Kate: To continue our discussions between people with type 2 and type 1 diabetes, I thought I’d talk with Laddie about dealing with diabetes while enjoying the great outdoors. Living in the middle of a pine forest makes it easy to enjoy the peace and loveliness of “the outdoors”. I love camping and hiking in the woods that are a stone’s throw from my home. Ray and I enjoy fly fishing, which we have to travel away from home to do. I’ve blogged before about my adventures when camping with diabetes but I’ve never given a lot of thought to what it would be like to camp with type 1. Well, my last statement isn’t exactly true. I have thought about the fact that insulin must be kept cold but I never really thought about how that would work or what level of stress that would add to the camping experience.
Camping with type 2 is really quite easy, at least for me. In fact, it’s easier to control my blood glucose while camping than it is at home. Why? Because what I eat affects my blood glucose more than any other thing I do. Yes, I take oral meds and yes exercise can lower my blood glucose, but if I overeat or eat too many refined carbs, my blood glucose will spike and there’s not a whole lot I can do about that. When I’m at home I have a whole smorgasbord of food to choose from, not all of it good for me. When camping I can only eat what I bring with us and I try, very hard, to limit the “bad stuff”. It’s still easy to eat too much while camping but I find that the fresh air and peaceful surroundings make it easier to focus on things other than food. I have been known to have fasting readings in the mid-80s while camping when here at home they are running in the 130s. (We currently can’t camp due to fire restrictions and my glucose could sure use the help!)
While spending time in the outdoors I am always careful to check my glucose levels, I get lots of exercise and I’m usually eating more healthfully. I’m also much more relaxed, which helps with blood glucose as well. Can I imagine what it would be like to add insulin to that mix? Not really. Intellectually I can understand what would need to be done, but emotionally not so much. The reality of dealing with type 1 (or anyone who uses insulin, really) is beyond my ken. (I have always wanted to use that word in a sentence, ever since I first saw The Sound of Music!) I greatly admire my T1 friends and am always impressed with how they handle everything required to control their diabetes. What’s it like away from home where there’s no conveniences?
Laddie: Kate is correct in stating that preparing for a Great Outdoors adventure is very different for someone with Type 1 diabetes compared to most people with Type 2. Although we can argue about which type of diabetes in worse in the long run (they’re both the “bad” kind!), in most cases there is little doubt that Type 1 is more dangerous in the short run. Going on an outdoor expedition ill-prepared can quickly become a life-or-death crisis for someone with Type 1.
I have never had an emergency diabetes situation while in the Great Outdoors and I would attribute that to a combination of thorough preparation and a healthy dose of luck. When I venture out into nature, I work hard to ensure that I am prepared for almost any contingency. I make lists. No matter how many times I have stocked a backpack, I don’t trust my memory. I use a list and I check it twice. I figure out what supplies I need and I double or triple that.
Luck has come to my aid a few times and I have been an attentive pupil. Many years ago I learned that multiple plastic bags and tape are not sufficient to keep a Medtronic insulin pump dry while whitewater rafting in Canada. Fortunately it was a cheap lesson because the pump survived with no water damage. I have been low and run out of glucose/food twice on long hikes and both times the trailhead and car with supplies were over the next hill.
The two scenarios that can quickly become an emergency for me are severe hypoglycemia and an absolute lack of insulin. To prevent severe hypoglycemia, the first thing that I do is carry glucose products in both my pockets and my pack. Multiple rolls of glucose tabs, gummy fruit snacks, juice boxes, granola bars, and a bag lunch are my standard fare for day hikes. Secondly, I always carry my Dexcom CGM and pay attention to its warnings of lows. My meter is easily accessible on my belt and I am proficient at testing while on the go. Third, I use temporary basals as much as possible to minimize insulin on board. Fourth, I carry a Glucagon kit and my hiking companions know its location and how to use it.
It is unlikely that I will have a problem with my insulin delivery, but this could become catastrophic very quickly. As a pumper using short-acting insulin, I start feeling sick if I go without insulin for 3-4 hours. Periodically on diabetes forums someone asks how long a person with Type 1 can survive without insulin. Will Dubois at Diabetes Mine has a good post on the subject and concludes with the answer of a few days to 1 or 2 weeks. How quickly would I feel so sick that I could not longer hike? Probably 5 to 8 hours.
To prevent an insulin emergency, I always start my adventures with a full or nearly-full reservoir in my pump. Secondly, if the battery level on my pump is not 100%, I put in a new battery and always carry a spare. Third, I carry syringes in both my meter case and backpack. I always pack back-up infusion sets, a reservoir, and a vial of insulin.
Kate mentioned her concern about the proper storage for insulin if and when it becomes part of her diabetes regimen. Frio cases are the easy solution. The soft pouches work with evaporation and only need a soaking in water every few days to provide adequate cooling for insulin. They puff up when “charged” with water and their Pillsbury Doughboy chubbiness helps protect insulin vials from breakage. They also come in sizes for pens, pumps, and other supplies.
Those of us with Type 1 have to be more neurotic in our preparations for life than those with Type 2. I don’t complain about diabetes very often, but sometimes I wish that I didn’t have to be so darn prepared all of the time. At the same time I am thankful for my pump, meter, and CGM that allow me to experience the Great Outdoors in relative safety.
I’m humbled. I’m impressed! Laddie, your preparations for a day of hiking are astounding. I always knew, intellectually, how much preparation is involved for going anywhere with type 1. I’ve read other blogs and Facebook comments about packing for a trip and needing to take multiple sets of this and that. I just never transitioned that over to being on a hike or camping. You always have to be prepared!
One thing that stands out to me is the fact that type 1 carries with it an immediate threat of serious issues. Someone like me who has type 2 and does not use insulin (or any medication that can cause severe lows) doesn’t have those worries. I’ve always known this, but this conversation has really brought it to the forefront for me. There is no “worse” type of diabetes but, in my opinion, type 1 is a lot more serious in the short run. Your need to control your blood glucose cannot be ignored. I am not someone who ignores my diabetes control but if I ever do I’m not going to die. That’s serious stuff. In the long run, we aren’t much different. People with all types of diabetes need to be aware of the fact that poor glucose control will most likely lead to serious complications. (It’s important to remember that even if we do control our diabetes the best we can, we may still experience complications and that is not our fault!) As a type 2 I intend to continue to pay attention and do everything I can to keep my bg as close to normal as I can. I’m afraid that many type 2s don’t do that. It’s easy to forget what can happen when we aren’t faced with the immediacy of type 1.
Laddie: Well said, Kate. I don’t think that I have anything to add to our discussion except visual proof that people with Type 1 or Type 2 diabetes can look equally goofy in fishing hats! (If we were men, we would also have to argue about whose fish was bigger….)
Be sure to come back next week when our conversation will be about Friends and Family. If you missed our first conversation about weight, check it out here..