Back Country Hunting with Type 1 Diabetes

[Mike7]

The excellent post above recommending letting blood sugars run a little higher I think is not bad advice in and of itself and should be safe. Just don't obtain this through withholding insulin, but rather by getting enough carbohydrates.

High blood sugars don't directly cause ketoacidosis, rather lack of insulin does. The elevated blood sugar may be an indirect sign that you are not getting enough insulin. To check yourself, take some urine strips along and monitor for ketones to see if you are not getting enough insulin or just eating carbs in excess of what you are burning. Urine ketones will be present typically before serum ketones become elevated, which are a signal of a real problem.

I believe there are some renal/kidney changes and acid-base changes that occur with large changes in altitude, and these are completely unrelated to diabetes. So for instance, if you notice significant urination while descending that seems in excess of fluid intake, but have normal blood sugars, then trust your blood sugars...because that diuresis is associated with fluid shifts in your body that aren't directly related to the diabetes.

 

[Shraggs]

Uzikaduzi, thanks!

I need to slow down when typing a complex topic!

Not good to have high blood sugars as we all know. The point I tried to make is how potent rigorous activity is. In my individual case, one hour of work out will consume the equal of 150 mg/dl of glucose, above my base 100. I eat the exact amount of food I know that equals that and immediately work out and do not dose my insulin.

Knowing how active you are going to be, how your body deals with it, and how to dose down to compensate is the key to learn before hand.

I like the triathlete analogy- fitting.

Best John

 

[Scoot]

Not disagreeing with people, but I personally found that everything I "knew" from many years of having diabetes wasn't very helpful when I got up above 10K in elevation and "worked out" (i.e., humped the mountains) for 12 hours/day. Those who are saying "make what you do on your hunt the same as how you prepare at home and you'll know how it will work" aren't factoring in the notion that it's really tough for many of us to do our workouts at 10K (I live at about 400 feet above sea level) and given my family, work, home life I can't work out for 12 hours/day on any day other than when I elk hunt.

I'm not trying to be argumentative, I'm just saying it's pretty tough to replicate the hunt when around home for a lot of people. The elevation is the real kicker for me and I just can't mimic that in any way around this neck of the woods...

 

[whaack]

Tagged. T1D and did my first CO backcountry hunt last year. Send me a PM and I’ll share my experience.


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[adamm88]

I saw this article posted today on Facebook and instantly thought of this thread.

https://beyondtype1.org/altitude-type-1-diabetes/


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[Ram94]

I know it’s an old thread, but there is some good information here.

In the past I have eaten a very standard backpacking diet high in carbs and have struggled through the roller coaster blood sugar levels. This year, I have a low carb high fat food list planned out and am hoping it will work better for me. I have eaten this way for the past 2 years will awesome results (A1c has come down to 6.0 and blood sugars are steady as all hell). The one thing I am worried about, is going low on the long hike in and out. Has anyone here tried this route? If so, did you need to lower your basal or supplement with carbs for the long pulls? My hike in and out is about 10 hours of hiking.

I believe it was mentioned already, but i have found it works well to keep my insulin in my jacket chest pocket at all times, day and night. Haven’t had it freeze yet in the frigid Alberta temps.

 

[hayesplow]

My dad carries his insulin shots with him. Nothin like stabbing yourself in the belly in the blind or on stand while a deer walks by. I'm just happy to still have him out there at age 70.

 

[dr.derek]

I know it’s an old thread, but there is some good information here.

In the past I have eaten a very standard backpacking diet high in carbs and have struggled through the roller coaster blood sugar levels. This year, I have a low carb high fat food list planned out and am hoping it will work better for me. I have eaten this way for the past 2 years will awesome results (A1c has come down to 6.0 and blood sugars are steady as all hell). The one thing I am worried about, is going low on the long hike in and out. Has anyone here tried this route? If so, did you need to lower your basal or supplement with carbs for the long pulls? My hike in and out is about 10 hours of hiking.

I believe it was mentioned already, but i have found it works well to keep my insulin in my jacket chest pocket at all times, day and night. Haven’t had it freeze yet in the frigid Alberta temps.

Im a brand new diagnosed T1, they think I'm still in a honeymoon phase. My A1C went from 9.5 when I found out and after 3 months I got it to 6.5. Im going to the idaho Pioneer zone for archery elk and Im pretty freaked out to do it due to the complications that Im aware of now. (I hunted fine without knowing, ignorance is bliss!)

Im currently only on 5 units of Lantus at night, and my endo is saying to leave it at home because my numbers haven't been that high.

Any recommendations for food options? I bought a pack of next mile meals which are Keto. Im going to also bring along a decent amount of peanuts (a good steady carb for me)

Would love input, wisdom, and advice from all you T1's

 

[Ram94]

Im a brand new diagnosed T1, they think I'm still in a honeymoon phase. My A1C went from 9.5 when I found out and after 3 months I got it to 6.5. Im going to the idaho Pioneer zone for archery elk and Im pretty freaked out to do it due to the complications that Im aware of now. (I hunted fine without knowing, ignorance is bliss!)

