Dealing with Diabetes and BS on the Trail

Three months into the Appalachian Trail and it’s time to talk about BS. For those of you who are fortunately not in the know BS stands for blood sugar, but the acronym works just fine.

When I first contemplated this adventure I was adamant that the worst thing a Type 1 diabetic like myself could do is sit in an office all day and control BS by either adding insulin or food – whichever is called for at the time.

While on the trail I have been reminded that while exercise makes the body more efficient at processing all caloric intake, a dead pancreas is still dead. So if I go crazy and consume too many calories without some insulin intervention havoc can and will ensue.

Applesauce Attack

My first crazy encounter occurred about three weeks into the hike when I took advantage of some applesauce someone was handing out as trail magic. Shortly afterward I tested my BS and the reading was the highest I have ever had – 570 – instead of the normal 90 to 110. I had a brief panic moment wondering exactly what I had done wrong and gave myself more insulin before it occurred to me that not washing my hands of the applesauce before testing could have been the problem. Sure enough, another test put me back in normal range but then I had all that additional insulin I had just given myself to feed.

Ups and Downs

It is hard to say if high BS or low BS is harder to handle. It is hard to make it up a mountaintop with either. Kind of like asking if it is better to be too hot or too cold.

I use an insulin pump and generally keep my basal, or hourly, rate of insulin next to nil while I am hiking. I add a bolus (another dose) to cover big snacks or lunch but sometimes – because some of it remains in the system for hours – that comes back to bring my BS down when I don’t expect it.

This is all a bit of inside baseball for those who don’t deal with diabetes but I hope it provide some insight for those who do.

Hiking the Appalachian Trail is not something to be taken lightly. However, I have met doctors out here who wish their diabetic patients would even walk around the block. I can’t walk in anyone else’s boots but I hope this is helpful info for anyone who has wondered. Please contact me with any questions.

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Comments 7

  • Ruth morley : Jul 2nd

    Good for you for doing this!

  • Brian Cahill : Jul 2nd

    Thanks for sharing. I would like to hike the trail one day as well and also am a Type 1. Keep it up. Would you mind sharing the meals you eat and other snacks.

  • Janet : Jul 2nd

    I plan to hike the AT in parts, while my husband does a thru hike. My doctor already said it’s going to be impossible to hike more than 3-4 days at a time with my pump, because of trying to keep the insulin cold during a longer hike. How are you managing this? Thanks for your advice!

  • Mike Joyce : Oct 11th

    Thabks for sharing. I have t1d for 23 years and am planning a SOBO thru-hike attempt 2019. I follow a strict low-carb diet as part of my management and use inhaled insulin. So logistically getting the right food in mail drops is going to be the focus. And resisting the carb heavy “trail magic” is not going to easy. Thanks for sharing your experience! You’re and inspiration!✌❤?

  • Jocelyn J Willis : Feb 22nd

    Hi, I’m also a type 1 diabetic. I was curious on if its better to carry prefilled pens rather than pump supplies?. In maybe a few years I hope to hike the entire trail. And considering all the weight and ahead planning and such I want to know which would be better. I own a pump.

    • Ben Brennan : Jan 9th

      Same question. I am planning to start a NOBO through hike at the end of March 2024. Currently on an Omnipod. My doctor said to stay on it, but I want to hear what other doctors and diabetics are saying.

  • Barb Abney : Jan 9th

    Hi Ben! I’m so glad folks are still reading these posts. Now that I am back to real life I can only wish I could get by on as little insulin as I did on the trail. In answer to your question I haven’t used the Omnipod however I think there is the potential for connectivity issues if you depend on your phone to monitor. Full disclosure I used DexCom for a while and hated it so am back to finger pricking. I also don’t know what kind of issues you would have with keeping the device clean and secure after several days of dirty hiking. I would certainly carry syringes and testing strips as a backup just in case. Also glycogen although I never needed it. As long as you are aware of your body check your sugar fairly regularly (especially after, say, a Pop tart) you should be fine. I’m sure you can also loop someone else in on your CGM and as long as you have connection they could keep tabs as well. Hope this is helpful. Let me know if you have other questions.


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