[pct-l] Insulin, Diabetes, and hiking

[Michael S]

Hey Joe.  It's possible, but as with anything with diabetes, you need to do more planning than those without the disease.  I'll try not to lead you astray, as I am also Type 1 diabetic along with having a graduate degree in endocrinology, specifically studying insulin effects (at the time, I hadn't been diagnosed, so it was just serendipity that I ended up studying it).

You need to switch your insulin injection system to a pen system.  They last longer without refrigeration, utilize smaller lighter needles (if you're a lightweight weenie type), and are very easy to dial in for accurate dosing.  Do this even if you're on the insulin pump, because when you're out in the wilds, it's just too dangerous if your pump fails, or the intraperitoneal tubing gets clogged.  There are literally 10-12 different insulins that are in the pen form, and they're covered by insurance (mostly).  
The best thing about the pens is that they can tolerate temps to the upper 80º range and are good for 28 days (used or unused).  If you plan your needs correctly, you may only need to carry 2-3 pens (with one for emergency) between mail stops.  Just before arriving at your mail stop, make certain that a good friend takes a sufficient quantity of pens and needles (including another emergency one, because you only have a 28 day non-refrigerated shelf life) out of their refrigerator (where it must be stored), pack it in a few cold packs, and ship it Priority to your next location.  This is a critical step.  
Remember alcohol swabs.  Because you're probably not going to shower every day, your skin's flora is going to have a lot of nice pathogenic organisms.  If you're giving yourself an injection, and accidentally hit a vein without swabbing, you could be septic within a few hours.  Don't risk it just to save a couple of grams of weight.
Disposal of sharps is going to be a challenge (another reason to go with insulin pens).  You do not want to pollute the trail with your contaminated needles, so you might need a small water bottle to carry used sharps.  Do not even think about reusing a needle, given the unsanitary conditions.  Also needles get dull after one or two uses.  Yeah, really they do.
Because the early legs of the hike (even later sections) can get warm, you need to carry a thermometer and an insulated bag/box to hold all of your supplied
You also need test strips and a small meter, which also should be replaced during the insulin pen shipment.
You probably should switch to a long-acting and short-acting regimen.  Lantus is probably the best long acting.  Your choice on the short acting.  This way you have coverage during long hikes.
To be safe, you really need to dial in your carbohydrate needs vs. blood glucose levels with heavy exertion under a load of your pack.  While on the trail is definitely not the time to adjust your insulin and glucose, because you know what happens if it's too low or two high.  Honestly, I would go on 8-10 hour hikes with your pack every weekend until the day you start, measuring your blood glucose once an hour, and using the calculations that you've been taught, adjusting your food intake and glucose. There are some CO2 metabolic tests, but the problem with them is that they're short-term (minutes/hours).  Furthermore, you will probably be adjusting your glucose/insulin while on the hike as you become more fit and your metabolism drops midway through the thruhike.
Again, to be safe, you need to carry a thermometer to have an accurate measurement of the temperature.  You need to pack your insulin away from the sun-heated portion of your pack.  On the other hand, 20º nights in the Sierra's is going to be just as bad.  This pack does work, and won't be as heavy as other solutions.  You must keep it wet (and I would even if the temp is moderate).  At night anywhere along the trail, I'd get intimate with your insulin pack by sleeping with it if the temperature drops into the 40's.
Type 1, 1.5 and 2 diabetics can have a great time on a long hike as long as they plan plan plan.  Also, I would bet a month's salary that a Type 2 diabetic will be "cured" while on a PCT thruhike from improved fitness, weight loss, and metabolism.  The other two types of diabetics just need to plan plan plan (in case I didn't mention it).

If you have any questions, just drop me a line, and I'm sure I can either contact a source or give you more advice.  I'm actually planning a thru hike in 2013, because I injured my knee this winter, and just don't have the knee strength yet.  Good luck.

Michael
michaels at skepticalraptor.com
http://www.skepticalraptor.com/skepticalraptorblog.php



On Feb 4, 2012, at 10:00 :02PST, pct-l-request at backcountry.net wrote:

Message: 4
Date: Fri, 3 Feb 2012 00:33:23 -0800
From: "Joe Barbera" <barberaj at tds.net>
Subject: [pct-l] Planning for diabetic hiker
To: <pct-l at backcountry.net>
Message-ID: <000001cce24e$7f014d60$7d03e820$@net>
Content-Type: text/plain;	charset="us-ascii"

Any other Type 1 diabetic hikers out there?  I am planning my thru hike now,
and am struggling with several issues:

1)      How to keep insulin viable during the desert?  What is the coolest
part of the pack?  Away from sun and body heat?

2)      Best carb ratios for meals?   I am finding almost no data on
sustained high output / 4,000 calorie diets     Thinking 50 - 60%.

3)      Continuous monitoring:  I have the Dexcom system, but the patch goes
right where the hip belt goes.  Any alternatives?



Joe B.