Im currently only on 5 units of Lantus at night, and my endo is saying to leave it at home because my numbers haven't been that high.

Any recommendations for food options? I bought a pack of next mile meals which are Keto. Im going to also bring along a decent amount of peanuts (a good steady carb for me)

Would love input, wisdom, and advice from all you T1's

If you’re going the low carb route, make sure you have been accustomed to it for a few weeks prior to your hunt or you may run into a severe lack of energy until your body is used to running that way.

I brought:
Good Fat Bars
Moon cheese
Mixed nuts with extra dark chocolate
Bacon jerky
Next mile meals
Ketosys protein powder shakes for breakfast

This worked well for me however I did also bring along cliff bars to satisfy any low blood sugars. Good luck!

 

[hoff1ck]

Great thread. Nice to see other guys getting after it too. Being T1D changes things, but it's definitely not a crutch. For those interested, do some reading on Loop. Essentially a DIY artificial pancreas. Works wonders, not sure what I would do without it now. Takes some time to tweak things, but also takes a lot of the thinking out when it comes to exercising and staying in range.

 

[Broken Compass]

I too have had type 1 for about 12 years. Diagnosed when I was around 23.
I hunt solo in the backcountry often but have never gone more than 3 days at a time.
I’ll admit I don’t do a great job of managing it, but with the technology these days it is far better than it was. Using a Dexcom g6 cgm, I only take with me the flex pens of the two insulin’s and some needles. I eat fruit snacks to raise sugars. And like others have said, only require about 50 percent of my normal dosage.


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[dr.derek]

I too have had type 1 for about 12 years. Diagnosed when I was around 23.
I hunt solo in the backcountry often but have never gone more than 3 days at a time.
I’ll admit I don’t do a great job of managing it, but with the technology these days it is far better than it was. Using a Dexcom g6 cgm, I only take with me the flex pens of the two insulin’s and some needles. I eat fruit snacks to raise sugars. And like others have said, only require about 50 percent of my normal dosage.


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Whats your food look like on those trips??

 

[beauhunter]

Whats your food look like on those trips??

I was diagnosed with T1D 25 years ago but have only been backpacking for the past 3 years. Definitely still have a fair amount of kinks to work out but I am comfortable with my system. Most importantly, this is MY system and like others have said on this thread, everybody's body reacts differently. I use a pump with a CGM and that has really helped me keep things in control. A few things that I think would benefit any diabetic would be:
1. Constantly check your blood sugar. It's a pain when you have other things on your mind and I find I have to force myself to do this but it will benefit you for sure.
2. Glucagon should always be with you and if you're with a partner make sure they know how to use it.
3. Even when I am with someone else I always bring my InReach. I trust my hunting partner but he is not a medical professional and should something severe happen he would be able to get help to me.
4. Pack more food than you think you'll need. I always end up packing about twice as much food as I need but I do not want to have low blood sugar with no way to raise it.
5. Temperature management for your glucometer and insulin is important whether you're hunting in the heat or the cold.

That being said, for meals I typically just bring freeze dried meals. I tend to bring a lot of snacks with me though. I do bring a fair amount of high fat, low carb items but I also bring along a lot of simple sugar things as well. Some of my favorites are the Honey Stinger gels and waffles, but that is just personal preference. Cliff Bars or something similar work really well for me to not only raise my blood sugar but to sustain it also. This year I have been dehydrating fruit to bring along too. I typically bring enough of these items to account for 3 or 4 low sugars per day (above and beyond my normal meals). Probably overkill but that is my insurance policy and a weight penalty I am willing to take. I don't tend to worry a whole lot about my food as long as I know that I have plenty of items to raise my blood sugar.

As far as managing my blood sugar on backpack trips I try to keep it 150-200 to give myself a little buffer. I do reduce by basal rate by 50% while I'm hunting though. I haven't ever adjusted my insulin to carb ratio, but after reading this thread it is something I will discuss with my endo. This is just what I have done and it works for me, but definitely discuss these things with your endo. If you would like to get more in depth feel free to send me a pm to discuss it.

 

[hoff1ck]

Done other out of state trips in the past, but this will be my first backpacking trip out west this fall. Have been running 5k's or hiking 5-6 days a week, so I've used that to tweak my settings. Generally if I get myself to the 160ish range without insulin on board and eat about 10 grams prior, I stay pretty good for a while. Use those 4 carb glucose tabs from Walmart to keep me going as I need it.

