Remote mountain trek: Would it help to switch from MDI to pump?

Hi, i just saw your post. I live in Switzerland, so if you need any help, contact me, be it with failed materials or other stuff :slight_smile: hope you have fun there! The Alps are a gorgeous landscape :mountain:
I guess the pump would mostly help with basal adjustments. I feel like my boluses work faster on MDI (bc the injection sites change each time) than on the pump, where the site stays in the same insulin-lake for 3 days. also, the material you carry around as a pumper is A LOT more than on MDI. i second the suggestion of a CGM. Maybe your hospital/ endo practice can provide you the CGM for that short amount of time, and you would have to buy the sensors yourself. i think a box of 4 sensors (that would last you 1-2 months) cost around 400$ here in Switzerland, maybe you can pay that for the trip?
For the long run you might wanna consider changing your insurance, but i dont think that that is a reasonable idea on such a short notice (to change insurance before the trip).
good luck and contact me if you need help!

Hmmm okay. I would build a diy OpenAPS. Or wait a year or two for an artificial pancreas to be for sale. New muscle use uses more sugar than previously trained muscle use. Exertion level makes a difference so if you are not pushing your limits you will use less sugar. Now you will be hiking day after day. The first four days after a rest day your insulin needs will decrease. The first day after a rest day you will require full insulin even though exercising unless pushing to extreme. If your blood sugar goes really high from unexpected ease with extra carbs then bringing blood glucose back down may take an extrodinary amount of insulin or just a little. One possible cause is stress being upset about the high. Unnoticed for three hours or more also places stress on the body as your effort to maintain the same pace will be super sized.

Thanks, looks like I’ll be buying a CGM without my insurance participating. They’ve got an appeal process but it looks lie a lot of red tape that won’t get any results. The main problem is their “Medical Policy” seems to be the bible as far as their bureaucrats are concerned. I’ve got to get it early summer so I can use it for a while before the big trip and know what it’s telling me.

Aaron10, I had not thought too deeply yet about the first day after a rest day versus further along, good to know and gives me some ideas for things to watch for/adjust on trial hikes this summer. To be honest, the mental stress issue of high BG causing further rise has not been a problem for me in past but you’re right, if I find myself in a “lose-lose” situation between huts with a high BG things could go haywire. I guess the CGM will help warn me so I can avoid that? (I’ve never used one, actually never even seen one up close).

SwissC, it’s great to know you are somewhere in der Schweiz and willing to be a local resource/helper in a pinch, that is cool. I don’t think it will come up, I am pretty self sufficient as long as my body does not throw curve balls at me. Your country is first class all the way and it sounds like you are too. Thanks!

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I was on some long hikes last week - with CGM - and think back to previous years when I just had strips. It’s a big difference. II think you’ll really appreciate the trends that the CGM shows you. Just remember the CGM values are about 15 min’s behind bg, which is not an issue when things are stable, but is important during rapid change. With a big trek lots of out-of-the-ordinary conditions happen, so having both CGM and strips is the way to go. Enjoy!

Based on comparisons with fingerstick BGs, the lag time my daughter experiences with her Dexcom CGM is more like 2 to 3 minutes, the only exception being recovering from a low BG when the lag time can be up to 20 minutes.

What’s not clear to me is how many days will this be (from when you leave your home until you get back to it)?

The advantages of the pump are:

  1. your bolus and basal are coming from the same place and are the same insulin (Humalog).
  2. you’re not having to “inject” your insulin as much (infusion sets last about 3 days).
  3. you can adjust your basal depending on your activity level.


  1. your bolus and basal are coming from the same place and are the same insulin (Humalog). If your infusion set gets messed up, you’re going to need to be able to inject anyway.

A few things to consider. If you’re bringing pens as your backup plan, you may be bringing a lot of Humira, because (depending on the pump you get) you’ll need it in a vial to fill your pump. If you’re going to get a pump (and or a CGM) get them as soon as possible. That way, YOU can make an informed decision on how comfortable you feel using them in the middle of nowhere.

I have had a Dexcom for less than two months and I am only now getting a handle on how to use it to more precisely to control my D.

