Since my 17. I have had diabetes mellitus since I was. As a type 1 diabetic, I suffer from an autoimmune disease in which the body is no longer able to produce insulin on its own. In the meantime I lead a quite normal everyday life with it, thanks to helpful devices such as insulin pump and modern measuring instruments. When I decided to hike a bit further on the Munich-Venice dream path, however, I had to prepare myself a bit more specifically. Because when doing sports or strenuous physical activities, the control of blood glucose levels is especially important.
Disappointed I did not find any experience reports or tips at that time. For this reason I would now like to take the chance and share my experience. As a diabetic who wears an insulin pump, you have to deal with the usual challenges of long-distance travel, such as changing catheters under skeptical eyes and not always sterile conditions in the sleeping quarters, or the fear of hypoglycemia during the night. The requirement to eat, although one is actually too tired to chew. Additional luggage such as spare pumps and devices, insulin, catheters, reservoirs or measuring strips that have to be lugged along, as well as an endless supply of dextrose and granola bars. Long-distance hiking is a challenge in itself, but as a type 1 diabetic it is even more so. But all this should not stop you from going for a hike!
BRIEF EXPLANATION: WHAT IS DIABETES MELLITUS AND WHAT DO YOU HAVE TO WATCH OUT FOR DURING EXERCISE?
Type 1 diabetics suffer from an autoimmune disease that causes the beta cells, which normally produce insulin, to be “attacked” and destroyed by the body’s own immune cells, causing the pancreas to stop producing insulin on its own.
Insulin, however, ensures that sugar (broken down carbohydrates that we eat) gets out of the bloodstream and into the body’s cells, where it is processed, thus giving us strength. It is impossible to live without insulin. That’s why I wear my “pancreas” externally in the form of an insulin pump.
This allows me to simulate normal insulin production through the so-called basal rate. This constantly delivers a small dose of insulin to me through a catheter – at about half-minute intervals – to lower blood sugar. When I want to eat something, I have to calculate the carbohydrates I plan to eat and deliver a bolus for them.
Type-1 diabetes is not to be confused with type-2 diabetes: while the causes of type-1 diabetes are still unknown, type-2 diabetes, which is also called adult-onset diabetes, is a consequence of too much sugar, too much fat and too little exercise during the entire course of life. The continuous overload of the pancreas then leads in old age to a fatigue of this and an insulin resistance of the body. This could easily be prevented by exercise.B. Counteract hiking.
The particular challenge with diabetes mellitus is proper metabolic control during exertion:
- If too much insulin is administered/too little eaten/too much exercise is performed, hypoglycemia can occur. Warning signs are, for example, ravenous hunger, trembling, fatigue or seizures. In extreme cases, this can lead to hypoglycemic shock. The correct emergency measure in extreme cases is the administration of a glucagon injection (concentrated sugar solution).
- If the blood glucose level is much too high, one suffers the opposite, a hyperglycemia. This can be manifested z.B. thirst, frequent need to urinate, lack of strength and fatigue. If no insulin is supplied as a countermeasure to hyperglycemia, a ketoacidotic coma can occur.
Even if hyperglycemia seems rather unlikely during long-distance hiking, it is important to be able to distinguish hypoglycemia from hyperglycemia because of the contrary countermeasures, respectively. to know about the difference – also for fellow hikers!
LONG-DISTANCE HIKING WITH DIABETES TYPE-1: MY PREPARATIONS & THE PLAN
To prepare for the hike, I tried to do regular endurance sports, especially running and cycling, in the months before the hike. In the course of this, I gained experience on how to deal with my basal rate during sports and with my bolus deliveries before and after it. Believing that I could “calculate” hiking this way as well, I was wrong. For me, the basal rate and bolus delivery during long-distance hiking were not comparable to those during running or cycling.
