Any diabetics here?

[Yak Attack]

Hey everybody. Thanks for reading.

I'm new to the site in the past couple of months. I've always loved the outdoors, and I've done several short backpacking trips here around the midwest.

I'm also a type-1 diabetic for about the last 25 or so years.

I've had the urge to get in better shape and get out for some longer trips. A lot of what I've read here is inspiring, but I've got several concerns about my health.

If there's any diabetics out there, I'd love to know how you keep your insulin cool, what you eat, etc. I have the disadvantage that I can't seriously "carb up" before taking some of the more serious climbs because it'll spike my blood sugar. How do you compensate for this and not wipe yourself out before then end of the climb?

Another problem that I have is that I always take a lot of food with me. Running out of food can be fatal for me, so I take it very seriously. On the short trips I've taken, I have frequent sugar crashes. I need to learn to manage my food better so I can carry less weight.

My normal "day" job is as an IT guy, so I'm not normally very active. Then when I go out, I walk my butt off resulting in low blood sugar. My endocrinologist suggested some ideas for changing my insulin dose relative to my activity level, but there's an iterative process to go through here to find the right dosage. I'd love to hear what others are doing.

I've also never camped in bear territory. Frequently I'll have sugar crashes at night after a day of hiking, so I can't be without some sort of simple carbs in my tent. How do you manage this?

I've love to have advice from anyone who's diabetic and gets out onto the trail frequently.

Thanks

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[d k]

There have been discussions on backpacking.net between at least a few diabetics who backpack – you might look over there. I think it was in their Backcountry Health & Safety subforum.

[Kevin Buggie]

I'm interested in hearing first hand experience too. I can add that when I took my NOLS WFR course in 2004 the uber experienced instructor had type I and alluded to ways he managed to cope while on technical trips ….. no recollection of details though.. it can be done though is the impression I got

[Bill Law]

I'm a Type I, dealing with it for 50+ years.

I am probably not the best source of advice. I also have been dealing with heart issues, which are having a greater impact of late.

Anyway, in answer to your questions (lengthy post ahead)…

1. How I keep my insulin "cool."

I'm on a pump. That helps a lot as I can do fine-tuning on my basal rate, cut off the pump when my blood glucose level drops, take a bolus when I over-compensate and eat too much (the latter of which rarely happens). The last few years, I reduced my basal rate by half when hiking. That seemed to work for me. But this is the kind of thing that varies greatly from person to person, I suspect.

Oh, and I also error on the low side when doing meal boluses; erring on the high side could have really negative consequences (especially for me, as I usually am going solo).

2. What I eat.

Hardly anything. Seriously. But this is more due to heart issues (I suspect; I'm trying to convince my cardiologist of it). The load on my heart while hiking is reducing blood flow, or causing fluid build-up, in my digestive system or related organs, leading to complete lack of appetite and nausea. Last summer I would go out for two nights and all I'd eat would be a Clif bar and maybe a Snickers if I got hypoglycemic. But aside from the occasional hypoglycemia (typically late morning), by blood glucose levels were good.

I used to do peak bagging on most trips. I did find that eating one peanut M&M every 50ft of elevation gain would keep my blood glucose level. Those were always short trips (one night) with short trips in to the base of a peak, then a climb, and descend. So it didn't seem to trigger the nausea I have suffered last year and (so far) this year. Most likely, since I was driving home and stopping to get a cheeseburger when it was time to eat, I never noticed these symptoms.

So don't do what I do :-).

For sure, do lots of monitoring. My new pack has hip-belt pockets where I can keep my meter and check often (versus having to remove my pack). Also, having small, easy-to-consume carbohydrates seems like a good idea. Especially if you are not on a pump and can't tweak the insulin dosage so easily.

I used to take too much food, also, but over the years have found how much I really need (even before the latest complications in this regard). Maybe you could do some math and figure out how many grams of carbohydrates you would need to deal with some hypothetical number of hypoglycemic episodes per day? I always keep a Clif bar in my pocket for such eventualities, and take enough in reserve (probably 2 per day). The liquid/gel packets (e.g., Clif Shots) are great; go down easy and I swear I can feel the sugar entering my blood stream immediately. Dried fruit is good, too.

