Got a hiking trek planned? Or ever dream of doing something similar, but worried about your diabetes management while out on the trail? Today, we've got some great tips for you -- directly from a type 1 making a grueling 550-mile trek across Spain even as you read this.
These tips are presented by Jenny Martinez, Project Coordinator for the Diabetes and Travel research initiative
at William Sansum Diabetes Center (WSDC) in Santa Barbara, CA. Jenny's been following along closely with hiker Jeanie Seashore, who has lived with type 1 diabetes for 20 years and regularly participates in research trials at the Center. For more on the WSDC Diabetes and Travel initiative, read below. But first, let's hear what Jenny reports on Jeanie's learnings re: glucose control while trekking...
A Guest Post by Jenny Martinez
Jeanie Seashore is a remarkable woman with type 1 diabetes who is taking on the 550-mile Camino de Santiago trek across Spain in order to commemorate 20 years of healthy diabetes management. An avid hiker and outdoor enthusiast, this is Jeanie's first multi-week expedition.
Supported by the William Sansum Diabetes Center of Santa Barbara, as well as Dexcom (through their Dexcom Warriors program), this trip has been years in the making. Jeanie is currently over 200 miles into her journey, and has been learning how to adapt to her body's needs on a daily basis throughout this extensive trek. The following techniques represent personal strategies she has used to meet the varied demands of type 1 diabetes and keep optimal control through the physical and mental demands of each day on the trail.
1. Adjusting overnight basal settings
Prolonged periods of exercise are known to reduce blood glucose levels as well as insulin requirements. Starting a few days into her Camino de Santiago trek, Jeanie reduced her overnight settings by up to a unit per hour, a drastic change for someone who generally tends towards lower basal settings to begin with. After another week on the trail, further (and more minor) reductions were made in Jeanie's overnight settings to account for her adapting needs.
2. Manage the breakfast bolus
Depending on the anticipated demands of the day, sometimes Jeanie will decide to skip her bolus insulin for breakfast. If her meal is solely composed of carbohydrates, then she is more likely to maintain her usual bolus routine. However, if the carbohydrates are accompanied by a fat or protein that will slow the effects of the carbs (such as a croissant with a slice of cheese, or nuts), then skipping the bolus and continuing with her walking for the day is often bringing her to a steady level in a desirable zone for the following hours. This is not textbook diabetes management!
It is important to note that Jeanie does not simply refrain from giving bolus insulin and then check her Dexcom an hour later. She is diligent to check her levels in approximately 15-minute intervals after making this decision to ensure that it is having the desired effect.
3. Bolus in increments
If Jeanie's levels are rising despite the continued exercise, then she will often give a partial bolus, instead of the complete dosage she would normally account for. Jeanie has experienced that it can be particularly difficult to get out of a low when on the trail, so instead of giving a full bolus and risking hypoglycemia due to the combination of insulin and exercise, she instead gives the bolus in smaller increments and then observes what her continued needs are. This way she doesn't have to fight her way back up from an inconvenient low! This strategy is possible through Jeanie's use of the Dexcom CGM system, which keeps her aware of her blood glucose levels on a continual basis.
4. Pay attention to stressful situations
As a general rule of thumb, exercise decreases insulin needs. However, Jeanie has found her levels going high on particularly straining days. After having this happen more than once, and correlating the pattern with the conditions and route of each day, it seems that abnormal exertion due to heat, steep inclines, or excessive mileage, has the opposite effect on her glucose levels than what would normally be anticipated. The stress of these factors can cause Jeanie to go high, and therefore need more insulin. This has been an incredible learning point, even after having had type 1 diabetes for 20 years.
5. Give your body the energy it needs!
With Jeanie's stress response in mind, we arrive at the topic of unexpected high glucose levels on the trail. While it can be very tempting to avoid eating when going high, this would be a serious mistake when putting in 20+ mile days in remote areas often exhibiting extreme environmental conditions. Your body needs energy! Giving a correction bolus of insulin would be one way to account for the high while also giving your body the energy it needs. As an alternative, there have been a few sections of the trail (such as a prolonged incline) where Jeanie has noticed her levels going high and responded by choosing to increase her basal rate for a temporary period of time. Although it requires high awareness of a situation, and close monitoring (again made possible thanks to the Dexcom system), it has worked wonderfully for Jeanie and is one more technique that she now has in her toolkit for good control.
Jeanie is working to inspire others with diabetes to live their lives to the fullest, and these techniques have helped her to do that while maintaining good control. She will be the first to say that it is not a perfect science and that there is a great deal of trial and error. Her patience has been tested but her persistence has won out and is leading to the discoveries of what her body needs while on this epic journey. Jeanie is teaming with the William Sansum Diabetes Center to promote their shared message that, with proper planning and foresight, no destination is off limits for travelers with diabetes! The Center is working to make this a reality through their recently released resource site, www.DiabetesTravel.org. If you are interested in following more of Jeanie's journey on the Camino de Santiago, you can do so at DiabetesandTravel.wordpress.com.
More on the WDSC Diabetes and Travel Initiative
David Kerr, WDSC's director of research and innovation, explains: "Our aim is to allow more people with type 1 diabetes to travel safely wherever they want to go in the world. To achieve this we need to better understand the impact of long-haul travel on an individual’s physiology and also on diabetes monitoring equipment and insulin delivery systems. We are collaborating with the T1D Exchange in our efforts to achieve this. Hopefully in the not-too-distant future we will have commercially available closed-loop systems for type 1 diabetes care – we need to make sure they work at 30, 000 feet and anywhere else in the world that a traveler with diabetes wishes to visit."
Specifically, the Sansum Center has:
- Launched #GuiltFreeSB – an initiative to get local eateries to serve healthier food, aimed at the half a million visitors coming to Santa Barbara each year with diabetes
- Launched the aforementioned DiabetesTravel.org site, that helps PWDs prepare for travel and even reset medication dosing times
- Recently published research examining the impact of extreme temperatures on the performance of blood glucose monitoring systems (Journal of Diabetes Science Technology, August 20th 2015).
- About to launch a survey of current approaches to long-haul travel with insulin in collaboration with the T1D Exchange
- Subject to funding, anticipating a study examining the effects of long-haul travel on type 1 diabetes using a cohort of 20 or so individuals
"Based on the above, we would subsequently like to test Artificial Pancreas systems across multiple time zones," Kerr says.
Excellent! Thank you to Jenny, Jeanie and Dr. Kerr for this important work, helping to once again illustrate NO LIMITS with diabetes!