Hiking with Diabetes in 2016

Posted on January 11, 2016 by Laddie

On January 1st I greeted the new year with a 9-mile hike in the Mazatzal Mountains near Sunflower, Arizona. I am an avid hiker and have written extensively about hiking with diabetes. You’ll find some of those posts listed at the bottom of the page.

Not a lot has changed with my hiking in 2016 except for two tech devices.

Dexcom Share: I have often complained that the Dexcom G4 receiver is unreadable in bright sunlight. Animas pumps are even worse. I can’t see a darn thing on the screen. This year is my first experience hiking with the ability to see my Dexcom numbers on my iPhone. It’s fabulous. I can read the numbers with no effort at all. Now when my Dex receiver vibrates, I can pull out my phone to see whether it is a high or low alert and what the number is! Unfortunately I still can’t read my pump screen.

Spot Gen3 Tracker: Despite my emphasis on safety, I have realized for several years that I was missing one device that a hiking group like mine should have. We are quite adventurous and most of our hikes are in mountainous areas with no cell phone coverage. If one of us were to get injured or sick (or have issues due to Type 1 diabetes!), we’d basically be up Sh*t Creek. Most likely we would have to split up the group with some hiking out and driving to get help and others staying behind with the hiker-in-trouble. When you are 5-6 miles away from the car, this is not an ideal situation.

In response to my first hiking post in 2013, Scott Johnson mentioned a satellite-based SOS device that he had used for job-related drives in the boondocks. He wrote:

I think it’s wise to have the glucagon and prep the group. Hopefully you’ll never need any of it. But that’s one of the things about living with diabetes — we have to plan for the absolute worst case scenario.

When I was doing some work that involved a lot of driving in very remote areas I found a device/service called SPOT that used satellites to allow me to call for help, if needed, or broadcast an “I’m Ok” message to loved ones. Thankfully I never had to use the rescue service, but it provided great peace of mind.

Two and a half years later I am now the owner of a Spot Gen3 satellite tracker. According to the company website, the device “provides location-based messaging and emergency notification technology that allows you to communicate from remote locations around the globe.”

That means that I can send out pre-programmed “I’m OK” messages to multiple phone numbers and email addresses. The two routine message options provide GPS coordinates and a link to Google Maps showing my exact location and track. There is a Help, but not life-threatening message that can be sent to designated contacts. Finally there is a SOS button that will summon a cavalry of emergency responders and helicopters.

I hope never to be in a situation where we must use the SOS alert. But if we face a life-threatening emergency, the cost of my annual Spot contract with be worth every dollar. (BTW I received my tracker free due to a pre-Christmas rebate contingent on purchasing an annual monitoring contract.)

Related Posts

Hiking with Diabetes Part 1

Hiking with Diabetes – Part 2

Short Hikes – Hiking with Diabetes Part 3

Oh Yes, I Can

Short Hikes-Hiking with Diabetes Part 3

Posted on January 13, 2014 by Laddie

My 2013/14 Arizona hiking season is underway with three long treks and multiple short hikes under my belt. I have been extremely pleased with how strong I feel and how confident I am in handling my diabetes.

In late July I wrote my first blogpost about hiking and discussed the possibility of hypoglycemia while out on the trail and the necessity of carrying a Glucagon kit. My second hiking post in August discussed my personal rules for being safe in the outdoors and how I’ve learned to balance acceptable blood glucose numbers with safety and a passion for the beautiful Arizona landscape.

In this post I plan to talk about how I prepare for short and easy hikes. I’ll discuss specifics of what supplies I carry, how I eat, and how I adjust my insulin. Although these short hikes are easier to manage than some of the crazy-long difficult hikes I do with my Friday hiking group, it is still important to plan and make decisions that keep me safe.

I categorize easy hikes as 3-5 miles in distance with some elevation changes, but not the think-you’re-gonna-puke climbs that are ubiquitous in Arizona. Because I walk my dog 3 miles every morning, is there a difference between a walk and a hike? Probably not, except that I call it a walk on neighborhood streets and a hike when I’m in the desert.

Supplies I Carry:

I never walk my dog without a full tube of glucose tabs (40g carb) in my pocket and I always carry my phone. I don’t take water because neither Abby the Black Lab nor I mind waiting until we get home to drink. I also don’t carry ID beyond what is on my medical alert bracelet (Name, Type 1 Diabetes, Insulin Dependent, ICE with my husband’s cell phone number). Maybe I should, but I don’t.

