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.
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
- 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.
- 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.
- 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.
- Medical tape: It’s useful for many things including blisters, but I used it to tape my site to my body, for extra protection.
- 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.
Tips I use to Help Control my Blood Sugar on the Trail
- 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.
- 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.
- 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
- 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.
- 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.