Hiking tips

Type 1 & LADA
1

I’ve been doing a lot of running since becoming T1, but haven’t gone out hiking yet. Any tips on how best to manage BG would be welcome.

My initial, simpleminded plan is to have no active insulin besides my basal (Tresiba) when I start and probably have a small (~15g) snack at the start to fend off an early drop. This is just a short trial day hike (not more than 3-5mi) to see how I react. I’ll have someone with me in case things go sideways.

A couple of more specific questions:

  1. I’ve read that some people’s BG rises rather than falling during hikes. Do folks correct when that happens or just ride it out? I’m pretty fast out there–I do this for exercise at least as much as for pleasure.

  2. I wasn’t planning on having lunch during the hike, just grazing on nuts and dried fruit on the way. That’s mainly because I want to avoid bolusing and then crashing once I start moving. How do folks who do bolus, eat, and get back to activity handle it?

Finally, any other things I haven’t thought of?

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2

It would be helpful if you have a CGM, even though I have a Dexcom G6, I carry a kit with me that has 2 kinds of snacks, glucose tablets and a glucometer. I also have a 5 OZ flask with my own glucose syrup/strong coffee mix that is 6 or 8 grams per OZ. I don’ hike often, but am a road cyclist.

I think you should carry some gel packs like from Hammer Nutrition or GU, a glucometer and a rapid insulin pen.

As to BG during exercise, It depends upon the physical stress. Mostly riding on the road causes a steady decrease over time, however hill repeats and sprints will cause a rise in BG. Hiking may be more stress than running on the road, depending on how technical the terrain.

Never go out without fast acting fuel, slow acting fuel, insulin and a meter, not even a short hike of a few miles.

The worst hypo I had on my bike was really strange. This is before I went on MDI, just Lantus and Metformin. I was just noodling along, when about 3 miles I thought, Something’s wrong with my bike.” I was weaving from pavement edge to edge. There was nothing wrong with the bike. My brain was lacking enough fuel.

Fortunately I got stopped and had enough sense to test - 40mg/dl and dropping. I ate everything I had, plus got a bacon sandwich from my cousin’s store so I could make the short trip home.

It was so out of the blue, but it made be ultra cautious. Hypos make one really stupid.

Edit to add one more thing, One of the best things I have read to understand BG management and exercise is Sheri Colberg’s “”Athlete’s Guide to Diabetes.” I need to get another copy as I gave mine to a nurse working towards being a CDE.

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3

Hi @CarlosLuis and thanks! I should have clarified that I never go out in daily life for any extended period without GU gels or similar, glucose tabs, dried fruit, and a mini Clif bar or two, plus my meter and insulin. I have a Dexcom G6. All of that would come with me for hiking. For runs I carry enough fast-acting sugar to get me home under anything but the worst circumstances.

The “weaving around” surprise hypo is one I’ve been told of but haven’t experienced. I test myself aggressively when I feel off, so with luck can avoid that.

I’ll give the Colberg book a look, too!

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4

Your initial plan sounds very good. No active insulin and a small snack before you start. That’s a safe and reasonable approach. :+1:

It depends on the person. If you are relatively fit, and the activity is not too taxing (i.e. not a very steep or fast hike), your BG will probably not spike. You will probably see a BG drop.

Since you have experience with that, I would treat it like an “easy” run in terms of BG management.

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5

Sounds like you are prepared well. When this supper hypo event happened, it was sudden and without warning. It was this event that caused me to split the Lantus dose along with my nocturnal hypos. My rides is we’re in the morning after breakfast. I would inject after the ride.

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Take plenty of water and stay hydrated, especially if the weather is warm.

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@CatLady Good advice! I’ve got a camelbak and a spare bottle, but it’ll be ~30F!

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When I’m working hard, I don’t notice that I’m going low. I don’t think I’d be ok if I waited to notice that I feel off. I depend on the CGM. Others may use time or distance to trigger manual testing. You need to find out whether your body enables you to be aware that you’re going low during exercise. Mine doesn’t, and it seems that CarlosLuis may be similar in this regard.

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9

I’ve done a lot of hiking and don’t normally do anything different than your plans listed above…although I usually carry enough extra food for a meal and on longer hikes or bad weather I carry the ten essentials (google it). As you get into it more you might be tempted to push yourself. It’s easy to get overambitious on a hike especially when starting out in the morning. My advice is remember the above truth spoken by @CarlosLuis , it can make things very unsafe very quickly. Never put yourself in a position where you are not able to stop and rest/treat a hypo. Examples of how people put themselves in that position of not being able to stop and rest are:

  • Going too far/high (or getting a late start) and not having enough time to comfortably reach the destination and get back to the car before dark,
  • Trying to outrace a storm or bad weather,
  • Hiking with a group of overambitious hikers and struggling to keep up,
  • Straying off the trail and getting lost,
  • Continuing to hike with an injury or blisters etc. without adjusting your destination/timing for slower pace.

