should continue to take extra glucose but this should be in 2 forms:
- He should start his exercise with blood sugars somewhere between 7-10.
- If his blood sugar is below this level, he should take 30 grams of glucose immediately.
- He should then make every effort to check his blood sugars whilst he is swimming, and when his blood sugar falls below 6-7, take 30 grams of glucose per hour thereafter.
- IWould he be better on be better on Isophane insulin, this would give him very low levels of insulin in the morning when he is training. He could have a second dose of Isophane insulin when he has his breakfast afterwards. He is going to check his blood sugars so that he could get a handle on whether this is necessary to do or not.
- In building up for his training, it would be very helpful to have his blood sugars checked regularly so that we can see whether he is getting enough glucose.
- It's going to be interesting to see how he gets on over the next month or so.
Channel Swim-August 12th, 2005
By early August, diabetes had ceased to be a major concern for me. It was recognised from the hourly testing in May, June and July that I needed to reduce the dose of basal insulin (Lantus) from 14 units to 8 units and double the concentration of the hourly Maxim carbohydrate drink feed (about 90g of carbohydrate per hour). Previously, as Dr Gallen remarks above, my glucose level had been driven down too low by the combined effect of basal insulin and rigorous exercise in cold water.
Over the last month or so, the water in the Channel has warmed up to a comfortable 17 degrees. No more the shivering for half an hour after emerging from the water and endless hot drinks to thaw out. Training swims became longer. My longest weekend was 7 hours on a Saturday and 6 hours on the Sunday. During the longer training swims, I entered the water with my glucose level between 10 and 15 and then didn’t test until the end. Usually my level after six or seven hours was a reassuring 8-12.
I was still harbouring the hope that on my Channel swim I would be able to test my glucose level. This was pie in the sky, as Mark Blewitt points out. Firstly, it is impossible amongst the waves to dry a finger for pricking. Secondly, in cold water the capillary system closes down. Blood is drawn to the body’s core to protect the vital organs. Mark maintains that any reading would, in any case, be unreliable.
So, there would be no testing of glucose levels during the swim; just the reassurance that concentrated Maxim would prevent the level falling too low.
My swim was due to take place during a neap tide (August 11-18). Five days before the start of the tide, during the last training weekend, I was informed that the forecast was for the weather to turn bad during that neap tide. Did I want to swim the following night? The forecast was optimistic and the currents during a low spring tide would not be too strong. Far from organised, I agreed, knowing that a prolonged period of windy weather might prevent me getting the chance to swim at all this year.
At 6pm, I consumed several bowls of pasta and injected Novorapid. After my daily Lantus injection at about 9pm and a few hours rest, I entered the water at 1.30am on the beach at Samphire Hoe, between Dover and Folkestone. My glucose level was 10.8.
The feeding plan was to take Maxim every hour for the first 3 hours and then every 30 minutes thereafter. After about 4.5 hours, I experienced a sudden feeling of weakness. I had read that after between 5-8 hours of swimming glycogen reserves in the liver become exhausted and the body relies upon its store of fat and any further food taken subsequently. Is this what athletes call a ‘bonk’ or ‘hitting the wall’? Anyway, after a Maxim feed, I just as suddenly regained strength. It encouraged me that I had recognised this stage of the swim.
Owing to my swallowing too much seawater, I vomited over and over. Each time I felt better for having been sick. When my stomach was empty, I just retched – less pleasant. The danger, of course, was that I was vomiting out all the necessary energy drink at the same time. The support crew kept insisting that I drink more.
That’s my first mention of the support crew. On many occasions during the swim, I would not have stayed in the water, had it not been for their persuasion and encouragement. I would have gladly aborted the swim, climbed aboard the boat and into a sleeping bag. Getting to France, at those times, didn’t seem as important as relief from the cold and aches. Once I lurched for the boat’s ladder, only for the boat to accelerate away from me! The pilot had heard whingeing before from swimmers. “Just put one arm in front of the other”, he said over and over again when my morale was low. Or “we’ll speak at the next feed”. I am, of course, extremely grateful to him for not doing what I was pleading him to do.
At about 4.30pm local time, I beached in Wissant Bay between Calais and Boulogne. My legs wouldn’t work and I collapsed in a heap. My time for the crossing was 14 hours 12 minutes.
I needed to be pushed on a surf-board the 50 yards back to the boat. Once aboard, the accompanying diabetic nurse took my reading – 11.2! Further tests over the following hours revealed little variation. After further vomiting, I fell asleep for most of the return journey.
