Diabetes and the Outdoors

written by K.Cronie, 28.1.21

I have been living with Type 1 Diabetes since I was 8 years old, however I am at an age now where I couldn’t imagine life without insulin injections, blood testing and hypos. Most of the time, diabetes is not too much of an issue, but without quick and decisive action when needed, it can be fatal. Despite this factor, I have gone through life having never let diabetes stop me from pushing myself past my comfort zones, and I have found myself in some pretty precarious situations due to my adventuring. However, one of the biggest adventures I have had this entire time, has been figuring out how to take control of my diabetes while exerting myself in the outdoors.

^ an exciting summers day on the Upper Moriston.

What is Diabetes?

Diabetes comes in many forms, put into simple terms, my body doesn’t produce the correct hormone to regulate blood sugar, leading to lows and highs of sugar in my body. Even more simply, if I don’t consume enough carbs or sugars for the amount of activity I’m doing, then I run the risk of falling unconscious due to low blood glucose – but that’s ok, because I (usually) plan for these things! However, it has taken me a long time to learn how to plan for these things, mainly experimenting through trial and error and learning by doing, but I am now confident in my ability to explore and become immersed in remote and wild places despite my diabetes.

I usually get a little giggle when I tell people this, but I went to diabetes camps when I was younger – and they were awesome! Diabetes camp is like any other camp, except all the children there are diabetic. These camps were where I first met and fell in love with the outdoors. I was introduced to activities I had never even dreamed of doing – hiking, climbing, abseiling, wind surfing, cliff jumping, sailing, canoeing, kayaking – and most importantly, I was introduced to other diabetics my age. (To any parent with diabetic children out there, I definitely can’t recommend these camps enough!) I think it’s fair to say that these camps were large factors in how I became who I am today.

^ reliably Scottish weather on Meall nan Tarmachan.

Diabetes Technology

Once I started proactively getting into outdoor sports at University, I wasn’t sure how my diabetes was going to react. I was on an insulin pump at the time, a small device I had to wear all day everyday which administered insulin for me (insulin being the hormone that regulates blood sugars). When I was put on the pump I loved it, it was so handy and meant I didn’t need to inject myself multiple times a day with insulin pens. However, once I began white water kayaking I slowly but surely decided the pump wasn’t right for me anymore. At first I would try to keep the pump on, but found it would fall off or be exceptionally irritating underneath the paddling equipment you have to wear. I even managed to break a pump or two by having them clipped to my t-shirt under my buoyancy aid – the pressure from pulling my buoyancy aid tight seemed to crack the encasing around the pump’s battery. After this I decided I would use insulin pens while paddling and be on the pump when I wasn’t, this method worked to some extent, but more often than not I would end up with very high blood sugars when getting off the river. With a 3 week European camping and kayaking trip on the horizon in the summer of 2018, I eventually ditched the pump all together in favour of the pens and paddling lifestyle – and never looked back!

The insulin pump may have not been for me, but there is one piece of diabetes technology that has been more than helpful while out adventuring. The Freestyle Libre flash monitoring system by healthcare company Abbott, has made keeping on top of what my blood sugar levels are doing while out on the rivers and up in the hills exceptionally easy. The Freestyle Libre is a small sensor worn on the back of the arm which is continuously monitoring blood glucose levels. The sensor can be quickly and accurately scanned through an app on your mobile phone (or by using a handheld device that comes with the sensor) to find out what your bloods are doing, and even shows which way your bloods are going – a very useful feature for preventing hypos. For me, this little device has revolutionised blood testing on the go.

Before, blood testing was an arduous task, having to stop to take off your bag, find your blood testing kit, sheltering it from the perilous Scottish wind and rain, and trying to draw blood from your shiveringly cold and wet fingers – all the while feeling your core temperature dropping from no longer moving on your hike – made blood testing a burden I would outright avoid while engrossed in the outdoors. However, thanks to the Freestyle Libre, blood testing is now quick and effortless, I don’t even have to stop walking to find out what my levels are at. This device has given me confidence and security for my diabetic life in the hills which was greatly needed. The only downside to the Libre I have found so far however, has been its susceptibility to the cold. Just like how a mobile phone will cease to function as the temperature drops below freezing, the sensor does this too. Trying to make sure the sensor and my phone stay warm enough to work is an issue I am still trying to get around. However, we all know that the weather in the Scottish hills can be relentless and unforgiving, so despite the technology available, I have accepted that sometimes I will have to go without blood testing for prolonged periods of time – but as I said at the start of this piece, I have learned to plan for these things!

^ exploring Tolmount’s plateau top.

Being Low

For anyone planning long days in the hills, making sure you are taking on enough nutrition for the activity is important, for a diabetic in the hills, it is imperative. A non diabetic person who has ran out of food while on a hike, will be able to continue walking on reserves for quite some time with their blood sugar levels generally staying within a functional range. A diabetic in the same situation however, will not be able to last long before their blood glucose inevitably drops to dangerously low levels, and falls unconscious.

