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Diabetes in the wilderness - backpacking:cs.unc.edu:"The rule of thumb for backpacking with diabetes is the same rule of thumb anyone should use: be prepared (it works for Boy Scouts!). You have to assume that things can and will go wrong and then try to plan for them. Major things to think about (I will try to briefly address) are your response to the trip, heat/cold, water, cleanliness, and the much feared SNAFU (getting lost or worse). Your response is the hardest thing to predict. You will likely become more sensitive to your insulin and need a decreased basal/bolus due to the activity. Altitude may diminish or increase your response (I seem to need more insulin for the first 3 days above 5000 feet) to insulin. People sometimes have infusion set problems because of extra motion/friction as well as additional sweat. The best way to know (as suggested by Bob?) is to do a mini-trip before you are a four hour hike away from anything. Oh, as noted last week, watch out for air bubbles"
http://www.cs.unc.edu/~ackerman/diabetes/wilderness.html

Diabetics leading healthy and adventurous lives:idea2000:"Welcome to IDEA 2000 - an international group of people with insulin dependent diabetes committed to leading healthy and adventurous lives and helping diabetics in need. Please follow our links to access pages that describe our Aconcagua Project; Who We Are and How to Join Us; inspiring Adventures and where to find us sharing our stories; information on Diabetes and Altitude and other interesting diabetes related Information; and about IDEA 2000 In the News around the world."
http://www.idea2000.org/

Information on strenuous hiking (overnight backpacking) and diabetic meal planning and precautions :childrenwithdiabetes:"In general, one needs to be able to regulate exercise according to the environment. In your case, it is the effect of high altitude on physical performance. Maximal oxygen consumption begins to deteriorate at an altitude of approximately 5,000 feet with pulmonary diffusion being the major limiting factor. As the partial pressure of oxygen decreases with altitude, the driving force of oxygen from the environment to the pulmonary circulation is impaired. In simple terms: The force of gravity is reduced as one goes away from the surface of the earth, and consequently less oxygen is brought into the lungs with each breath"
http://www.childrenwithdiabetes.com/dteam/1997-07/d_0d_1yl.htm

Backcountry Menus For Diabetics:backpacker:"Diabetics eager to log serious backwoods miles better plan a special menu, right? Not necessarily. "With proper education and within the context of healthy eating, a person with diabetes can eat anything a nondiabetic eats," says Karen Chalmers, R.D., M.S., C.D.E., Director of Nutrition Services at Joslin Diabetes Center in Boston. That means that the same carbohydrate/protein/fat percentages that apply to the general population of hardworking backpackers also apply to diabetic hikers. Maintain those ratios in the 50:20:30 to 60:20:20 range and you or your partner should get the energy you need. End of story? Not quite."
http://www.backpacker.com/technique/article/0,1026,2023,00.html

Backpacking and basal adjustments:insulin-pumpers:"I seems that a basal rate of 25-50% of your normal rate works pretty well. For extremely tough sections you may want to suspend the pump. You will have to experiment to figure out the "right" setting for you. Lower your basal rate 30 minutes BEFORE starting your hike. After finishing the hike return your basal rates to normal and check your blood sugar 30-60 minutes after. For me, my blood sugar rises, so I need to bolus a couple of units to correct. Another approach would be to return your basal rates about 30 minutes BEFORE ending the hike if you can calculate that easily. Carry glucose tabs, gel, glucagon, and snacks while hiking. Check your blood sugars often (1-2 hours) while hiking"
http://insulin-pumpers.org/faq/backpacking.html

Hiking -- It's A Terrific Exercise:diabetic-lifestyle:"Now you have a place in mind, the length of the hike, your stopping points, camp site, gear, hiking companions, and you're ready to go. Not just yet. Remember you have diabetes and you must take care beforehand so that your trip is not ruined. First, read the article in this issue on foot care. You will need very comfortable hiking boots or shoes that you have broken in before the hike. Make sure your hiking companions(s) know that you have diabetes and are alerted to the signs of hypoglycemia. Carry carbohydrate snacks to counter this condition. Make sure you have sun screen and that you dress according to the weather. For example, if it is quite hot, a wet scarf around your head, under your hat, will help cool you off. Remember to stop for water and to drink often to avoid dehydration. Talk to your health care team about any items they think you'll need, and get suggestions on the length and pace of your hike. Make sure you do stretches before starting out, and don't overdo. If you start slowly and realize the benefits from hiking -- the beauty, tranquility, comradeship, and the just plain great air out there, soon you'll be starting your own hiking group and planning for more difficult and rewarding walks into the great outdoors. Have a great hike!"
http://www.diabetic-lifestyle.com/articles/jun98_burni_1.htm

WHY I EXERCISE (AND WHY YOU SHOULD TOO):nfb.org:"I went through childhood, adolescence, and early adulthood without the benefit of a blood glucose meter. I still participated in a variety of sports and physical activities “pre-meter,” including swimming, running, racquetball, soccer, tennis, weight training, gymnastics, volleyball, cycling, aerobics, dancing, stair master, hiking and backpacking, canoeing, football equipment managing, snow shoeing, cross country and downhill skiing, horseback riding, sailing, snorkeling, and sky diving. I did many of these activities, however, feeling less than my physical best. Since I could not test my blood sugars, tightly managing them to prevent highs and lows was virtually impossible. Growing up I always experienced that exercise of any kind made me feel better overall, although at the time I did not understand human physiology well enough to know why. I felt I had more control over my diabetes when I exercised as well. Consequently, I began exercising regularly on my own and through participation in sports as a young teen-ager and have continued this participation (albeit recreational only at this point) throughout my adulthood."
http://www.nfb.org/vod/vodfal0101.htm

Have Diabetes, Will Travel:backpacker.com:"It's been in the headlines a lot lately: Diabetes is on the rise in the United States, with the number of people diagnosed increasing nearly 40 percent over the past 10 years. While it is a serious condition, diabetes isn't reason to avoid the wilderness, as long as you know how to monitor and treat it. Practice on overnight and weekend trips before undertaking longer treks. Changes in physical activity, eating patterns, and climate affect how much insulin a diabetic needs, and how often. By starting slowly, he or she can accommodate the new requirements."
http://www.backpacker.com/destinations/article/0,3772,2004,00.html

Dale Obbie wants to climb the Adirondacks with his dad - and he won't let a "wretched disease" stop him:adirondackexplorer.com:"Dale has Type 1 (juvenile) diabetes. He's had it since he was 10. Unlike the more common Type 2 (adult-onset) diabetes, the cause of Type 1 has nothing to do with a person's physical fitness or bad diet. It's an autoimmune disease that robs a child of his ability to produce insulin, forever. Without insulin, our bodies can't process the carbohydrates and simple sugars that we need to survive, and we can eventually go into a coma and die. Too much insulin can have a similar outcome, particularly when there's a lack of food or excess of exercise. Think of the light head and queasiness you get with severe hunger, and multiply that by 10--that's what being very low feels like. Managing Type 1 diabetes is a constant balance of injected insulin, food and exercise."
http://www.adirondackexplorer.com/jan2002triumph.html



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Last updated by Andrew Lopez, RN on Wednesday, September 29, 2010


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