As I was only diagnosed 10 months prior to the swim, I was already well into the preparation and training. It would have been disappointing to be told by a nurse or doctor that a Channel swim would be foolhardy or impossible. Everyone, however, from the diabetic nurse and Dr Baxter at Ashford Hospital (Middlesex) to Dr Gallen encouraged me, were generous with their time and saw no reason why diabetes should prevent me from swimming the Channel. To those people, the diabetic nurse on the boat, Jo Butler, Simon Murie of Swimtrek Holidays and the pilot Neil Streeter, I shall be forever grateful.
I hope that this and Mark Blewitt’s contribution will encourage diabetics, perhaps recently diagnosed, to ‘give it a go’ in their chosen sport.
Paddy's Progress, 25th May
After a winter training in heated pools, about 30 aspiring Channel swimmers took the first plunge into Dover Harbour at the end of April. The water was about 10 degrees. Under the eye of coach, Freeda Streeter, the first swim lasted just 20 minutes!
As the water warms up, the length of the weekend swims increase. Last week I made it up to one and a half hours in the water, swimming between the walls of the harbour. By the end of July, it is reckoned that I should be able to swim for 7 hours on a Saturday and then another 7 hours on the Sunday. Fourteen hours is the approximate time it will take me to swim across to France.
With regard to my control of Diabetes, it has been suggested that my body be free of insulin during my swim. The exercise itself will prevent hyperglycaemia. A swimmer in the sea will apparently burn 600-700 calories per hour.
I have been testing my glucose level every hour or so during training. I have been advised me to try to start training when my level is between 7-10mml and that I will need to consume about 30g of carbohydrate every half hour to keep my level above 5-6 mml. Obviously, I shall need to avoid allowing my level to drop below 5 mml.
I am exploring ways in which my glucose level might be tested mid-Channel. As far as I know, however, no pharmaceutical company has produced a waterproof meter. I’d be glad to hear any suggestions! It may not be necessary to take insulin during the swim but injecting whilst in the water will need some practice.
In case you were unaware, we are now into the Channel Swimming season! The first swimmers and boats hope to get away from Dover this weekend for their journey to Cap Gris Nez, in France. The water has warmed up to around 15 degrees.
If you’re passing Dover Harbour on your way to the ferry one Saturday or Sunday before September, you’ll see a couple of dozen heads bobbing up and down. Swimmers are now spending up to 8 hours a day in the water, in preparation for their swim later in the summer.
My ability to stay in the water and swim strongly depends entirely on my blood glucose level. My aim is to try to start training at above 7 and keep that level throughout the training period.
I have discovered that the recommended hourly dose of Maxim energy drink (30g of carbohydrate) is wholly insufficient and my glucose level drops to just over 4 after the next hour’s swimming. At this level fatigue and cold prevent me from swimming for much longer and I’ve had to abandon my training early.
Last weekend, concentrating the carbohydrate drink led to an improvement in my performance. I was able to complete a 6 hour training swim and my glucose level didn’t dip below 6.
This coming weekend I aim to swim for 7 hours. In order to raise my level further, I shall reduce my dose of glargine the night before (from 14 to 8 units) and concentrate the feed still more. With luck, my blood glucose level will remain above 8 and my body will be able to perform better.
As you can see, all I’ve learned has been as a result of having to abandon my training swims and asking for advice from Dr.Gallen and our coach on the beach, Freeda Streeter. Each weekend, I swim a little bit further and learn a little bit more what my body needs. With luck, I’ll have learned enough by mid-August to make it across to France!
I am 41 yrs old and have been in the Army for 22 yrs. I have been a Type 1 Diabetic for 13 yrs and have been keen to continue to undertake periodic challenges. I completed the New York and London Marathons in 2003 & 2004 and a 3-way Channel Swim Relay(in the local pool) a couple of yrs ago. This solo attempt is without doubt the most significant physical challenge I have set myself as a diabetic. Although I have trained harder for this than I have trained for anything previously, the chances of success are still low. It has been a sobering experience to get my head round the fact that I am training hard for something that statistically I am likely to fail. And, due to all my early morning training & even more sobering - I have had no alchohol in 2007 and do not plan to until after my solo attempt.
The last 3 months
I would class this period as "conditioning/learning/preparation & excusing the rugby expression "doing the hard yards".
