My boyfriend Ryan has Type 1 Diabetes. Before we met, I didn’t know anything about Diabetes, but over the last five years of adventuring together, I’ve learned a lot. We hike, ski, and go backpacking together, and I’m continually inspired by his athletic abilities and the fact that he doesn’t let his diabetes hold him back. With that said, there are a number precautions we take, especially when we are off-the-grid, to make sure he avoids dangerously low (and high) blood sugar levels.
If you have Type 1 Diabetes or you know someone who does, in this blog post, I share some of the tips I’ve learned and steps Ryan takes in regards to his diabetes when we are out in the wilderness. My hope is that these tips give those of you with diabetes and your friends the confidence to go hiking and adventuring together.
*Disclaimer: I am not a doctor and this should not be taken as official medical advice. What I’m sharing is all based on personal experience and tips Ryan finds useful for hiking with diabetes. If you have specific questions regarding your diabetes, I recommend consulting your doctor.
1) Tell your hiking partners about your diabetes
First things first – make sure to tell the people you are hiking with that you have diabetes, what can happen (what low blood sugar looks like), and how they should respond.
The first time I ever saw Ryan with low blood sugar it was scary, but because I was warned, I knew to quickly get him some sugar. Without him educating me first, I would have had no idea what to do.
2) Test your blood sugar more frequently than you do at home
The easiest way to prevent scary lows when you’re on hikes is to test your blood sugar frequently. Blood sugar can change rapidly during and long after exercise. Sometimes Ryan will eat something that would normally cause his blood sugar to go up, but when his metabolism is in full drive, like on a steep hike, his blood sugars will run lower than he expects, sometimes crashing unexpectedly. When we first started dating, Ryan tested his blood sugar by pricking his finger. He would test before and after we ate, before and throughout big climbs, first thing in the morning, and always before we go to sleep at night.
If getting a continuous blood glucose monitor is an option, I highly recommend it. A few years back, Ryan got a Dexcom continuous blood glucose monitor, and that has been a total game changer. He pairs it with his Apple Watch and iPhone and can see his blood sugars at any instant simply by looking at his watch. He can also see the direction they are headed, and he can eat or take insulin preemptively. Not only has it helped him better manage his blood glucose levels, it’s given me as his hiking partner much greater peace of mind.
3) Carry extra snacks
On our backpacking trip it always seems like we are bringing way too much food and our packs are very heavy as a result. However, there have been times right before bed when Ryan tested a little low and needed to eat something. If we only brought exactly whaat we needed, we would have run out. Make sure to carry extra snacks for these types of scenarios and that your hiking partner also knows where the snacks are. If you are backpacking, this is even more important. We like to bring Gatorade powder or a sugary drink of some sort that would go down easily in case of an emergency. It’s also a good idea to bring We also recently picked up some of these glucose gels that would be easy for me to squirt in Ryan’s mouth in the case of an emergency.
When backpacking in bear country, it’s always tricky making food accessible at night. Typically Ryan will set an alert on his Dexcom for 80 and if it goes off, that gives him or I time to go out to the bear canister and get a snack. We make sure the quickest snack for him to ingest is readily available right at the top of bear canister so he doesn’t have to go digging around.
4) Drink lots of water & electrolytes
Ryan doesn’t get leg cramps all that often, but when he does they are very intense. One time we were in the North Cascades hiking down from Hidden Lake Lookout after watching the sunset, and all of a sudden Ryan’s quad started cramping up, almost to a debilitating point. Apart from abnormal blood sugar levels, leg cramps in diabetics can be due to dehydration and low potassium levels, which can happen when you sweat a lot.
We always use a CamelBak or similar hydration reservoir when we are hiking for easy drinking, but since that incident in the North Cascades, Ryan has also started taking electrolyte tablets or supplements to keep his potassium levels in balance when we are hiking. On our recent 4-day backpacking trip in Yosemite, he added NUUN Tablets to his water throughout the day. These come in a variety of different flavors, are low carb, and taste pretty good. I also like SaltStick tablets which have no sugar or sweeteners. These come in capsule form, and you just swallow them. I took these daily during my John Muir Trail hike, and I thought they helped a lot with my energy levels and recovery.
5) Avoid sodium packed backpacker meals
A lot of those just-add-water backpacking meals contain a sh*tload of sodium, and too much sodium before bed can contribute to dehydration and thus leg cramps. Unfortunately, it’s hard to find healthy, low-sodium backpacking meals, but there are a few out there (although many of them still have a ton of carbs). For pre-packaged, lower-sodium options, I’d recommend a brand called Good To-Go, which is available at REI or Amazon. For a full review of Good To-Go, check out this post.
