I went on a 5 mile hike Sunday and had some bg issues, normally I walk around 1-3 miles a few x per week where I live and it's not a problem, but this was more extended and fast paced, longer distance and even with some stops I had issues.
I started out dropping at the beginning but then dex went to an extended ??? and continued to do that(thanks dex for failing me when I really needed you, lol) and two finger sticks failed so I treated with some food and glucose tabs and then spiked a bit which was fine. Eventually I ended up hypo again at the end even with some 0% and I had to over treat a bit because I had no idea how close to the end we were, the leader just kept saying we were half way there a few x. It was one of those hikes where you are stuck on the trail once you're far in and there are no signs or proper marking. I got lost there 4 years ago when I missed the group and tried to do it myself and it was pretty scary.
I'm going on another group walk/hike friday which is less isolated, on a path between two towns, but it will be longer, 7 miles back and forth, and I'm wondering what to do. Should I just try a lower basal for the whole hike? Boost my bg ahead of time? I'm always worried about lowering basal too much because I can spike up a lot sometimes without the right basal. They said they will do this in 2 hours which is less time than the 5 mile trail.
Have any of you had these issues and how do you handle it? Usually I'm at home when I'm doing extended exercise like gardening or shoveling snow and I can just stop, go inside and eat/rest etc.
oh, the hiking… idk, flat hikes/ strolls are ok for me but as soon as it goes upwards, i am doomed.
i must sadly admit that i think diabetes has kinda ruined big hikes for me, just bc it seems to be impossible for me to have just somewhat acceptable BG during hikes.
my problem is that i go low in the beginning, and then, usually in the last ascent i start rising and then i am high for forever, but the following night i go low again. its just a real thightrope walk.
what i would try is lower your basal with a temp basal like 30 mins b4 you start and then see how you go. you have the great advantage of having a dex that hopefully will work the next time!! pack plenty of fast acting foods and be agile and try to think ahead. i know its easier said than done! make sure your hiking mates know about your D and that you can stop for a short while if needed. i try to start into hikes with a bg of like 160-180 so i dont go too low immediately.
have fun!
SC
I’ve tried the suggestion that Gary Scheiner made here on one of the videos to reduce the bolus for the meal before the exercise by one third. I’ve done that succcessfully.
I’ve also reduced basal insulin two hours before the exercise start. I’ve used minus 20-50%. Starting two hours before the start of the hike should match your needs pretty well. To really get this dialed in, take the same hike several times in a row and you will find the best formula for you. And you’ll get some great exercise!
I slow my pump down by either 50% or SUSPEND it if I'm a bit low. I usually guess pretty well these days, since I wear the Enlite sensor. It keeps me right in a good range for activity when the sensor is a good one (it'a all about exact body location for me--the sensors are undoubtedly created equal, in my experience.)
I put my basal to -60% for at least an hour before I start hiking and I aim to have a blood sugar of 150ish when I start. This has worked pretty well for me on some moderately difficult hikes but I also monitor my dexcom pretty closely and carry a backpack with lots of water and lots of snacks.
I do a lot of hiking, and it is challenging to maintain decent control. For a strenuous hike, I lower my basal rate by 80% about 2 hours before the start. If I am climbing a mountain, I have to carb up in addition! Then, I carry GU or Clif Shot in my pocket, and track via my Dexcom. If I am hiking all day, I have to make adjustments in the afternoon, such as increasing my basal rate, because otherwise I go high. So I have no good answers for you, Meee, other than I REALLY have to lower my basal initially or I go low.
Terry and Melitta's posts follow what I do pretty closely. I routinely lower my basal to between 0% - 50% depending on where I start out BG-wise. I do this for one hour before and throughout the exercise. For pre-exercise meals, I give 50% of the normal bolus and I resist the urge to correct for post-meal highs unless they get over about 275, and then I will give about 50% of the correction bolus.
If you can carry a backpack, I would carry extra glucose tabs/gels and a protein bar (or 3!), along with your meter (in case your Dex goes ???). Also, I find the Dex will continue to read low BGs once you get below 70, so having the meter with you helps in not over-treating.
I have recently been finding that walking lowers my BG more than other, more physically demanding exercise ... curious, I know.
Bottom line is you are going to have to play around a bit to find what "works" for you, while recognizing that the formula will be less than perfect.