3. Bears

I used to hike with my dog, who has since died (rest his soul). Never saw a bear on the trail. I did have similar concerns about the hypo during the night so always kept a Clif bar, or M&Ms, or a candy bar at hand in my tent. Lesser of two evils, in my estimation. I have *never* had to consume said food.

Feel free to ask questions. I'm glad to share my experience. Any advice should be taken with a grain of salt. My cardiologist said *none* of his other patients tried to do what I do (climb/hike at elevation with a heart only working at 50% efficiency) so he didn't know what advice to give.

[Jeremy and Angela]

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[Yak Attack]

Thanks for posting Bob. I'm sorry to hear about your heart troubles, and hope you improve them soon.

I don't use a pump, I use pens. I have Lantus for Basal and Humalog for Bolus. I have a couple of the "frio" cooling cases (http://www.frioinsulincoolingcase.com/) to store my pens in, but they evaporation as the cooling mechanism. Here in the midwest's hot, humid summers it's not so effective.

I suppose maybe for periods of less than a week the warmth may not be anything to worry about, unless it's burning hot outside? If that's the case, I'm unikely to be on the trail anywhere.

How long are your normal trips? Do you worry about having a backup for your pump, either the delivery device or the insulin itself?

For food, I'll take either FBC-method home made stuff where I accurately estimate the carb count, or packaged FD meals with a nutrition label. I do carry some sugar tabs for crashes (these never leave my person). I also carry a number of spare clif bars, usually 2-3/day.

I'm surprised that you never had to eat your emergency in-tent stash. I will normally have to do that every other night of a trip. I have a dog and would love to take her with me, but she doesn't mind so well and I don't want to bother other hikers w/ her. Or have her destroy my tent trying to get out to chase racoons at night.

Bears scare me. The only other advice I've been given is that if I have food in my tent at night in bear country, I'd better also have a 357. I don't plan to go to grizzly territory anytime soon, but WV/VA/NC/TN has plenty of the smaller variety.

I'll take your advice to monitor a lot. My endocrinologist gave me the same advice. She suggested that I reduce both my basal and bolus rates by about 20% to start and monitor 5-8x/day, then adjust accordingly. I'm surprised you were able to cut 50%, but perhaps that's because of your near-nothing diet?

I know it's nothing by the standards of many of the folks here, but my goal is to be able to through hike the Sheltowee Trace next spring or fall. it's a 260-mile trek through the Daniel Boone NF in Kentucky.

I'm just unsure of a path that leads me to getting that level of confidence w/o pulling a trailer through the woods…

[Bill Law]

I suppose maybe for periods of less than a week the warmth may not be anything to worry about, unless it's burning hot outside?

I worry more about this when doing normal travel. I was just in Israel (and Jordan) for 2 weeks plus and kept my insulin in my suitcase (room temperature). Seemed to not lose effectiveness. Lantus may be different. You can probably find mor info on this on the web.

How long are your normal trips? Do you worry about having a backup for your pump, either the delivery device or the insulin itself?

You mean *usual* trip :-). I try for at least 2 nights now. Went on a 4 night trip last summer, plus a 3 night trip cut short at 2 due to ill health. I carry a vial of insulin and a syringe as backup. Enough for 2 days, which would be enough to get me home, theoretically, at least.

I'm surprised that you never had to eat your emergency in-tent stash.

My lows tend to occur in the morning and late afternoon, fortunately. And I do try to error on the safe side with meal boluses in the evening. That's much harder than dealing with the peaks and valleys of the long-acting insulin, as I recall.

Bears scare me.

Not nearly as much as you scare them, I'll bet. I do tend to avoid camping where the bears (and other people) hang out. Like I said – the lesser of two evils. I suppose I could just get up and open my bear canister if need be. More of a hassle, that, if you're hanging your food.

I'm surprised you were able to cut 50%, but perhaps that's because of your near-nothing diet?

Perhaps. I have tried sticking to my normal basal rate (thinking that lack of insulin was negatively impacting my metabolism). Didn't seem to make that much difference. I suspect this will vary from individual to individual, much like basal rates in general.

my goal is to be able to through hike the Sheltowee Trace next spring or fall. it's a 260-mile trek through the Daniel Boone NF in Kentucky.

