Multi-Day Trekking with Diabetes

#1

My wife and I recently signed up for a 6-day trek through some amazing countryside in Tasmania (the Overland Track for those Aussies on the forum). It should be an incredible trip and we are really looking forward it. However, this will be my first time doing something like this with diabetes, so I wanted to see if anyone out there has any experience or advice on how to manage diabetes on multi-day outdoor trips.

I was diagnosed with Type 1/LADA in Feb 2016. Prior to that I wouldn’t have thought twice about a trip like this. I’ve done Everest Base Camp, Kilimanjaro, multi-week river trips, etc, but all before I was diabetic. Like a lot of people out there I try not to let diabetes control my life and impact what I do. But I’m still nervous about the trip and how I will control my blood sugar.

Obviously my main concern is getting too low when I’m out in the wilderness. Should I decrease my basal dosage? Decrease the amount I bolus with meals? Snack more often while we’re walking? Do all three things? What do you do to stay healthy while you’re in the outdoors?

Also, any advice on handy gadgets for carrying insulin pens while on an extended trek is always welcome. I have a Frio, but don’t love it and would upgrade it there were something better.

Thanks for the help!

David

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#2

A Frio is the best thing to use for keeping your insulin cool. If you are going soon, it is spring in Tasmania and there won’t be excessive heat to concern you. Besides, Tasmania does not usually have excessive temperatures.

As to how to manage your diabetes on your trek, I find that even a one-mile walk will bring my BG down dramatically. I would suggest you make a few trial walks and test a lot to see what happens as we are all different.

If you are on a pump and CGM, then you can dial down your basal and watch what happens on the CGM. If no pump or CGM, then test a lot to keep on top of things.

And, yes, carry enough carbs with you to address the lows. I like Skittles because they come in 1g bits and are easy to count. There are others. Also carry some protein/fat to extend the duration of the carb digestion such as cheese sticks, which work well for me.

You are doing my dream thing in one of the best places in the world. Enjoy! And do tell us all about it when you return…

#3

If you are going to be active for many days, yes, do all 3 things! And in general, increase your overall carb consumption for the extra activity.

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#4

Have you had a chance to do some hiking since your diagnosis?

I find that muscle workouts tend to spike my blood glucose levels whereas a walk or run causes me to drop. A strenuous hike with an incline falls into the former category for me, so I’m actually more likely to run high than low on difficult hikes.

I don’t know the terrain in Tasmania, but it might be helpful to do some research on the treks you’ll be doing and try similar elevation hikes before going. That could help you gauge what direction your blood sugar levels will go while hiking.

I find that liquid (e.g. gatorade) or glucose gels tend to digest faster on hiking trails. I bring sweets (e.g. skittles) with me on hikes in case I drop low, but when I use them to treat a low, they take much longer than gatorade.

I’d look into getting some of those glucose gel packets. I think they’re gross, but they kick in fast.

#5

I’ve done several 1 to 2 week hut-to-hut mountain treks after my 2014 diagnosis. Glucose tabs and raisins were always in my pocket for raising BG and were used often, as well as other miscellaneous fruit and glucose gel. Other than that, a CGM and drinking plenty of water are essential. The Frio worked great for me. If you use a Dexcom, a hard case for spare sensors is important. The plastic tabs will get knocked off if the sensors are stuffed into a backpack without protection.

My main difficulty on those trips was the only food available for dinner was usually pretty high in carbs. I was usually pretty well starved by dinner time so portion control was tough, and I struggled with night time highs. I was using Humalog at the time and late night corrections were a PITA because they took so long. I suspect that faster bolus insulin such as Fiasp would have been more effective. Only other insulin related issue I had was when I fiddled with my basal dose during a trek which was not a success. I was on Lantus at the time and was not able to fine tune to an optimal basal dose. I subsequently changed to Tresiba and recently took a 2 week bike trek with no basal issues at all.

#6

Not sure how strenuous your trekking will be, but it can be useful to think about how many calories are burned per hour and replenishing glycogen (unless you’re experienced and seriously “fat-adapted” from endurance training while eating keto for months on end). In traditional mountaineering (i.e., trekking mile on mile with 60+ pounds in a pack, plus gear, at altitude, and summiting involving moderate climbs), the rule of thumb is that an average climber (150lbs with 15% body fat) burns a bit more than 200 calories per hour.

In order to keep muscle glycogen stores filled, it is general practice to target eating 200 calories worth of carbs (about 50g of carbs) per hour, every hour while trekking, and again within the first hour after ceasing activity. Clif bars (and similar products) were designed to this end.

Obviously, the calculus is a bit different for us, but even though I eat low-carb in day-to-day life, I’ve found that if I do any kind of serious endurance training/work with duration more than an hour (cycling, trekking, climbing, etc.), I do need about 50g of carbs per hour of work to keep performing and keep my BG from plummeting. It is worth testing before your trip to see what works best for you!

#7

John,

Thanks for sharing your experience. I also suspect that most of our meals will be carb heavy; pasta, rice, bread. But I’ll deal with that issue just like I’d deal with it in a normal situation. Actually, running a little high might help put my mind at ease while we’re trekking. Regardless, I’m glad to hear that you were able to do the trip with no serious issues. Our trip will also be hut to hut, so a little more glamorous than sleeping in a tent. At my age, it’s hard to still do that.

#8

David,

Thanks for the great advice. I was planning on stocking up on Cliff Bars anyways. They are pretty high in sugar and are one of my go-to snacks when I’m out hiking. I know they’ll raise my BG without fail.

I’ve found that hiking and running don’t seem to affect my BG as much as biking does, probably because it’s a more intense workout. I’m hoping to go on some longer hikes over the next few weekends so I can test out some theories and see how my BG response over a strenuous 4-hour hike. The problem is that I live in Hong Kong and it’s crazy uncomfortable outside these days. Maybe by October it will be more comfortable. Anyways, thanks again for the info.

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#9

David, same here. I am too old to sleep on the ground! Huts can be a lot of fun especially (a) socializing with other trekkers and (b) having beer or wine with dinner. The huts in Europe I’ve stayed in differ a lot with available foods for breakfast. Some have just bread and cheese, a few crackers etc. others have hot food. It might be wise to carry some breakfast and mid morning snack foods with you unless you know the huts will be able to supply a decent meal. I forgot about the Clif bars…I travel and hike with a multi-day stockpile of bars for that purpose but there are limits to how many you will want to carry. I avoid some bars which are loaded with carbs. Sometimes shopping in local stores will discover some new bars that are lowish on carbs (20g or less) and low glycemic.

#10

Peter Adolfsson is a swedish MD, Ph.D. who has specialised in excercising with diabetes, and he has come up with some rules of thumb:

Activity longer than an hour:
Eat a fruit or something with 15-20 gr carbs before you start.

Then add carbs every thirty minutes:
0,3-0,9 g/kg (to me I´ve found 20 gr to work). And I prefer to use liquids. not bars.

When on a hike and you would like to use something other than bars, I would recommend finding a liquid gel with a cap. I´ve found these here i Norway, and one of them contains 40 gr carbs, which means I use one every hour. They are lightweight and don´t tak up much space either in your back pack or your pockets:

And off course keep in mind that you probably will need less and less insulin as the days with trekking goes by. Day 1 will probably look different than day 6.