Hiking With Diabetes

[DayTrip]

The person I have recently been hiking with to get her ready for a Mt Washington hike in the next year or two is diabetic. Curious if anyone here hikes with diabetes and the types of things you do to manage your blood sugar, etc over long duration, strenuous hikes. She really has no experience with the condition over sustained, lengthy periods of strenuous exercise so doesn't really have a good sense for how much food to eat, what to eat, when to eat it, etc. Most of our hikes to date have been hikes in the 3-4 hour range with mileage and climbing I would consider easy from my perspective. She has handled them fine to this point albeit being sore the following day or two but in my opinion she is not eating enough on the hikes for sustained energy needed to do a mountain like Washington.

Obviously not looking for certified medical advice here but some general recommendations from someone who may have the condition and what has worked so she has some sort of "framework" for experimentation on future hikes, things that have happened to you in very hot or very cold weather, etc. Any practical advice on emergencies that may arise would also be helpful for me so I'm prepared in the event of a problem. I've read this section in the WFR manual and it seemed relatively vague (or in reality the treatment is pretty straightforward and I'm just imagining it being more complex than what it is).

 

[TCD]

My advice:

>Work your way up to longer harder hikes. This allows her to test out the eating and insulin combinations on gradually more difficult trips.

>Carry: Blood sugar test kit; sugary beverages (or glucose in a tube) for potential emergency use; extra insulin for potential emergency use.

>Get trained on insulin injection. Highly unlikely that you would need to do that for her, but keep it mind.

>Consider longer and harder hikes that are not committing or far from the road. Long hikes that parallel road corridors with many bailout options are a possibility. Also, though it's boring, two laps on one of those 3 hour hikes would add workload, but keep you close to the starting point.

Treatment is straightforward mostly because real diagnosis is difficult in the field. It can be very hard in the field to distinguish hypoglycemia from hyperglycemia. In general, hypoglycemia is considered to be a more emergent condition, so without being able to tell which condition is affecting the patient, the general rule is to administer sugar. It helps fairly quickly with hypoglycemia, and it doesn't make hyperglycemia that much worse short term. That's a little hard to explain, which is why the treatment description appears vague.

 

[sierra]

Once a buddy brought his girlfriend and her friend to meet me for a 3 day trip. The friend had Diabetes. My memory is cloudy as it was the early 80's, but this girl had quite a hard time. Our plan was to camp at the third crossing on the North twin trail, then head to Guyot. We ended up spending two nights at our first camp, when she bonked on North Twin. I remember her sweating and having very little energy. That being said, I knew nothing about her background, but it does illustrate that issues can come up.

 

[jniehof]

She really has no experience with the condition over sustained, lengthy periods of strenuous exercise so doesn't really have a good sense for how much food to eat, what to eat, when to eat it, etc.

IMO she should figure that out before doing the same thing hours away from definitive medical care. The fact that she's held up well on 3-4 hour hikes is a good thing but how closely has she been monitoring her levels?

There's a lot missing from your query, including whether she has type 1 or type 2, if she is insulin-dependent is it pump or injection, etc. I don't think you can take the lead in making a plan for managing her condition; she has to do that in conjunction with her doctor and support organizations, and has to tell you how to help.

 

[DayTrip]

My advice:

>Work your way up to longer harder hikes. This allows her to test out the eating and insulin combinations on gradually more difficult trips.

>Carry: Blood sugar test kit; sugary beverages (or glucose in a tube) for potential emergency use; extra insulin for potential emergency use.

>Get trained on insulin injection. Highly unlikely that you would need to do that for her, but keep it mind.

>Consider longer and harder hikes that are not committing or far from the road. Long hikes that parallel road corridors with many bailout options are a possibility. Also, though it's boring, two laps on one of those 3 hour hikes would add workload, but keep you close to the starting point.

Treatment is straightforward mostly because real diagnosis is difficult in the field. It can be very hard in the field to distinguish hypoglycemia from hyperglycemia. In general, hypoglycemia is considered to be a more emergent condition, so without being able to tell which condition is affecting the patient, the general rule is to administer sugar. It helps fairly quickly with hypoglycemia, and it doesn't make hyperglycemia that much worse short term. That's a little hard to explain, which is why the treatment description appears vague.