A worthy goal. My "goal" would be to do the JMT. But I'll be happy to do 2 nights this weekend. And a 3 night trip 4th of July. Then work up from there. The key is getting a feel for what your body can, or can't, do. And adapting. Kind of like dealing with the diabetes in general. It sounds like you have a good handle on that. Get out when you can and practice.

Good luck. Holler when you want to come hike in some real mountains!

[Ryan Bressler]

I've been type one for almost 20 years, also work a desk job and have done a tone of hiking and climbing including multi week trips, long solo days, technical climbs, skiing volcanos etc. You need to learn to work around diabetes but it isn't particularly hard to do so. Test often while you figure it out.

For a long day you need to eat more or reduce your insulin or both. It is, however, freeing to realize that the people doing this stuff at a high level are essentially snacking every 30 minutes on easy to digest calories. Energy gels, sport drinks with some sugar (but not too much) in them etc.

There are tons of products out there to help you get the calories you need, mostly focused at runners and cyclists but also used by alpinists, ski mountaineers etc and very applicable to hiking. I'm a big fan of a bike bottle on my pack shoulder strap with scratch labs hydration mix in it for long climbs, I'll usually also have some gummy bears (sun ridge farms real fruit juice ones bought in the bulk section of a health food store) or shot blocks/energy chews in my pocket as well if I need more.

To keep your insulin cool in really hot weather use evaporation. I once kept a couple months supply of insulin cold on a 114 degree bus ride across the Paraguayan chaco by keeping it wrapped in a wet t-shirt. Frio insulin cooling cases are also a worthy investment, they use some sort of beads/grains that absorb a ton of water forming a gel that slowly releases the water to evaporation keeping stuff cool for a long time.

I usually keep my insulin somewhere in the center of my pack wrapped in a wet handkerchief (or now sometimes a frio pack) and put it down in the shade when I take it off. I have never had a problem while hiking. Ask your doctor but most insulin just gets less effective from heat exposure so you can always use more in an emergency.

I've never had an issue with bears but I tend to avoid areas where they are accustomed to campers as a food source (ie where bear canisters are required) and haven't spent time in an area with an active grizzly population.

I try to only keep factory sealed food products with me in the tent and keep them double bagged in a ziplock or other air tight containers. I know that bears can probably even smell those but figure they won't smell them from as far away and they probably smell less like food then my breath and clothes…

I have had mice get into my overnight food stash but I was sleeping without a tent at the time.

I've also had to drop the bear hang in the middle of the night to get additional food at least once…be aware that the effects of exercise last a while so you may want to reduce your overnight insulin dose as well, I usually use a quick release knot involving a stick and keep the sweet stuff on top of one of the bags.

And instant oatmeal packets are great, light, emergency "stuck out for an extra night" food provided your in an area with water.

[Aaron Catron]

I'm also a type 1 for the last 18 years. I do get nervous about not having food when my blood sugar gets low, and so I bring a decent amount of snacks. The more trips I've gone on, the better I have been about figuring how much I need to bring. Probably a good idea to have some glucose tabs with you as well.

I use an insulin pump, so I don't worry too much about keeping my insulin cold, but I hear the Frio packs are nice.

I definitely have to keep eating through out the day to keep my blood sugar from going to low. I normally cut my basal by 40-50% as well. I also mark all the food I bring with how many carbs are in it.

That was also good advice in keeping your meter in a hip belt pocket. I keep it close and test often. I normally don't even stop walking while I test.

[Bob Shaver]

I was type II, but now I inject insulin, so does that make me a type I? I don't know, don't care. I take a pen of Lantus, and a pen of Novolog, and oral Metformin. I have had no trouble with refrigeration. Its cooler where I go, so I worry more about the pens freezing than getting too hot. I sleep with them nearby if its going to be close to freezing. Its gets down to 25 in the middle of the summer here.

My own body's reaction is to produce a little more natural insulin when I am working out. If I walk 5 of 6 hours a day, I'm not diabetic. I scale back my insulin to near zero after a few days, but monitor as usual. After a bagel for breakfast, I snack all day, on granola bars, dried bananas, yogurt covered raisins, dates, triscuits and cheese, and beef jerky. And, I don't need insulin all day, and very little if any at night. Generally my eating is limited by how much food I can carry, but the typical 2 lb of dry food per day is pretty accurate for me.

