Swimming with parts you weren't born with.
swimmer25k
Charter Member
Does this qualify as an assisted swim? Thanks in advance. Please call me Wolverine from now on.
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I call it "Tampa Bay Marathon Swim 2007, surgery number #9"funny thing was thst I wasn't even entered in the swim. RIP Dave Parcells.
I was expecting something very different.
Is that your leg? What happened?
MSF might have to look into a cyborg division.
Seriously, hope recovery goes quickly!
Speedy recovery!
I totally qualify as a cyborg. :-) Have you met my pancreas?
The CSA approved my electronic bits (along with my use of insulin) as acceptable additions to the standard swimming costume. Technically, though, all my swims are deemed assisted under MSF rules until there's some sort of allowance for therapeutic use exemptions.
Honest question, how do you swim with an insuliin pump? I have heard of baseball players playing with one, and I have worked with people who wear pumps, but they aren't exactly spending that much time in such a harsh environment as saltwater. I understand why you need it, but do you need some sort of extra waterproof enclosure to swim with it?
Not trying to be nosy for the sake of being nosy, I'm just genuinely curious.
Hey no problem! I'd be curious too.
So, in the picture I referenced above, the pink device clipped to the girl's jeans in the insulin pump. It delivers insulin every 3 minutes through the tubing that connects to the pink and white thing (infusion set) stuck to the girl's belly. The tubing is quite a bit longer than shown (23", 31", or 43") -- it's just that it's neatly tucked away for marketing purposes.
Most pumps on the market are IPX8 waterproof. They publish and meet standards such as "tested to unlimited surface swimming and 30 minutes at 10 feet" or "tested to 3.6 meters (12 feet) for 24 hours". I place my pump down the front of my bathing suit. During most of my training, my suits have enough stretchiness that the suit tends to hold the pump wherever I put it. When I pick a super-loose suit for longer swims (for anti-chafing purposes), the pump tends to migrate around a bit. I'm not really aware of the movement, so it's not annoying or anything. When I need to adjust my insulin rates (which happens every couple hours when I swim), I just pull the pump out of a leg hole, change the programming, and then put it back. The tubing is long enough to accommodate this.
The grey thing on the white adhesive is a glucose sensor and wireless transmitter. The glucose sensor waterproof as well, and the adhesive keeps it in place. It has a wire probe inserted into interstitial fluid that converts electrical conductivity into a reasonable estimate of blood glucose levels. Every five minutes, it does a reading, and broadcasts to a nearby device (iPhone with an appropriate app or a medical device with programming to read the signal). The signals the transmitter sends while underwater aren't read by devices that aren't underwater, though, which is unfortunate. The pump in the picture can receive the glucose sensor's signals on land, but it's not marketed to work underwater.
While the pump can display the transmitter's readings, it can't act on them. "Closing the loop" (taking the human decision-making out of the insulin/glucose balancing game) is one of the holy grails of type 1 diabetes. Some think it's the closest we may come to a "cure". We're not there yet, but perhaps in the next 5-10 years...
It's worth mentioning that, for me anyway, an insulin pump and glucose sensor are amazingly amazingly wonderfully wonderful technology. They have made diabetes management much easier.
@JenA technology is so amazing! Yay for your external, computerized, cyborg pancreas!
I knew that from a type 1 diabetic I know relatively well. It seems odd to me, though, that your pump can "hear" the signals from your automated glucose reader, but can't act on them. That seems like it should be an easy programming problem to solve, but I'm just an engineer, I don't understand diabetes that well.
I didn't realize that they had devices that could automatically check your insulin levels. That's cool, I was going to ask how you knew to adjust your pump. The woman I know still has to prick her finger to check that. Do you ever have to back check your detector?
I believe it's more of a legal issue. If someone's blood sugar level is under the control of a computer, and they crash their car and kill people due to low blood sugar that the machine either caused or didn't prevent, there are huge liability issues.
It can't check your insulin levels -- it just estimates what your blood sugar is. They aren't the same thing, unfortunately.
Knowing how to adjust an insulin pump is both a science and an art. It's really, really complicated, and there are cases where external insulin simply cannot match what the body needs. For example, when Gary Hall Junior (who has type 1 diabetes as well) sprints a 50, he can start with a blood sugar of 7 mmol (126 mg/dl) and touch the wall 22 seconds later with a level of 17 mmol/L (306 mg/dl). (A person without diabetes would rarely have a blood sugar level over 7.8 mmol/L (140 mg/dl), and his blood sugar would be double that.) Counter-regulatory hormones, such as adrenaline, have a huge effect on blood glucose. So do the hormones that wax and wane monthly for a woman. Hypothermia (with its catecholamine-induced glyconeogenesis) is very challenging as well. Even happy emotional "stress" (such as being proposed to) spikes blood sugars.
It takes insulin 4-5 hours to do its job, which means you are always predicting into the future. (So, the dose of insulin I took 5 hours ago has just stopped working.) Knowing how much insulin you need means:
Most of these rates and ratios can (and do) change throughout the day, as well as day to day. There is a fair bit of guesswork because the numbers change too quickly to distinguish between variables. For example, if your blood sugar is too high, it could be because your metabolic needs are higher, because you didn't take enough insulin to lower your sugar, because you didn't take enough insulin to cover the food you ate, because you didn't correctly assess the amount of carbohydrate in your food (nutritional labels are only accurate to +/- 20% by the way), because your insulin level is too low and your liver is pumping glucose into your bloodstream, because you were too stressed, because you were too happy, because you were too cold, because your hormone levels changed, because your had a bubble in the tube that delivers your insulin and you missed part of a dose, because you're getting a cold and your metabolism has shifted, because there's a bit of scar tissue in the area you placed your infusion set (and the insulin isn't absorbing as well), because your exercise tipped into anaerobic, etc. etc. If you change the wrong rate/ratio, you blood sugars will be out of whack the next hour/day.
It's a fair bit of work. Please understand that when someone says, "Oh, yeah, my uncle/grandma has type 1 diabetes, but they don't take care of it", it's often because their uncle/grandma doesn't have the math/problem solving skills/medical understanding, or because they can't afford the technology or most appropriate medications, or because their medical team doesn't have the knowledge to support them (this happens terrifyingly often), or because it's really hard to spend a lifetime sustaining high levels of energy managing something that seems as manageable as a herd of cats, or because the workload associated with diabetes has crushed them, or because they've been so beaten down by failing to manage their diabetes that they've given up.
I am very, very lucky to have the tools, knowledge, and ability to manage my diabetes exceptionally well.
I calibrate the sensor about four times a day through regular finger-prick blood glucose testing.
@JenA - thank you for the long, very explanatory answer. I'm thankful I don't need to worry about diabetes for myself or anyone in my family, I'm always curious to learn more about it
Second this.... my nephew has Type 1 and this really helps me understand what he must go through to manage it. He comes across as happy and positive, and is successful in his work. Knowing this, I admire him all the more.