Diabetics Pushing the Edge of Normal

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Sean Busby

Sean Busby, a Type 1 diabetic, has lately been bagging big lines in Iceland, Antarctica and Patagonia. According to an article at Espn, Sean is preparing for a trip to Greenland with a few first descents in his sights.  While most adventurers worry about their water freezing or their boots getting left out in the cold, for Sean if his insulin freezes while he’s on a remote continent, nowhere near a drugstore, he’s toast.

I should know. I’m a diabetic too, and learning to compensate for the disease in an outdoor setting offers a unique set of challenges. Sean uses a OmniPod, which attaches to his skin, keeping the insulin close to his body, away from freezing temperatures. Containing 3 day’s worth of insulin, the pod can maintain his latest doses, but the vial, the one he will use to refill the pod, must also stay out of the elements.

That isn’t easy when you’re climbing in subzero temperatures. For that matter, it’s pretty challenging even on the slopes at Crystal, or any overnight backpacking trip. Extreme temperatures, either hot or cold, will render the insulin useless.

I use an insulin pump (the Medtronic Paradigm). It has many of the advantages of the pod, but I can take it off when I jump in the shower or even go surfing. I’d be afraid the pod would get ripped off in the breaking waves. Furthermore, if I have a low blood sugar, John knows how to disconnect the pump, in the event of an emergency.

When I was first diagnosed with diabetes nearly twenty years ago, my doctor told me not to worry. Innovations in diabetes management were on the horizon. A mechanical pancreas, capable of monitoring blood sugar levels and dispensing insulin accordingly was just around the corner. Twenty years later, they haven’t gotten much closer.

Instead, most diabetes research funding goes into fixing the Type 2 epidemic. 1.9 million people were diagnosed with Type 2 diabetes in 2010. Many of those are due to lifestyle—the wrong diet and lack of exercise. Whereas Type 1, on the other hand, is an auto-immune disease.

Mt. Rainier

When my doctor told me that I could live a “relatively normal life” as a diabetic, my heart sunk. I didn’t want to live a normal life, and any scale diminishing that even by a fraction seemed devastating. A year later, I climbed Mt. Rainier. I recently published an article about that trip—the first post-diagnosis physical test of my body and my medication—in Diabetes Forecast Magazine. I hadn’t yet figured out the ratio for hard physical activity to insulin levels. My doctor had told me to cut my insulin in half on the climb up, assuming that the aerobic exercise would bypass my caloric intake to metabolize my food without the help of the medication. Too much insulin and I ran the risk of a severe low blood sugar reaction. Instead, I went the opposite way and when I reached the summit and checked my blood sugar, it made sense. I’d struggled the last few hours, each footstep a gargantuan effort. When I saw my blood sugar on my glucometer, I understood why. At 365, all the calories I’d been eating were just sitting in my blood stream, causing long term damage, but not getting into my muscles. Without insulin, sugar stays locked in your blood, where it can’t do anything but harm. Too little insulin in the blood stream and your brain could starve. Too much and you risk vascular damage. It’s a balancing act more difficult than the tallest of slacklines.

So, this is why I’m even more impressed with Sean Busby. Props to him. Way to advance the edge of diabetic normal, Sean. If bagging first descents in Greenland is “relatively normal”, then I guess it isn’t so bad.

Check out Sean’s website, Riding on Insulin, where he offers skiing and snowboard camps for diabetics. Go Sean!

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6 responses »