I personally would feel a little worried that I wasn’t used to my CGM enough. Even after almost two months, I am still leaving the room without my CGM a lot (because my previous CGM is still in my pump, shunned).

You should still plan on bringing plenty of strips. The really big problem with that is that it will be a real hassle to test in the wild.

I love hiking vacations! My craziest, most remote one since being diagnosed with Type 1 diabetes was Bhutan, in the Himalayas, which was spectacular. Glacier National Park was also lots of distance, altitude, remoteness. And grizzlies! I wear the Animas Ping and the Dexcom. Be sure to get the Dexcom CGM, it is so superior to the Medtronic (I have used both). The Dexcom makes hiking vacations so much better. I wear it clipped to a belt loop with a mini-caribiner, and I wear cargo pants so I have easy access to sugar sources (Gu is a good one for me). The Dexcom is a game changer! Have a great trip!

You seem to be pretty switched on and have done a bit of hiking so I’d stick with the MDI, but do add the CGM. They are as inaccurate as hell but, once you’re attuned to it, they do at least give a continuous trend line and warn of any sudden up or down movements, BEFORE I get into trouble.
I’m probably about as active as you; long distance runner, hiker, ocean sailboat captain, and the Medtronics CGM has kept me out of the emergency room for about 4 years now.
Glaucagon kits are simple and reliable; I carry one on board but have yet to use it.
Simplicity & Reliability are the two most important virtues and, it I have to carry a lareg supply of “spare syringes and vials…” may as well stick with the pens.
Good luck on your trip, I’m envious!

Perhaps your CGM is “inaccurate as hell” because you use Medtronic’s CGM (as opposed to a Dexcom CGM) or perhaps it’s your particular metabolism. My daughter uses a Dexcom G5 and it’s scary accurate, at least compared to the readings she gets from her Freestyle meter. But we all need to remember that even the best meter (if such a thing exists) has limited accuracy. I believe the accuracy of anyone’s CGM is a YDMV sort of thing…

Actually, tried them both. The Dexcom took too many “holidays” during prolonged, strenuous, exercise. Their help desk was pretty condescending in working to resolve this whereas Medtronics persevered until we came up with a credible explanation that I could then use in determining what the expected ranges would likely be. Invaluable when travelling to places where there are no US toll free numbers nor web access.

FWIW, I just came back from an 8 day, 450 mile pedaling trip on my recumbent trike and there were significant periods where my Dexcom CGM was “inaccurate as hell” in both directions. I had two different days where the CGM was telling me 220 - 260 (trending up) and the fingersticks were a full 100 mg/dl lower (trending flat to down) and nearly everyday where the CGM was reading 50 - 75 (trending down) when the fingersticks were 70 - 95 (trending flat to up).

I still find the CGM highly valuable and a good indicator of what’s going on 70 - 80% of the time, but wow(!) - when it was so far off, it really gave me pause to think of how an AP would act unless it has a better algorithm then the Dex.

@John58, I would definitely use a CGM for your trip, but get it sooner, because despite all the reading and research you can do, you must have time to live with a CGM before you get real value out of it.

For me, I would also use a pump. I have a back-up pump that I carry with me, plus all the supplies. It’s essentially a hot standby, so if my pump fails, all I have to do is swap the pumps out and I am back in business. Some manufacturers have a vacation pump loaner program, too.

Re Medtronic versus Dexcom CGM, in my opinion there is no comparison, Dexcom is SO superior (I have used both) and Dexcom is incredibly accurate for me, even during extreme exercise. A real vote for Dexcom came from a TCOYD (Taking Control of Your Diabetes by Dr. Steve Edelman) panel–all the endos with Type 1 use the Dex.

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I just did an overnight mountain trek. I dropped my basal from .9 to .35. I boluses 2.8 units for 45-50 grams carb not my usual 10/1 ratio which would have been 4.5 units. I hiked mountain terrain 10.5 miles two days carrying a 35 pound backpack. There was no water source. I ate three rolls of glucose tabs the first day. The second day none until the finish where I laid down to rest and blood sugar alarm sounded. The first day I tried a higher basal rate which made the lows. I used to have more stamina but that’s a first time carrying weight. I wore out the second day much sooner than I expected.