Originally I planned my hike on the Munich-Venice dream trail from northern Tyrol via the Dolomites to Venice alone. The idea of simply wandering around for a few weeks sounded neither dangerous nor particularly difficult to me. My family did not feel this way – especially because of my illness. When two of my friends joined in, they were very reassured. In the course of the tour I also became more and more aware of the fact that I was pleased and very relieved to have company. Be it hypoglycemia, a minor ache, equipment failure, or just help unpacking a hiking map, having a fellow hiker by your side makes a lot of things more bearable.
So the three of us walked about 430 km, starting in North Tyrol over the Dolomites to the northern Adriatic Sea, of the 550 km long hiking trail “Traumpfad Munchen-Venedig”.
THE SETTING OF THE BASAL RATE DURING LONG-DISTANCE HIKING
As mentioned above, “my external pancreas” continuously delivers insulin to regulate my blood glucose, this is called basal insulin or standard basal rate. Together with my doctors, I adjusted this setting to my daily routine in order to avoid hyper- and hypoglycemia as much as possible. For out-of-tour plans, however, the standard basal rate is unfortunately not applicable.
Unfortunately, I could not transfer my previous experiences of suitable insulin settings for running or cycling 1 to 1 to hiking. So I realized very soon that I would not reach my goal with either too high or too low basic insulin. Finding the right balance was difficult. If my basal rate was too high, I risked a prolonged hypoglycemia, which causes weakness, weakness and dizziness. In exposed areas where surefootedness is required, this can quickly become very dangerous! On the other hand, a too low basal rate causes a permanently too high blood glucose level, which manifests itself in sluggishness, fatigue and the feeling as if one simply could not use the available energy.
The first days I finally needed only 40% of my usual rate, although I had a slight hypoglycemia every now and then. After a week or so a certain habituation set in and my pump continued to run at 60% of my usual standard basal rate from then on. For the breakfast and the snack on the way I usually gave only a part of the suggested bolus, which also proved to be successful.
By the way, the Austrian Society for Nutrition also gives helpful tips for type 1 diabetics who do sports.
EATING & DRINKING WHILE LONG-DISTANCE HIKING AS A TYPE-1 DIABETIC
On the huts dinner (spaghetti, polenta, soup,…) and for breakfast, snack & snacks carry your own supply, I can highly recommend. On most huts (with me in the Dolomites) there was unfortunately only white bread for breakfast. Only a few times in Austria there was brown bread. White bread is not a long-lasting, sustaining meal for a healthy hiker, nor for a diabetic.
Therefore one of the most important experiences: It is worthwhile to carry whole grain cereals/oatmeal with you! Because they give you three times more power than you need to take them with you.
The same applies to the snack on the way: a wholemeal bread gives lasting strength and prevents hypoglycemia better than anything else. Of course you also have to have dextrose and muesli bars in your luggage. But these are intended for the acute management of a weakness attack and keep the blood sugar not very long stable.
I replenished my supplies at supermarkets along the way. The list of snacks that I won’t leave at home and that were also available for purchase almost everywhere – even in smaller mountain villages, here:
Recommended snack list for hiking with diabetes
- Whole grain bread (sliced, wrapped)
- Whole grain crispbread
- Dried fruit
- Nuts
- Muesli bars – fruit bars
- Dextrose/sugar gel
- For breakfast at the huts: Basic oatmeal or. whole grain muesli (can be mixed with jam and (hot) water at the hut)
We have been completely consistent with the frequency of meal breaks according to our needs. Some days we easily walked for 3 hours without stopping and on others we unpacked our snack just an hour after breakfast. When I was hypoglycemic, I usually ate a glucose or granola bar and then a piece of bread to keep the blood sugar up for a longer period of time. I measured sugar much more often during this time than in everyday life (about 7 times per day). But that was mainly because I often couldn’t distinguish whether I was already tired from the kilometers I had covered or from blood sugar that was too high or too low. And I wanted to be sure!
