A Beginners Guide to Backpacking with Type 1 Diabetes

Note: An Updated version of this post can be found here

I grew up assuming that backpacking was not an option for me.  Backpacking along with scuba diving was looped into the “too dangerous for diabetics” category in my head. A category, which I’ve only recently realized is completely ludicrous.

Unlike scuba diving, no one (other than my mom) has ever told me that backpacking is not an option.  Honestly, no one has ever told me to my face that scuba diving is not an option, but that’s what the doctor who diagnosed me with type 1 diabetes in 1992 (pre-pumps and CGMs) told my father who is an avid scuba diver and backpacker himself.

Backpacking along with scuba diving was looped into the “too dangerous for diabetics” category in my head.

IMG_2601
Los Padres National Forrest Big Sur

Growing up in San Diego, I honestly had zero interest in backpacking, and it wasn’t until I went to college in Maine that my interest in the back country was piqued.  My first real foray into the wilderness for an extended period of time was a 4 day ocean kayaking trip between Maine’s islands, and it was completely manageable.  My mother made sure I was well prepped with special containers to keep my pump/ test kit/ insulin dry and plenty of glucose and pump changes.  All of these things were stored in a large 8 x12 clear plastic box with dividers that could easily be strapped to my kayak along with clothing tent etc.  It was bulky and a pain in the ass to carry up the muddy island slopes where we set up camp.  If that’s what was required for kayaking, then how the hell was I supposed to fit that in a backpack and carry it on my back for over twenty miles.

Well, seven years later I have a few trips under my belt.  I wouldn’t call myself an expert, but I thought I’d share some advice and some useful tips I’ve learned on the trail.  Please sound off in the comments section if there’s anything you’d like to add.

What I Pack

  1. Gels: (3-4/day)   What most of us don’t realize is that walking with a pack on your back is hard work.  I can hike ten miles sans-pack with few lows and few breaks.  Add a pack and an incline and elevation change and that’s a different story.  Suddenly you’re carrying more weight and therefore burning a lot more calories.  Bring on the low blood sugars.  I find that gels are the most efficient.  They pack a lot of fast-acting glucose into a light little packet (perfect for backpacking), and I can just take one out and eat it on the road.  I prefer the Honey Stinger brand, because they taste the most natural to me.  I keep about four of these handy in the front hip pockets of my backpack in case I get low on the trail.
  2. Humalog pens with needle:  Bring a pen or two even if you have a pump.  Humalog pens are a lot more convenient for treating highs trail-side than syringes and bottles of insulin.  It’s lighter, more compact, and easier than stopping to draw up some insulin.  These are also great if you need to refill your pump.
  3. Extra Pump Supplies: Ladies and gentlemen this one is obvious. If you have a pump bring at least one pump set change if your going overnight and possibly two to three if you’re going on a 3-4 day trip. You never know what might happen on the trail. I started off with two insertion sites this weekend and both got ripped out, so I was grateful to have an extra set.
  4. Medical tape: It’s useful for many things including blisters, but I used it to tape my site to my body, for extra protection.
  5. Satellite Messenger or PLB: I have a Delorme InReach for emergencies. I’ve never had to use it, but it’s nice to take extra precautions when you have a medical condition. In fact, these are useful to have on hand for anyone, as you never know what might happen on the trail.
Pants off pump off
Pants off pump off

Tips I use to Help Control my Blood Sugar on the Trail

  1. Insert your pump somewhere where the backpack won’t rub : I typically wear mine on my thigh when back packing.  You may wonder why thigh and not abdomen or hip (where I typically insert). For that see above. I had two sites ripped out of either hip by my backpack, and I’ll assume you may face the same issue with sites inserted into the abdomen (due to the hip strap). It’s not something I considered before starting out on the trail, but my backpack is made to rest its weight on my hip bones. The sweat and weight just rubbed my site out, something I didn’t realize until I set my pack down and began to set up camp. I was actually happy to be running on the high side after all the lows on the trail and simply didn’t notice that the site had ripped off. Anyways, I would say prior to the trip consider your insertion site and ALWAYS have a backup.
  2. If on a pump, consider using the  temporary basal function: This saved me. Even though I’m extremely active, I don’t typically walk over ten miles a day with a large heavy pack.  For me, this change in activity level greatly increases my risk of hypos.  I’m typically able to make up for this by decreasing my basal rate by 60-70%. I still had a few lows when I was climbing for long periods of time, but I was able to minimize these by reducing my insulin on board (IOB).  That being said, with reduced IOB you may find you have higher blood sugars at night, so take this into consideration.
  3. Your CGM is your Best Friend: I recently invested in the Animas vibe, which has changed my approach to diabetes management. Although, I have problems with accuracy every once in a while, it is incredibly to finally have my CGM and my insulin pump integrated. I now have everything on one device that’s connected to me, and vibrates annoyingly sometimes singing some Mozart to especially annoy me. This saved me on my trip. As soon as those trend arrows started pointing down, I felt something vibrate at my hip and I was able to take a preemptive gel, keeping myself from having to stop, rest, and slow the group. Yay CGM, you are forgiven for that time you said I was 215 when my meter proved me to be 350.

