I was poking around on our local motorcycle forum and found a post about Type 1 motorcycle riders and one of the questions that came up was how can we help a rider in distress? Allow me to share what I know and point you, my reader, to a few resources that can help. I’m, for one, thankful if I needed help, someone was able to give it to me.
I’m not a medical doctor—just a Type 1 who rides. I’ve pointed to resources provided by respected organizations that discuss specific techniques.
What is Type 1 Diabetes?
According to Google’s GPT:
Type 1 diabetes (T1D) is a chronic autoimmune disease that occurs when the body’s immune system destroys the pancreas’ insulin-producing cells. Insulin is a hormone that helps glucose, or sugar, enter cells to produce energy. Without insulin, glucose builds up in the bloodstream, causing high blood sugar, which can lead to many complications.
Basically, we need injections of insulin to stay alive. If we have too much, problems ensue. If we have too little, different problems ensue. What we’re not is Type 2. We’re not Wilfred Brimley with the ‘beetus either 🤣. Managing Type 1 is a lot like tuning a carburetor – we need different amounts of insulin at different times of the day to stay well-tuned. Insulin is a powerful drug: we measure in microliters and even 1-2 μL off can trigger low blood sugar.
Open the conversation gently
For many Type 1 Diabetics, we’ve been probed by the medical establishment for most of our lives and misunderstood by those who don’t understand what Type 1 diabetes is about. If you see a fellow rider with an insulin pump (they usually have corded tubing or look like a white plastic bump) or a CGM which looks like a small electronic device on the arm or stomach.
As riders, we’ve all heard our friends and acquaintances tell us about their uncle Joe, who had this horrible outcome on his bike. Diabetes is the same way. We’ve all heard about Grandma Jane… We’re all different and diabetes care is much better today than it was in Jane’s day.
It’s ok to ask, “Hey, I see you have an <insulin pump, CGM, or are testing your blood glucose>. Is there anything I can do to support you on the ride?” They may decline, and that’s ok. They may need some extra time to test, eat a bit more, inject some insulin, or fiddle with their pump. Everyone approaches their diabetes differently. Please respect everyone’s autonomy.
Left to right: Dexcom G7 & G6 CGMs, Freestyle Libre CGM, Medtronic insulin pump, Omnipod insulin pump
In the case that things go wrong, they generally go wrong in two ways: blood sugar goes too low or too high.
Blood glucose going too low
Low blood sugar is caused by too much insulin in the bloodstream. In motorcycle terms, the bike is running rich – too much gas for the current conditions. Insulin lowers blood sugar. Sugar brings the blood sugar back in range. I manage my diabetes via a “smart pump.” A glucose sensor communicates with the pump to speed up insulin delivery when I need it and slow it down to prevent a hard low. My phone notifies me if things are going out of range so I can more proactively deal with them. Other diabetics use manual injections to acheive thier control and test with a manual fingerstick. Everyone has their own approach.
When blood sugar drops too low the first line of defense is some simple sugars: glucose tablets, 6oz of full sugar soda (not Diet Coke/Coke Zero/Pepsi Max), or 6oz of fruit juice. Blood sugar will begin to rise and return to normal in 15 mins or so. I’ve had to stop a few times and signal to the group I’m pulling over.
If a Type 1 patient falls unconscious due to low blood sugar, more direct action is required. Glucagon is the hormone that tells the liver to convert glycogen back into glucose. There are three commercially available ways to administer glucagon: a two-part injection, Gvoke – a single injection, and Baqsimi – a nasal spray.
Each video below highlights how to use the product from the Mayo Clinic (left) and the manufacturer (center and right).
Blood glucose going too high
Correspondingly, high blood sugar is caused by not having enough effective insulin on board. For those of us who have pumps, sometimes the site goes bad. Other times we’re not given enough insulin for the food we eat. Sometimes digestion doesn’t work the way we think it should. Often times these situations are easily correctable and no cause for genuine concern.
Sometimes, insulin goes bad. Riding long distances over hot terrain is hard on insulin, a soft protein that doesn’t like heat. I’ve perfected my technique, explained in the blog Diabetes, Motorcycles, and Insulin, which works for me. Other times, I’ve dropped a vial, forgot it at home, or whatever. Running a 24/7 diabetic management clinic is hard, and sometimes, things go wrong. To fix high blood sugar, you need insulin and a way to get it into you (pump site, syringe, etc).
Getting insulin is hard. It requires a prescription in the US (and many countries) and requires jumping through many hoops, as noted here: Insulin in Canada. Most states allow the purchase of syringes in limited quantities over the counter, though. If all hell breaks loose, go to the hospital or call 911. Walmart does sell R and N which are old insulins that will keep you alive, but most of us aren’t trained to use those types of insulin any more.
If you have read this far, do me a favor, write to your representatives and senators and ask them to make modern insulins available without a prescription. Write Congress!
It’s all a journey.. thanks for reading!
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