A great hiking app is Gaia GPS. If you use something like this you can get a handle on your pace as well as your position on the map etc. You can (and should) download the maps before your hike and you should also carry a paper map as backup.

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Still hydrate :potable_water:

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11

Right, @John58 all good tips! More food and breaks can never hurt.

I’ve also hiked a lot prior to becoming T1–I hiked Mt Whitney in a day, have done most of the major peaks and trails around Tahoe and Yosemite, and regularly hung out in the GA and TN mountains. I’ve got AllTrails, download the maps, and have laminated maps (plus a compass) for most of the AT-adjacent places I’m on. But I’ll check out Gaia GPS as well. Refreshing and doubling down on all of the usual cautions, as you suggest, seems like a sensible baseline to start with!

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12

Sounds like you know the drill! Building in some flex time to the itinerary just in case diabetes’ wants your attention can save a lot of grief. I’ve got a friend who ended up spending a sleepless night in the Cascades years ago, she missed a turnoff back to the car late in the afternoon and kept hurrying farther down the wrong trail trying to catch up to the group she was with…getting herself farther away from her destination. That’s the type of “Oh $&/%#*” that a hypo can facilitate at tge end of a long day.

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I’ve done boneheaded things like that even before T1. Once in Tahoe I reached the top of the trail and realized it didn’t end at the true peak. I decided I’d wander up and bag it, without noticing the noon light and shifting sands would immediately erase my footsteps. When I realized I couldn’t sight the trail I figured, well, worst case scenario I can bushwhack down the side of the mountain following the faint sounds of traffic and then hitchhike back to my car. Through blind luck I stumbled on the trail (and a helpful fellow hiker) shortly after that, but it would have been a bad day. After that experience I took orienteering training and started carrying a compass and a paper map…

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We just had a story in New England about an experienced hiker who fell off the top of a mountain and died. He was trying to take a picture and he was right next to his wife when he fell.

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@needlesandmath my son has done 20+ mile days with more than 4000 feet of elevation with approximately the same approach. Of course when he returned (tired) he did worse than not have any food left, he came back without the map my wife has kept going for longer than my son has been alive. That was not a pretty evening meal. Stay safe.

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I had discovered that my Onetouch finger stick seemed to be in error when I was hiking above 12K feet in the High Sierras. This was before my CGM system so can’t contribute any additional information. I have done the C2C trail up to the 8500-foot level twice with no problems. That is one of the toughest trails in north America.

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As a T1D also did the back side of Mt Wittney from a 20-mile starting point. That was many years ago with no altitude problems. Of course I have always carried my insulin supplies since I have always been a multidose insulin T1D for the last 49 years. Now for the last 5 years with a CGM system it will always be a new adventure.

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18

I’m not a hiker like you people, but I do play a lot of golf and I try to walk the course when I can (during peak hours they require you to take a cart). Golf is obviously not the most strenuous game around, but it often means 4-5 hours walking in the hot sun, especially when we’re down in Florida. I always have a snack in the bag just in case, but for me, hydration is the key. If I forget, which is easy to do when you’re out there with your buddies having a good time, I find my urine is dark gold when I get home, my BG is correspondingly high and I am tired and cranky with no appetite and usually just want to crawl into bed. On the other hand, when I am vigilant about hydration, I can be out there all day with no D issues whatsoever, and when I get home I’m ready to have a nice light lunch then leash up the dog and take my cigar out for a walk around the neighborhood. Huge difference.

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I have done a bit of hiking and backpacking in my early 60’s, some with Llamas carrying camping gear and food, in the Cedar Mesa Plateau. Now I just do day hikes with camera gear. Also, day hikes in that area and western NC.

In addition to the fast acting glucose, I always carried some snacks with protein to sustain fuel needs. Peanut butter sandwiches, granola bars, and the like. Otherwise I would just have lows chasing one another

Mike.

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20

Yes peanut butter sandwiches are the best. Always take more food than you would ever think you would need. Water also.
Also if on pump carry an extra infusion set since I have ripped it off taking care of business many times.
And get in the habit of checking BS at every break (meter or CGM). It always surprises me how beautiful scenery makes me forget I’m a diabetic.

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