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Glucose levels and mountains

phoenix

phoenix

Expert
Messages
5,671
Type of diabetes
Type 1
Treatment type
Pump
I've run marathons and walked hills but I find that I have to stop and take onboard glucose as I go along. I also think I'm often influenced by T2 posts and tend to try to keep 'normal glucose levels but in reality I can't function like a non diabetic and often end up too low.

Next week I'm going to embark on what think is my biggest challenge yet. It should take seven days to do this walk.There is no rush but each day has a lot of climb. I cannot control what I will eat at breakfast and dinner as that will depend on the fixed meal at gites.There won't be many shops to buy food in between stages.

Do I attempt to keep 'normal glucose levels all the time or deliberately aim for higher glucose levels to try to avoid too many hypos.
(ps I know my strategy at the moment but I want to know what others would suggest)
 

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Hi

Have family who live in the alps and often hike along the top of mountains. Find the altitude has big affects on my BG levels due to altitude (about 2400m) don't know how high your going?? I tend to aim high as weather can change in 5 mins from boiling hot to -10c even in middle of winter! Keep a good supply of high cocoa fat chocolate on you as this is better than gluco tabs as there slower acting and be selfish, your chocolate is your chocolate and there are no tesco's on top of a mountain? ( at least I haven't found any yet!! ) being prepared, as with any proper walking is the order of the day? Tend to find that the more prepared I am the more I enjoy the walk.

Hope this helps? I love being type 1 as close to heaven as I can get then climbing back down, to a cracking bar!!

Viva fellow climber!!
 
I'd solve the problem by throwing money at it: Aim for normal glucose and test every hour. Or rent or otherwise acquire a CGM for the trip.
I cannot control what I will eat at breakfast and dinner
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You can control when you eat it though - grab all the carbs (bread is easy but other things like pasta/rice/potatoes are possible if you bring a container) in the morning, and have appropriate amounts throughout the hike to get the extra glucose you said you needed (e.g. when you stop every hour to test BG)

Do I pass?
 
This is more of a hypo preventer or though could be used to treat as well and that is to carry some American Hard Gums on you and just suck one every so many minutes to keep bg levels from dropping too low........ But dont worry too much about trying to achieve perfect bg levels no matter what.
 
I would loosen my control somewhat to perhaps aiming to keep around 6.5-7.5 mmol/l whilst walking.. I would make sure that I have an adequate supply of fast acting carbohydrate (i.e. a tonne of dextrose!).. You probably have an idea from experience what mmol/l / hour glucose drop you can expect from the type of exercise? calculating therefore your hourly carb intake shouldn't be to difficult.. I would if possible take extra carbs from the meals to feed myself as I went.. if none are available then you have the dextrose. I would probably also carry a mixture of sugar free and sugar based liquid.. you can then alternate whilst you hydrate..

Other than that a CGM would be a nice bit of kit for piece of mind... or its the hourly testing... perhaps additional tests if you have particularly exerted yourself on certain points of the walk.

I am not sure on how much exercise that is daily? but you may need to take on additional insulin to help replenish glycogen stores?
 
My 15 mile walks have me reducing my longer acting by about 30 percent the evening before, the same morning and also the evening afterwards, then the morning dose of rapid will be halved - that will land me with a blood sugar around 7.5.

After a couple of hours, this will be back down in the 5 range and I will have to start testing 'often' or as I sometimes do, have 5g carb per 30 minutes.

I will pre-treat, but not overtreat, if I see my blood sugar below 5 on a day like that. At lunch personally, I will need 0 or 1 unit of insulin (I am Type 1.5 so I probably have some leaway) but certainly not my full dose - I will not low carb on these days. At dinner on a day like this, my insulin sensitivity will peak and I will often find I can take on board about 300 percent of my normal carbohydrates at evening meals or during the evening to avoid hypo's, even with minimal insulin (30-50 percent of my normal dose for a normal meal).

I would start out slightly higher, reduce long acting and halve the rapid doses for main meals.

But that's my body... Good luck, btw!
 
Personally I would go for slightly higher levels to avoid the inconvenience of hypo's, if walking all day I would reduce both my insulin's by 50%.

Good luck with the walk Phoenix and hope you reach the end without to many problems :)
 
Ive no idea but just wanted to wish you good luck for your trip :thumbup:
 