It is all about learning & "setting the conditions" for a successful attempt. Trg - pool based, 25 - 30km per week, one rest day per week. Mix of stamina & speed trg.Diet - B'fast at 0510hrs - porridge oats 45g (27g of Carbs) soaked in 0.2ltr of apple juice + banana.(4 units of humalog)In pool for 0600hrs - sessions generally 4 - 6 Kms. Generally drank 0.25ltr per km of made up drink( 50:50 fruit juice & water + 2 scoops normal maxim)A representative set of readings for 2 days:0520 - 4.8..........9.30840 - 12.4........12.31000 - 8.6.........7.5small snack + 2 units humalog (generally because I felt hungry)1200 - 8.4.........5.6Pasta lunchIf I had a bad control day it was the hunger making me want to pick at food mid afternoon.
I now check my blood at this time & only snack if I am below 6.Dinner - 8-10 units of HumalogSnack - 2/3 units humalog + 12 units Glargine
During this period I have lost 4/5Kgs and need to put this back on safely for insulation purposes, hopefully it will be me "who ate all the pies!"
1st Key Test/Challenge - SwimTrek Long Distance Swim Trip
Last week(28 Apr-2 Jun 07) I undertook a 5 day swimming holiday on Gozo off Malta - 15hrs swimming in 3 days with 8 other potential channel swimmers. All guides & safety boat staff had completed successful swims & were aware of my condition.Day 1 - 1st session 1.5hrs, 2nd session 2hrs - sea very rough & swallowed too much sea-water, violently sick 8-10 times, managed to swim through the retching & swig maxim drink(3 scoops per 0.75 ltr). Blood was 9.8 at the end. Hard day but +ve (you can swim & be sick & carry on). Future days, took travel sickness pill & all was OK.Culminating in 6hr swim in sea in 16 degrees. Blood 15 on entry, 5 on exit 6hrs later.Feeding regime: Maxim(3 scoop strength) every 1/2hr(about .25ltr)....at 3hr point & every other feed we had bananas. At 3.5 & 5hrs I had 10g glucose gel tubes. Not a perfect regime, too high at the start & too low at the end,BUT, it was a successful start to true long distance swimming and something to build on.
I would class this period as "putting everything into practice & acclimatisation to the cold & open water environment". Key trg now outside at weekends( 2 days of outside sessions per weekend) - mainly at Dover harbour, but with a fallback option of Heron Lake off M25(J13) - I still have a family to see & support through the summer!3 or 4 pool sessions - sets, sprints & technique - reduce to 3 when Dover sessions get longer.Holiday has given me a big boost - I need to build on the lessons learnt/feeding plan etc and take it forward & build up records on how I react to trg in the cold(Dover was 12 degrees last weekend).Also need to give more thought to the whole mental side for the swim - +ve thoughts etc.
Channel Relay Team Event 31 Jul - 4 Aug 07.
Channel Solo attempt 4 - 10 Sep 07.
The first recorded completed English Channel swim was in 1875.At least 6,000 people have attempted since then this amazing feat of swimming the 21.7 miles in treacherous conditions, with only approximately 600 of those succeeding. It’s cold, currents are unpredictable and the sea is has hidden dangers like jellyfish and visible hazards like cargo ships. However, Mark Blewitt, has successfully completed this challenge, in addition to many more record-breaking marathon swims.
I was diagnosed with Type 1 diabetes in 1980, aged 13, since then the treatment of diabetes has changed enormously. In 1994, working in PR, I realised I led an unhealthy lifestyle, entertaining journalists several times a week meant too many rich, fatty meals and too much alcohol. Having to travel with my job also meant I had little time for physical activity. About this time I saw a table showing participants in the London marathon by profession with top of the list Firemen, Police and Postmen and bottom of the list Marketing and Public Relations employees. It forced me into thinking that I needed to do something about my own health. As a result I started to casually swim at my local pool and as a result my fitness levels increased dramatically. I remember the first time I could manage 4 lengths crawl without stopping, then 8, 32 and 64 lengths and then finally the magic mile! The pool closed which forced me to find a neighboring pool; which had an open water-swimming club ‘Howe Bridge Marlins’. Through training there got I fit enough to swim 2 miles in Grimsby Docks the following June. I was hooked. I was determined my diabetes was not going to stand in my way – I always compared my performances with able-bodied swimmers.
