# Newly diagnosed Tpe 1 - Hillwalking advice?



## simonkit (Jun 18, 2013)

I was diagnosed Type 1 just over 6 months ago, which came as a shock as I'm 45 :shock: 

 Anyway I'm a keen hill walker and want to get back onto those mountains asap but obviously it's now much more of a challenge than it ever was. I've tried some shorter coastal walks and sort of managed ok but had to take in silly amounts of carbs, could really do with some advice on how others manage the same activity..to make things more complicated I'm also into landscape photography so usually carry quite a bit of gear around too

cheers

Simon


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## Donald (Jun 18, 2013)

Welcome Simon there is a few members on here who I'm sure will be able to help with advice.


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## simonkit (Jun 18, 2013)

Donald said:


> Welcome Simon there is a few members on here who I'm sure will be able to help with advice.



Thanks...

Doing ok day to day, carb counting and using the Accuchek expert meter has made it easier to adjust to.

Hiking is certainly challenging though, last week did some coastal walking..before climbing was at 9.4 after taking in extra carb, after 20mins of steady climbing had dropped to 4.5?? Found that jelly babies and/or lucozade help but it's a bit of a rollercoaster ride


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## Redkite (Jun 19, 2013)

Hi Simon,

You're going to have to experiment, but your options are to reduce your insulin and/or to have plenty of extra carbs.  You could try reducing your meal bolus at whatever meal is immediately before your hike, as the exercise will make less insulin go further.  If 20 mins of steep climbing drops you by 5mmol (sounds like my son after 20 mins on his bike!), you need to have some extra carbs before starting the ascent.

 You might like to consider an insulin pump, as this allows you to programme a basal insulin by the hour, rather than a fixed dose every 24 hours.  You can turn down your basal before starting your hike, and can also run a reduced basal rate for several hours after you've finished, because your BG levels can run low for 24 hours after strenuous walking exercise.  Watch out for night hypos after a day out hillwalking.

More advice on exercise and insulin can be found on:

http://www.runsweet.com/


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## Redkite (Jun 19, 2013)

P.S. If you end up a little on the high side after your walk (BGs not mountains!), be cautious when correcting the high with extra insulin.  The exercise will increase your insulin sensitivity for up to 24 hours after you've finished, so it's sensible to take this into consideration when correcting high levels, to prevent your levels plummeting.  For my son I would reduce correction doses by a third or a half, depending on how energetic he'd been.


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## Copepod (Jun 19, 2013)

Welcome Simonkit.

As another person who developed type 1 diabetes as an adult, aged 30 years, some 17 years ago, and had no intention of stopping hill walking, perhaps I can help. In fact, I remember asking DSN at hospital in West Mildlands where I was diagnosed about hill walking, but she just mentioned her version of gentle rambling, which wasn't what I meant at all. As there was very limited internet in those days (mid 1990s) I had to work things out for myself. Initially, I was put on bimodal insulin, which was pretty impractical, but after a trip to Belgium with a friend who was training to be a midwife, spoke with her mother, a pharmacist in Tasmania, who posted me a photocopy of an Australian pharmacy journal about basal bolus / MDI (Multiple Daily Injections) and I haven't looked back. In that first year, I climbed 2 of 3 Peaks of Yorkshire Dales with different friends, led an expedition of teenagers to Costa Rica, then started MSc in London, so not much hill walking, until next summer when I went to Northern Ireland to do my research project. 

Briefly, what I have found is: if I know I'm going hill walking next day, then I reduce long acting night before by approx 25%, reduce in morning too (I take my long acting Humalin I twice a day, which I find more versatile), plus reduce short acting dose for same amount of breakfast (or eat more breakfast - depends on food availability, appetite etc). If hill walking happens unexpectedly, then I eat more. I always carry a combination of sweets (jelly babies / soft sweets / mints etc - whatever is on offer at shop), muesli bars, squeezy pouches of fruit (emergency rations, long use by dates, more robust than fruit such as bananas), dried fuit, normal food eg sandwiches, pork pies, crisps etc. For drinks, I often carry 2 bottles eg 1 flask of hot drink and 1 of cold, 1 of which contains sugar, the other sugar free. But equally, one of the pleasures of hill walking is drinking stream water, and I still do that, which means I don't have to carry much water in some areas. That's particularly important if you're carrying heavy kit - I only use a pocket digital camera these days, but marshalling on mountain marathons, adventure racees etc often means carrying tent, stove, food for up to 3 days, controls to put out / collect, so weight is an issue sometimes. You're right that sometimes you have to get some carbohydrates into yourself before heading up a slope - so always have some things in pockets (in trousers / shorts / jackets / rucksack belts etc) that you can reach without having to take off rucksack. After hill walking, I find I needto reduce long acting doses for at least 24 hours after, longer for more energetic / longer exercise. 

Don't worry that a pump is essential - many people do find it necessary, but many of us manage fine with basal bolus / MDI regime.

Mountains for Active Diabetics (Facebook group) is also very good for practical answers from people with diabetes who love being active in mountains, in addition to Runsweet. 

Hope that's enough to get you started. Just to reassure you, you might like to look at www.howfast.org - James Thurlow has just run across Coast to Coast, east to west in just under 4 days, less than 2 years since he got type 1 diabetes in his early 40s.


