Let’s Talk About Diabetes #1 - The Tools

I was diagnosed with type 1 diabetes when I was 9 years old – that was 32 years ago and damn that makes me feel really old when I see it written down in black and white! Almost ancient history now and certainly long enough ago that I can’t really remember a time when I didn’t have to think about the balancing act between food, insulin, and activity. The daily patterns of testing my blood sugar, counting carbohydrates, calculating insulin bolus, always making sure I’ve got some type of emergency snack with me just in case, and the hundreds of other little things I do to manage my diabetes as we’re living this boat life just sort of happen without a ton of conscious thought on my part. And for some reason, my diabetes has also always been a really personal topic for me that’s not been something I open up about very often. At any rate, doing some blogging to cover this area of our life has proven to be a lot more challenging than I first expected, but Megan keeps bugging me to get on it so here we go!

The Basics

To start with, let’s cover the basics. Type 1 diabetics don’t make their own insulin, which is the hormone that allows your body’s cells to use the glucose floating around in your bloodstream and turn it into energy for bodily functions. Without insulin, glucose piles up in your blood and causes all kinds of damage. Without insulin, your body doesn’t have access to the energy it needs to perform normally. Without insulin, your life expectancy is drastically reduced. 

So it’s a really good thing medical science has figured out how to manufacture insulin and provide the tools for type 1 diabetics to monitor their own blood sugar levels and inject that insulin into their systems to make up for what their own bodies aren’t able to do automatically. When I was first diagnosed with diabetes, that meant carrying around a glucometer (glucose tester), a “finger pricker” to take blood from my finger tips, lancets (little needles) to go in the finger pricker, test strips to put the blood on, syringes to inject insulin, and vials of the insulin itself. Talk about a large kit of stuff to cart around which definitely didn’t make it easy to hike, swim, go to the beach, or generally do all of things we do on the boat with regularity. Not to mention the sideways looks I used to get as a kid when I pulled out the syringe and vial and injected myself in a public place. Thankfully, those days are long gone and I’ve got a much better and more discrete set of tools now!

Finger pricker, lancets, test strips, glucometer, syringes, alcohol wipes, and insulin vial all used to be carried around with me wherever I went. That’s a lot a little annoying things to take care of at all times. Thankfully things are a lot more convenient these days, and the set-up shown in the picture is only what I use for an emergency back-up.

Now I use the Freestyle Libre glucose monitor in combination with the OmniPod insulin pump system. While not perfect, I’ve found this setup a good compromise between cost, flexibility, and ease of management given our current living and travelling arrangements. Let’s look at it in a little more detail.

Glucose Monitor

The Freestyle Libre is a glucose monitor that has 2 parts. First, there is a small, disk-shaped sensor that I stick to the back of one arm and which has a small tube on the underside that gets inserted under my skin. A single sensor stays in place for two weeks before needing to be replaced. Second, there is the glucose meter which automatically reads the sensor when it comes in close contact. Once ‘tapped’, the meter not only shows me what my current blood sugar is, but also indicates whether it’s rising, falling, or staying level. It also shows a continuous history of my blood sugar so I can see how it’s moved up and down over time. Even better, if I don’t want to carry the glucometer there is an iPhone app that allows me to use my phone in place of the glucose meter. 

The sensor is attached to the back of my arm and stays there for 2 weeks before I take it off and replace it with a new on the other arm. To get a blood sugar reading along with the current trend (rising, falling, or level), along with the historic curve, I can tap it with my glucometer (shown here) or my iPhone.

Talk about a massive improvement from the good old days! No more test strips. No more finger pricks. Down to one device to carry (my phone which I’m carrying anyway) from the glucometer, finger pricker, and test strip combo of yester-year. Oh, and the sensors are waterproof down to at least 60 feet (that’s about the deepest I’ve been down diving so far…) which is pretty essential given our current wet and salty lifestyle! 

Insulin Pump

The Omnipod is an insulin pump system that, similar to the glucose monitor, also has 2 parts. There is a small ‘pod’ that contains an insulin reservoir large enough to last for 3 days along with some electronics to manage insulin delivery and a small needle and tube which inserts under my skin. In case it isn’t obvious, the pod has to be replaced with a new one every 3 days (duh!). The pod is controlled by a ‘Personal Diabetes Management’ (PDM) device which contains all the programming necessary to tell the pod how much insulin to deliver and when.

Again it’s a huge improvement over carrying around syringes, vials, and doing multiple injections per day. The pods are also rated to be waterproof down to 25 feet for 60 minutes which is perfectly fine for most things we’re doing. From experience I can tell you it’s actually possible to go down to about 40 feet (about the deepest I’ve tried free diving so far) without any trouble, but below that they tend to fail (as I found out when testing the pods while scuba diving).

Here’s my PDM. Unfortunately not waterproof and unfortunately the one piece of this puzzle for which I don’t have a back-up. I guess no system is perfect.

Here’s a pod currently stuck to my abdomen. The worst part is definitely not putting it on, rather it’s taking it off! I lose a lot of body hair that way…

 For the most part when we’re out sailing, or swimming, or diving, or doing boat work or generally doing any of the other life things that come with this cruising lifestyle, I barely notice having the pod attached to my body unless it happens to get snagged on something which doesn’t happen very often. Not to mention the improved blood sugar control I have due to the ability to make small adjustments in real time based on what my blood sugar is doing in the moment. 

The biggest downside is the PDM part of the system doesn’t allow for an easy back-up (they’re very expensive and the company doesn’t just hand them out on a whim). So if anything happens to the PDM (gets dropped in the water, gets lost, gets otherwise broken in any way…), I’m shit-out-of-luck until I can get a replacement shipped in from North America. So far, knock-on-wood, this has only happened once in the whole time I’ve been using the Omnipod, but of course it happened in Dominica during the period of covid-related lock-downs, so getting a replacement shipped in was a little bit of a pain. On the other hand, it was a chance to test the back-up system of going old school and reverting to syringes and vials. Thankfully it turned out to be fine for the week or so needed for the replacement to arrive, but definitely reminded me how good I’ve got it usually!

Summing it Up

At the end of the day, I’ve got a couple of key pieces of technology that make living with diabetes a whole lot more manageable and allow me to do almost anything I want. In future posts I’ll cover how we go about making sure we’ve always got enough supplies (sensors, pods, insulin, etc.) on board that there’s no risk of running out, how I go about keeping the essentials with me as we’re out exploring, where we keep all this stuff given our small living space, and of course some of the differences between managing my diabetes afloat vs on land. Until then…