No Cgm (actually I hated the 2 weeks I wore one as I got a rash from the tegaderm keeping it in place so I wouldn't want it)
I was very positive about the walk until a few days ago. I love to walk places that have meaning, this is the supposed route that the Cathars would have used to excape France during the inquisition, its's also probably one of the routes that people used to escape France during WW2. But it's the hills that get me and this is all hills. Am I trying to do a walk that is beyond me because of my age, let alone my diabetes.?
The first backpacking trip after D, I ended up sitting in a ditch with a hypo , worrying my OH to death.
On the last one there were a couple of nights where I wasn't able to get out of the 3s for what seemed to be all night half way through.
It might be a bit easier now though, I haven't had nearly so many lows in the last year (Possibly lost a few more beta cells; it's been 7 years since I started insulin so I wouldn't be surprised)
I think that I'm going to cut my basal down to the lowest it will go and keep topping up. Last time I used chocolate covered apricots as a trail food (low GI). I can't get them as they came from the UK but I can get some dried apricots and nuts.
It's good to get the reassurance of other T1s that it's OK to eat more carbs. It's one thing knowing it intellectually, another in practice. I often get very stubborn about taking on glucose in the 5s and wait until I'm much lower before I do anything. (yes I may know some of the answers but don't always follow my own advice) Comments elsewhere also haven't helped.
Carby beakfasts are all I'll get anyway, good idea to take some with me, rather than eating half the amount of everyone else because I'm a diabetic' and then running out of steam by 10.
I think I ought to to print the thread out out to remind myself; it's OK, ,
And thank you Pneu for the reminder to stock up on dextrose. Not so easy here as the only place I know sells them is Decathlon and that's 80km away but I've got time.
I'm going at the end of next week. I've got to see my diabetologue on Thursday, heaven knows what she will say, she already thinks I'm this crazy Englishwoman!
Thanks again.
 
Not so easy here as the only place I know sells them is Decathlon and that's 80km away but I've got time.
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If there's nothing else you can get it from (ironically?) myprotein.com here. Apparently shipping is 2 days to France. Amazon sells Glucotabs.

Good luck.
 
Phoenix you probably are aware already but cutting your insulin whilst undertaking an endurance type event may not be the best way to go about it.. you may find after a couple of days that you aren't recovering or are quickly fatiguing..

One thing I found when I was walking 8k / day and biking 10-20K in the evening was that although cutting my insulin would maintain stable blood glucose it wouldn't help my muscles recover as they need the insulin to re-take in glucose.. in the end I ended up having to increase my carb in take by around 80g - 100g (most of this was fruit salad! my favourite had a massive bowl of it in the fridge!) / day to maintain that level of exercise and keep 'refreshed' for the next day.
 
Ooh interesting.... My friends live in "Cathar country" - south of Carcasonne! It's a lovely part of the world! I can recommend a good English B & B if you want :D
Enjoy your hike! I'm sure with good planning and lots of "plan b's" you will be fine!
 
One thing I found when I was walking 8k / day and biking 10-20K in the evening was that although cutting my insulin would maintain stable blood glucose it wouldn't help my muscles recover as they need the insulin to re-take in glucose.. in the end I ended up having to increase my carb in take by around 80g - 100g (most of this was fruit salad! my favourite had a massive bowl of it in the fridge!) / day to maintain that level of exercise and keep 'refreshed' for the next day.
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Well, thing is thought that exercise increases insulin sensitivity. Normally, people would adjust for that by reducing insulin secretion ["At [<60% VO2max], plasma glucose is constant during postabsorptive exercise and declines during postprandial exercise (and often in persons with diabetes). During such exercise, insulin secretion is inhibited by β-cell α-adrenergic receptor activation."], which obviously will not happen if you use fixed basal insulin or don't adjust your pump's basal rate. So, arguably, the closest to a healthy response you could get would be cutting the pump's basal rate.

So whilst extra carbs may help to restore glycogen stores, but I'm not sure about the advice to not reduce insulin.
Edit to add: How much carbs were you eating on exercise days?
 
Well I'm back and have survived. OH had a few scary moments though so wasn't perfect.
First decathlon had no dextrose, so was left with one packet. What they did have though was a gel made from raspberry puree and glucose. This was a fantastic find. I think it's probably a bit slow for a hypo caused by too much bolus insulin but is great for low levels caused by exercise. Each gel has about 9g carbs and because it's base is fruit puree they don't taste horribly sweet like the alternatives.
In 7 days though I ate a packet of dextrose, 6 gels, 3 'energy choc biscuits and a delightlful chocolate brownie with creme chantilly!
Lowest level in the week 2.5mmol/l highest recorded 8.5mmol/l. (obviously loads missed both ways)
What didn't work was lowering basal to 10%. I tried that on day 1, blood glucose didn't fall to hypo levels but I still ran out of energy, glucose levels started to rise,not high ,as I was keeping an eye on things so 8 mmol/l was the highest. Because I wasn't low I wasn't eating anything (unlike non diabetic OH) and I simply ran out of energy and then levels began to rise.
After kept basals at 50%, needed to keep glucose levels up with dextrose etc.