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## fencesitter (Jun 19, 2013)

Like Copepod, my son turns down his basal by 25% the day before and reduces the amount of insulin he takes with meals by a similar amount. He also eats about 20g of carbs per hour while walking, although I suppose this shouldn't be necessary if he turned down his insulin even more? Seems to work for him though after a bit of experimenting. He takes lots of sugar with him (Kendal mint cake a favourite) and lots of longer acting stuff too. We do tend to carry a glucagon injection kit but so far haven't had to use it, although he did go very low on one long hike in the Lakes. If it's hot, you might need to reduce basal even more. He tends to keep the basal low until a day after all the activity has finished. This is easier if you're going on holiday, not so simple if it's something you like to do more regularly. Runsweet is a good website for sports/exercise and diabetes.


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## simonkit (Jul 25, 2013)

Sorry about been rather late getting back to this one...thanks for the very useful replies, especially about reducing background insulin the night before.

I'm also looking into quick acting food that I can use but which doesn't contain mad amounts of sugar, has anyone tried the energy gels that seem increasingly popular with athletes etc?

Simon


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## Copepod (Jul 28, 2013)

The problem I find with sports energy gels is that they contain a lot of sugar per pack - sometimes 60g sugar in an 80g or 100g pack, and once you tear it open, you're left with a sticky mess of anything you don't eat. That's why sweets eg wrapped boiled sweets or jelly babies are often more convenient - easier to take small sugar quantities more often. 

As an alternative to tear open sports gels, I have found that screw top sachets of fruit puree, sold by Asda for children's lunchboxes are ideal - approx 15g sugar in each 85g sachet, which are not so sweet and sticky that you need lots of water to wash down, but can eat without water, and can screw lid back on if you don't want to eat all at once, or until you find a rubbish bin. 

Just to encourage you (I hope) - I'll be taking at least a couple of sachets for each day of OMM (Original Mountain Marathon) B class in late Oct 2013, when I'm competing with a female friend who doesn't have diabetes, on her first MM, my third (as competitor, not counting marshalling on about 10)


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## simonkit (Jul 28, 2013)

Copepod said:


> The problem I find with sports energy gels is that they contain a lot of sugar per pack - sometimes 60g sugar in an 80g or 100g pack, and once you tear it open, you're left with a sticky mess of anything you don't eat. That's why sweets eg wrapped boiled sweets or jelly babies are often more convenient - easier to take small sugar quantities more often.
> 
> As an alternative to tear open sports gels, I have found that screw top sachets of fruit puree, sold by Asda for children's lunchboxes are ideal - approx 15g sugar in each 85g sachet, which are not so sweet and sticky that you need lots of water to wash down, but can eat without water, and can screw lid back on if you don't want to eat all at once, or until you find a rubbish bin.
> 
> Just to encourage you (I hope) - I'll be taking at least a couple of sachets for each day of OMM (Original Mountain Marathon) B class in late Oct 2013, when I'm competing with a female friend who doesn't have diabetes, on her first MM, my third (as competitor, not counting marshalling on about 10)



Thanks for the tips, I'll pop into Asda and pick a couple up to try

Simon


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## Copepod (Jul 31, 2013)

Definitely wise to try before you set off - half way up a hill is not the place to discover you don't like them


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## trophywench (Aug 1, 2013)

The 'Expert' has an 'Exercise' option on the calculation screen, so get that set up if not already (for interest I use minus 20% for E1 and minus 40% for E2, but rarely do E2 - except when it's a normal walk and has been silly hot - as per recently.  Include that option with any meal prior to exercise.  That combined with the reduced basal and the standby of the gel or whatever you choose, should see you not going hypo.

Have you thought about bananas? - bit carby for me normally, but quite good in this situation really cos of all the other stuff in em too (potassium and a few other things ISTR) so they actually help with good hydration as well as maintaining BG.


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## Copepod (Aug 1, 2013)

Bananas are great in theory, and perhaps I'm unusually careless, but I always seem to get them crushed or shaken around if put in a sandwich box, which I don't usually use, due to bulk. Plus, carbohydrate content varies so much with size and ripeness. That's why I use fruit pouches, which are more robust. Or apples, which are pretty robust - and sheep like the cores  I always bring back banana and citrus peels, plus any packets, of course.


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## zuludog (Oct 22, 2013)

I go hillwalking and backpacking, here are some comments based on my experiences

The symptoms of diabetes include tiredness and weakness, so if you've recently developed it, you're probably feeling fairly knackered. Don't expect to keep up the level of fitness you had a while ago, settle for something less while you get fit again

You might feel the cold a bit more than you used to, and winter is fast approaching, so wear or take a few warmer clothes

The usual recommendation for hypos is a sugary drink, but they are heavy. Instead I take jelly babies or liquorice allsorts

Some of the medication I take gives me a queasy feeling now and again, so I suck fruit flavoured boiled sweets, or a small piece of mint cake. This will give me a slow release of sugar as well

I can't afford to run out of food now, so no matter how long my backpacking trip is, I always take food for an extra day. Typically a 'no cook' AFD pasta meal where you just add boiling water to a foil pouch; a few cereal bars;and a small block of mint cake

You can get pouches for injection pens, but I wanted a harder case for them, and spare cartridges; I use one of my daughter's old pencil cases

I like to be unrestricted when I go walking, but if you have a family it is only fair to reassure them. I take a mobile phone and send a brief text message when I'm on the last summit of the day, when you are more likely to get a signal than if you descend into the valley

Carry a few boiled sweets or a couple of small/fun size chocolate bars in a jacket pocket or a pouch or pocket on the waist or shoulder straps of your rucsac. Then you won't have to keep stopping to get into your rucsac


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