I, too, find that even an easy 20 minute walk can drop my BG, so for a vigorous walk (with faster interval segments) I have to drop my bolus at least two units. I'm on MDI so it's that's about all I can do. On a recent trip we did a rain forest hike and I checked my BG before we started, at the halfway point (waterfall vista) and then again when we were done. I ate a 20 gram carb clif mojo bar during the hike and finished nicely at 108.
Think Like a Pancreas has an awesome chart that was kind of my roadmap through several rounds of running training. I haven't had a good, long race since 2012 but for running, I try to clear insulin on board before I start. Then lower basal as much as I need to. When I first started, I would cut it to 10% of usual and found that my BG would go up so I've sort of experimented and settled on 50-75% most of time for moderate to long runs but I also try to eat like 5-10G of carbs/ 3 miles of running. But I live near Chicago and the biggest hills I run into are geez, maybe 70'? Not much more than that unless you run up stairs or maybe a parking garage. A hike through hilly terrain is probably as if not more strenuous. I also think that I got more "bang" or more lowered BG when I worked out less as I sort of feel like I've gotten used to it to the point where it doesn't phase me as much. I would say bring alcohol wipes and another thing you can do is swing your arms back and forth or big giant circles or something like that to make sure you can get blood out for testing?
Enjoy your hike and bring supplies!!
The combo of Smarties and Starburst Jelly beans has worked really well for me and is compact, each little bag is like 35-40G of carbs. Two will last me a long way. For running, I balance that with Gatorade and mostly try to match the Gatorade to my BG and I've sort of figured that out for me. Maybe too, training hikes, 3 miles, even just around the neighborhood, might help sort of "beat yourself up" so the more gonzo events are less stressful and you get more practice figuring out how to load and balance carbs?
That is too bad SC I hope you can figure out a way to do those ones- maybe with a dex. I didn't tell anyone this time because the last time I went on a hike I was ok. I was on mdi then, my bg was dropping at the start so I corrected- it went up, not too high and I didn't go low again. That hike was a bit shorter and slower paced on flatter terrain as I recall with a different person leading it. I will tell someone for the next one. I did tell someone I had D and I was going low at the end- she was having a lot of knee pain so we walked a little slower, but normally I would like to stop till I start to come up. I felt this would be a burden to everyone maybe. Her mother has D so she understood about lows. I'm going to lower the basal and maybe have a snack before hand to boost me up next time.
Ty Terry- I definitely had too much meal fast acting prolly for going on a hike that long. I will try to eat in advance and then have a snack post pre hike was well as lower basal a bit before, 2 hours may be too much though? Yes, I'm having some car problems and my feet were sore from the last one but hopefully I will make it to this one which is at night.
Thanks Everyone for your replies! I'm going to try these ideas, lower basal a bit ahead of time, lower mealtime insulin and or eat far in advance and have a non bolus snack before hand.
@YogaO I did have my meter(never go anywhere without) and I tested but it failed on the first two finger sticks and the first low at the same time dex failed, in addition it was a very sunny day so it was hard to see anything, the next hike will be at night so I have to plan ahead for that. I had glucose tabs/gel and a snack too of course. The last two I went on I was fine but they were shorter and slower paced.. one was just a garden walk and I spiked a lot at the end, nothing to do with the walk I'm sure.
@Amy- Thanks :-) I'm going to try something like this... not sure what percentage I will try yet...
@Melitta, Thanks :-) the most strenous things I have done so far have been extended gardening and shoveling snow.. I usually have to keep stopping and taking glucose tabs and meals/breaks for that as well as reduce basal, That is interesting that you go high on the all day hike, so far I don't think I have had that happen with long activity.
@Catlady, sometimes that happens to me too, and other times I'm fine with longer activity.. usually on my own walks it is ok because I can stop, test, treat as needed etc.
@Acidrock Thanks! I will check that out. Alcohol wipes? lol, I never use those. My big problem was the failed dex and two finger stick where the meter failed.. I gave up at that point and just ate something but later I was able to do a finger stick. It was pretty cold so maybe it was due to that. I do do around 2-3 miles for my longer walks and I don't usually go hypo for them unless it's one of those days or I have too much fast acting but now I can lower basal, for some reason I do that more when I'm shopping than walking. But after I have to be careful and bolus 20 minutes or more into a meal or I will crash. Another thing I do now is do a 0% basal while I eat if I start dropping. I think carbing up may be a good idea, protein and fat has helped me too in the past while shoveling snow for a few hours. No iob also, I think that will help me a lot.
hope this will work out. right now it is snowing, so no hiking for me, but i will try another time this summer, and i also got approved for a CGM so i hope this will help. i really like hiking, just not the amount of brainwork it requires for me to have somewhat stable BG…
I lowered my pre hike meal bolus a bit, ate a slightly larger meal: (eggs, raw veggies, cheese and strawberries with some green tea) and I spiked right away to 160's- more than I wanted, so I corrected a bit at 2 hours before the hike. I think the spike was also maybe partly due to not doing any correcting as I woke up which helps control my dp. I didn't do any reduction of basal prior to the hike due to going up so quickly.
