Thru Hike with Type 1 Diabetes

[SamBrooks_01]

Apparently this was posted in the wrong spot- still got some good answers but figured I'd give it a shot here, haha.

I'm 23, been diabetic since I was 15. Always kept it controlled, and pretty strictly, too. I've hiked and had jobs that required me to maybe adjust what I eat/what I take (Lantus/Novalog), and I've got that part pretty well figured out. If I know the kind of terrain and hiking I'll be working with I'm normally pretty good at figuring out what I'll burn off compared to what insulin will need to take care of.

My big question is about the best way to resupply and carry the insulin, I use pens for both. I know I'll also have to make sure it doesn't freeze. I'm pretty good at packing light so if I need something that weighs a little more I can work with that, what I DON'T want to do is take something that's just freakin huge- I'm not strapping a 35qt Yeti to my back to keep that stuff cold...

I guess timing could be important too, so here it is:
As much as I'd love to get going right now it just isn't an option. I figure it'll be about early-mid March next year when I get started. I'm determined and just stubborn enough to not quit the trail unless it tries to kill me. Planning to go all the way.

Any advice welcomed, just be warned that if you say I'm better off sitting at home you'll be one of the ones who gets proven wrong next year. I'm not asking for your permission, I'm asking for good advice.



Thanks dudes,
Sam

[nsherry61]

Well, it's pretty easy to carry a month's supply of insulin. So if you resupply insulin every 3-4 weeks, you can reduce the frequency of temperature critical resupply. If you order you insulin on-line, you probably get it in a Styrofoam packing box that you can re-purpose for your own shipping. You can also probably purchase some pretty hardy insulated packing boxes. Your insulin should be safe in a insulated packing box for several days of days if needed. You need a reliable friend to manage communicating with you about when and where to ship your supplies. Then, a little more careful research on resupply locations that can handle your temperature sensitive resupplies (probably most places are fine, especially with a heads up before it arrives). On the trail, just a Frio wallet works well and they weigh very little and are not bulky. All the rest, you're already doing every day.

Go do it and have fun!!

[Slo-go'en]

The Frio wallet looks like your best bet since you only need water to keep it going. If you need to carry more then what will fit into the wallet between resupplies, a glass lined thermos would be best for carrying a bulk supply. Depending on how cold you have to keep the insulin, you might just have to fill it with cold spring water every couple of days.

[RangerZ]

My response from the other thread ...


Originally Posted by RangerZ Check Frio coolers on the Internet. Search WB for insulin.

Sorry about the abrupt response, I was on a bus.

Look at Frio wallets, http://www.frioinsulincoolingcase.com/ . I've used one to keep my pens cool in the summer, I don't think that they've ever pushed the upper temp limits in the wallet.

Like Grumpy says you have to keep insulin from freezing. While hiking in the cold keep it in an inside pocket or if its not too cold insulated with your sleeping bag in your pack, etc. I've evolved to a "do not freeze bag" (actually the mesh bag my Snow Peak pot came in) while tenting - contains my pens, glucometer, AquaMira, phone, camera, etc) - it keeps everything together while sleeping with it. Phones and glucometers don't like <32*. It is fun exposing parts of your body to freezing temps to inject. Heresy I know, but you can inject through a base layer.

I started this three years ago, thanks for giving me an excuse to bump it up, http://www.whiteblaze.net/forum/show...king-logistics . I haven't advanced it much, my thru seems to be receding into the future. If you search on insulin there is a lot of info here on WB.

I'm a very well controlled T2 (last A1c 4.9) so I have different concerns than you. Again, hike and test frequently at first until you figure out how your body reacts. I only test at mealtime and bed time, really just to have the record. I usually hike alone; if I'm with someone I let them know. I wear a red dog tag and have one on my right boot (old habit) and pack with info on them. I carry a card with my ID. My concern on my last long solo wasn't the T2 but getting hurt on the rocks.

Others have done it, just take your time and figure it out for you.

[2NewKnees]

My son wants to go backpacking with me. He is Type 1 and 10 years old. He was diagnosed just before his 7th birthday. He is very good about managing his diabetes, but he does have a tendency to go low with exercise. This frustrates him and thus has limited his experience hiking, biking, etc. I'm planning on taking him next week for a two night easy trip. Shouldn't be too cold to worry about freezing insulin. Here is my question. What do you do with what you take to treat lows at night? I hate to hang it in the bear bag and have to go trek it down when he goes low at night. Should I just keep a small supply of juice boxes in the tent? Only good thing is we are going to an area where there typically isn't a lot of bear activity.

[squeezebox]

There's a national level pro bicycle racing team that is all type 1. I'll try to find their website. They will certainly know what you need to do.

[squeezebox]

Teamnovonordisk.com

[2NewKnees]

Thanks. I'll check it out.

[nsherry61]

My son generally had to reduce his basal by 1/2 to 3/4 to keep from going low while backpacking.
We still always manage to have a few lows to feed early on though.
Diabetes snacks trump bear concerns all the way. Many of us sleep with all our food most of the time anyway. When I've been in bear country with my T1 kid, we hang all the food except his low treatments, which he sleeps with either inside his bag or right next to his head. The likelihood of any animal problems with a sealed tube of glucose tablets or hammer gel is ridiculously small.

