Dear Dr. Shark I’ve got a long-planned surf trip coming up - me and a few friends are heading down your way but I have developed a problem lately. I’m a Type I – insulin dependent – diabetic and I had a couple of blackouts lately both connected with extra long surf sessions. I’m trying to figure out how to deal with this and now I’m wondering how safe it is for me to be hanging out in remote surf spots down in some banana republic. What’s the emergency medical care like where you are? Is it expensive? Gene Sayers, Outer Banks Fair enough Gene, thanks for the timely question since diabetes seems to be on the rise in our banana republic like many other places. Let’s answer your primary question directly: if your emergency medical needs go beyond a glass of water and someone to hold your hand then we recommend you make prior arrangements for emergency medical care. If you think you might need an ambulance hire one by the week because if you need something as complex as oxygen or an IV that level is not available locally. Not that it matters much because our beach is well beyond the ‘golden hour’ so you’ll be long gone before they get here. Now let’s look at some helpful hints about the care and feeding of diabetes: A diabetic is a person with a disease in which the body has trouble breaking down and using sugar (glucose), so that the blood begins to carry abnormally high levels of sugar, and the only way the body can dispose of it is via urine. A poor man’s test for diabetes is to pee near an ant hill, and if the ants come running to check out the new candy store, it’s time for you to run to the doctor – you’ve probably got diabetes. Other major symptoms include: continual thirst despite drinking large volumes of water, weight loss and hunger, unexplained sensations and pains (often in the back). A morning (fasting) blood test to measure the level of glucose usually cinches the diagnosis if it is clearly above the normal range of 60 to 110 mg/dl. There is no cure for diabetes but it can be controlled by: 1/Limiting sugar intake (particularly simple carbohydrates – junk food). 2/ Maintaining normal fat stores – don’t get overweight. 3/Avoiding dehydration, stress and infections. 4/Taking sugarlowering pills; or, if all of the above don’t Dominical Days 20
work, taking insulin injections. Among other abnormalities, diabetics don’t produce enough insulin, a substance made by the pancreas that allows the body to break down and use sugar. Diabetics usually need to inject insulin twice daily. The Surf Docs advise for a diabetic surfer not to take the dose of insulin that would normally cover the time during which you are surfing. Spending a few hours a day with a slightly higher than normal blood sugar (‘loose’ control) is not dangerous (aim for 125-175 mg/dl, or higher). Be sure to wear a Medic-Alert bracelet at all times, especially when surfing. Teach your surf buddies how to detect trouble and how to respond. If conscious give glucose by mouth – fruit juice, soda pop. Unconscious, they need to inject you with glucagon, which works opposite of insulin. Have your doc prescribe you a ‘Glucagon Emergency Kit for Diabetic Insulin Reaction’.
Preparation and prevention is the key. Eat and drink plenty before going out, and make yourself come in for more of the same once an hour (set your watch). The spontaneous ‘go for it’ attitude in surfing doesn’t apply to caring for diabetes. Stay loose (sugar level-wise) and have fun. A positive attitude is always helpful. Thanks again for the useful question Gene, good luck and pura vida! Dr. Shark