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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