We are definitely doing the slow and steady build up, which is why I am trying to anticipate issues rather than learn from them. She is an obsessive planner. She has thoroughly researched even the tiny hikes we have done and is allocating a lengthy build up to Washington. I know she has insulin for emergencies and eventually we'll probably go over how all that works. I'm not sure about the test kit but I suspect she has that as well. Thanks for the specific details.

 

[DayTrip]

IMO she should figure that out before doing the same thing hours away from definitive medical care. The fact that she's held up well on 3-4 hour hikes is a good thing but how closely has she been monitoring her levels?

There's a lot missing from your query, including whether she has type 1 or type 2, if she is insulin-dependent is it pump or injection, etc. I don't think you can take the lead in making a plan for managing her condition; she has to do that in conjunction with her doctor and support organizations, and has to tell you how to help.

I agree 100% and like I said I'm not looking for detailed medical advice. I am not trying to take any lead role, just trying to guide the process because she is in uncharted waters right now and has no relevant experience to draw off. Our previous hikes have been quite short and not far from civilization. Yesterday was our first more "serious" hike in both duration and distance from help. We had some discussion about food, etc yesterday while walking. IIRC correctly she took her insulin via injection and her problem is that small amounts of sugar cause her sugar levels to soar and then crash (not sure how that translates into Type I or II - I haven't read much on the topic beyond immediate first aid concerns).

We were out for about 5.5 hours/8 miles/1900' vertical yesterday and all she had was a Kind Bar, another small but similar bar and one sourdough pretzel bite with about 1L of water (it was pretty warm yesterday where we were - high 60's and plenty of direct sun). That is the most she has ate or drank on any of our hikes. She was fine at the end, a bit tired but not sore. I didn't bust her balls at all but in the few short steep sections we did she got gassed pretty easy, which I'm sure had as much to do with lack of fitness as anything. I know when I first started serious hiking and was less fit I needed a lot more food and water than I do now to avoid bonking. The hike was very easy for me but I still ate and drank more than she did.

So I guess that was the major guidance I was looking for was on trail nutrition management, hopefully from someone who is diabetic and has first hand experience managing it. What types of foods do you snack on to get the required energy you need without screwing up sugar levels, hydration, etc so I can pass that along to her and tweak these things as we hike. Gaining overall fitness I'm sure will help but I just question the lack of food consumption.

 

[weatherman]

Did some prolonged dayhikes (up to 20+ miles) and long section hikes (4-5 days all over NE) with a buddy with type 1 DM (the kind where your body doesn't make insulin so you need to inject it), a former poster on this board, before moving west. He led them and continues to do lots of stuff both solo and with groups. Though everyone with DM is different- probably the most important thing I can write here! - his approach was pretty simple. Increase carbohydrates, though not simple sugars; decrease insulin a little; and stay hydrated. Protein helps stabilize glucose levels, just like it does off the trail. So really not that different from daily life. Of course he carried emergency stuff and several of us had the background to act quickly if need be, but never needed.

 

[jniehof]

I suspect the best advice is to google "diabetes endurance athletes" and go from there. The difference in hiking vs. other sports, particularly in the Northeast, is that we tend to start with a few hours of about the heaviest exertion of the day in the initial climb. Most people are generally working hard enough there that they don't eat as much and then play catch-up when they hit the ridge; it might be better for managing levels to back off a bit more on the exertion and be proactive about relatively easy calories. Your friend really should be monitoring her levels throughout so she can know how she'll need to adjust insulin and food during the phases of the hike. It's a figurative and literal pain but there's nothing like data; my friend who was recently diagnosed was fortunate enough that she could back way down on other commitments for the first few weeks while she basically spent a huge amount of time and effort on logging and measuring and was able to really get things dialed in.

Common hiking diet tends to overemphasize fats/proteins or sugars without much good starchy stuff in between and it's probably worth exploring that space: boiled potato or sweet potato, rice in various forms (onigiri or these sticky rice cakes which have really changed my hiking diet). A lot of bars are pretty high on sugar content and just kinda hard to digest.

