Diabetes in the Wild

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Submission By Morgan McGonagle

I was diagnosed with type 1 diabetes when I was 12 years old. As a very active and independent 12-year-old, this was not a convenient diagnosis. I wanted to be outside as much as possible at the time and was planning to attend a summer camp where I would be away from home for a month and would participate in hiking and backpacking trips that went deep into the backcountry. Managing diabetes gets slightly more complicated the further you get away from home, but it is something that I started to figure out as a teenager and am able to do quite successfully now that I am in my late 20s and working professionally in the mountains year-round.

When I started to do strenuous backcountry activities again after being diagnosed, I erred on the safe side and carried more sugary snacks than were probably necessary. I still sometimes do this especially if I think I’m going to really be pushing my limits. I think it is always comforting to get back to the car with a few extra snacks in your bag, knowing that you had them as backup if needed. The more experience I get living with diabetes and going on extended backcountry trips, the easier it feels packing my snack bag and feeling comfortable with the amount of food I am bringing.

Diabetes can be quite challenging to manage, and it is often hard to find people who can relate to your struggles. I did not know many diabetic folks growing up, nor do I have many in my current communities. It can feel overwhelming to have to explain the complexities of the disease with others and can feel like a burden to have to ask your mountain partners to stop and take a break when your blood sugar is low. More often than not, my mountain partners also need some sugar when I do.

In terms of managing my blood sugar during my mountaineering trips, there a few tips and tricks that have worked for me throughout the years. A lot of what I carry with me is dependent on how long I am going to be exercising for the day and how strenuous the activity I am doing is. What has worked for me might work well for another type 1 diabetic, and they might need to do some adjusting as they learn more about how their own blood sugar fluctuates throughout the day while active and in harsh environments.

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Packing for Denali

I have used a few different methods of treatment for type 1 since I was diagnosed 15 years ago, but I currently use a T-slim pump and Dexcom g6 continuous glucose monitor. The pump and continuous glucose monitor have really improved tracking and regulating my sugars and make it easy for me to proactively treat low blood sugars. This is not to say that this is necessarily the best and most functional system, especially for long trips at higher elevations, and I do always carry a backup option to my pump.

If I am going on a full-day trip, whether it is mountaineering, hiking, skiing, or biking, this is a non-exhaustive list of what I’ll have in my pack:

  • 4-5 quick-sugar snacks – Each of these contains at least 15 carbohydrates (sugars), is “quick” acting, so a liquid or gummy, and can be eaten when my blood sugar is dropping or is already low. I like to use energy gels, Honey Stinger chews, or (my personal favorite) pure maple syrup packets! Some of these have caffeine in them so I try to pick the simplest ones that don’t. These are fairly lightweight and also tasty, which is a plus. Other quick-sugar snacks that I mix in include dried fruit, applesauce, and gummy candy like sour patch kids or Scandinavian swimmers from Trader Joes.
  • A few (2-3) slower-acting carb snacks – This can be your typical grain-filled energy bar of your choosing and should have somewhere between 15 and 30 grams of carbs in them. This could also just be a PB&J sandwich or a bag of pretzels! The key is to bring a range of things you like to eat even when you might not be that hungry. I like to bring some sweet and some savory options.
  • Lower-carb snacks – I like to bring some snacks that have under 10 carbs that I can eat when I’m hungry and my blood sugar might be higher or I don’t want to have to worry about giving myself insulin. Some options include cheese, sliced meat or jerky, nuts and seeds, some veggies like carrots, peppers, or cucumbers.
  • Extra/emergency pump supplies:
    • Glucagon
    • Extra infusion set – on day trips I will bring at least one extra infusion set in case I somehow rip mine off and need to replace it. I don’t typically bring more than one unless I am going on a multiple day trip and I will need to change my infusion set and pump cartridge.
    • Alternative insulin option – I will carry long-acting insulin in the form of an insulin pen with a few needles, or an insulin vial with syringes. I will also bring my short-acting insulin with syringes in case of pump failure. If I am going to be traveling at high altitudes (above say 14,000) and/or at extreme temperatures (below 0°C) I make sure to have some way to insulate my extra insulin like between down layers or in a small vacuum flask.
    • I only bring extra Dexcom sensors if I know that my sensor is going to expire within the time that I am doing whatever activity it is I am doing. If it is going to expire that day, I will typically change my sensor a bit early, so that I don’t have to carry the bulky sensor applicator with me on my hike. I also will usually carry a glucometer if I am on a multi-day trip or going far into the backcountry.
    • If I am going on an overnight trip, I will usually carry a battery/charging block and a cord to charge my pump with. This is a great thing to have on hand in case of an emergency or if I didn’t check to see how much battery I had on my pump before I left. It can also be used to charge a phone, especially if you’re using your phone to check your blood sugar and as a navigational device!

I personally benefit a lot from sharing my experience as a type 1 diabetic and am always looking for advice on how I could better manage my diabetes. It took me almost 10 years to realize that the system I was using to manage my diabetes was not working for me, but I didn’t really know any better, nor did I have much to compare it to. I hope this blog post can be a resource for diabetic folks in the outdoor community, or for those who have family and friends who are living with diabetes. This disease can take up a lot of mental space, can be time consuming, frustrating, and expensive, but it definitely does not have to prevent someone from doing the things they love.

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Syrup Break at 19,000 ft

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