Smokies Part 2: The Diabetes Dilemma

Welcome back! I apologize for the gap between posts. In the past week I have been covering some crazy miles! We last left off with me describing my time in the Smokies. I was rather vague about my time during the snow storm and about my diabetes management.

It’s safe to say any thru hiker caught in a snow storm would have a difficult time. For one, we all wear trail runners. These are not conducive to foot high snow drifts. In addition, we have fall/spring gear setups, not winter ones. Being caught in a storm with these factors would be stressful to anyone.

What you may not think about, however, is how you’re going to keep your chronic illness managed through a 48hr storm. Intense excercise, such as thru hiking, is already a challenge to type one diabetics. Factor in white out conditions and sub freezing temperatures, and a scary situation for the average hiker can turn deadly for someone like me.

How I felt after day one of the snow

Note: I am not a doctor. Anything I write has been learned through trial and error and discussion with my own medical team. This is not meant as medical advice. That being said, I am a scientist. I will try to provide you with reliable sources with diabetes information.

A Quick Science Lesson

To recap: type one diabetes is a disease where your body’s own immune system attacks an organ called the pancreas. Because of this, a type one diabetic cannot make a hormone called insulin, which allows for uptake of sugar into the blood. For a more in-depth look at type one, be sure to check out the link at the bottom of this post.

Carbohydrates, or sugars, are the most efficient way for your body to get energy. If you eat a candy bar, your body breaks down the sugars and then insulin tells your cells to let the sugar in to be used as energy.

If you don’t have sugar available for your cells to use, your body will start to burn fat. There is a popular diet out there called “The Keto Diet” which operates on this principle.

When your body starts using fat for fuel you are in a state of ketosis (hence the name of the diet). The by product of this are acids called ketones. For a normal person, ketones will not effect you. For a diabetic, they can lead to a condition called Diabetic Ketoacidosis. It basically means your blood is acidifying. If untreated, this may lead to coma or death.

In a type one diabetic, this state can also be caused by high blood sugar or a fasting state. Your body gets tricked into thinking that you don’t have and carbs for fuel, so you start to produce ketones as you burn fat.

Why is this important?

I’m getting there. Let’s come back to the snow storm. It’s freezing cold and you are trudging through 8+ inches of snow. If you stop moving, you get too cold and potentially hypothermic. Stopping to eat takes too long, and you’re 7 miles from shelter.

This is once again a picture of the storm Friday. Saturday it was honestly too cold to turn my phone on, let alone take pictures.


If you are the average person, you might be scared of the cold and maybe a little worried about being hungry all day.

If you are me, you are worried about the bad circulation to your diabetic hands and feet. You’re worried about not eating enough and potentially causing a low blood sugar, which would force you to stop walking in harsh conditions. You’re worried about developing starvation ketones because you aren’t eating enough. This, paired with high blood sugar could lead to acute sickness and blood acidification.

So, how did I deal with these anxieties during a freezing cold winter storm?

1. Large Meals

For one, I made sure to eat as much as possible before heading out and when I got to camp for the night. I wanted to make sure my body had carbs to burn, not fat to avoid ketosis. I had oatmeal before heading out and high calorie and carb dinners at camp.

This was taken the day after the storm. Happy to be in the sunshine!

2. Snacks and Glucose Tabs at the ready

During the day, I hiked with at least three clif bars in one coat pocket and my emergency sugar tabs in my other. Like I said before, stopping too long to eat in those conditions could lead to other problems caused by cold.

I also tried to eat while walking because like I said, I was trying to prevent my body from making ketones. In the cold you are burning through way more fuel than normal, so the amount I eat on a regular day may not be enough in 11 degree weather.

3. Insulin Adjustments

Type one’s have to take insulin when we eat or if our blood sugar is high. How much depends on the person, their body, and activity level. Because my body was working hard to stay warm as well as hiking 14 miles a day, I somewhat decreased my insulin intake.

I halved the amount of insulin I would normally take for a clif bar, and thanks to my insulin pump I lowered my overall insulin for the day. Despite this solving the low blood sugar issue, it does raise potential problems of high blood sugar and ketones. Luckily, this was able to work for me.

4. Consistent and Steady Pace

As I have now mentioned a few times, the goal in this kind of weather is to keep moving and get to shelter. I didn’t want to make my body work too hard though, because that could lead to a low blood sugar. I managed to keep a steady pace nearly the entire storm, and was able to avoid any lows.

All In all, I survived.

It goes without saying that this was a really stressful time for me on trail. As much as I love being out here, I think it is important to highlight that things can sometimes turn scary, particularly as a diabetic.

That being said, I want any diabetic reading this to know that despite the extra steps we sometimes have to take for our own health, we can do absolutely anything. Luckily for me, I have had cold weather exposure before and learned from those experiences. I can’t reiterate enough that these are things that have worked for me, and may not work for everyone. It is important to discuss matters like this with your doctor to make sure you do the right thing for you.

With the Smokies behind me, the trail has felt a bit more manageable. If I can survive that storm, I can do anything!

Don’t get Dead,




Type one diabetes overview:

Ketones and Diabetic Ketoacidosis:

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Comments 2

  • pearwood : Apr 20th

    Oh, wow, Carly. I’m glad you were able to keep things regulated.
    I am enjoying following you on Instagram.
    Blessings on your way,
    Steve / pearwood

  • Sam : Apr 20th

    You know what really sucks? Having to get your food bag out of the tree at 3 AM because the two energy gels and tube of glucose tablets didn’t do it. This, while with your 6 year old on her first camping trip. I had picked up a stomach bug and didn’t know it yet (thankfully the fun part of that didn’t happen until we were back home). Good times! It can always be worse right?


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