Walking on hills and mountains should hold few fears for well-managed Type 1 diabetics, but the growth in use of insulin pumps can add a new sense of freedom to those who love to walk in high places. I have been insulin dependent since early 1977 and have since spent 30 years living as normal a life as possible.
Born in England's glorious Lake District, a fell-walker's paradise, I visit there as often as I am able these days, to renew my love affair with its wonderful mountains. I walked there regularly when only equipped with a glass syringe and vial of rapid-acting insulin, and later with an insulin pen. Like many other diabetics, I also needed slow-acting insulin once a day to work in the background.
Walking was always manageable with suitable insulin management precautions, but lacked the feeling of freedom, even euphoria that hill walking always used to bring. The added responsibilities and liabilities were always uncomfortably close and even regular blood glucose testing and snacking sometimes failed to keep me at an optimum level, taking the joy out of a normally joyful pastime.
A few years ago I invested in an insulin pump. It felt like I had escaped from an invisible cell, finding new freedoms in almost every aspect of my life. Since becoming an insulin pumper, I have flown fixed wing aircraft and helicopters and my urge to walk in high places has a new momentum.
Planning a Day of Walking for a Diabetic
Planning a walking day in the hills must meet the same basic needs as those of non-diabetics. It is always sensible to start with a local weather forecast and additional predictions of temperature, wind speed, precipitation and visibility at higher levels.
Whether diabetes has affected my body's temperature control I do not know, but I seem more sensitive to cold than I used to be, so am keenly interested in temperature at altitude and wind-chill too. Temperature reduction as you gain altitude is known as 'lapse rate' and there are guidelines to help you work this out at the foot of the article. Wind chill is a bit more complex, so I have included a web link to the ‘Easysurf’ site’s very useful wind chill calculator.
Hiking Equipment
Although possibly self-evident, essential items should include a route plan plus a copy you should leave behind with a responsible custodian, map, compass, appropriate footwear, torch and whistle for summoning help if needed, rucksack, and spare clothing for cold and for wet as indicated by the forecast.
It always makes sense to carry a survival bag in normal conditions and a thermal sack in winter and enough food and drink to sustain you for the planned duration and a bit more. For diabetics this should include glucose in energy drink, liquid tube or tablet form and 'normal' food with known carbohydrate value. Carry plenty of other drinks, hot or cold as needed and you are almost ready. So what about insulin pumping?
Your Pump and BG Testing
Your pump should have sufficient insulin, be free of air bubbles, accessible with layered clothing and protected against very cold conditions. To use it effectively for an arduous walk, you need to set its 'temporary basal rate' function to a lower than everyday level, which is normally done by instructing it to use a lower percentage of your normal basal. I have always found it sensible to lower the rate before starting, not as an afterthought and to set the duration for the planned duration plus some contingency time for any delays that might be encountered.
When walking on hills in the Lake District, I find that a 50% basal rate reduction works well for me.
The other essential item is a well-stocked blood glucose testing kit and again accessibility will be important. Many hill walks start with tough ascents, then can ease off or level out as you walk the tops, so test frequently on the tough bits, say every half hour and let your experience guide you once you are on the gentler sections. I always carry an energy drink bottle, taking small but regular sips and this seems to work well for me.
Mealtime Insulin Boluses
When you have a meal stop, you will need to reduce your bolus from its normal level too and again I have found that halving the normal amount for a known quantity of carbohydrates works well for me.
Enjoy the Hills!
So why not take your insulin pump on a hill walk? Adapt these experiences and those of others to suit you, test your blood glucose regularly and keep notes to help plan future walks. Enjoy the freedom that insulin pumping can bring as you discover or relearn that not only is hill walking good for the body, it’s great for the soul too.
Notes on lapse rate and wind chill
Lapse rate suggests that temperature may fall by about 3.5 degrees Fahrenheit per thousand feet of ascent and by 6.5 degrees Celsius / Centigrade per thousand meters.
Try the wind-chill calculator at EasySurf.cc/cnver16.htm, a U.S. site packed with useful information and calculators.
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