I tackled longer and tougher swims. In 1998 I swam in the premier championship 10.5 miles Lake Windermere and finished 4th. In 1999 I faced up to the longest swimming race in the world - 28.5 miles around Manhattan Island. British Airways sponsored flights for my coach and I, and Airtours paid my race entry fees. Entry is restricted to the best 30 that apply. This swim started at 6am and finished 8 hours later. My performance was fantastic. I felt on top of the world. My coach was so pleased and couldn’t wait to tell our supporters back home in the UK about my success.
In 1999 I was taking Actrapid and Ultratard and on the day of my race I just reduced my Actrapid dose. After my success in New York I thought it was time to start training for the Channel. In 2001 I entered but a problematic sea swim and a new job, prevented me from training each morning, so I was forced to pull out. Suddenly I had a big void to fill- I had trained hard all winter and spring and now nothing to aim for. At that time I was invited to swim Two-Way Lake Windermere (21 miles)-the longest lake in England.
Before a race I would cut down on my insulin dose, take glucose drinks and bananas. It seemed to work and I did not give it much thought other than to advise the race safety officials of my diabetes, and to make sure I topped myself up with carbohydrate during my swims and keep a waterproof packet of glucose tablets in my swimming trunks. During a swim fluid and chocolate bars were passed from the mandatory escort boats. Back then I used to take additional food and drink every hour. No matter what I consumed or what insulin dose I used my blood glucose levels were always rock bottom at the end of a swim –1.0mm/l or less. Testing during a swim was impossible as touching another person would mean disqualification, and I was submerged up to my neck in water so blood glucose testing was out of the question.
For my Two Way Windermere Swim I set off at 7pm in August sun after a teatime meal of soup and baked potato. I had cut down my Novorapid dose. My support boat took my flasks of tea, coffee and Ribena plus my usual chocolate and bananas. I had thought about my evening dose of Ultratard, but thought, as I wouldn’t be doing so much physical activity an injection wasn’t necessary!
Needless to say 10 hours later I was in trouble. I had started to be sick and everything I tried to eat made me vomit even more. I had started to slow down considerably. I realised that I had not been able to eat properly since just after midnight. With 17 miles completed and 4 to go I told my boat crew I was struggling. My pilot said he was watching out for me. I stayed in and I finished in 14hours 20minutes after starting and came third place in the men’s section.
I was carried from the water and patted dry. The Independent on Sunday had written a piece about this race and had described the terrible condition my body was in. I tested my blood glucose levels; the meter barely registering 1mmol/l! Later I would realise that if the reading simply could not be true else I would not be capable of testing my blood let alone swimming and walking out of the water. An ambulance was called and I was admitted to hospital. The president of the BLDSA visited me in hospital to present me with my certificate and to see that I was ok. Fortunately, I was and after my lunchtime dose of Novorapid I was released from Kendal Hospital. I was delighted, with my excellent time and my swim was short listed for the BLDSA swim of the year.
At this time I was training with and swimming for Haslingden Swimming Club. In recognition of my swim my club invited me to present the annual awards. Each year they get a celebrity swimmer to come along. I was delighted when they told me that this year they did not have to look beyond their own club. This is one of the highlights of my swimming achievements.
At this time my training partner Peter Mulderigg put me in touch with a friend who is a diabetes specialist nurse Judith Campbell. To swim such a length again would require much more medical input, however, at this point I was not sure if my body could be put through such a punishing ordeal but by the start of the next season I was back. But I was planning on an easy year.
The opening swim of the racing calendar is the Budworth 1 mile handicap. You predict your finishing time, swim and the winner is the one closest to their predicted time. At 1 second inside my predicted time I won the race easily. Once again I felt on top of the world. I remembered that I had paid my deposit to swim the Channel last year therefore decided that I would train and have a shot at the channel later that summer!
May and June were filled with training, lots of outdoor swimming, lots of discussions with my doctor – Dr I O’Connell at Wigan and Leigh Infirmary, my nurse friend Judith and Dr Brown, my girlfriend’s mother. Dr O‘Connel had always supported my swimming and I have a special respect for him, as it was he who signed my medical release to say I was fit to swim in cold water for hours on end.
After my experience the year before the doctors and I knew we had to reassess my insulin and nutritional requirements to ensure I didn’t run in to trouble again.
In hindsight I now know I had been consuming insufficient carbohydrate - a third of what I should have. All I had ever eaten while swimming was 30grams of carbs per hour, consuming foods like bananas, chocolate and yoghurt drinks whereas I needed to take 1320 grams of carbohydrate over 16 hours or 95grams per hour!
