Diabetes, Motorcycles, and Insulin

John Ryan was an exceptional individual.  He pushed the boundaries of motorcycling time and time again with his involvement in the Iron Butt Association.  He came to San Francisco to speak about his adventures which truly inspired me.  I’ve met many long-distance riders over the years.  What impressed upon me about John was not only was he the premier long-distance rider, he also had type 1 diabetes.  John was able to ride from Deadhorse, Alaska to Key West, Florida in 87 hours.  That’s averaging over 63 miles an hour for the entire journey.  He was also diabetic.  John and I had a fascinating conversation that afternoon talking about running motorcycles on insulin.

Back when I was starting to ride, there wasn’t a ton of information on the Internet about riding a motorcycle on insulin.  When I asked my doctor if I could ride a motorcycle, I got the quizzical look of “are you serious?”  I was in luck though, as the chief endocrinologist at the hospital managed one of the largest motorcycle rides in Atlanta to raise money for diabetes.

I’ve learned a lot over 15 years and wanted to take a few moments to share tips from the trade.  I’m a type 1 on an insulin pump in good health.  The techniques described below optimize for my care.  Yours may be different.

Diabetes – good control & tight control

I won’t go into all the reasons why you should take care of your diabetes.  I’m sure you’ve heard all that from your doctor.  What’s important to realize, is that motorcycling takes all of the dynamics of diabetes care and reduces the margin of error.  While riding your bike, low blood sugar at 65 miles an hour can be a really bad thing.  Knowing your body and the rhythms of your blood sugar are critically important when riding a bike.

The motorcycle – pack the same way, every way

When packing the motorcycle, I use a consistent checklist to ensure I have everything needed for the ride.  The checklist has way more things that I actually need as it is designed for a multi-week trip.  The benefits of using the checklist are that I can mark off everything I specifically don’t need.  I strike through everything I’ve packed and put an X next to everything I don’t.  I’ve got a particular section for all of my diabetes related care so I know I’m bringing everything I need.  In particular, I’m looking for testing supplies, insulin, needles and pump supplies, glucagon, as well as fast-acting and slow-acting carbohydrate.

Protect your insulin

My sister bought me a thermos a number of years ago that I didn’t use regularly at the time.  When I was going on my first long trip I decided to keep my insulin in that thermos in this wacky contraption of film canisters, air bladders, ice, and water.  I’ve greatly simplified the process over the years.  When insulin goes bad, you’re hosed.  How do I keep my insulin cool?

Keeping insulin cool is the most important part of the journey.  Unlike many medications, insulin is a protein that needs to be kept cool to remain fresh.  If frozen, the insulin will be rendered ineffective in lowering blood sugar.  I have found the small thermos from REI to be great in buffering extreme temperatures from the insulin.
I take a quart sized Ziploc bag which can easily hold three bottles of insulin.  I usually way overpack insulin, but I figure it’s better to have more than less in case one bottle goes bad.
Place the bottles at the bottom of the bag as shown.  Tightly roll the bag taking care to remove most of the air.  Some air is okay inside of the bag is a will help buffer the insulin from the coolness of the ice.  You want to make sure however the seal on the supply bag is tight so that the insulin will remain dry.
Slide the Ziploc bag into the thermos.  Ice will tend to float to the top so you want to make sure the insulin is near the bottom of the thermos.  It may take a bit of crumpling the Ziploc bag to fit inside of the thermos.  Fill a thermos with water and then add a couple of cubes of ice.
It’s just a personal preference, but I like to drop the thermos inside of a sock as it will help protect the finish of the thermos.  I have Givi hard luggage on my bike.  When the bike leans from side to side I found that was murder on the finish.  So far, the new thermos hasn’t been scratched being inside of a sock.  🙂

ProTip: Most insulin in the United States requires a prescription.  Always carry a copy of your prescription for all supplies with you.  If in a pinch, traditional regular insulin is available without a prescription.  Always consult a pharmacist in each state you regularly ride in to confirm local laws.  Canada is the exception.  Fast-acting insulin is freely available and much more cost-effective than it is in the United States.  The same bottle of insulin in San Francisco was 80% cheaper in Calgary, Alberta. Go figure.

Test regularly

Most of the time I test I’m looking for a particular number to tell me what my blood sugar is at the given time.  While riding, you need that information but you also need to know if your blood sugar is rising or falling.  Continuous glucose monitors are excellent at providing this information. I find my Dexcom G5 linked to my iPhone invaluable for managing tight control on or off the bike.

You’ll need to work with your care team to define what is an acceptable range of your blood sugar while riding a motorcycle.  It may likely be more liberal than when you’re off the bike.  I tend to be less aggressive in treating small highs and more aggressive in treating lows.  That effectively increases my margin of error while on the bike.  The Dexcom, however, helps me overtreat or under-dose.

Heated gear

I remember reading the warnings on my first set of heated gear.  It specifically states that people with diabetes should not use this gear.  My hunch is the main concern is for those who don’t have great circulation or sensation.  Heated gear does get hot.  Left unchecked, it can burn the skin.  It is critical to have a long sleeve T-shirt underneath any heated gear.  The T-shirt provides a buffer between you and the heating elements.

The other side effect I noticed (again for me) is that my blood sugar would rise while using the heated gear.  I’m not sure if it’s the drying effect from the heating elements but I find I need a touch more insulin as well as continuing to drink water.  If I don’t drink water, blood sugar becomes significantly more difficult to control with insulin.

Let others know

It’s really important to let others know that you have diabetes.  If you’re riding with the group, take the time to educate those around you what the signs are of low blood sugar, the treatment protocol, and where the supplies are on your bike.

If you’re riding alone, always wear a medical bracelet or necklace.  Having that jewelry will let the paramedics and police know about your diabetes.  Also, let someone know at home what your ride plans are as well as what time you’ll be home.  I always give two times for when I’ll be home.  I’ll give a time that I expect to roll into my garage as well as a time to start worrying.  I tend to take plenty of stops and smell the roses so I often miss the time I expect to roll into my garage.  I always, however, call well before the worry time out of respect for those at home.

Riding a motorcycle on insulin is totally possible.  Like any high adventure activity, learn the basic steps of care, how your body responds, and give yourself a larger margin of error than you would be at home.

Have any tips?  I’d love to hear the comments!