It's highly unlikely you'd need to administer insulin in an emergency situation; hyperglycemia takes time to creep up and the damage it does is usually cumulative over time. Hypoglycemia can whack you over the head and be immediately life-threatening. So you should know how to administer glucose and/or glucagon, and help with management afterwards.

 

[expat]

"Hypoglycemia can whack you over the head and be immediately life-threatening. So you should know how to administer glucose and/or glucagon, and help with management afterwards."

You should also become familiar with early signs. She is not likely to notice a problem once she has passed a point of "general fatigue". Many of the signs are similar to the signs of hypothermia, including stumbles, mumbles, and general incoherency. When those occur, it's critical to get sugar into her.

I have a hiking buddy who has Type 1, and I regularly check with him to make sure he has eaten recently (past half hour or so), and I "quiz" him to test his mental status. For example, I'll ask him to count backward from 81 by 3's. If he has a problem doing that, then I know that there's something wrong.

We did have one incident many years ago, but fortunately we were at Pinkham after coming out of Great Gulf. We had postponed lunch since we were close to being out, and after we were in Pinkham getting out of our winter stuff into street clothes, he crashed. We got syrup from upstairs, and also called for EMS. His blood sugar was 25 when EMS tested, so it was close, but once the sugar kicked in, he was fine.

 

[DayTrip]

Thanks for the info all.

 

[hikerbrian]

I only have a little bit to add: my roommate in college was type 1 diabetic (i.e. he had to regularly inject himself with insulin). I witnessed the onset of hypoglycemia (i.e. low blood sugar, the really dangerous one) twice. Once I woke up early one morning and he was in his bed, generally unresponsive and having convulsions. I tried to get some soda into him, but he was too far gone to get anything down. I didn't have any sugar tabs or anything to stick under his tongue. EMTs administered glucagon and he was fine 15 minutes later. I don't like to think about what would have happened if I hadn't been home. Second time we were playing volleyball. This is the type of scenario I think you want to keep an eye out for. He was missing shots that he generally should have made. Acting kind of funny. Foggy in the head and responding a bit slower than he should have been. Acting quite tired. Not really putting in the effort that he usually did. Finally he just sat down. Didn't say anything. We thought he was just tired. We were in college - late nights and hangovers were standard. He started to get a bit twitchy. Not full on convulsions, but mild twitching. That's when it finally dawned on us that his blood sugar might be really low. We got him some orange juice and soda, and 15 minutes later, once again, he was fine.

If I were hiking with a type 1 diabetic, I'd definitely get myself very familiar with signs and symptoms of hypoglycemia. It's no joke. I have no experience (that I know of) with type 2 diabetics.

 

[DayTrip]

I only have a little bit to add: my roommate in college was type 1 diabetic (i.e. he had to regularly inject himself with insulin). I witnessed the onset of hypoglycemia (i.e. low blood sugar, the really dangerous one) twice. Once I woke up early one morning and he was in his bed, generally unresponsive and having convulsions. I tried to get some soda into him, but he was too far gone to get anything down. I didn't have any sugar tabs or anything to stick under his tongue. EMTs administered glucagon and he was fine 15 minutes later. I don't like to think about what would have happened if I hadn't been home. Second time we were playing volleyball. This is the type of scenario I think you want to keep an eye out for. He was missing shots that he generally should have made. Acting kind of funny. Foggy in the head and responding a bit slower than he should have been. Acting quite tired. Not really putting in the effort that he usually did. Finally he just sat down. Didn't say anything. We thought he was just tired. We were in college - late nights and hangovers were standard. He started to get a bit twitchy. Not full on convulsions, but mild twitching. That's when it finally dawned on us that his blood sugar might be really low. We got him some orange juice and soda, and 15 minutes later, once again, he was fine.

If I were hiking with a type 1 diabetic, I'd definitely get myself very familiar with signs and symptoms of hypoglycemia. It's no joke. I have no experience (that I know of) with type 2 diabetics.

It seems like those readily absorbable glucose tablets/powders/syrups are a smart addition to a first aid kit. They seem useful for other stuff too like hypothermia and just general pick me up energy when you're fatigued. Lot of brands out there but they seem pretty inexpensive for the potential value they have.