How to Keep insulin Cool

  1. Pack your insulin deep in your pack, near the bottom. The bottom/middle of your pack tend to stay the coolest, so this is a good place to keep your insulin cool. This is of course taking a gamble, it is possible that if it’s really hot and your pack is out in the sun, the bottom will heat and your insulin with denature; however, I was able to keep my insulin cool enough in my pack hiking in 80 degree temps in sunny Big Sur this weekend.
  2. Instant cold packs or Frio Cooling Case: Note: I have never tested this in practice. In theory I think it would be advisable to pack a couple of these for longer trips that include different climates. This way, if temperatures peak in the 90s you can pop one of these causing the endothermic reaction to keep your insulin cool.

9 thoughts on “A Beginners Guide to Backpacking with Type 1 Diabetes

  1. Hey I think we should be friends! You are not only backpacking but you are doing yoga by rivers while you do it, one of my favorite things! I’ve written a lot about backpacking with T1 too on my blog and for a regional magazine and love hearing your thoughts and similar sentiments. Happy trails!
    p.s. I use frio packs when I go to keep insulin cool and rewet them in cold streams, usually works pretty well, but all my trips have been 4 days or less.

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    1. I completely agree! I read your article on backpacking with diabetes a couple of months ago when I was doing some research on through hiking with diabetes. I’m planning to do the John Muir trail next summer. Any interest in joining me?

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  2. Julie,

    I appreciate your tips listed here. Since you are studying nutrition, I’d enjoy reading more of your diet tips if you post more in the future. Honestly, diet is the area I struggle the most with backpacking. It’s tough to get lightweight, reasonable volume food for 5 to 7 days (bear can limit).

    I have been a type 1 for almost 50 years and backpack all the time. I only go in the Sierra’s; I had too many tic and poison oak issues hiking the coastal mountains when I was younger. I hiked the JMT in 2016 as well (south to north starting in late July).

    I haven’t tried gels. I use shot blocks, but will try gels based on your input…but weight concerns me since I’m old and slow. I agree with you about temp basal, but have had some elevated evening BG due to “light” IOB. I use a FRIO pack. It’s worked great with one exception; we got stuck in a cold spell (teens) and I left my insulin in the pack and out of my sleeping bag. That insulin ended up being very ineffective.

    John

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    1. Hi John,
      Thank you so much for your thoughtful comment! I love the Sierras. It’s been a dream of mine to hike the JMT, but unfortunately I haven’t had the time off to complete it, but maybe after grad school.
      Nutrition is definitely a challenge on a longer trip with a bear can limit and the increased energy needs associated with backpacking. As I mentioned I’m a big fan of the gels (Honey Stinger, Cliff, etc) as their light weight and super easy to eat while your hiking to avoid lows. If I can, I typically make my own backpacking meals, but for longer trips that require a bear can and lighter weight meals, freeze dried meals are probably the preferred option.
      I’ll try and write a post on it in the next week or so when I have a chance.

      Julie

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      1. On the backpacking trips I’ve gone on, I have had a few instances of lows at night (I have Type 1) and used a sealed snack that I’ve stored in a scent proof bag (all my other food, toiletries, etc. are stored in scent proof bags that are hung in bear bags away from camp). However, all the places I’ve been on have either a low or no bear population, and the bear bags are honestly more for critters like raccoons, mice, etc. Have you ever backpacked on a long trip in bear country? If so, do you keep any food in your tent and have you had a problem?

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      2. Hi Julie,

        Thank you for your posts. I enjoy reading them and agree with all of your input on insulin costs, etc. I haven’t got my wife to try any of your food posts yet, but will.

        I’m not exactly clear on the order of the comments below or if there is even a question from you or “Kait”. But since I do have a solution that has worked well for me, I thought I’d reply to your email.

        I use roll life savers. They are fantastic. Each roll is about 50 gms carbs (all fast acting sugar). I keep two to three packs in my pocket at night during backpacking trips. I wear shorts with pockets for that reason. I have actually just put them in the tent storage pouches as well. They are very well packaged; aluminum foil inner wrapper. Also, I doubt they have much smell to begin with. Night time low BGs are a MUCH higher risk than black bears in the Sierras. Also, I doubt any bear can smell them with that packaging despite their remarkable sense of smell. I have never backpacked in grizzly country though. I have used these my entire life as my emergency carbs. They last a LONG time in my pocket relative to other candy packaging. With pumps and the remarkable CGM accuracy available today, BG lows are much less common than 40 years ago. However, I do get them hiking due to the rapid change in metabolism and somewhat variable pump settings at the start of a long trip.

