Exercising with type 1 diabetes is challenging – blood glucose levels are hard enough to control at rest, and exercise is another factor that affects them. Generally, exercise reduces blood sugars and makes you vulnerable to hypoglycemia, since your body is burning glucose and exercise activates non-insulin sensitive glucose transporters. I’ve written in detail about hypoglycemia in this article.

Kayaking has some additional challenges, and kayaking solo and unsupported on the sea has even more! In this article, I’ll detail these challenges and discuss how successfully I dealt with them in chapter 1 of my adventure.

When kayaking, the hands are gripped around the paddle meaning they aren’t free to test blood sugars or ingest carbohydrates. This is especially true in racing, where taking your hands off the paddle means stopping, and losing your group. Even if you do stop, you can’t reliably use a blood glucose monitor – the meters aren’t waterproof and any water on the hands will dilute the blood and give an inaccurate reading. Getting a drop of blood out of your finger and onto a test strip is very fiddly, so it would be near impossible in an unstable kayak, especially if the sea state is rough.

For the first six months after my diagnosis, I would test my blood sugars before I got on the water, but then have no idea what my levels were whilst kayaking. I often felt extremely vulnerable and scared – not only was I walking the tightrope of blood sugar control, but I had my eyes closed and if I fell off the tightrope, it would be into water. Sometimes a freezing cold river Trent in full flood in the dark on a icy January evening. Sometimes five kilometres offshore over a reef where the waves are breaking and I can’t see any of my paddling buddies. The possibility of going hypo and falling unconscious was very real.

The solution? Run sweet. Basically, if in doubt, take on some carbohydrates and exercise with elevated blood sugars. I always have spare energy gels on my body and use a drinks bladder or bottle with a carbohydrate solution which I can drink hands-free. In addition, it’s vital to establish a trend in blood glucose before starting exercise and to then take on carbs accordingly. While this method does work, exercising whilst hyperglycemic is bad for you long term and makes you feel lethargic and heavy.

I’m very reliant on my CGM, which unfortunately isn’t very dependable itself. Each sensor only lasts 10 days meaning I had to carry multiple sensors which are bulky thanks to the ridiculous single-use applicator needed to insert each sensor. With limited room in my kayak, this took up valuable space and I only carried 6 – enough for two months of paddling. Therefore, at some point in the trip, I had the logistical challenge of getting CGMs sent from the UK.

I found Jorg, a Warmshowers host willing to let me use his address in Marseille. Unfortunately, along with my insulin, the CGMs got stuck in customs and I paddled away from Marseille without them, not knowing when they’d turn up. As you can read on Day 44, Jorg texted me to say they’d arrived just as I’d paddled around to the other side of the Calanques Not wanting to repeat my paddle, I walked over the mountains in my beach shoes to collect them, which made for a good bonus adventure!

Instead of lasting 10 days, my sensors were losing adhesion and falling off sometimes after 5, thanks to rubbing on wet clothes and sand all day.

In addition, for the CGM to be useable, I was reliant on my phone working. I carried multiple battery packs and always ensured my phone was on maximum power before getting on the water. When my phone died from water damage I had a spare phone capable of connecting to my CGM.

Although I was reliant to an extent on my CGM, in case of failure, I could revert to my old method of running high sugars on the water.

While using a CGM made managing my sugars far easier, I still found it very challenging. Before starting the trip, I was injecting around 25 units of Levemir a day, split into 2 doses. Training normally makes me very insulin sensitive, so I assumed that my insulin usage would be reduced considerably by paddling for hours each day on the trip.

For the first few days, this is what happened – I was only injecting a couple of units a day. However, my doses then increased throughout the trip, until by the end I was very insulin resistant, having to inject more than 60 units of Levemir a day. My usage has now returned to around 25 units of Levemir a day.

What caused this? I don’t know. One explanation is that my insulin degraded in the heat. Insulin is meant to be kept refrigerated and used within 6 weeks at below 30°C. Instead, mine was baking under the hot French sun all day.

Another explanation is that hyperglycemia itself drove my insulin resistance higher. Every day I was eating large portions of porridge and pasta to fuel my exertions, but I found it very difficult to inject the correct amount of insulin to cover these portions. As I became more insulin resistant, the doses of insulin I had to inject increased, and the margin of error in my blood sugars also increased. This resulted in long periods of hyperglycemia, particularly at night. My sugars would skyrocket, but repeated injections of insulin seemingly did absolutely nothing, like I was injecting water, until suddenly my sugars would come crashing down, sending me hypoglycemic. Sometimes I was camping in isolated places, like an uninhabited island, and I had to make sure I always had sugars available to treat hypos.

It was frustrating and made me feel exhausted. At one stage it did get me down, and I spent a day lying in a hovel in Carcasonne feeling sorry for myself and eating to satisfy my enormous hunger, despite knowing it would make my hyperglycemia worse. Dealing with diabetes every day can get overwhelming, and sometimes I reach this stage of self-destruction, which is bad enough for me to ask why the hell I’m doing this to myself and gives me renewed motivation to keep trying.

One other explanation for my insulin resistance is that the physical stress of paddling for hours every day made me more insulin resistant, in the same way that having an infection does – inflammation.

A contributing factor may have been that my body became conditioned to paddling at a low intensity for several hours each day, meaning my rate of metabolism slowed down and I became more efficient. This contrasts with training, where the stimulus is constantly being to keep you challenged and progressing.

I managed to balance the bad days with some good days, and blood tests on my return showed I’d averaged around 10 mmol/L over the 3 months of my trip. This needs improving because it is quite poor blood glucose control. While not disastrous for my health, spending time at this glucose level damages my body and puts me at risk of complications such as retinopathy. Usually, my average number is around 7.5 mmol/L (HbA1C of 6.3%/45 mmol/mol) which is the inside the target range for type 1 diabetics.

What will I change next time?

1. I’ve tested my response to fasting, and have found it is effective in increasing my insulin sensitivity. If I start to become insulin resistant, I’ll implement a period of fasting to reset my sugars.

2. I am going to experiment with my diet, shifting from a carb-heavy diet to a lower-carb/higher-fat diet. Instead of my calories coming from porridge and pasta, they will come from nuts and oils. A detailed article discussing this is in the pipeline!

3. I’m going to use an adhesive to prevent my sensors from falling off.

4. I’m going to use a frio cooling pack to keep my insulin from degrading.

5. The logistics of sending insulin and CGMs from the UK remains a challenge, but I can’t think of a solution. In an emergency, hospitals will always provide me with insulin. If you’re happy for me to use your address or know of some kind of parcel locker, please get in touch.

6. I’m going to document my diabetes management daily, as part of my blog.