Abstract
As a lifelong sailing enthusiast, I was lucky to meet Jack and hugely impressed by the scale of his ambition and achievement. I am particularly impressed that Jack has remained undaunted by the additional challenges posed by a diagnosis of type 1 diabetes mellitus (T1DM) in 2015. I thought it would be inspiring for doctors and patients to learn more, and so I put some questions to Jack about both sailing and self-management of T1DM under extreme conditions.
How did you get into sailing?
Unlike most in the sport, I do not come from a sailing background. It was in fact a chance day out at a local sailing club open day – something my mother thought my twin brother Alec and I would enjoy, that turned into her spending more hours on wind-swept quaysides and muddy reservoir banks than any human being should suffer. I was 6 years old and from then on I was putting in the hours, learning how to race and developing a passion that I think will never leave me (Fig. 1).
Jack breaking the Length of Britain World Record on Artemis II.
Tell us about the upcoming sailing challenges
I am now targeting the yachting ultimate – the Vendée Globe, in 2020. The Vendée Globe is the famous round the world, non-stop, solo marathon. It is often rightly described as the single hardest sporting challenge known to man. To put some perspective on it, less than 100 people have completed this near impossible feat, whereas over 550 people have now been into space, and thousands made the accent of Everest.
The next step on this journey is to compete throughout the 2018 season in ‘Class 40’. This class is effectively one-step down from the Vendée Globe circuit, like Formula 3 to Formula 1, and will take me through a series of races around Northern France and the UK, culminating in the ‘Route du Rhum’ in November. This is an iconic solo transatlantic race, starting in St Malo, France and finishing in Guadeloupe.
How have you been training and gaining experience for the challenges ahead?
Having been sailing since I was 6 years old and racing almost as long, time on the water is not always the goal. Training becomes less about volume and more about training smart. Experience sailing solo and in the boat that I will race in is the key, but sailing around the World in order to train for sailing around the World is not necessarily the most efficient use of time. So, we break it down and focus on the specifics – training on manoeuvres, set up and straight-line speed and then looking at the bigger picture – coping with the sleep deprivation, looking at global weather systems and strategy, etc. Time in the gym is also plentiful thanks to the sports physical demands, and then there is the optimisation process – making sure the boat is as fast as possible, the systems are efficient and reliable, and everything is tailored to my style of sailing. Lots to juggle!
When were you diagnosed with T1DM?
I was diagnosed in Spring 2015. There is no recorded history of DM in my family, and so to be honest it was a bit of a shock! I was taking part in a 3-week-long offshore race in the Middle East. In hindsight, I probably knew something was wrong, but at the time I put the symptoms down to race hardship – extreme thirst I attributed to the 40-degree ambient air temperature, and serious fatigue and rapid weight loss I figured were just side effects of pushing myself to hard. However, when I returned home and realised I had lost 20 kg in that period I knew something was more seriously wrong. Shortly after, I was taken to A&E barely conscious with DKA.
What challenges has this posed for you?
Offshore sailing is probably one of the more challenging things you could try to do with DM, especially sailing shorthanded (solo, or with one other person). It is extremely physical, and the exercise is unpredictable; it could be long-duration low-intensity cardio, which can set blood sugar levels on a downward trend, or short bursts at a high intensity, which will trigger the release of adrenaline, raising blood sugar levels. There are eight sails on the boat, weighing upwards of 80–100 kg each, and these are regularly moved around, hoisted and dropped. On top of this, everything on the boat is powered manually – one individual sheet may be holding up to 5 tonnes of load, and sails are being constantly trimmed or adjusted. Sleep is difficult, we aim to sleep between 20–40 mins every 2–4 hours, but you might go through a particularly tough 36 hours where you do not sleep at all. Food, similarly, can be difficult – at times I am burning upwards of 8000 calories in a 24-hour period, and in certain conditions, holding down any food at all is near impossible.
How have you learned to manage the DM?
The perspective that solo offshore sailing gives you and the approach it forces you to take in order to be successful is unique, and perhaps surprisingly quite well suited to DM. This style of sailing is about management, risk management, personal management and prioritising. If I pay attention to myself I perform better, and I stay healthy, so managing DM offshore is just another thing I add to the priority list, and as long as it is always in the right place on that list I will not have any problems.
How do you plan to manage the DM with the particular challenges and demands of single-handed, extreme sailing?
Technology is the key. Diabetes-specific technology is making leaps and bounds at the moment, bringing devices to market that have a significant impact on management of the condition. One of the more serious implications of being on your own, compared with being part of a crew, is that there is no one to watch out for you, no one to look for your tell-tale hypo signs, or in a worst-case scenario administer a glucagon shot. Continuous glucose monitoring, for example, with active alarms and real-time data can play a huge role in blood sugar awareness and thus safety, even when your attention is elsewhere.
Insulin pumps can also have a hugely positive impact; injecting is a nuisance at the best of times, but at sea it is just plain impractical. The hassle of taking off your foul-weather gear, and the difficulty of injecting while being thrown around in a small dark space, rather like the inside of a washing machine, makes you less inclined toward good management, which not only puts you at a health risk, but is also a drain on performance!
The real power of the modern-day insulin pump, however, is how smart it can be. Having the ability to adjust your basal patterns to preprogrammed rates, program in carb ratios (perhaps the only good thing about packaged, dehydrated food is that the exact carbohydrate content of the whole meal is written on the label) and more, allows much tighter control and more specifically more versatility. In an environment where routine is scarce and numerous uncontrollable external factors exist, this is a big factor in allowing me to do what I do at the top level.
Of course, as we become more reliant on tech, we also become more susceptible to its shortcomings, and so it is no reason to become complacent. The ocean racing philosophy makes this point clear; in an extreme environment thousands of miles from land, you must have robust systems in place for failures and have a focus on reliability, redundancy and simplicity. These lessons can certainly draw parallels with using technology for DM management in everyday life.
What advice do you have for other young, active and adventurous people with their management of DM?
Diabetes certainly does not have to hold you back from challenging yourself, physically or mentally, it just needs to be factored into the equation. Good diabetes management requires being analytical, so take an analytical approach to it. For me learning to manage the condition in an extreme environment like the Southern Ocean may seem impossible, but then I would not sail around the World as a novice sailor. So, take it a step at a time and approach DM management as a part of the progression to whatever your goal is – just another small part of your challenge. This way you can build confidence, you mitigate the risk of diving in too deep and in theory by learning what specifically works for you; DM should never hold you back.
Will you keep us informed of your progress?
Absolutely! Anyone can follow me on my website www.triggerracing.com or Facebook page fb.me/triggersailing. What we are aiming to do is a step up and I plan on being as open as possible as I go through the process of pushing myself to the limit. We are still in the early stages of the project and I am starting to build a wonderful team around me, but the more people that are interested and wish to support us the better.