Sugar and Summits: Hiking the Appalachian Trail with Type 1 Diabetes

Picture this: you’ve been hiking all day, since an hour after sunrise, the pack on your back carrying everything you need to survive out here in the woods. The trail has steepened significantly over the past hour, transitioning from stunted evergreen trees to bare rock. Finally, you reach the summit, legs shaking a bit from the climb, stomach growling. As you shed your pack and glance at the horizon, your heart drops; the line of dark clouds crawling toward you kills any thoughts you had of resting on the summit (and all your hopes of camping dry tonight – the shelters will be packed, your rain fly ripped a few nights ago and you just hadn’t gotten around to fixing it…). Slinging your pack back on, you hear a beeping from one of the side pockets.

And this is where our stories diverge; for you, that beep might be a text from a loved one or a low battery alert. You silence the device, take a quick sip of water, and speed off down the mountain to the safety of the treeline. And while that could be true for me as well, this scenario could also be the beginning of a perfect nightmare: a low blood sugar on an exposed mountain ridge with a thunderstorm rolling in.

You see, (as I mentioned in another post) I have type 1 diabetes. This means that the beeping in my bag is probably my Dexcom continuous glucose monitor, a device that tracks the amount of sugar in my blood at any given moment.

And if the robot is yelling at me, chances are that my blood sugar is headed toward a dangerously low level.

In my daily life, this isn’t usually a huge problem for me – I just reach into my fridge and get myself a juice box, or a bag of Skittles, or some other deliciously sugary treat. I can sit comfortably for the 15 minutes I need to bring my blood sugar back into a safe range. I could call for help if I’m seriously in trouble, though I’ve fortunately never been in that position.

But out here in the woods, dealing with diabetes isn’t nearly as simple. In the scenario I set up earlier in this post, I’m faced with a real dilemma. Unlike the average hiker, I can’t easily decide just to start hiking again. A low blood sugar can make me lose focus, coordination, and (if it’s extremely low) consciousness. I have to treat the low, but I also can’t afford to get caught in the onrushing storm.

My internal monologue in times like this is less than pleasant, and definitely not worth sharing with you all – let’s just say that I’m probably frustrated, flustered, and more than a little scared.

But the overwhelming question running through my mind is simply: now what?

Before I get into this, I do want to give a quick disclaimer; while I am an EMT with lofty dreams of medical school, I’m not a medical professional. My advice comes mostly from personal experience, with a little bit of supposition thrown in there to make this all more fun.

In the case of stormy summit sugar struggles, my instinct is still to get down the mountain. Maybe that’s because I’ve been a hiker for longer than I’ve had diabetes, but the thought of adding lightning and rain-slick rocks to an already dangerous situation just seems like a bad time. As I pick my way downhill, I’d try to shovel Gummy Bears into my mouth without choking on them. Multitasking is a must for diabetics, and I’ve gotten pretty good at inhaling sugar when I need to. And so the crisis would be averted, at least for the moment.

Since prevention is the best solution, I aim to avoid moments like these, times when having diabetes adds more risk to an already challenging situation. But that’s easier said than done; type 1 diabetes can be so unpredictable, even with the incredible technology that is available to help manage it. So what goes into a good blood sugar day on trail?

Eating – All the Time

For me, one of the best ways to keep my blood sugar in a comfortable range is to nibble throughout the day. If I stop and eat a big, full meal in the middle of the day I tend to have high blood sugars for a few hours afterward, followed by a nasty drop once the insulin overtakes the sugars. Not eating isn’t a good choice either, even for folks who have fully functioning pancreases. Instead, I stuff pockets with nuts, dried fruit, bars (Thrive Tribe is a personal favorite), and eat on the go. I aim for higher protein and fat content, with a few carb-heavy items thrown in as well.

Consider Energy Requirements Ahead of Time

If I know that I’m going to be climbing a mountain first thing in the morning, I add more sugar to my breakfast and reduce the amount of insulin I take; conversely, if I’m looking at a pretty easy trek, I might load up more on the protein-heavy snacks and leave the carbs for another day. The type of energy that my body will work best with is variable, but just looking at an elevation profile before setting out can allow me to ensure a more stable blood sugar.