[2NewKnees]

Thank you nsherry61. That's the way I was leaning with the low treatment supplies. Great advice on adjusting his basal rate. We usually pre carb load with peanut butter crackers. He has a CGM which is real handy in monitoring his sugar and trying to head off lows. This will be his forst backpacking trip so we're going somewhere not too tough with good views so hopefully he has fun!

[SamBrooks_01]

Personally, I've always eaten something (good ole pb&j always does the trick for me) at night without insulin. I don't know what your son is taking or what his doctors might think of that, but I definitely plan to take in a few more carbs than I'll be taking medication for on the trip.

[2NewKnees]

The doctor said to do a little carb load before activity. Usually with pb crackers. And see how his sugar is going with his CGM. He's just 10 and really sensitive to exercise so our first trip here will be an easy hike. Thinking about going to Max Patch for the gentle hiking and great views. Any suggestions on where to go close to Asheville?

[nsherry61]

I just talked with my son. He is saying that the problem with trying to start off carb loading is that with 100% basal, he can't eat enough to keep from going low.
He remembers that we usually set his basal to about 1/2 one or two hours before starting to hike. Then, he keeps his basal at about 1/2 while hiking. Then adjusting to about 3/4 basal at night. Then, he also adjusts his insulin to carb ratio about the same way, bolusing 1/2 what he usually would for carbs eaten during the hike and bolusing about 3/4 for post-hike carbs.

I definitely remember some vigorous days where we have had his basal at 1/4, but he says most of the time it is just 1/2. Of course, your son is going to be different in his own way. But, definitely drastically reducing both basal and boluses was a must. And yeah, a CGM rocks for this setting. . . assuming it's not 100 degrees out and his sets will stay put!

If you get into hiking in hot weather and are struggling to keep sets stuck down, climber's tape rocks for taping over sets and holding them in place. Climber's tape is like super-sticky athletic tape that doesn't sweat off and is available from any of your local climbing outfitters.

[2NewKnees]

Wow, thanks for the info. We'll definitely try adjusting his basal before we hike and during. Last night he did a test run in his sleeping bag in the house. HE was 5-6 away and his CGM would not pick up through the bag. Is this something your son has experienced? To deliver insulin with his PDM we had to unzip the bag as it wouldn't pick up either. I believe the synthetic fill inhibits the reception. So when we go this week I'm planning on checking his sugar at night manually like we used to before the CGM.

[nsherry61]

My son uses a Medtronic pump with cgm so it's all attached to him. I'd recommend just sleeping with the electronics in the bag with him if that can be made to work for you guys. Also my son went back through his notes from our last trip to double check numbers, and we were apparently bolusing only about 20% not 50% both while hiking and at night. FWIW, from talking with them, I know T1 professional athletes do let themselves run a little bit high in preference to fighting lows all day.

[2NewKnees]

Yea I have to let him run a little high, but we have to sit down and rest if he gets to 300. My son uses the Omnipod pump which we love and Dexcom CGM. The Dexcom is pretty reliable for him. Novonordisk professional team has been a great influence for my son that he can do these things even with Type One. May try to go the camp they have this summer. We live only about 2 hours from ATL. Thanks for the info again.

[nsherry61]

. . . May try to go the camp they have this summer. We live only about 2 hours from ATL. . .

FWIW: My son went to diabetes summer camp two different years and although he had fun, he found it hugely frustrating because he was very independent and capable of managing his blood much tighter and more effectively than the camp would let him. They pretty much ran all the kids on the same a very structured and ridged schedule and kept their blood numbers high and "safe".

[2NewKnees]

My son went to Victory Junction the past two years and absolutely loved it. They were very thorough on the check in and they are staffed by lots of diabetes speciatlists. Anyway, we'll see if we get to go. I doubt we will attempt an overnight trip until we can regulate the lows better while day hiking. And I may not be able to do anymore backpacking due to my sleep apnea.

[nsherry61]

Oh man, you can feed lows at night in a sleeping bag just easily, if not easier, than sleeping at home! In the sleeping bags, you don't have to get out of bed to help out your kid, you just have to roll over and do it. I found it kind of a nice break from having to get out of bed for night time blood checks when my son was young!

As for sleep apnea, are you on a CPAP? I am. I can get by most of the time pretty well by making sure I sleep on my side, so yes, a good sleeping pad is kinda important. I am now experimenting with these mandibular advancement devices that hold your jaw slightly askew to keep your airway open. They are apparently the alternative to CPAP for people that don't tolerate CPAP well. You can get them for less than $100 on-line and they may well keep your apnea manageable if not as well managed as with a CPAP.

Here's a web site with some reviews of over-the-counter versions of some mandibular advancement devices.

Good luck. Have fun!

[Options]

Hey guys. I'm a Type 1 , T1D (The D) and currently thru-hiking. I'm currently using an Animas Vibe pump and Dexcom G4 CGM. I store my insulin in a Frio and sleep with it if the temps drop close to or beneath freezing. I carry a thirty day supply of everything and have pens for a backup. The entire kit including batteries is just over 3 pounds. Lows that come on at night are treated with glucose tabs. I sleep with two small containers of them always within easy reach. In case you're wondering I'm hiking solo and having a blast. I'll be in Erwin, TN tomorrow so that's just over 350 miles counting the approach trail. The D has caused no problems to date. I do monitor closely as everyone should. You can check out my hike progress at trailjournals.com. My trail name is Options. I'll be happy to answer any question concerning my management plan. PM me if you'd like. Happy trails.