HIKING FAR WITH DIABETES TYPE-1: THE FEAR OF HYPOS WHILE SLEEPING & SETTING THE BASAL RATE WHILE SLEEPING & COUNTER-REGULATION
Since I am lucky enough to feel hypoglycemia very well, I did not so much fear the hypos during the day, but rather the nights after very strenuous days (actually almost every night)!). This fear was also shared by my fellow hikers, who always made sure that I ate a good dinner before going to bed. I was always very careful with the basal rate settings for the night – first week: 50% and then 70% after that. I always went to sleep with a slightly higher blood glucose (110-140mg/dl), but counter-regulated on a lot of nights (for those who don’t know what that is, see: counter-regulation ). I underestimated how long the exposure would burn afterward! Here I learned that it is important to eat enough carbohydrates at dinner.
THE EQUIPMENT WHEN HIKING FAR WITH DIABETES
My backpack would have been almost empty if I hadn’t had all my spare equipment with me. In addition to the usual hiking gear, I carried the following diabetic gear with me for the 3 week period:
- Insulin pump
- Insulin (5 ampoules with, 3 used)
- Spare batteries (3 with, 1 used)
- Reservoirs (5 with, 3 used)
- catheters (15 with, 9 used)
- Disinfectant & swabs
- Measuring device (with measuring strips (150 pieces with, about 100 used) and lancets)
- Spare pump
- Spare meter
- additional pen with spray attachments
Fortunately I did not need any of the spare devices. I will pack them again in the future, because the fear that something could break would inhibit me to enjoy the hike to the fullest.
LONG-DISTANCE HIKING WITH DIABETES: MY EMERGENCY PLAN
Even though I am well adjusted in everyday life, I could not estimate how it would be when hiking. Maybe this respect – this residual risk, which I could not judge, made me pay even more attention to my body. Since I rather assumed the danger of hypos, the absolute emergency plan was the administration of the Glucagon syringe, which is a concentrated sugar solution.
I wanted to exclude their use in any case. Inwardly I had agreed with myself in advance that it would not be used. Fortunately I was able to keep it. For the extreme case I trained my hiking colleagues. Should I lose consciousness, one of them would give it to me.
For the administration of the glucagon injection it does not need basically much. Needed: a quick reaction time and a bit of courage. The syringe is usually placed in the abdomen or thigh. After 1-2 minutes you should then slowly regain consciousness. For quick retrieval it was placed in a fixed, easily accessible place in my backpack!
Because of my good attitudes as a diacetician, I fortunately have never had to test this out!
Whether, when hiking, my caution about hypoing too much or fear of being administered by one of my fellow hikers “Just squirt it straight into my heart, or?”(in no case into the heart, but into the belly or thigh. ), saved me from this, be left to one side.
MY BEST TIPS FOR HIKING AS A TYPE 1 DIABETIC
In summary, I can give the following tips for long-distance hiking as a diabetic based on my experience:
- carry a full snack and breakfast with you – saves hypoglycemia
- Eating enough carbohydrates in the evening to prevent hypos at night
- more frequent changing of catheter – disinfecting.
- more frequent blood glucose measurement (I measured up to 7 times a day)!)
- Reconsider basal rate settings for every single day – include degree of difficulty, length of the planned stage in the considerations
- Familiarize fellow hikers with diabetes hazards and train them well
My summary after 3 weeks of long-distance hiking & the time afterwards
After the three weeks with a total of about 430 km with an average of about 7 hours, 27 kilometers and 950 meters of altitude per day, my metabolism has become accustomed to the constant movement. Back home I had to fight the first weeks always with slightly elevated blood glucose values. My alternative diagnosis: “post-hiking depression” (triggered by the lack of mountains in Vienna).
Here is probably the only true remedy: as soon as possible “aufi aufn Berg” again.
About myself (guest blogger Valerie)
My name is Valerie, I am 22 years young and I study at the University of Natural Resources and Applied Life Sciences in the master program “Energetic and material use of renewable resources” and as an addition at the University of Vienna “Italian”. My diabetes does not stop me from doing a lot of sports, traveling the world or eating with passion.
More tips for hiking? Click here for tips on environmentally conscious trekking and hiking or for tips on trekking and hiking alone! Happy hiking!