I haven't the faintest idea how someone on a low carb diet would manage this trip. Only once did I have anything other than bread and jam for breakfast, there was nothing else available....and that was one of the problems; I'd eat a tiny amount compared with everyone else and 2 hours later would be low; not so easy to secrete some for later when there is only you and your 'host'
I'm going to do a day to day blog about it but if anyone is going to visit Montsegur, can I recommend the gite d'etape Lou Sicret?
http://www.gite-montsegur.com/gite_mont ... aurant.htm
It was the only gite we used that had a dormitory, rather than separate rooms but had the most fantastic food, all 'home cooked' loads of home grown veg/leaves/flowers!, local goats cheese. duck, wild mushrooms, home made apple tarte, and for breakfast a piperade with eggs, peppers and lardons in addition to the bread and confitures.
 
phoenix said:
I haven't the faintest idea how someone on a low carb diet would manage this trip. Only once did I have anything other than bread and jam for breakfast, there was nothing else available....and that was one of the problems; I'd eat a tiny amount compared with everyone else and 2 hours later would be low; not so easy to secrete some for later when there is only you and your 'host'
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Glad to have you back!

Someone on a low-carb diet would be more efficient at burning fat and would therefore deplete their glycogen stores at a much lower rate.

You should take a listen to this:
http://livinlavidalowcarb.com/blog/tag/tim-noakes

The fact that the man that wrote the standard text on carbohydrate loading now says that carb-loading is bunkem should tell you something about the necessity of carbs for endurance exercise.
 
Stephen,
My point was actually that there is nothing else available. The normal French breakfast comprises tartines and milky coffee or chocolate. (sometimes the variant of brioche or a croissant )I'm not exactly enamoured with the idea of white bread and jam either but it was that or do without!
At the final gite.; before an uphill slog of 1000 metres of climb in 10km (and return), the breakfast available was packaged cereals and/or biscottes.
There is a very big difference in eating in hotels and eating in gites/chambre d'hotes where there is no choice; eat what's there or go hungry (and we only found 2 shops that were actually open in seven days)
 
phoenix said:
Stephen,
My point was actually that there is nothing else available. The normal French breakfast comprises tartines and milky coffee or chocolate. (sometimes the variant of brioche or a croissant )I'm not exactly enamoured with the idea of white bread and jam either but it was that or do without!
At the final gite.; before an uphill slog of 1000 metres of climb in 10km (and return), the breakfast available was packaged cereals and/or biscottes.
There is a very big difference in eating in hotels and eating in gites/chambre d'hotes where there is no choice; eat what's there or go hungry (and we only found 2 shops that were actually open in seven days)
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Oh I see. I agree. Believe me, it's a constant challenge in my life too... Off to India in a couple of weeks, not looking forward to being reliant on meat in a country of vegetarians.

How did the mountains compare to your marathons? Are you feeling ultra-fit after your exploits?
 
Someone on a low-carb diet wouldn't be more efficient at burning fat
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And this would magically stop their fixed basal insulin from working during high intensity exercise? Wow, that's impressive.
Again: Healthy people release less insulin during high intensity exercise. If you're healthy or T2 not on insulin then that's fine; otherwise the basal insulin that keeps your BG steady throughout the day will result in a massive fall in BG during high intensity exercise. It's not about muscles using fuel but about insulin in the blood stream pulling glucose into cells.

What's the point in giving advice only applicable to people not on insulin in the T1 forum in a thread by phoenix who is a T1 diabetic taking insulin?
 
AMBrennan said:
Someone on a low-carb diet wouldn't be more efficient at burning fat
Click to expand...
And this would magically stop their fixed basal insulin from working during high intensity exercise? Wow, that's impressive.
Again: Healthy people release less insulin during high intensity exercise. If you're healthy or T2 not on insulin then that's fine; otherwise the basal insulin that keeps your BG steady throughout the day will result in a massive fall in BG during high intensity exercise. It's not about muscles using fuel but about insulin in the blood stream pulling glucose into cells.

What's the point in giving advice only applicable to people not on insulin in the T1 forum in a thread by phoenix who is a T1 diabetic taking insulin?
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  1. aerobic exercise is by definition not high intensity.
  2. Exhaustion in all athletes - whether they are T1, T2, or non-diabetic depends ultimately on glycogen depletion.
  3. I thought that Phoenix was making the point that a low-carb diets weren't suitable for mountain walking (I was mistaken - see above). I thought that it was a general point and not related to T1. I'm an endurance runner too, and Phoenix's insight has helped me greatly with understanding how to manage my own BG levels during long runs.
  4. However, my point stands: low-carb is absolutely a valid strategy for T1 endurance athletes (although I appreciate it takes a lot of fine tuning):
    http://robbwolf.com/2011/11/18/sean-pal ... endurance/
    http://paleohacks.com/questions/126306/ ... z28w2aTWIZ
    http://asweetlife.org/feature/the-ketog ... n-insulin/
    http://www.tudiabetes.org/group/diabeti ... ice-please
  5. Am I advising anyone to do it? No. Is it possible? Yes.
  6. Do you have any personal experience of endurance athletics or any practical experience on sports nutrition? Thought not...
  7. Does the fact that you are getting all snotty about T2s posting on a T1 forum, mean that you won't be entertaining us with your insights in to the value of low-carbing and testing for T2 diabetics any more?
 
Great to see you back Phoenix safe and well :thumbup:
 
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