Backups for the Backup Plans

OK, yeah, not having to give myself shots whenever I want to eat is pretty great. So is using my Dexcom to see the trends of my blood sugar on my smartphone without pricking my fingers every five minutes. But while I love my robots, I also know that I need to listen to my body as well, and be prepared for the failure of any of my systems at a moment’s notice. For me, this means I bring a few extra syringes and a few glucagon kits (which are the diabetic equivalent of an EpiPen). I wear my medical ID bracelet, since I’m hiking alone, and always have a stockpile of sugar in easily reachable pockets.

Just Keep Hikin’

As one of my favorite animated fish says, “Just keep swimming.” There are always days when dealing with diabetes feels like an undue burden, when persistent high blood sugars make me grouchy for hours on end, when I just can’t pull my blood sugar up from a pit of lows and my hands are shaking too badly to retest. But sometimes those low moments – both literal and metaphorical – force me to stop and recognize the momentousness of what I’m trying to accomplish. Hiking the Appalachian Trail is hard, even with all your internal organs in good working order. It’s important to recognize that going on these sorts of adventures sometimes means giving up a bit of the consistent control that I’m used to. But I have found that the only way to move forward is to accept these imperfections, to learn from them, and to always be ready to adapt my approach to managing my diabetes to fit the reality that I’m faced with.

Here’s to hoping that I’m still this optimistic about all these things in a couple hundred miles.

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Comments 17

  • Mark Whitcombe : Feb 21st

    As a Type 2 diabetic hiker — and father of a Type 1 nonhiker — I’m rooting for you. I have some personal sense of the additional layers you’re dealing with. I love your constant nibbling approach. Think I’ll practice that right now …

    • Rachel Hemond : Feb 25th

      Hi Mark,

      Thank you for your thoughts and support! It’s always good to hear from people who understand firsthand what it is to deal with all these mental calculations on trail – and who also practice constant nibbling 🙂

      Hope you and your family are well,


  • Cindy : Feb 22nd

    Thank you for talking about this! I am type 2 diabetic. I start my NOBO this coming Sunday. Prepping for a thru with diabetes had extra challenges!! Like how to keep taking meds that have to be refrigerated. See you out there! Snacking all along the way:)

    • Mark Vingoe : Feb 22nd

      I’m 68 with type 2 and hopes of starting NOBO segment this fall. I’ll b interested in what low carb foods you will be using or do you think the amount of calories you will need allow your body to eat more carbs?


  • Nelson : Feb 23rd

    Awesome to see your posts and your backpacking goals. In the last five minutes I’ve shared the link to this article with much of my family. My 19 yr old son , who also has Type-1 diabetes, is planning on starting the PCT NOBO on May 28th. He started a blog last month, so that people could follow him on his journey.

    I hope you the greatest success in your adventures!!!

    I’ve been wondering if there are any people that have thru-hiked the PCT, AT, or CDT with Type-1 and haven’t found any records or suggestions of such. Have you?

    • Rachel Hemond : Feb 25th

      Hi Nelson,

      Thank you so much for sharing my story – always trying to find connections to people like you and your son who are embarking on similar journeys! The PCT is next on my list (a few years from now, probably) but I’ll definitely follow his trek as best as I can!

      I also haven’t found any records of other solo T1 diabetic thru-hikers, though I’ve been looking! I’ve found a few other people who definitely attempted thru-hikes, but not their blogs or anything that tells me if they finished. Here are a few links I’ve found in my own research:

      Wishing you and your son all the best!


    • Stefanie : Feb 26th

      Hi Rachel,
      Hi Nelson,

      it’s so great to hear that other type 1 diabetics are doing the PCT and AT!
      I’m planning to do the PCT in 2019. I was diagnosed with T1D when I was one year old (I’m 28).
      My biggest struggle right now is the question on how to distribute/ send ahead my diabetes supplies. It’ll be way much to carry ahead for 5-6 months :-/

      Good luck on the trail Rachel!

      BR from Munich (GER),

  • Rick Baxter : Feb 23rd

    Good luck Rachel, I’ve backpacked many miles with type1 diabetes and had very few problems. I never had the time to do the whole AT, but have completed about 650 miles in sections. While keeping my pack weight down I skimped on food once and hiked into Monson with only 5 M&Ms left to eat! Big lesson there. If you have any questions that I may help you with please get in touch. I’ll be following you. Rancid

    • Rachel Hemond : Feb 25th

      Hey Rancid,

      While I’m going pretty light on gear, I’m definitely not trying to go ‘5 M&Ms’ light!! I definitely appreciate the offer of advice – if you can think of anything important off hand, then please share! Also wondering what you used as a quick sugar source; I know sugar tabs are easy and cheap, but I just absolutely hate the taste of them by this point.



