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.

Dexcom CGM monitor and Omnipod PDM.

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.

A thru-hike’s worth of insulin pumps.

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.

My pancreas.

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.

Affiliate Disclosure

This website contains affiliate links, which means The Trek may receive a percentage of any product or service you purchase using the links in the articles or advertisements. The buyer pays the same price as they would otherwise, and your purchase helps to support The Trek's ongoing goal to serve you quality backpacking advice and information. Thanks for your support!

To learn more, please visit the About This Site page.

Comments 20

  • Brian C : Dec 4th

    Hey David,

    I am Brian and I was close to walking the AT coming up on two years ago. A good job opportunity came up but it is still something I would like to do. I saw your post on the trek.

    I also have type 1 diabetes and use the Dexcom. I also use the Tandem insulin pump. I have had diabetes for over 45 years now so i have dealt with every aspect of the disease. I was not able to find any type 1 thru hikers that used dexcom so I look forward to hearing how it holds up for you and about your diet.

    I wish I had more hiking advice but I have only taken a few over night hikes and many day hikes over the years.

    I wish you the best of luck and look forward to reading about your hike.

    Brian

    Reply
    • David : Dec 7th

      Thanks Brian! How do you like the tandem? Omnipod has been the only pump I’ve used so I’m a bit biased toward it.

      Reply
  • Mark Zaitsoff : Dec 4th

    David,

    I’m a well managed T2 so we’re not quite in the same situation. I hiked the southern half of the AT this year; you’re right diabetes does not keep you from long distance hiking.

    You’re right to work things out with your doctor. We set up some general guidelines about eating, testing and dosage. Even though eating rather indiscriminately (Snickers and Nuttt Bars included) I reduced my insulin dosage twice during the hike – the exercise and 45 lb weight loss decreased my need.

    Get your resupply requirements right. I had to call my mail order pharmacy from a mountain top in VA to get them to mail a pen resupply a couple of weeks early.

    Figure out your storage and disposal plan. I kept my used test trips and pen needles in a pill container, then glued and marked it for disposal. I don’t know what the needs are with a pump.

    I have a thread over a White Blaze about my plan.

    I’m restarting in PA in May to finish the northern half of the AT. Keep in touch and maybe we can get together on the Trail.

    Mark

    Reply
    • David : Dec 7th

      Hey Mark! Thanks for the tips. I’ve been working on a few different storage options on shorter hikes over this past fall. I have a tentative plan for resupply while on the trail but will probably need to fine tune that as I go. Good luck this year and maybe I’ll see you out there!

      Reply
  • Ruth Morley : Dec 4th

    I think it’s wonderful that neither you nor the previous commenters have let life situation this land you on a “safe” sofa the rest of your life. It sounds like you and your doctor have a good plan of action worked out. I have hiked the lower 1100 miles with extensive food sensitivities. I dehydrate all my own food and have it sent to me. If we want something strongly enough, we can usually make it happen.

    I truly look forward to reading your future posts.

    And, Mark (earlier commenter), I will also be finishing the northern half beginning May 1 from Mt Holly Springs, PA. I hope to meet you on the trail at some point. I go by the name of Chocoholic.

    Reply
    • David : Dec 7th

      Ruth, thanks for reading! Good luck on finishing this year and maybe I’ll see you out there.

      Reply
  • Jason : Dec 5th

    David,

    I have done a week long section of the AT and also a week in the Tetons with plans to do another section of the AT in June. I also have a pump and the dexcom sensor. I found that my blood sugars were well controlled and had no issues with lows during the night. I am actually going to go back to injections this year for my hike as I found it to be an annoyance to carry all my pump supplies along with my sensor supplies along with a back up in case my pump malfunctioned. The biggest issue I had is sites becoming dislodged or malfunctioning due to the amount of sweating. I used clif-gel blocks for any lows and slept with my water and a packet of powder Gatorade at night in case of a low. If anything I had issues with a few highs during my hikes due to being overly cautious not to wipe myself out with hypoglycemia. Also a few times I spiked high sugars due to some muscle breakdown from the long hikes (similar to hyperglycemia after lifting weights that occurs). Overall my diabetes didn’t cause any issues while I was out there. If you have any questions or I can be of any help with ideas or questions regarding all the stuff that comes with type 1, please let me know. Best of luck!!

    Jason

    Reply
    • David : Dec 7th

      Hey Jason, thanks for the tips and info. I have also found the same problem with sites falling off or not working well because of sweat. I’ve had better luck with using the tacaway wipes and the simpatch dexcom adhesive stickers. Did you find any particular site placements that were more problematic than others? The clif blocks and stinger honey chews are my go to for any lows and are also a great snack on the trail! Thanks again for the response!

      Reply
      • Jason : Dec 12th

        I always have issues when I use my abdomen. I know Dexcom doesn’t support the site but I have found the best area for me is my anterior thigh. I have tried my arms but with the pack coming off and on when hiking it is not ideal. Without using adhesive stickers the anterior thigh has lasted 7-9 days when hiking. The anterior thigh when not hiking has lasted 12-16 days with accurate readings.

        Reply
        • David : Dec 16th

          Dexcom on my arm has almost always failed. I’ve been sticking with abdomen and thigh placement. The thigh seems to be the most promising for hiking. I’ve had really great success with the omnipod on my arm but I’m not sure how well that is going to work while hiking, I can already see pods being ripped off by my pack coming on and off.