Judith recommended Glargine but as it was not yet available on prescription from my health authority (it was 2002) this was therefore not an option.
After a discussion with Mike Oram, my pilot for the swim and one of the most successful channel pilots on the scene, I discovered I was consuming insufficient carbohydrate, calories and the type of fuel I was taking was incorrect. I learnt I needed to drink hot high energy drinks and Mike swore by Maxim, Maxim and more Maxim. Maxim is a high-energy drink similar in calorific and nutritional value to Lucozade but instead of being fizzy it is flat and importantly Caffeine free. I learnt that I should be taking this drink hot, as hot as I could, 600ml every 30 minutes. The benefit of this drink is that it is absorbed straight into my blood stream, with minimal digestion therefore meaning I would not be wasting energy digesting the drink. Being hot also helped to ensure I would be retaining all my internal body heat.
And all this information less than a week before my swim! A quick call to Judith to tell her the bad news - the carbohydrate figures we had been using for my swims were totally wrong.
I contacted my doctor and came up with a new regime. Dr Brown also spoke with Dr O’ Connell independently. It was the worst possible preparation as this was all still being discussed over mobile phone on a fraught drive down to Dover. I was caught in the middle; I had increased my carbohydrate from 30grams per hour to 95, but planned to take the same amount of insulin. And I should have been resting.
My swim started on the 18 July at around 7am. I felt great until my first feed, then I felt awful and eventually I started being sick and started to complain. My pilots said give it another hour. I did and did not bother to complain again. I was enjoying my swim. My crew was giving me all the encouragement I needed especially Andie my girlfriend who was shouting on every stroke. Perhaps it had been going too well, I had that invincible feeling you get when a little drunk (with hindsight hypoglycemia) and felt on top of the world. After 9 hours in the water disorientated and confused I aggressively requested more insulin, then carbohydrate though I had enough emergency gel (Maxim – it is like Hypostop) to stop the worst hypo. I took a slug of the gel and started swimming again but as I was not responding to the instructions shouted from the boat I was retired on medical grounds. On the boat it became obvious to my crew that I was not hypothermic but hypoglycaemic. My attempt was over and with France in sight the boat was turned around back to Dover. On checking my kit later I discovered I had barely touched any of the gel!
Before we got back to port I had decided to try again. Learning from what I had done wrong, I knew I could do the swim through tweaking my dosage of insulin down, eating more and being less sick! I trained in earnest feeding properly on this hot high energy drink, solo swims with my coach Matt Simpson on Lake Windermere and races every weekend. A special visit to see Dr O’ Connell, much discussion with Dr Brown and of course Judith. I had managed to get a slot on the 16 August a month after my first attempt. As a rule the weekend slots get booked up well in advance and if you are prepared and able to swim in the week you stand a better chance of getting a slot. I gave my Doctor Judith the dates and she moved everything to be there and support me.
Jude and I drove down to Dover on the Thursday, just the day before my swim. Friday came with an early start and I started swimming in the dark at around 5am. At one feed I felt myself drifting round so I would be facing back to Dover. I knew to see the white cliffs would not be good psychologically so I resisted. The day turned into a milky day, as if I was swimming in a giant Tupperware box. I was sick, stung by jellyfish but was determined to continue.
Before my swim I had received encouragement from Alison Streeter MBE who has swum the channel an amazing 42 record-breaking times however now she was on the boat as the official CS&PF Observer!
As the day drew on I started to tire – I knew exactly how long I had been in, feeding every hour, taking X amount of carbohydrate. As many with diabetes will understand the normal diet for sportsmen with Type 1 diabetes is high in carbohydrates, as such my body has a high carbohydrate tolerance the normal trick that an athlete will do of carb loading is less effective. I knew that my glycogen store would be optimized yet called upon quite early in the swim. As a rule it is best not to ask the distance you have swum, as the reality might be less than you thought. Then I caught a glimpse of the lighthouse at Cap Graz Nez, the closest point in France to England, but then nightfall and the image disappeared. Then at last I saw light, I could see windows illuminated in houses, curtains being drawn, car lights! Alison, the official observer, got in the water to swim along side me and guide me through the last little bit. Then I was told to stand up but after all this time in the water I could only swim! I managed to stagger up the beach and I was not able to receive assistance or I would be disqualified. Eventually I cleared the water. I had made it! Some French lads came to congratulate me. Back on the boat I was wrapped up in a blanket and offered a cup of sweet tea. My doctor, Judith, was keen to check my blood glucose level – 10.4, RESULT! I was violently sick bringing up lots of awful stuff that I don’t remember eating. We eventually managed to find somewhere to stay for the night and I checked my blood glucose levels at regular intervals. They dropped throughout the night and the next morning were 5.6. I lost weight over the next week, my face became gaunt and eyes sunken. My bloods were continuously on the low side for the next ten days.