Feeling ‘low’ is a hard feeling to explain. You can feel weak all over, wobbly at the knees, out of breath, light headed, confused, sometimes even frantic, and sometimes you can’t even find the energy to move yourself. Feeling ‘low’ while in remote and exposed places can also bring a sense I can only describe as impending doom, as you think about where you are and how far from help you might be. So far during my adventures, I have had a couple close calls which let me get to know this feeling intimately. Once while I was still fairly inexperienced, hiking in full paddling gear and carrying my boat to the get in for a river near the base of Suilven. I had greatly under appreciated how taxing the hike in would be, and after finishing my sugar tablets and the mini can of coke I had brought, only made it down the river and back to the car thanks to a tube of GlucoGel (GlucoGel usually being the last line of defence in a Diabetics armoury).

The other time I can recall was while hiking to the Taigh Thormoid Dhuibh Bothy on the Isle of Raasay. This is an exceptionally remote and nestled away bothy on the northern, uninhabited end of the Isle, and we couldn’t find it. It was already dusk by the time we discovered the coordinates we had for the bothy’s location were incorrect. We spent the next 2 or 3 hours searching the land around us under moonlight. I had been fighting off low bloods for sometime by this point, working my way through my sugar supply and wrestling with the rising fear that I might not have enough left if we had to give up the search and trek back to the car that night. Nerves were wearing thin as we decided to check one last place, leaving our heavy bags on the track to climb to a high point. You can imagine the relief as we spotted the looming shape of the bothy through the beams of our head torches. Finally we were able to get the fire roaring and eat our dinner, then after a beer and a nip or two of whisky, I had one of the cosiest and fullest sleeps in a bothy I’ve ever had.

^ deep in a gorge in Valsesia, Italy.

Making Energy

This sense of impending doom I mentioned can be intense and scary. Thankfully I haven’t had to experience this feeling too often, and now that I am more confident in my ability to prepare for my adventures, I hopefully won’t have to experience it again.

So, how do I prepare for my adventures as a diabetic? There are a few simple things I have learned that help to keep me plodding along in the hills. One of the first important things is making sure I do less long acting insulin the day or two before the adventure, (depending on what type of insulin you are on this can vary. For those on pumps, make sure to lower base rates or do temporary lower rates on the day) this makes sure the base level of insulin I am on is not too high for the activity. One of the other very important things I always do on the day of an adventure, is make sure I eat a massive bowl of porridge for breakfast. There is nothing that will give you energy for a big day ahead like porridge oats will – there’s a reason Scottish Highlanders back in the day where obsessed with the stuff! Eating a lot of porridge means taking a lot of Insulin, which is good because it’s the Insulin that converts the carbs and sugars you consume into energy for your body to use. Porridge is also great camping food as it’s cheap, light (if you take sachets), cooks quickly on a camping stove, and – if I do say so myself – super tasty! (I usually add raisins and hot chocolate powder or flavoured Nesquik milkshake powder to the porridge, which can be mixed together and brought along in a sandwich bag.)

In preparation for being low while in the hills, I basically try and take as much fast acting sugar as I can – going on the assumption that I can never have enough – and making sure I also have a variety of options. Apart from the obvious sugar tablets most Diabetics are acquainted with, I usually take along 2 or 3 bars of tablet, a tin of Kendal Mint Cake, some form of sugary chewy sweets like fizzy Haribos, and a few tubes of GlucoGel. I find it important to have a variety of sugar to consume as there is nothing worse than only being able to eat, and inevitably getting sick of and hating, one kind if you are fighting off low bloods for most of the adventure (it was tablet for me on Being a’ Bhuird, hated the stuff by the end!) Taking GlucoGel with you, and making sure if you’re walking with a group that someone in the group has a tube of this gel, and knows how to use it if you were to fall unconscious, is also highly important. On top of fast acting sugar, high energy, carb full snacks are also essential – these are what will keep your bloods from becoming low in the first place. Porridge oat bars, pork pies, Soreen malt loaf, Jamaica cake, flapjacks – anything that is dense with energy but quick and easy to eat when your’e half way up the mountain will do.

^ a stop for breakfast in Torridon, under protection of the rain from the midges.

There have been times during my hiking where I have felt low for the majority of trip, pretty much entirely functioning on mint cake and sugar tablets. As long as I know I have enough sugar to keep going, then I am completely okay with this. Renowned Scottish Mountaineer W.H.Murray and his partner consumed nothing more than water and sugar tablets on their astounding 24 hour traverse of the entire Cuillin Ridge including Clach Glas and Blaven. Through this astonishing feat, they showed how far the body can be pushed on so little when the experience itself is part of the consumption. Their reason for only eating sugar tablets on this trip may have purely been for saving weight, but I feel like I can relate to how they may have felt during this gruellingly grand day. The experiences to be had in the outdoors are like no other, nowhere else can you find yourself speechlessly mesmerised by a view, or at such complete ease with your splendid isolation. Nowhere else can you learn so much about yourself and what you are capable of than in these wild places. It is these character shaping experiences that keep drawing me back to the marvel that is the great outdoors, and I will never let diabetes stop me from having these experiences.

original : https://kcronie.com/blog/diabetes-and-the-outdoors

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