I am extremely lucky to live a few blocks from the McDowell Mountain Regional Park, an Arizona gem of 21,000 acres of desert beauty with hiking trails, bike trails, and campgrounds. There are mountains to climb and multiple flat easy walking paths. The views are fantastic. If I walk from home to explore this area, I carry a bottle of water in addition to glucose tabs and my phone. I don’t know exactly why I add the bottle of water except that it is a sensible rule to never go into the desert without water. I also carry a photo ID along with my required park pass.

If I am hiking farther from home, I take a fanny pack that holds two bottles of water, a pack of granola bars, some fruit gummies, and of course my glucose tabs, phone, and photo ID. I also take my BG meter which I never do when I’m just walking/hiking from home. Although I’m willing to trust my Dexcom for an hour or two near home, I want back-up for driving and for longer periods of time.

Breakfast Bolus:

The vast majority of my hikes and walks take place in the morning and breakfast is the meal I need to be concerned about. What is working for me right now is to limit carbs so that I don’t have to worry much about active insulin. At the same time I must have some carbs or my BG will go up with post-dawn phenomenon or whatever you want to call it. My current breakfast of choice is plain Greek yogurt mixed with berries or apple pieces for a total of about 15 carbs.

Temporary Basals:

Because I have the luxury of being able to walk/hike after breakfast almost every day, my basal rates have exercise built into them. If I don’t exercise, I usually need to use a temporary basal to up my rates through the morning. If I’m a bit low before starting to hike, I often munch on 1 or 2 glucose tabs and then use a temporary basal of zero for 30 minutes. It’s just like proactively using the Medtronic Threshold Suspend!

Summary:

I think I’ve outlined just about everything I do in preparation for short and easy hikes. Because each of us is different in our fitness level, insulin requirements, and goals, what I do is not necessarily what you should do. But you should think about everything that I mentioned. Maybe you like to carry your BG meter on short neighborhood walks. Great, then do it. Or possibly you need to start a temporary basal two hours ahead of exercise. Then set an alarm so you remember to dial back the insulin. If a walk of one-half mile is a challenge for you, it doesn’t matter. Get out there and be proud of what you can accomplish.

The only “musts” that I prescribe are to always carry fast-acting glucose and to always wear some sort of medical ID. Glucose tabs, gel, or whatever. Choose what works for you and don’t leave home without it. There are lots of nice medical ID’s out there and find one that you are willing to wear 24/7/365 for the rest of your life or until there is a cure.

And if you are taking your dog with you, don’t forget the poop bags:-)

Hiking with Diabetes – Part 2

Posted on August 1, 2013 by Laddie

I started writing the second part of this series and got bogged down in too many temporary basal rates and 50% boluses. So now I’ll start over on a different tack.

Slowly, but surely, my hiking plan has come down to a couple of rules. Although my blood sugars may go on a different adventure every hike, these rules/guidelines seem to remain constant.

The first rule is that safety must be the primary goal of my insulin and food regimen. Actually safety starts with my preparations for the hike. I have a printed list that I use every week. On the surface it may seem a bit neurotic, but it’s very easy to go down my list every Thursday evening and confirm that I’ve packed my Glucagon kit, extra snacks, a second tube of glucose tabs, and extra socks. My list has all the basics including a hat and hiking boots. That might seem like overkill, but one person in my group did forget her boots one week and hiked 11-1/2 miles in the Goldfield Mountains in sandals. So don’t laugh too hard at my list. Then I do another last-minute list for Friday morning: water in my camel reservoir, lunch, my phone, and a bottle of water for the car.

I’ve been brainwashed by many people on the Internet who claim that they never go above BG 140. With lower-carb eating, consistent exercise, a pump, and a CGM, I often try to be “perfect” and make corrections on readings that should maybe be left to simmer. Slowly but surely while hiking, I’m learning to see readings in the 130’s and 140’s and leave them alone rather than correct them. Most of those readings eventually end up in a good range. Occasionally the 145 turns into a 185 and that warrants a correction. What’s frustrating is that I can never figure out why one week 145 goes to 95 and another week it goes to 200. But I’m working hard to accept that I feel good at 140 and I don’t feel good at 65 with two arrows down on the Dexcom. So the second rule is: leave the heck a 140 BG alone!

