Managing Your Blood Sugar on The Trail

For any diabetic that has been out on the trail, we know that low blood sugars are a real fear.

Elevation and steep climbs force our body to suck up sugar to keep us moving forward. So I am chatting today about a game plan that balances tips to do with our pumps or insulin shots and dive a bit into what gear to bring on the trail.

Avid T1D hiker, Larry Lam, looks out onto the horizon

Avid T1D hiker, Larry Lam, looks out onto the horizon

Did you know that you burn about 450 calories per hour while in the backcountry? That means eating a whole, extra-chunky PB&J sandwich each hour to keep up! Read more from the AMC

Diabetes management is a science with a whim of art form. I have spent each summer growing up along the rocky coast of Maine hiking along the Appalachian trail and summiting peaks like Katahdin. In fact, on the wall over my headboard is a panoramic shot of the sweeping stretches of forests and lakes you see from the summit of Katahdin, the end of the Appalachian trail.

The personal advice about hiking also comes from being an outdoor orientation leader for over four years and going on treks like the Te Aroroa trail in New Zealand.

So let’s begin.

Ask your endocrinologist for medical advice when adjusting insulin ratios. The information below is not medical advice, but is based on experience living with Type 1 Diabetes. 

Blood sugar management tips to do before leaving the house

1.     Before even hitting the trail, I set a temporary basal rate that reduces insulin for the day. For pen users, you may reduce the amount of long-lasting insulin like Lantus.

I set a temporary basal rate 2 hours before heading out and this usually is around breakfast. A good starting point for me is reducing the basal by 20-50%. The goal is to find a reduction in insulin that matches the intensity of the hike.

The "Carb Burn Rate" is the amount of carbohydrates needed to be consumed per (hour/lap/mile) to keep your blood sugar stable. In this example, 10 uncovered carbohydrates per lap keeps the blood sugar stable at 105 mg/dl. Note, notice how in lap 1 without uncovered carbs the BG points drop by 20 mg/dl.

You can experiment with the rate that works best to keep your blood sugar from plummeting down.

2.     What is your IOB? Or in other words, do you have “Insulin on Board”? Insulin stays active in our bodies for 3 hours. This means the blood sugars you are experiencing now are affected by insulin you took up to two or three hours beforehand. Many people try to reduce how much IOB they have before working out but this is not always possible.

Tip: In general, pump users can find their active insulin displayed on the home screen. Ask your endocrinologist to show you this at your next appointment if you cannot locate it. Or, send me a message ;) 

3.     Hydrate, hydrate, hydrate. All of us need to drink water while exercising. Diabetic hikers can receive false high-blood sugar readings (or hyperglycemia) when dehydrated. Think of your blood cells like grapes that shrivel up and concentrate the sugars in them without enough water. We do not want to turn into raisins!

How much water should I bring on the trail?

First, remember that most emergencies come from a lack of preparation. I tend to carry about 2 liters of water in Nalgene bottles or 3L in a camelback.

IOB: Insulin On Board. Displayed on the main screen of the Omnipod Personal Diabetes Manager (who came up with that awful name?) - aka the Omnipod black brick.

IOB: Insulin On Board. Displayed on the main screen of the Omnipod Personal Diabetes Manager (who came up with that awful name?) - aka the Omnipod black brick.

There are two camelbacks I use. One is for short runs and the other is for bigger hikes and long rides (small one; large one)

A camelback is one of my favorite outdoor pieces of gear. Why? You can easily carry 3L of water right on your back. The water sac slides into a separate compartment of the backpack and this feature eliminates the bulkiness that typically comes with a water bottle.

Do you sometimes find your water bottle still full at the end of the day, even though you are thirsty? We are so focused while hiking making sure not to slip on a rock or keeping an eye out for trail markers that time flies by. Suddenly, you are exhausted and dehydrated.

The camelback puts a water spout directly next to your mouth. You can sip on the go or stop for some big gulps. No dealing with awkward water twist-off caps or splashing yourself in the face from a Nalgene. We have all been there ;)

Having water purifying tabs are a good backup encase you become stranded. Iodine tablets are extremely popular and I have also used Chlorine drops while hiking. Water filters tend to be avoided by many hikers because of their bulkiness and vulnerability to breaking. Resiliency is everything.

Nutrition tips for a diabetic on the trail

  1. Eat a mixture of long-lasting energy sources to keep you fueled all day. You can burn up to 4,000 calories by hiking all day. Our bodies must replace these calories to keep going. Not sure what snacks to pack? Do not worry, the next article in this series dives deep into this topic.

  2. Figure out your carbohydrate burn rate. There may be a technical term but this is what I call it. The idea of the “carb burn rate” is to figure out how many carbohydrates you must consume in a certain time frame to maintain stable blood sugar levels.

For instance, runners may notice that for every 1 mile they must consume 5 carbohydrates. Therefore, their carbohydrate burn rate = 5 carbs per 1 mile. The distance can be changed for anything: laps, 30 minute segments, or even FitBit steps while hiking.

As an example, a hiker may figure out that for every 30 minutes of hiking they need to consume 25 carbohydrates. This helps you calculate how much food to bring while on the trail and at what rate to consume it. And do not forget, eat foods that give you energy throughout the day. Unless you are treating a low!

If you want some tips for your hiking notebook here are a few that have worked for me:

  • Cut back meal-time boluses by 20% if you are currently or about to exercise
  • Reduce your basal rate by 20-50% one to two hours before exercising
  • Calculate your carbohydrate burn rate
  • Pack snacks that keep you fueled for the day
  • Hydrate, hydrate, hydrate.