At night I hang my pack with food in it, in a high tree for bear protection. I have an odorproof zip lock bag I keep in my tent, with a granola bar and yogurt covered raisins, and if I wake up super hungry I pop 10 or 20 raisins. I had to get up once and lower my pack and eat more food, so since then I always have some food handy in the tent.

My reaction is different from yours, but it has not been a big hindrance for me.

Bob

http://www.backpackingtechnology.com

[James Marco]

Yes. I amType 1. I have been for about 15 years. It has been a bit difficult with all the monitoring, but I keep it to an A1C of about 5.8-6.2 (high, normal range.)

When I am out hiking, I cut my pills (metformin, glucophage) in half. I rarely take one in the evening. After 6-10 hours of hiking, I do not need it.

Nor, do I take my meter. I did the first couple years, but quickly found I didn't need it. I know when things get about 180 or so and I know when it gets less than 70. Not everyone can tell, though. I use this test: I multiply three digits in my head. When it it low, I cannot do that, I need to eat. If I don't care, it is too high, I need a pill. Metformin ONLY works if you eat something significant…at least 300 calories. So, candy bars are a typical part of my kit.

Other than that, I ignore it. There is too much going on on the trail to worry that much. Excersize is GOOD, as long as you blood sugar doesn't get too low. Muscles will eat a lot of sugar out of your system. If it at all high, I just hike a bit harder. Never had a problem with it being too high when I was out, though.

[Joshua B]

Hi all.

i just joined because I am looking for ideas and feedback on diabetes gear.

About me: Type I for 35 years, on a Medtronic Paradigm insulin pump (no CGM, but am contemplating), and I love walking in the woods.

My issue: This year, I am planning two trips of at least 7 days, one at Isle Royale National Park, and the other in the Bob Marshall Wilderness. Traditionally, I have taken shorter trips due to time limitations, but now I have a job in which I am encouraged and expected to use my vacation time, so I am looking for longer hikes. With longer hikes comes more diabetes gear.

Over the past couple of years, I have been lightening the load as much as possible, but the fact is, insulin pump supplies take up serious real estate in a pack; they are not too heavy, but very bulky. And they must be protected.

I figure that for a 7 day backcountry trip, I want to bring along at least six infusion sets and reservoirs. I would feel more comfortable bringing eight, but feel like maybe that’s overkill. However, on a shorter trip a couple of years ago, I accidentally snagged and damaged my tubing on a branch, and had to switch infusion sets. As I tried to insert it, I dropped the inserter and infusion set in the dirt. So I started over. End result: two infusion sets opened for one switch. I have stuck with that math since that incident. I figure that bringing six sets gives me the two I may need for the mid-trip switch, and enough for two more botched switches.

This is what I intend to carry for the two 7 day trips I have planned this summer: 6 Medtronic Quick-set Paradigm infusion sets which are bulky; six reservoirs, which are not so bulky; at least 4 mastisol 2/3 ml single use vials (very tiny and handy); a bunch of IV 3000 dressings; remove wipes; IV prep wipes; alcohol pads; 150 test strips; the Bayer Contour meter that speaks to my pump; a backup Contour meter; a glucagon kit; a spare pump; a long-acting insulin pen (TBD by my doctor); a couple of U-100 syringes; 2 bottles of insulin (that I carry in a frio pouch).

I have been I have been continually trying to figure out ways to protect all this diabetes gear while minimizing the weight of the carrying case for pretty much 35 years (although the gear has changed, its’ always been bulky). In the past, I used one of those waterproof plastic boxes that you can get at a sporting goods store. From my perspective, this case is the gold standard for protection, but weighs a ton. Also, because I am carrying more infusion sets than I would otherwise, I would probably have to use a larger and heavier version of the one I’ve got. I recently picked up a “diabete-ezy” case from Medtronic’s online store that comes close to what I am looking for, but isn’t big enough to handle all the bulky stuff, and isn’t waterproof or crushproof. Looking for a better solution, I have ordered a generic equipment case from a company called Shell-case. It might do the trick, but is not crushproof to the degree the hard plastic case is, and it is not waterproof (although I can put it in a plastic bag or waterproof stuff sack). I have not yet received it, so I can’t say how its going to play out.