Planning on staying pretty low carb for my breakfasts and lunches during the trip. Peak refuel meal for dinner where I don't have to worry about the extra insulin. Insulin on board always sends me into a plummet once I start any strenuous exercise. Also have settings through Loop where I can set an infinite temp basal/BG target, so I'm planning on using that with a slightly higher target BG and 60ish % of my normal needs (carb ratio, correction factor, basal, etc.). Mostly a set it and forget it type approach with that app now that I'm getting it dialed. Use an apple watch with my dexcom to keep from having to check my phone to see my BGs. So far, so good in testing but we'll see how it works in theory in about 2 weeks. Always interested in hearing what regimen/foods works for you guys on extended trips.

 

[whaack]

Adding some personal experience.

For background, I'm T1D on pump therapy. Been T1D for 25 years, well controlled with A1c's always under 6.5 and often hovering around 6. I used Omnipod therapy (which I absolutely love) after bing on Medtronic and TSlim for years.

Two years ago I went on my first backcountry DIY elk/archery hunt in CO. This was wilderness area and remote, steep country.

A few simple items you can do. I invested in a SPOT messenger which was very nice for my family. If I was purchasing something today I would get the InReach mini, you can do you research and find the option that works best for you, but having some form of emergency alert and communication is a requirement IMO.

Secondly, my BIL is a PA which was key for me. I think it would be a non-starter for me to go without someone who isn't at least fairly familiar with T1D and the symptoms of hypo.

My BIL is a great PA and very smart so he had a great baseline of treating hypos, etc, but I did a 30 min deep dive with him prior to leaving for our trip.

Logistics were easy. I put all my supplies in a dry-bag and then made up a small dry bag for my BIL to carry in his pack. This included back up Insulin, backup Ominpods and syringes and glucagon. In the event something happened to my kit, he would have backups.

As for dosages, as soon as we got the trailhead I cut my basal in 1/2. I normally am around 23 units of Humulaog over a 24 hour period, I took it down to 12.

Then I found that I often needed about 1/3 of my normal bolus amounts at meal times. This worked well for me over the course of a 7 day hunt. I checked my BS often (4-6x day). Another option would be if you have GCM (which I have used in the past) which would give you real time BS numbers as you are hiking which would be good.

I kept a small snack in my sleeping bag at night and always loaded up on food before hitting the trail in the morning.

Lastly, don't let anyone tell you that you can't/shouldn't do this style of hunt as a T1D. If my doctor discouraged me I would transfer to a new Dr. ASAP. This disease is fully manageable if you just educate yourself and prepare. I'm actually slightly offended for you that your dr. would discourage anyone from not going after it. Shame on him/her.

PM if anyone has questions, happy to share my experiences.

 

[whaack]

The excellent post above recommending letting blood sugars run a little higher I think is not bad advice in and of itself and should be safe. Just don't obtain this through withholding insulin, but rather by getting enough carbohydrates.

High blood sugars don't directly cause ketoacidosis, rather lack of insulin does. The elevated blood sugar may be an indirect sign that you are not getting enough insulin. To check yourself, take some urine strips along and monitor for ketones to see if you are not getting enough insulin or just eating carbs in excess of what you are burning. Urine ketones will be present typically before serum ketones become elevated, which are a signal of a real problem.

I believe there are some renal/kidney changes and acid-base changes that occur with large changes in altitude, and these are completely unrelated to diabetes. So for instance, if you notice significant urination while descending that seems in excess of fluid intake, but have normal blood sugars, then trust your blood sugars...because that diuresis is associated with fluid shifts in your body that aren't directly related to the diabetes.

This is good advice. Running your BS slightly higher than normal 150-190/200 is not going to kill you and will make it safer. I tend to run very low BS on average, but when hunting run higher.

My Dr. is constantly amazed at how low I can be and function fully. The other night for dinner we had a very low carb/low fat meal for dinner after working in the yard all afternoon. After dinner a bit I felt low, and new I was low for a while. I went and checked my BS and I was 26. Fully functioning, having coherent conversations with our company and made correction with some juice and peanut butter and went back to our company.

 

[dr.derek]

Just got back from my first 2 nighter. Learned a lot. Next mile meals are excellent, but I noticed I needed more carbs than I thought

 

[Ram94]

Just got back from my first 2 nighter. Learned a lot. Next mile meals are excellent, but I noticed I needed more carbs than I thought

They are awesome, just wish they shipped to Canada. Had to get a buddy from Oregon to ship them up to me. Beef Taco

 

[Jmort1754]

Animas pumps are no more.

Lots of information here.

 

[Ram94]

I just recently switched to a Dexcom G6 from a Freestyle Libre. The Libre worked well in the backcountry for me as the reader battery lasts nearly 1 month on a charge. I’m wondering if anyone has used the Dexcom on an extended trip (8-10 days) and what you do for charging either your phone or receiver? Or can you get by for extended periods by just turning the receiver off between checking bs?


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