While walking I gradually dropped, ending up at 108 towards the end at the 2-3 hour mark. At that point I felt a potential crash coming so I set basal to 0% and had a 15 gram snack while we walked. Unfortunately I spiked again when I got home- to 150. I think that was from the snack and too long a 0% rate(1 hour). I over corrected a bit but managed a safe landing and set a temp rate to 0% with dinner bolus 20 minutes after I started eating.
Unfortunately I spiked again so I should have bolused at the start of the meal and only reduced basal if I started dropping probably.
Still it went pretty well overall. I think it was one of those days where my bg just spiked up naturally and I was going to stay there for a few hours whatever I did so that definitely helped. Next time I will try to reduce basal ahead maybe or just on the hike but still keep myself lower if possible. I wonder if it's possible to flatline a hike like this?
The hardest part of this hike was that I was out of breath at the end due to the fast pace, I was on my own for the first half basically and set my own pace which was better for me. I did tell the group this time about D- one was an ent and everyone was very nice. I am sooo stiff now though, I'm not used to walking these distances all at once with no breaks, I can barely move around today.
Here's my dex graph, fortunately dex was working perfectly!
I struggle to get the tempy basal rates right because I have to set it far in advance of when the activity occurs.
When I ride my bike, I normally start out @ 50% (it's kinda my default setting) and then work down pretty quickly to 0%. For me, I don't worry a lot about the spikes because I know they will be relatively short-lived and my increased metabolism will help bring them down.
Not having lows during the activity makes it all so much more enjoyable, and allows me to focus outward. Lows make me just feel like putting one foot in front of the other in a plodding way, focused on my own little world and small - ugh!
Really happy for you and hope your next hike goes even better.
Great work meee and thanks for sharing the report! It seems like you are very close to being pretty perfect! The 108 at the end and "dose" of food and 0% basal is a great combo and, from the results, a spike to 150 is pretty solid too. Maybe a 50% basal or whiff of bolus to cover the snack would have kept it a bit flatter but still an excellent job! "Think Like A Pancreas" has an interesting chart with suggestions for cutting boluses, based on activity:
I used the chart as a rough guide to adjusting basal too and it seemed to work decently for me. I thought that his carb rx was a bit heavy, something like 95G of carbs for a 1/2 marathon, which I usuaully do in around 2 hours, which I would generally cover with closer to 50G of carbs. It's hard to guess a precise formula but it's fun to get out and around. Another thing I do sometimes is have a Kind (brand) bar before longer things. There are several tasty varieties that have 15G of carb/ bar but they have quite a bit of protein and I think that can sort of deploy usefully if you're in action for an hour or two. Good luck and happy trails!
Thanks Yoga! I'm not sure how reducing ahead would work for me, I will try it at some point. I think I should try lowering it a bit at the start and see what happens. Having very little iob helped a lot. I hope so, when my muscles recover I'm going back to redo this one for sure.
@acidrock Thanks! I think a 50% is what I'll try next time or maybe 0% and skip the snack. I find when I'm shopping and I start to drop I usually need both, I'm so grateful for 0% lol. I admit I'm not positive if my snack was 15g I had some falafel chips and nuts so it was high fat though, but that can spike me too. I agree that is way too many carbs for me. But I'm just walking not running etc. I wondered if part of my spike was a reaction from a possible low too. I have to review tlap again. I haven't tried those bars I think, they all seem to make my bg crazy if they have wheat, I think it may be that. I have been planning to make my own somehow.. I have tried some lower carb ones at wholefoods too. I think the protein and fat keeps me going for a long time. I hope next time I can do it with less spikes maybe, we will see!
I am preparing for a hike, after a long stretch of little to no exercise. Thanks for the graph from Think like a pancreas. I’m going to try that. Anyone got any blister prevention strategies? After low BS, that is my next concern. And, does anyone have any experience using the “Spot” for hiking in areas with no cell communication?Thanks!