      • Rancid : Mar 3rd

        Hi Rachel, for quick sugars I like M&Ms with peanuts and spearmint leaves or orange slices. After much consideration for night time lows, I found that a small tube of icing for cake decoration is perfect. I keep it in my bag to stay warm and bite it open if needed. As long as it’s sealed, it will not attract bears or mice. I have other thoughts and questions for you. Can you gmail me so we can chat. Good luck and HYOH. PS: I’m planning a rim to rim hike of the Grand Canyon in Sept. Can’t wait.

  • Bloodhound : Feb 26th

    Hey Rachel!
    Wonderful story. Brave of you to put yourself ‘out there’, physically and on social media.
    In case we meet up while I’m out doing trail angeling, what is your trail name?
    Look forward to meeting you!



  • Ryan : Mar 15th

    Awesome read! Thanks for sharing your story. Good luck and please keep us posted!

  • Chris : Mar 20th

    What an awesome article! I have been a Type 1 Diabetic for the last 21 years. The last 13 years on a pump. And although I have not hiked the AT I have been hiking most of my life. I am also on a Search and Rescue Team and have to bush-wack most of the time (read lots of lows). My go to food for keeping my sugar up is trail mix. Normally make my own. Peanuts, raisins, craisins, granola, shelled pistachio, M&M’s. I feel like this gives me a good mix of simply sugar, protein and fats. If you need anything don’t be afraid to ask. I’m up in Maine when you get up this way and need a hand.

    • mat : Apr 12th

      As another 41yr type1, you have to graze all day. Gobble a few big meals and throw the insulin away (except for maybe a couple of units with tea, if your to high at the end of the day). Drop your long lasting (lantus) to swf.

      Your bodies burning so many cals. You dont need it. Much. With Cavets. Everyones different. To hell with doctors advice Who thinks every ones to busy sitting on their asses drinking coke and getting fat. If I did what the doctors have suggested. I’d be a corpse on the trail
      The amount of skittles in my pack manages to please a lot of people. Heat them up like pop corn, yum.

  • Curt : May 10th

    Thanks for sharing and keep pushing. I’m type II and that is the very thing that has gotten me into hiking since I can’t stand gyms and treadmills and my dr said to walk more. I more than understand the constant battle of being on a never ending roller coaster and just trying to plan when you will need more energy and when you don’t just to feel good enough to push on another mile. You are inspiring and I am Looking forward to following more of your posts!

  • Michael : May 10th

    I have been a T1D for 42 years, I have dreams of hiking the AT when I can phase down with my work. I have some moderate long distance hiking, I have had few situations on the trail. I wish you the best, and I look forward to reading more. My wife and I spend most of our summers in Western MA and Southern VT. When you hit those areas and anything please email. We will meet you with food, insulin, or just conversation. You are a hero to all T1D’s..

  • Mtneer92 : Aug 23rd

    Hi Rachel and all. I went to college in Western NC and have hiked parts of the AT. Ever since I was a child and heard of it, I’ve wanted to do it. I am T1, wear an insulin pump, and still dream of thru hiking NOBO someday. I’m currently OCONUS working and will be back to the US in a few years. Hopefully, within a year or so after my return, and some training on some parts of the AT, I will go to Springer Mountain in late March or early April and embark on a 3 1/2-4 month journey and finish at Katahdin. I just found this and am looking on other sites… it seems that Rachel was successful at completing her journey (I saw a picture of her at the end)… I am in the initial stages of planning this and will need to figure how others did it, and attempt the same thing. There will be some challenges and I’m sure that after I read Rachel’s and others, I will have some of the answers that I need… such as how I will get insulin to me, how far they went and others. At this present moment in time, I plan to complete in under 4 months, including off days, but, that may change in the future.
    I’m still a T1 baby, as I was diagnosed less than 3 years ago. Anyway… enough about me. Thank you Rachel for posting. I am looking forward to following in your footsteps and being one of the few T1s to complete the 2,200 mile journey.


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