Physical Demands of Sailing:
The type of sailing I take part involves “hiking”, which is a way of using your body as a lever to keep the boat flat to achieve maximum speed. This technique puts large strain on the legs and the upper torso, as the sailor needs to keep the body in a straight line to achieve maximum leverage. In addition, energetic upper body movements are needed to push the boat through waves, thus putting large emphasis on aerobic fitness. (See picture below)
Difficulties Diabetes Causes in Sailing:
Sailing regattas involve racing over a 5 day period. Each day comprises 3 races with each race lasting around 45mins to 1 hour. Three races coupled with sailing out to the race area (often 2-5 miles from shore) means the sailor may be on the water for 6-7 hours per day, constantly working to manage their boat. This tests both stamina and endurance. Exercising at this level for such duration makes the calculation of insulin much harder to judge than on “non-sailing” days.
In addition to dosage calculations, taking adequate food over a sailing regatta can be challenging. Due to the long days on the water, refuelling is vital to avoid hypoglycaemia. To minimise risk, I carry sports drinks on my boat along with “Science In Sport” energy bars taped to the deck. I also carry fast acting glucose in my lifejacket pocket in case I ever become separated from my boat. However, this amount of food is not enough, and I need to go to medical support boats to get food stocks replenished. I also use this opportunity to test blood sugar levels between races and check I am within an acceptable range of 7-12ml/mol throughout the day. If I lie outside this range, I try to take Novorapid (fast acting) insulin on the water. However, this insulin will stay in my body for at least 90mins, so is difficult to judge whilst doing exercise.
Good Race Preparation:
I have an established routine that I follow on race days to ensure I am managing my diabetes as effectively as possible. Here is my daily routine:
Each morning of a regatta I get up at the same time (8am) to test my blood sugar levels. This early testing allows me to alter the reading easily before racing, since having extra insulin in my system during races makes managing hypo risk more difficult.
In addition, I always take the same amount of carbohydrate on race days so I know exactly how much insulin to take, thus avoiding the risk of miscalculating the insulin dose to cover what I have eaten. Furthermore, I use ratios that I calculate the week before racing so I know how much insulin to take for every 10g of carbohydrate. Calculating ratios the week prior to a regatta ensures the ratios are accurate, therefore reducing risk of high or low blood sugars.
Throughout the day, I test often so I can see a pattern indicating how my body is reacting to insulin and food, eg: Is my blood sugar going lower than I thought? When should I next take a “top up” of carbohydrate?
In addition, I test immediately before I launch to go racing because due to the long sail out to the race area (often over 30mins), I will not get a chance to test again until much later. I have access to a test kit and Novorapid while on safety boats, but if it is very windy and lots of waves it is hard to test and even harder to inject, so often I simply try and balance the exercise levels with carbohydrate intake on the water.
After each race, I immediately refuel using Science In Sport “Go Bars” and Lucozade sport, which have 40g and 30g of carbohydrate respectively. When I need to hydrate but want to avoid taking carbohydrate, I use Powerade “Zero”, which has no carbohydrate content.
Coming off the water after a day’s racing, I test blood sugar levels as soon as I can. I then take more carbohydrate to avoid post-exercise hypos and to aid recovery for the next day.
For dinner, I make sure I have complex carbohydrates such as pasta, combined with fish or chicken to help recovery. Occasionally, when I don’t have protein available I use Science in Sport “Build” protein powder, which has no carbohydrate content so I have one less thing I have to factor into insulin calculations.
Throughout the evening I test every 90 minutes, as I will still be burning carbs from exercise. Regular testing builds a picture that shows how quickly I’m burning up carbs. This will influence how much “top up” carbohydrate I take after sailing each day.
I try and eat early to get a good idea of what my blood sugars are doing just before I go to bed. If it has been a windy day, I can be in bed by 9pm or earlier. Eating early means insulin and carbohydrate has already finished acting by the time I go to sleep, so overnight hypo risk is reduced.
