Paul Coker & Rachael Hunter Dunn – Diabetes & Swimming; How to Manage Blood Glucose Levels in a Swim

I’m really excited. I’m sitting here in Brighton today with Rachael Hunter Dunn. Rachael is a friend of mine. I met her about three years ago at the Animus Sports Weekend, when we both learning the foundations of how to exercise with diabetes and Rachael does some incredible open water swims for incredible distances and today I will be asking Rachael about how she manages her blood glucose levels during swim.

We spoke earlier in a previous video about what you do before a swim. So in this video, I want to talk about what strategies that you have during swim.

So is there anything special that you do? We spoke earlier, you do different types of swims. In cold water swims, are very short and then you do longer swims in warm water. So do you actually manage during those long swims?

So, what I can do is give you an example of what happened in Lanzarote. Seeing as that was my longest swim. 8 kilometres. So, I was wearing my insulin pump because it's waterproof, so I was able to wear it during the swim and as I mentioned before, reduce the basal rates on the pump. And then, because we were out for long distances, we had kayak support. So, obviously this isn't always the case. You haven't always got someone on the kayak but part of going to Lanzarote for me was to work out whether I could do these long swims with diabetes and not worry so much about being in the open water.
So, I did have food and drink on board the kayak but I found in the swim, I didn't actually want to take on food. You don't feel like ... I personally didn't feel like eating. So I had some tropical fruits juice as that kind of thing because you want something. So I tended to take on liquid rather than food. But I also tested my sugar levels while we were out on the sea.

Am I right in thinking that you were doing that with a blood glucose monitor? You weren’t using a flash sense or a CGM?

No I haven't ... I don't use CGM or a Flash Sensor. It was with a standard blood sugar metre. So, I would swim up to the kayak, dry my hands, hang onto the kayak and do my ... test my sugar level and then put it all away in a waterproof bag. And then swim off.

Sounds like you must have had some very calm seas. I can’t image hanging onto the back of a kayak and doing a blood test while the seas rough.

It wasn't that calm to be honest. There was one moment where it wasn't really calm at all. I nearly had a little meltdown but it was ... it kind of worked and it meant I had peace of mind while I was out there. And I could see at one point that my sugar level did drop, so I just took on some fruit juice because that's all I really wanted while I was out there. That kind of worked and kept me ... I actually finished the 8K with a sugar level of about 8.5 so I was slightly higher than normal. To me, I was very happy with that.

You know, I’ve run a lot of half marathons and there’s been a really mixed bag of blood glucose levels that result most of them are reasonably within target but if I finished a half marathon at 8.8, I think I’d be delighted. And I think that you should be too.

So, when you’re doing an open water… a long swim like that and you’re taking on fruit juices, do you have a rule that you take on fruit juice every 30 minutes or 20 minutes or one an hour? Is there a method that you follow?

There's no method as such. I mean, it was all quite trial and error for me. So, that particular swim that I did, but we stopped every half an hour, so in terms of time I knew that I had a half an hour window before the next sugar text and feed basically. So I had in my mind that's all I had to get through. There was one moment where my sugar level did drop, so I called the kayak over before the half an hour but it was tricky.
What's tricky in the open water is to know, when you're swimming and it's slightly rough, whether you feel slightly queasy because of the waves or whether it's because you got a low sugar level. That was tricky for me so, it's better to check and then you know. But I had amazing support and that's what you need.

So if you were doing an open water swim, perhaps not the long distance, but if you’re doing an open water swim and you haven’t got kayak support how do you then carry your pump? How do you carry your glucose supplies?

Well I wear my pump strapped to my costume and I have ... you can have a sort of tow float. Sort of an aluminium tow float that you can put your stuff into. Wrap it up and then its becomes waterproof and then you sort of swim with it around your waist and it follows you. So, it's close to you. You can use that. But I don't tend to ... so at the moment, if I'm going out swimming I tend to go in a group. Most people I go out with know that I'm diabetic or I'm not that far away.
So swimming in Brighton for example, not that far away from the shore. Don't tend to go out that way. What are we all going to do go out to whims for a swim? Which is over there. Can you see the whims mom? So yeah, I think for me it's peace of mind knowing that if I'm swimming along the coast, I can always get in and sort myself out if I need to. Or just wear a tow float because that's really handy. Then it's on you.