        On the JMT, there are some areas where bear risk is higher (Vidette Meadows, Red’s Meadow, Yosemite, Rock Creek, Thousand Island Lake…especially Vidette). I’ve camped in Vidette several times. One time a nearby hiker had a bear claw at his bear can at night. Another time, one came right up to someone’s camping area. The ranger warned me about this area as well. Still, the black bears in the Sierras aren’t real aggressive unless you do something “way over the line” (my opinion). One did shred some campers food at night that forgot to screw their can lid closed tight (Ansel Adams Wilderness area). Also, they seem to be in Little Yosemite Valley almost every night. When I solo hiked the entire JMT in 2016, I stored my bear can in my vestibule area. I’m more worried about people or a bear rolling my can away altogether. I know rangers would advice against this, but losing our food completely could be a much higher health risk than a black bear attack.

        Keep in mind, the south end of the JMT has bear boxes all the way to Wood’s Creek. That’s about 1/3 of the trail; Horseshoe Meadows, Rock Creek, Crabtree Meadows, Wallace Creek, Tyndal Creek, Vidette Meadows, Charlotte Lake, Rae Lakes, and Wood’s Creek are the ones I know about. There’s also a map on-line. When you do the JMT, if you leave from Horshoe (Cottonwood Pass entry) like MANY are now, you can actually stay at campsites the first six nights that have bear boxes. Theoretically, you could carry about 11 days food and make it to MTR without a resupply at Kearsrge. I don’t because the thought of carrying 11 days of food doesn’t thrill me. Also, I generally have at least one emergency day food for inclement weather. At my age, making it to MTR would be risky if I got slowed for some reason.

        Another tip I wanted to pass on regarding cooling insulin. I’ve devised a system that should work in the Sierras, but in lower water areas…??? I carry the Frio, but reality is that only gives you a few degrees. I hiked in 85 degree weather in Lyell Canyon and Red’s Meadow areas last summer. That insulin “worked” but it was REALLY weak. That’s somewhat risky. I will still use the Frio as my primary cooler and I’m sure it’s fine up to 70 or maybe 75 outside temperature. I bought these two wireless “button thermometers” (see photo). They fit in a hard medicine or seasoning container with the insulin. So I can monitor insulin temperature on my iPhone all day. If the Frio isn’t “cool enough”, I can move the insulin/thermometer container to a Nalgene (light polyethylene one) bottle and keep refilling with creek/lake water as the sun warms the water. I haven’t tried it yet. I’m doing the JMT from the south this year and will test it out. If you’ve jumped in Sierra lakes, you know it’s cold enough😉 The downside is that with the bottle filled, thermometers, and seasoning container will weigh almost 2 lbs. But it’s only 150 grams (1/3 pound) without the water.

        You and your husband/boyfriend should consider the Evolution Valley Loop (Bishop Pass to Piute Pass or vice-versa). I know you said you said you don’t have time to do the entire trail now. This is almost certainly the best section and doable in 5 days (about 55 miles). Muir Pass, Evolution Valley, McClure Meadows, Wanda Lake, the rock monster… You need to get a permit 180 days before you start from recreation.gov. If you get time to do it, please don’t be bashful about emailing me for itinerary tips.

        Thermometers (both are about 1.3 to 1.5” diameter): Inkbird ($25) https://www.ink-bird.com/products-smart-sensor-ibsth1mini.html Blue Maestro ($50) https://bluemaestro.com/products/product-details/bluetooth-temperature-humidity-sensor-beacon

        Take care of yourself. Stay away from Covid!

        John Nelson

        Sent from Mail for Windows 10

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      3. Hi John,

        Thanks for this incredibly detailed comment! This is all excellent advice! Great idea with the thermometer for hotter temps. I’ve only really done the Frio bag and temps have never been hotter than 80 deg, but I’ll have to try that. Hoping that I’ll be able to get outside for a trip in the late summer/Fall/whenever it’s safe again, and I won’t risk putting strain on our healthcare system during COVID. Definitely going to look into the Evolution Valley Loop, as that sounds incredible!

        Also, still meaning to write up more on nutrition and backpacking, but honestly for longer trips in bear country I sometimes struggle to pack enough food, and am still trying to figure that one out.

        Hope you and your family are staying safe! Take care.

        Best,

        Julie

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      4. Hi Kait!

        I have backpacked in bear country on multiple occasions, but all have been in the Sierras like John, and not in grizzly territory. I always keep at least 2 gels in my pocket in my sleeping bag over night, as I (like John mentioned) am much more concerned about hypos. I also figure that the bear canister with all the opened food is going to smell much more appealing and tend to leave that outside and away from the tent in case a bear comes to hang out at night. Knock on wood I haven’t had any problems. I’ve never tried the lifesavers, but that might work as well.

        Where are you planning to go?

        Best,

        Julie

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