Informing regatta organisers of the intricacies of my condition improves safety, as organisers will understand how to deal with a diabetic emergency if it were ever to arise. In addition, clear instructions are given to medical support boats detailing how to operate relevant medicines (eg: glucagon injections and glucogel sachets) that get stored in waterproof boxes. (NB: See end of article for a list of what I put onto safety boats)
To deal with hypos, I have glucogel sachets in my lifejacket pocket, along with “Glucojuice” bottles in my boat. These are small bottles of glucose liquid that are made by the same company called Glucogel. (Formerly known as “Hypostop”)
Key Lessons Learned From Diabetes and Sport:
I thoroughly recommend to all sports people who have diabetes to tell appropriate individuals how to act in case of an emergency. This not only makes sport safer for people with diabetes, but the athlete’s own subconscious mind will be at ease as they know they are at less risk of danger. Of course, less worry in this area leads to better performance.
In competition, stress hormones stop insulin’s ability to act, thus raising blood sugar levels. If I have an unexplainably high sugar reading before launching, I will usually take a corrective dose of Novorapid and assume the high reading is caused by stress. If it is very windy I may not take any insulin as a corrective dose, as higher physical demands in strong winds could mean I have a hypo later if I were also to take insulin – instead I just allow the exercise of sailing out to the racecourse to bring me down naturally.
However, I think the most important aspect of managing diabetes with sport is to have a diligent and focused attitude towards taking care of the condition, and not leaving it as an after-thought. The wise patient should realise that they have extra safety responsibilities that are more important than their responsibility to perform well at the expense of their health. Such an attitude means people with diabetes can enjoy taking part in sport whilst still staying safe, no matter at what level they compete in their chosen sport.
What I Learned From Dr Gallen:
I visited Dr Gallen in 2010 after having issues with hypoglycaemia both on and off the water. With him, I discussed my training schedule and the physical effects of sailing on blood glucose levels. In addition, we discussed how much insulin I needed for specific quantities of carbohydrate, which gave insight into how sensitive I was to insulin.
Dr Gallen told me that the body’s sensitivity to insulin changes with varying training loads. Therefore my insulin requirements would be constantly changing according to my training schedule. We looked at other factors that would also affect insulin requirements. These included the duration of a regatta; changing weather conditions (as stronger winds increases the physical demands of racing the boat); and the effect of fatigue as a regatta progresses (as the constant exercise through racing over a number of consecutive days meant less insulin was needed for the same amount of carbohydrate).
I quickly realised that more detailed monitoring of blood glucose levels together with increased diligence on my part would allow me to make the next “leap” in my sailing performance.
I started to keep detailed records of blood sugar readings throughout regattas and collected a “database” of diabetes-related information that included the amount of carbohydrate I took at each time of day of a regatta; my blood glucose readings; the amount of insulin I took to cover a certain amount of food, and the weather conditions that affected how strenuous sailing the boat was on a particular day.
This database of information resulted in a great improvement in my management. Now I can look back on previous regattas to achieve better insight as to how different sailing conditions and food intake affected my insulin sensitivity and respective blood glucose levels.
I am now looking forward to a summer competing at the Laser Radial World Championships in France and am confident that good diabetes management will increase my chances of performing well!
Summary of food used for sailing regattas:
3x Science in Sport “Go Bar” 40g
3x Lucozade Sport 30g
NB: (I give all juice to ribs before race to avoid carrying extra weight)
3x Powerade Zero 0g (substitute for Lucozade sport if not windy)
2x Glucojuice (to cure hypos)
2x waterproof container with dextrose tablets (to cure hypos)
In safety boat
2x Lucozade Original (to cure hypos)
1x waterproof box of glucogel and glucogon injection for safety
3x Lucozade sport
3x Powerade Zero
4x Science in Sport Go bars
1x packet of glucose tablets
Novorapid (in thermos flask to keep cool)
1x 50ml lucozade bottle
2x glucogel sachets (to cure hypos)