          Reply
  • Culligan : Dec 5th

    I hiked the AT this year with a T1 diabetic named Fun Facts. She, too, used omnipods and Dexcom. She’s @sweet.life.on.trail on IG if you want to see her journey, and I think she’s written a couple pieces for The Trek as well (Rachel Hemond is her name). She’s a pretty good ambassador, and I’m sure she’d be willing to answer questions if you have any.

    Reply
    • David : Dec 7th

      Thanks for the info! I’ll be sure to check it out.

      Reply
  • Mark Zaitsoff : Dec 5th

    As a T2 using pens my situation is different than a T1. I’m interested (and others may be) on your resupply and disposal needs.

    My thread on White Blaze is at:

    https://www.whiteblaze.net/forum/showthread.php/93725-Diabetic-thru-hiking-logistics?highlight=

    Ruth- my trail name is RangerZ. I’m restarting at Pine Grove Furnace later (TBD) in May, so you’ll probably run ahead of me, I’m not fast.

    Mark

    Reply
    • Ruth Morley : Dec 6th

      I’m not fast either, so I’m sure we’ll meet up at some point. I stop and take a lot of photos, talk to nearly everyone I meet and rarely go over 12 miles per day. And I love it!

      See you out there.

      Reply
  • Janet Nelson : Dec 14th

    Hello fellow (diabetic) hikers.
    I’m planning on “visit hiking” with my husband and cousins in 2020 for their thru hike. I’ll have limited time on the trail, someone has to stay home to care of our farm animals. So I might be looking at only a week or two stretch of hiking at a time, here and there. I’m a T1, and I’m following this with tremendous interest. I have a Medtronic pump and use an Enlite CGM. I’m mainly concerned with resupply. But as I reading, I realize that the adhesives and placement of both the infusion set and CGM may be an issue I never thought of!
    I hate to admit this, but I feel very intimidated in trying to figure all this out. How do you make sure your resupply insulin is still cold and on time? I want to prepackage my insulin ready to be inserted into the pump rather than have a vial of insulin. How much extra pump supplies should I carry if something needs replacing due to malfunction? These issues seem mind boggling. My endocrinologist’s suggestions we’re to follow blogs, so I’m so glad I found this one!
    Thank you all for this great discussion! All the best to you on your hikes!

    Reply
    • David : Dec 16th

      Hey Janet!
      I’m glad you stumbled onto my blog and thanks for the support!
      I am glad to hear that I am not the only one that feels slightly intimidated by this. The planning can seem totally overwhelming but with some help from others and some trial and error on my previous short trips that I have taken, I’ve been able to work on a system that works well for me. Now the real challenge will be applying it to a thru-hike and integrating resupply with it.

      I use Omnipod for my pump and a Dexcom CGM. I have a small sea-to-summit dry bag that serves as my “emergency supply kit.” I keep two spare pumps, one spare CGM and some other odds and ends in there. I only use those if have run out of my planned supply that I am carrying. My plan for the thru-hike is to have about a weeks worth of supplies sent to whatever my next anticipated town stop is going to be, with the anticipation that I will be stopping though a town about every 5-7 days. I am sure that the first few weeks I’ll probably end up carrying way more stuff than I actually need, but I am ok with that until I can get a better idea of how the pump and CGM are holding up to the environment and hours of hiking each day.

      I normally use vials to fill my pump but for the hike I’m switching over to using pens to fill the pods. The pens are much less breakable and easier to pack. The pens also give me a safety net in the event something catastrophic happens to my pump, I’ll still be able to give myself insulin with pen/ needle if needed. As for insulin resupply, my tentative plan right now is to let my girlfriend know when she needs to include a pen or two into the next resupply box. Most insulin is good out of the fridge for 28-30 days. I’m just planning on that 28-30 day window starting the day that my girlfriend sends out the resupply.

      Reply
  • Mark Thiel : Dec 30th

    David,

    Thanks for your Trek writing. My son is Type 1 and I will share your story with him. He manages his diabetes with a Tandem pump. He recently graduated from college with a Geological/Chemistry degree. He was diagnosed the first semester of school. Your journey will be an encouragement.

    Mark

    Reply
    • David : Jan 2nd

      Mark,
      Thanks for reading! I have had a number of people that have encouraged me along my diabetes journey, I can only hope to do the same for others too!

      David

      Reply
  • Lee Atkinson : Jan 21st

    David-
    Any thoughts or suggestions from any of your correspondents would be appreciated.
    I am going to be backpacking in Tasmania in March and am going to be taking the “belts and suspenders” approach to manage my T1 diabetes. I normally use a Tandem T-Slim pump (with Humalog) and a Dexcom CGM which sends data to my iPhone. The “belts” will be taking a solar charger to keep both the pump and phone charged, but I am also going to be taking as “suspenders” insulin pens and my glucose meter. My question: what do you or others recommend for a charger? The web is full of options, prices, and weights.
    Thanks.
    Lee

    Reply
  • David : Jan 29th

    Hey Lee,
    That sounds like an awesome trip and since I read your comment I’ve been doing some research into backpacking in Tasmania… maybe a future place for me to go!
    I’m taking a similar approach as you. I’m using my Omnipod and Dexcom through my phone. Fortunately the only thing I need to recharge is my phone (omnipod uses AAA batteries). I’ll be taking my meter and strips with me and will be refilling my pump with pens. I am going with a anker powercore charger, I have used anker brand chargers and portable speakers for a few years and absolutely love them, they are reliable, hold up well under many conditions and are fairly lightweight.

    Reply

What Do You Think?