Harmony House also makes an awesome kit of dehydrated ingredients, including veggies, beans, and meatless protein that you can use to make your own meals.
5) Make your own diabetes first aid kit
The store-bought first aid kits are a good place to start, but hiking with diabetes requires getting your first aid kit dialed to your specific needs. Here are a few of the things we carry in our first aid kit:
- Chewable aspirin: Research shows aspirin can help reduce clotting and possibly buy you some time in the extreme case of a heart attack. Chewable aspirin is digested more quickly than the kind you swallow, so it’s a good idea to put a few of these in your first aid kit as a just in case.
- Extra needles (or whatever you use to administer your insulin)
- Personal medications
- A couple of sugar packets or pieces of quickly digestible candy that your hiking partner can administer if necessary.
- Small bottle of saline solution and bandages: Streams carry bacteria, and since diabetics are more susceptible to infection, a safer way to clean out your wounds when you are hiking is to use saline solution.
- Blood glucose monitor and extra strips
- Hand-Sanitizer: before you test your blood sugar, you’ll want to rinse your hands and hand sanitize to make sure nothing on your skin is interfering with the results.
- Back-up insulin for overnight trips
- Glucagon pen – these are expensive, but it’s a really smart thing to bring in case of an emergency. Make sure your hiking partner knows how to use it, and if backpacking, sleep with it in your tent.
I can’t stress enough the need to bring extra insulin supplies. When we went packrafting on the Escalante River, Ryan had multiple pens fail due to sand getting in the plunging mechanism. The last 24 hours of the trip, he didn’t have any insulin pens that worked, and his blood sugars were through the roof. He felt very sick on the hike out, and if this had happened sooner in our trip, it could have turned into an emergency.
6) Keep your insulin cold
If you are going to be hiking in hot weather and your insulin requires refrigeration, check out the Frio Wallet. You submerge the insulated gel pouch in water, and then the pouch stays cold for up to 48 hours. Ryan used this when we went backpacking to Havasu Falls, and it worked perfectly. It also provides a nice cushioned layer to protect your insulin vials against breaking.
7) Carry a communication device
This past spring I got Garmin InReach – mostly for my solo travels, but it also gives me peace of mind when Ryan and I are out hiking together or traveling in our van without cell service. In addition to mapping features, it gives you the ability to send a custom text message or to send an SOS signal to emergency responders no matter where you are.
I also make sure to get the evacuation insurance so if we do need a rescue I won’t be out tens of thousands of dollars.
9) Wear a diabetic ID bracelet
Whether you hike solo or not is a personal decision. If you are diabetic and choose to hike alone, you should always wear a medical ID bracelet that states your condition and personal information. Ryan actually has the words “Type 1 Diabetic” tattooed in big letters on the inside of his wrist. That way, he doesn’t have to remember to put a bracelet on everyday, aand in the case of an emergency, a stranger or medical professional would know what’s going on.
10) Consider training a Diabetic Alert Dog
We have trained our dog Charlie to be a diabetic alert dog. This means he will alert Ryan when his blood sugar is high or low, based on the smell of Ryan’s breath, before it gets dangerous. Training a service dog requires a lot of work and diligence, and it’s also not foolproof, but for us it’s been worth it for the extra peace of mind when we are out hiking and camping.
You can buy a pre-trained diabetic alert dog, but it is very expensive ($15,000+!!!). This wasn’t something we could or were willing to pay for, so we trained Charlie ourselves with the help of a professional service dog trainer been training Charlie on our own, with the help of a professional service dog trainer.
If this is a topic people are interested in, let me know if the comments, and I can share more on this later.
11) Consider a Plant-Based Diet
Ryan and I transitioned to a plant-based diet in 2019, and Ryan’s A1Cs have dropped significantly since while reducing his insulin intake (despite eating more carbs). He has also been able to get off his Metformin and his cholesterol pills (the ones he was on were known to cause muscle craps), and his blood glucose levels are much more stable throughout the day. He still has some highs and lows, but he doesn’t experience the yo-yo-ing between high sugar spikes and low crashes like he used too, and he feels 1000x times better. There isn’t a ton of research on Type 1 Diabetes and a plant-based diet, but there is a wealth of information about the effects of a plant-based diet and Type 2 diabetes. Science has shown that a plant-based diet can increase insulin sensitivity and lower A1Cs over time. If this interests you, you can read a bit more about our plant-based journey here.