In 2003 it was time again for the two way Windermere swim which is held in alternate years. This swim is usually cold but this year I had noticed it was seasonally a little warmer and I thought maybe I’d swim breaststroke, a slower, less energetic stroke, not suited for cold overnight swims. This time I was also determined to finish in style after my last two way swim in 2001. The race was held in August. I set off strongly and was determined to do my best, then maybe ease off a bit later. There were others competing but nobody came close! I led the first wave from start to finish except for a brief period around 1am after a bad feed. I had taken an electrolyte drink. I had called for the isotonic drink thinking that I needed to top up on electrolytes. Perhaps it was the absence of carbs or was it my body converting fat? I completed the course and set an inaugural men’s breaststroke record, smashed the overall breastroke record and became the first person ever to swim the course using two strokes. This time I swam on Glargine (it was now available) and Novorapid. The Glargine helped in that it is a longer acting insulin that I could take once and get through the whole swim without taking another shot, however, I took several small shots of Novorapid and a reduced Glargine shot around midnight so my routine the next day would not be shaken too much!
In 2004 I became the first person to swim the length of Loch Lomond using breaststroke. It had been a cold year and it was a cold swim. Compared to the others I was far more prepared mentally which was just as well as it took me 17 hours 50 minutes to complete the 22 mile course.
You may be wondering what my next plans are. Finances permitting I will do it again, or attempt the channel breaststroke? There are so many nice swims out there-anything is possible. But remember what and who are important to you. Live your dreams!
For further details contact Mark Blewitt 07854100271
Jen Alexander, Marathon Swimmer with Type 1 Diabetes
I’ve had type one diabetes since 1988 and have swum for most of my life. My first open water swim was actually at diabetes camp! A fish looked at me while I was swimming, however, and it scared me out of the lakes for a solid decade.
I live and train in Halifax, Nova Scotia, Canada. The training conditions up here are outstanding. Nova Scotia is bordered by Northumberland Strait, where the mid-strait waters get up to 22oC (72oF), and the Atlantic Ocean where the waters are considerably colder. Between the lakes, the Strait, and the ocean, the outdoor season here is actually quite long! I can swim outdoors April-November.
I’ve swum 18+ hours on a couple of occasions, and made one attempt at swimming the English Channel. (My Channel swim was called the swim by the boat captain because the conditions were becoming dangerous to me and the crew.) In 2008, I was awarded the Diabetes Exercise and Sports Association’s “Athlete of the Year” award.
Marathon swimmers routinely swim distances that require several hours – by boat – to return to shore. A health crisis in the middle of the English Channel could require helicopter evacuation. Rescue could be complicated by nightfall, the escort boat pitching at 45° angles in 2-3 meter seas, the neuromuscular impairments (and reduced ability to follow directions) that accompany moderate hypothermia, severe nausea, and the hallucinations that result from an exhausted and under-stimulated brain. (I’ve experienced each of these.)
Swimmers with diabetes face additional risks: hypothermia complicates hypoglycaemia. Core body temperature falls during hypoglycaemia , and recovery from hypoglycaemia is impaired at low body temperatures. Conversely, hypoglycaemia complicates hypothermia: a small study of people without diabetes suggests that blood glucose levels under 2.5 mmol/L suppress both shivering and the sensation of being cold. A swimmer unable to shiver to generate body heat risks advancing through the stages of hypothermia. Swimming safely demands careful diabetes management.
The “standard” challenges of blood glucose levels affecting performance still apply. Hypoglycemia causes me to pull through the water less strongly. Both hypoglycaemia and hyperglycemia reduce my stroke rate (cadence). I swim at my best when my blood glucose level is between 5-8 mmol/L.