So I guess what it boils down to is this: am I being paranoid about the amount of supplies, and how can I find the lightest, most protective means of carrying all that diabetes crap into the wilderness? Any thoughts?

[JAMES CALL]

Test while walking? Do you use finger sticks and test strips? I’d spill those all over the trail!

[Joshua B]

Glucose monitor is the way to go, my friend. Although I have the shitty Medtronic 670g with the mediocre Medtronic sensor, I have been able to watch my sugar during long multi-pitch days climbing, hiking, and in every day life. There are points at which I have to test, but those are few. The Dexcom sensor requires NO blood tests.

[Joshua S]

I’ve been a type I diabetic and a backpacker for a long time. I recently got the Dexcomm G6 and it is absolutely worth it. I still bring back up strips/pricker that work with my Omnipod, but I might cut those out as I’ve been on several short and long trips and never had to use them.

I also use the Frio bag every time I go backpacking just in case. It works well, I’ve used it up to 95 degrees in high humidity (Ohio/Pennsylvania) and my insulin has never had any issues..

For carrying supplies I just use a few ziplock bags inside my backpack liner and it’s never really been an issue. For weekend trips in state I just bring what I need, for longer trips I always bring 2 extra sites on top of however many I’ll need for the number of days and 1 extra GCM sensor. I also take 3-5 syringes incase something goes wrong with my pump, but I’ve never had to use these either. On long trips all my diabetes stuff weighs about 26 oz (for 9 days) with my pump/sites/sensor/insulin+frio bag/spare test strips+pricker/3-5 needles/spare batteries.

Filling the frio bag adds another 5 oz, if I’m hiking alone I don’t take the glucagon shot, I just try to keep my blood sugar a little higher than I normally would.

Another thing I absolutely love taking with me as a diabetic is honey sticks or a honey bear for a longer hiker. Sometimes I’ll take a honey stick/swallow of honey before starting a big climb just to keep my blood sugar up-in addition to the slower acting carbs.

[Carlo]

Noted that people are still adding to this post.

Couple of 2020 updates.

Continuous glucose monitor is best innovation, you get constant readings on your phone and alert if you start to drop and an even louder alert if you’re rapidly crashing, including in the middle of the night. Alarm has roused me from deepest sleep in backcountry. I’ve found that I have to put the transmitter a bit higher on my stomach than normal. I’ve had problems from, I think, my hip belt impeding performance. Before setting out, I adjust the alert settings to trigger an alarm at a higher reading than when not backpacking. I hear you can now even get readings on a Garmin watch. The Dexcom has been a life changer not just for backpacking, but for everyday life and esp things that driving, work, assuring that you’ll wake up. I still pack an old fashioned meter buried in my pack w/ a cartridge of short acting & a syringe in case, worst case scenario, I lose my short acting pen.

I keep insulin in a frio next to bladder in my pack. Honestly, just keeping it next to the bladder is enough. I did that for a week in capitol reef w/ out the frio & it was fine.

I take sport gels for lows. I keep one or two in my tent, in grizz country, in a small Mylar bag w/ my short acting insulin. I keep this gel pack out of my food bag. Btwn being factory sealed and in the Mylar, I figure if a bear’s going to come after me for that, he was just going to come anyway. I also camp in designated sites with people around. Bonus, the Mylar bag makes it easier, way easier, to find in the middle of the night should I crash.

For trail snacks I munch on a clif bar and have Gatorade in a bottle. I do a heavy mix, toss in an extra tablespoon.

I’ve gotten in habit of chomping 1/2 a cliff bar right before I put food up or in locker for the night. Find that helps prevent lows esp since with long summer nights I may finish dinner a few hours before turning in.

I significantly cut my dosage. Long acting gets cut by 1/3 first day and by half second day. I’ll knock one unit of my short acting but I’m less worried about that since I can compensate and it runs out in 90 mins or so also with less long acting in the background I need more of a bolus, it’s a mental juggling act.

I down an entire cliff bar or snickers at the trail head. I find that as soon as I start hiking with weight on my back my glucose drops.

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