Living Dangerously With T1D
By Jerry Gore
Jerry Gore, co-founder of Action4Diabetes, which supports children with T1D in seven countries, recounts a scary and instructive experience he had while staying at a seafront hotel on the Mediterranean island of Cyprus.
The real challenge on this 30 year wedding anniversary holiday was, as always, the constantly changing food we ate. My wife Jackie and I had treated ourselves, as it was our first holiday together in years, and we checked into a fancy seafront hotel famed for its three Michelin starred restaurants on Cyprus for a weeklong stay.
I think Jackie was trying to kill me off. Monday it was French night, Tuesday Italian, Wednesday Indian. Then there were the “extra special” restaurants located at the hotel. In summary, it was a seaside food fest. This place was renowned for its huge buffet meals – breakfast, lunch and dinner.
Luckily, I had a couple of tricks up my sleeve. I find that daily exercise is the only reliable thing that will always help regulate my blood sugar levels. If I can do at least some basic cardio each day that increases my heart rate for 30 minutes or more, it greatly aids my glucose management.
However, I travel a lot, and each day is different. As co-founded of Action4Diabetes, supporting children with T1D in seven different countries, I am in Southeast Asia at least a month each year working for the charity. I am also a Himalayan Mountain Guide and new route expedition mountaineer, and I run businesses in France and the UK.
While traveling, I eat different foods almost daily. My secret is, always go heavy on protein and fats. And stay off carbs like potatoes, bread and rice. I eat a lot of vegetables, and love big salads full of tomatoes, feta, onions, lettuce, and nuts, normally downed with a tasty glass of red wine.
My bike riding guide on this day, 26-year-old Marios, was a typical Cypriot athlete – tall, strong, and very fit for his chosen occupation. He was a gifted bike rider who seemed to flow effortlessly down the dry diamond gravel trails of this sunny Mediterranean island. We had already ridden together a couple of times, so he knew, or thought he knew, his old (61 years) diabetic client for that day.
He greeted me with his usual “Ciao, Jerry” and asked if I was “OK” for the big ride – more than 50 miles into barren and remote countryside, with some challenging hills along the way. He smiled down at me, knowing he would suffer far less than I. He was so right!
“You have water, Jerry? It will reach 35 [celsius] today” (95 degrees Fahrenheit).
I nodded nervously, mentally checking all my supplies. Marios shot off in the direction of the early morning sun, and I raced after him, psyched but full of dry-throated apprehension.
Almost immediately after reaching the end of town, the land started to rise up – steep, scrubby, snake-infested wilderness. Within an hour I was boiling hot and ready for a drink. Marios picked up my vibe and stopped just below a small barren brown crest.
“OK, Jerry?” He asked rhetorically. But I wasn’t, and so I said so.
“Feeling a bit fuzzy, mate. Think I will do a blood test.”
Fuzzy was not good. It is the only word I can think of to describe how I feel when my blood sugars are high. Normally, it means I am around 15 mmols/L (270 mg/dL) and need a couple of units of insulin. Job done. But when I saw the readout on my phone, I was instantly alarmed: 25 mmols/L (450 mg/dL) – yikes!
I was always told training hard when you are 14 mmols/L (252 mg/dL) or higher is not a good idea. I also knew that high temperatures could affect my glucose levels. But “no worries, I’ve got Humalog,” I reasoned with myself. I realized what I needed was more insulin. I had not taken enough at breakfast. I would inject, carry on slowly, and my blood sugars would come down. I had trained so many times, over so many years, for such situations.
I told Marios we would ride hard for another 10 minutes, and if my blood sugar did not drop, I would inject and go from there. He agreed and we continued. But at the next test I was at 26 mmols/L (468 mg/dL).Not good. I immediately opened up the insulin pocket on my day pack only to find it was empty. That really was not good.
Now I had to think calmly and clearly. I asked Marios how long it would take to get back if we just used the pavement or tarmac. He reckoned 35-40 minutes minimum and only if we sprinted. I apologized and said, “follow me and try and keep up.” He smiled, but I was already off.
Less than 30 minutes later I was already back at the hotel, begging the floor maid to let me into my room. Jackie, my wife, was probably out swimming in the sea, and not expecting me back for hours. I injected 5 units of Humalog and ran back to my waiting friend. This is, I admit, not the kind of behavior that others should follow.
“Sorry about that, mate. Now where were we?” I joked.
Marios knew I would not give up and had already planned another ride. So, we headed straight off again on a lovely snaking single track. In total we did 45 miles that day with just under 4,000 feet of elevation. My blood glucose returned to normal, and I finished the day at 8 mmols/L (144 mg/dL).
Like so many days before, I got through the day by testing and experimenting regularly. I know what my body can and can’t cope with, and how it reacts to different situations. This gives me a high level of confidence and a “can do” attitude. But most importantly, I don’t feel like a diabetes prisoner. And that I find very motivating.
I am definitely not an easy partner for Jackie, but she has stuck with it and endured everything I have thrown at her, the children, and the dog! Both our daughters have had to deal with me when in the midst of severe hypos. But it is the night time hypos that are the worst for Jackie.
Imagine waking up around 3 am under bed sheets saturated in sweat, to be confronted by a nasty snarling monster who happens to be your husband? It takes Jackie 30 minutes to coax a small honey sandwich into my mouth to bring my blood sugar levels up to where I can walk to the bathroom.
I shower, she showers, then we change the bedsheets and I go straight back to sleep, normally after muttering an embarrassed, “Sorry, Jackie” under my breath. But her day has already started, and it is impossible for her to go back to sleep. At one stage in my T1D “career,” before continuous glucose monitors existed and could alert me to to such approaching episodes, I was having three such hypos a week.
Jackie is very practical. She has read many books about diabetes and talked to a lot of caregivers in similar positions. And so, together, we plot and plan our diabetic journey through life.
My catch phrase is “Diabetes is NOT an excuse.” But it sure is a pain in the butt sometimes. I have always been told to adapt my condition to my lifestyle, and not the other way around. And that is exactly what I try to do each day. We only have one life, so I try to make it as good as it can be.
Get involved in the Action4Diabetes Insulin360 Challenge:
The Insulin360 challenge, which began this month, is an endurance mountain bike trail across the southern French Alps to give health and hope to people with Type 1 Diabetes. You can join the Insulin360 team virtually and make a difference to the lives of young people. It will also motivate you to get out and cycle, hike or swim.
Every virtual participant has the chance to complete the 360km route in one month, by uploading the distance they cycle, hike or run. Click on this link for all the details and how to sign up.