Tight control over blood glucose levels is critical, but it seems challenging enough on land, doesn’t it? Finding a way to test blood while swimming was an exceptional challenge! Open water swimmers around the world adhere tightly to the code of England’s Channel Swimming Association: the swim is disqualified if the swimmer touches the boat, or a crew member touches the swimmer. Neither continuous glucose monitors nor heart rate monitors transmit properly in the salt water, so blood glucose levels must be measured by finger stick. Additional challenges included waves, sea spray, wind blowing so loudly that I couldn’t hear my meter beep, test results being skewed by water on my finger, and the daunting challenge of being able to squeeze enough blood from a finger vasoconstricted by hypothermia.
To get my test kit to me, we’ve constructed a “fishing pole” of sorts. On the boat, my crew has an aluminum painter’s extension pole. Instead of twisting a paint roller onto its end, however, we’ve twisted the marine version of a carabineer onto the pole, then twisted a cap on top of that to ensure the hook doesn’t move. We roll 25 meters of rock-climbing rope around a kite-string winder, then thread the rope through the carabineer. My crew attaches items to the rope, extends the pole, and then unwinds the rope to lower the item(s) to me. This is “legal” in the open water world as long as the rope remains slack.
We use a waterproof container made of transparent plastic to house two meters, a facecloth, and a lancing device stuck to the side of the container with Velcro. During the early hours of a swim, we use a standard lancing device, but switch to larger, disposable lancets (and then blades) as needed. When it’s time to test, my crew prepares my test kit by putting a strip in each meter, and then activating the finger flashlight. The boat pulls close and my crew dangles my test kit over my head using the pole and rope. I grab the kit, open the lid, and dry off my finger with the facecloth. I lance my finger, and apply blood to each strip until the finger flashlight turns off (which confirms enough blood has been applied). Sometimes there is too much seaspray to see clearly into the container, and sometimes the wind blows too loudly to hear the meters beep to signal they have enough blood, so watching the finger flashlight turn off is the only way I know the tests are working. I reseal the plastic container, drop it into the water, and resume swimming. Easy, right? My crew knows that I cannot stop to chat: in strong currents, a 30-second rest can cause a swimmer to lose 100 meters (or more). They pull the test kit back on the boat and read the results. (In 1986, Lynne Tetley of the UK became the first person with type 1 diabetes to swim the English Channel. I cannot imagine how she managed her diabetes.)
Swim-specific diabetes management starts 5 hours before the scheduled start. I don’t eat anything. I recognize that this isn’t the greatest strategy for preserving muscle glycogen, but it works for me in terms of managing my diabetes. I swim with a waterproof insulin pump. My general strategy is to run my basal rate high enough that I don’t need to bolus for carbs. I turn my basal rate up to 150% and test my blood glucose just before I am about to jump into the water. From this blood test and until the swim ends, we react to each blood test in the same way:
• If my blood glucose is < 6 mmol/L, I get 40 grams of carbs.
• If my blood glucose is 6-8 mmol/L, I get 30 grams of carbs.
• If my blood glucose is 8-10 mmol/L, I get 15 grams of carbs.
• If my blood glucose is >10 mmol/L, I get water.
We test and feed every 30 minutes. My crew dilutes 50 grams of flavoured sugar crystals/ Gatorade in 750 ml of water to give a solution that’s 6.7% carbohydrate. I receive three feeds of flavour crystals and then one feed of Gatorade. (I don’t have the same need to replace electrolytes because I’m not sweating much, if at all.) We’ll mix in liquid acetaminophen every 4-6 hours for pain, and we deduct this from my carb allowance.
If my blood glucose level has trended downward or upward for two consecutive tests, my crew prompts me to adjust my basal rate. Even though I start my swims at 150%, I’ll titrate down to about 50%. Severe nausea can be part of open water swimming, and I’ve dealt with this by turning my pump off for 30 minutes and consuming ginger chews. Other than this, I don’t consume solids during my swim. This plan works extremely well for me until hypothermia begins to affect my blood sugar. (Acute hypothermia elevates glucose levels due to catecholamine-induced glyconeogenesis. )
Hypothermia aside, my blood glucose levels are sometimes easier to control while swimming than they are on land! During one 19-hour swim, over 10 consecutive hours, I averaged 6.2 mmol/L with all readings between 4.5 and 7.6 mmol/L. I consumed 617.5 grams of carbs over the same time period. I used to make a game of managing my sugars as tightly as I could, but I now think it’s safer to aim to keep all readings above 6 mmol/L.
I’ve worked really hard at being able to swim while managing my diabetes and I’m very proud of my accomplishments.