  1. Nice article Kim. I happen to be funded through the Diabetes and Endocrinology Research Center (DERC) at UW so this article hits closer to home for me. Its interesting you bring up the differential funding for Type 1 and Type 2 Diabetes mellitus. Our lab investigates the effects of glucose and fatty acids on mesenchymal stem cell signalling in the skin. We hypothesized the diabetic metabolic environment causes changes in cell-cell signalling and interactions. We defined that environment as including elevated plasma glucose and fatty acid levels. Interestingly, high glucose had no effect on our cell type using the end point assays we looked at. However high fatty acid levels had a significant impact on cellular responses. These results have led us down a more “type 2” research path. Unfortunately, glucose data that shows “no change” just isn’t sexy enough to pull strong NIH funding so we have stuck with the elevated fatty acid storyline (data to be published soon).
    Type 1 research is more strongly dependent on embryonic stem cell research or the hot new induced pluripotent stem cell with a targeted approach of replacing the Islet cells that are no longer producing insulin. Stem cell replacement therapy has come a long way but unfortunately is a strong source of contention and moral debate.
    Here in lies the problem for PIs applying for NIH funding: go with what will get funded and continue to put food on the plate, or apply for the new and novel potentially risking your career if the stem cell usage gets nixed. Given the fact Type 2 is by far more common than Type 1 also makes it a larger research target to hit. What is helpful is having smaller funding sources aside from the NIH conglomerate, like DERC at UW, that can be more targeted with their funding to help push forward the newer and novel research that would be more likely to target Type 1.
    With all that being said, we are collaborating with a bioengineering grad student on a new “smart bandage” that can adhere to a wound (chronic or otherwise) that will send a glucose reading to a computer so your Dr can monitor the metabolic environment of the wound remotely. While this is not necessarily diabetes mellitus specific, chronic wound metabolism is complex and this could be a very therapeutic tool for clinical applications in the future. We will see.
    Thanks for letting me share 🙂
    Andria

    • Wow Andria. That’s fascinating. I’m so glad you did share. I agree that stem cell research is key to Type 1. Unfortunately, as you say, its a contentious point. My hope is that stem cell research can get past the naysayers and start making a difference. Next time I see you, I know what I’m going to pick your brain about.

  2. Kim,
    Thanks so much for the great post. I really appreciate your kind words—it means a lot coming from someone in the industry who also has T1! I just wanted to answer some of your questions about the OmniPod. Before I got on it, I was on traditional pump with tubes and I found I had a hard time from keeping the insulin from freezing while snowboarding. That was a big reason I decided to go with the OmniPod. And since I started using it, I’ve never had an issue with the insulin freezing or with the pod ripping off. You’d think it would rip off, but seriously that has never happened to me yet, even with all the snowboard expeditions. I actually tried wakeboarding for my first time last weekend and had no problem there as well. I recently heard about another OmniPodder who is a diver – he keeps it on with a light adhesive athletic tape and has never had a problem. In regards to disconnecting, that’s another huge reason I love the pod. Although I too would disconnect to shower, etc. with my old pump, the OmniPod is so much easier to wear for me because I don’t have to worry about connecting and disconnecting, etc. It’s always there and I don’t even know it! Of course there are different pumps that are right for different people… just wanted to give my two cents on what’s been working great for me.

    Also, wanted to let you know Crystal Mountain is my favorite mountain to ride in North America for its Alaska-like feeling and great access to the backcountry! So jealous that Silver King is right in your backyard! Keep doing all that you do. Sounds awesome.

    Again, great meeting you here and thanks for the write-up — if you have any other questions about my experience, please let me know! I’d be happy to talk.
    Best regards,
    Sean Busby

    • Sean,
      Glad you like the post and thanks for the information about the Omni Pod. What about surfing? Do you think it would stay on then? Keep in mind I’m new to surfing and so I do get thrashed around in the surf a bit. Also, is it ever possible to take it off, if say you want to go in the hot tub? Or would that require taking it off and starting over with a new site after you’re out? I know what you mean about worrying about the tubing freezing while on the mountain. I keep my site covered and my pump in my bra, making sure no stray parts of the tubing are outside, but I am inclined to think that’s happened before when I didn’t realize it, resulting in unexplained highs. I like the idea of getting in the shower, into bed, etc without having to worry about it. I’d love to just forget about my pump site and worry instead about other things.
      Thanks for stopping by. Keep me posted about your exploits. I love to hear about a diabetic pushing the edge.

  3. Hi Kim,
    I’m a professional paddle boarder and surf with the OmniPod – I have been wearing my pods in the water for ever a year now. I have never had a problem with them ripping off in rough water or while surfing. I do use a patch of clear Tegaderm film to cover the whole pod, but only when I am surfing in tropical climates. The reason for this is that my body gets very sweaty when it’s humid outside. I find that the adhesion to my skin is fine but once it gets wet with the warm tropical water, it loses its hold. I don’t have to use the Tegaderm at all when I surf at home in California. The cooler weather definitely helps the pods stay completely secured for their three day life span. Please let me know if you have any other questions!

    Thanks,
    Brian Haag

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