Insulin, Glucose, and Hiking, Oh My!
Since announcing my plan to thru-hike the AT this coming spring I have been fortunate that my parents, family, close friends, and coworkers have been more than supportive in helping me with this goal. The outpouring of support and motivation and offerings of everything from planning to meet up with me along the trail, extending a shower and clean bed for when I get near the towns they live in, and even offering to send resupply boxes with all sorts of great food, has truly been incredible.
Naturally, I have also been answering a lot of curious questions on a variety of topics related to my planned thru-hike. So let’s answer some common questions y’all may have about planning a thru-hike with type 1 diabetes and how this chronic disease is totally manageable with some extra planning and attention to detail.
This is not intended to be a substitute for professional medical advice. Always seek the advice of a physician or other qualified health-care provider with any questions you may have regarding a medical condition.
What is type 1 diabetes?
Type 1 diabetes is a chronic autoimmune condition; this means that the body’s immune system attacks itself. The disease is typically triggered from some sort of environmental event, like a virus or infection. The body then attacks the insulin-producing beta cells located in the pancreas, making them unable to produce their own insulin. Insulin is the hormone that allows the body to use the glucose (sugar) in the bloodstream as energy. Insulin allows glucose to enter the cells and be converted into energy. Without insulin, the body resorts to breaking down muscle and fat stores (no bueno).
T1D is not preventable and is not curable (yet). However, thanks to modern medicine, it is totally manageable. I currently use an Omnipod insulin pump that is placed on my arm, leg, or abdomen to administer a basal or set rate of insulin throughout the day as well as a bolus dose with my meals, much like a working pancreas does on its own. I can also program my pump to make adjustments throughout the day based on activity, stress levels, food intake, illness, and a slew of other factors.
I am fortunate to have a Dexcom continuous glucose monitor (CGM). This monitor gives me almost instant feedback to my phone via Bluetooth from a small sensor usually placed on my abdomen and displays what my current blood sugar level is and also shows me trends, which allows me to proactively get ahead of a pending low blood sugar event or give myself a correction bolus of insulin in the case of high blood sugar.
These two devices are amazing and have changed the way I manage living with type 1 diabetes for the better. They are both crucial for me to be able to live and maintain my active lifestyle and will play a major role in helping me complete a thru-hike.
Is it dangerous for a diabetic to do a long-distance hike?
Nope! I am honestly more concerned about suffering a physical injury while hiking than I am concerned about suffering from something related to diabetes.
The greatest concern is having a low blood sugar event while on the trail. Here enters my handy continuous glucose monitor. This monitor has alerts that will alarm when my blood sugar begins to fall at a quick rate or if it begins to get to a dangerously low level. Being an active person who has been living with this disease for quite a while now, I have also become fairly in tune with my body and can feel when my blood sugar is becoming low or high during physical activity. While not what I rely on primarily, it is a good indicator for me to stop and double check my blood sugar.
The glucose monitor also has an option where it will share my data with another person (my girlfriend), which allows her to receive the same alerts I do in the event my blood sugar is low. Unfortunately, this feature needs cellular service to function, and while there is fairly decent coverage on most of the AT, leaving this option on all day will drain my battery in no time and a dead phone does me no good if I am relying on it for my blood sugar readings. So for my hike I am planning on having a small GPS tracker with a built-in SOS feature that will allow me to get help in the rare event something happens where I am unable to get to help on my own.
How do you manage your blood sugar while hiking?
For non-diabetics this section may sound foreign.
I have been working closely with my endocrinologist and have gone through some trial and error to come up with a basal rate and bolus dose that works for me when I’m backpacking. While it’s not exact and always subject to change based on so many different factors, we’ve found a nice sweet spot to start with (pun totally intended).
Basal rate set at 0.30 units/hour; normal rate is 0.70units/hour.
Bolus I:C ratio we kept the same, but I just cut whatever the total bolus dose is in half.
No correction factor.
I have found on previous trips that constantly snacking between meals with no bolusing helps significantly in keeping me from having late morning (before lunch) or late afternoon (before dinner) lows. It also gives me some extra energy to finish out the day strong. While backpacking, I do not correct high blood sugar before going to sleep, unless it is unreasonably high. I have found in the past that adding a correction factor will almost always lead to an overnight low or a low the next morning when I start the day. I’d rather have the comfort of knowing that I am not going to experience a low blood sugar event in the middle of the night and deal with the slightly elevated glucose in the morning that will inevitably decrease as the miles are put on.
This is a plan that my endocrinologist and I have worked on and are both comfortable with. Do not do this without consulting your own physician first.
Do you need special food?
No, but a balanced diet goes a long way. Unfortunately, trail diets are not known for being the most balanced and it can be a challenge to resupply with good food that fuels your body. Fortunately, hikers love to talk about food and there is a ton of awesome information from different sources on how to supplement typical hiker food options with more balanced choices and options that will fuel you for the long haul.
You can’t eat sugar, right?
Total myth. You’re crazy if you think I won’t be out there devouring Snickers bars, Sour Patch Kids, and the occasional gallon of ice cream like the rest of them.
Calling other diabetic hikers!
If you’re a diabetic hiker and have any cool tips, tricks, thoughts, ideas, or suggestions about managing any aspect of diabetes while backpacking and you’d like to share them, leave a comment or hit me up on Instagram. I’d love to chat and hear about your experience.
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