My third rule is to ask for help if I need it and to stop to rest if necessary. This rule is not always related to diabetes. Our hikes are hard and occasionally everyone needs a rest. Well, maybe not Caroline. But the rest of us occasionally get over-heated, sore feet or leg cramps, so it’s not always me. Part of being strong is the willingness to accept weakness.

My fourth rule is to do my best to understand my limitations while having confidence that I am prepared for the hike and that I am strong enough to complete it no matter how difficult. The hardest hike that I have ever completed was a 2012 13-mile loop around Weaver’s Needle in the Superstition Mountains. Some of the elevation changes were exhausting and the day was much warmer than anticipated. This year in 2013 I chose not to go on one hike because I thought the combination of difficulty and heat would be too much for me. So I think I’m doing a good job of balancing the goal of pushing myself while being sensible to not put myself in a dangerous situation.

My fifth and final rule is to enjoy every minute of every hike. Be safe, but not frightened. Be strong, but admit weakness when necessary. Trust that I have my diabetes under control while checking constantly to make sure that I am in control. All in all, a sensible rule to live a successful and active life with diabetes.

Hiking with Diabetes Part 1

Posted on July 29, 2013 by Laddie

I am lucky to be able to escape winter in Minnesota and spend several months in Arizona. Although I’ve always been active in sports such as tennis and golf, I have expanded my athletic repertoire to include hiking. I belong to two women’s hiking groups in Arizona. My primary group is a serious gung-ho group that hikes 8-12 miles with significant elevation changes on a typical Friday. Many of the places we hike are in mountainous areas where we have no cell phone coverage. My second group is more casual with shorter hikes on more populated trails. Although I certainly carry food, glucose tabs, and water with my casual group, I am not too concerned with diabetes causing a problem. So most of my comments below are related to my more rigorous and remote hiking excursions.

Although I’ve always made sure that my hiking companions know that I have Type 1, I’ve never done much else except ensure that my pockets and backpack have plenty of glucose tabs, granola bars, juice, and other food. This year it finally struck me that it was absolutely insane to repeatably go out into the no-wheres of Arizona without a Glucagon kit.

I stopped getting Glucagon kits years ago because I’ve never needed one and they expire so quickly. My husband would call paramedics 100% of the time before he would ever give me an injection. If I’m low at the grocery store or mall, no stranger will know to find the orange kit in my purse.

This hiking season I finally got a new Glucagon kit. Fortunately my hiking group includes a former RN and a former school principal who has a sister with Type 1. Even if they weren’t along, the others in my group are strong and confident women who would take control if needed. I wrote up a sheet to share with everyone describing the levels of hypoglycemia and directions to use the glucagon kit. I indicated that I would handle mild lows myself and they would probably never be aware of them. I wear a Dexcom G4 which gives me some guidance as to what is going on with my blood sugar. I also have a One Touch UltraMini attached to my belt and I have perfected testing while walking without falling off a cliff.

My favorite advice for moderate hypoglycemia is if they ask me if I am OK and I say “yes”, don’t believe me. I am getting better about admitting that I am low when asked. But old habits die hard and I don’t want my false bravado to fool anyone into thinking I’m safe when I’m rapidly getting into trouble. I also described symptoms that they might notice such as slurring of words and vacant eyes.

I discussed severe hypoglycemia and indicated that at this point I would be unable to eat food or drink juice. Although the Glucagon kit comes with instructions, I wrote up a clear and more succinct page of instructions using some of the images from the Glucagon website. I also mentioned that Lilly has an iPhone/iPad app if they want to review that. The weakness of that app is that the instructions are just a copy of the printed material that comes with the glucagon kit. Too wordy for an emergency situation IMO.

I feel confident that I will never be in a situation hiking where a Glucagon kit will be needed and I hope that my confidence is not misplaced. I am very aware that if I experience severe hypoglycemia, Glucagon will be only part of the solution. My hiking companions will still have to arrange for emergency help to evacuate me if I am sick from the Glucagon or the effects of severe hypoglycemia. In areas where there is no cell phone coverage, that might mean spitting our group with some hiking out for help and some staying with me. This whole scenario is something that I never want to visit, but my safety motto is to be prepared.

I often joke with my hiking companions that my aim every Friday is to not end up on the evening news. Unfortunately lost and injured hikers are a regular occurrence on Arizona newscasts. So far I have succeeded in that goal through hundreds of miles of hiking. I’ve been sore, dirty, and exhausted many weeks, but never on the news. Hallelujah!