A Beginners Guide to Backpacking with Type 1 Diabetes

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 to 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

Controlling your Blood Sugar on the Trail

  1. Insert your pump into your thigh: 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 off, 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 insert your site into your thigh and have a backup.
  2. Utilize 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. I was 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.
  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.
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5 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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