Diabetes Management and the PCT

Living Life Unconstrained

Living with type 1 diabetes (T1D) is all about making choices. When I was first diagnosed with T1D, I was 16 and already had a strong connection with nature and the outdoors. My doctors and family encouraged me to continue to live the life I wanted to live. I had to learn to be vigilant to maintain my blood glucose levels as many of my favorite activities are fairly strenuous. But with a little practice and a few hard lessons I quickly took control of my life again, going on adventures on my terms. I hope other people living with T1D and even people struggling with other issues realize that they too can make the choice to live life on their terms. 

Insulin Requirements on the Trail

I have backpacked enough to know that my insulin requirements on trail are much lower than in my normal daily life as a college student. This means that I often only need a fraction of how much insulin I would normally require for a meal or snack. However, I also know that in the middle of the night, around 3am my glucose levels will drop fairly significantly. To manage these different requirements I have several different insulin profiles on my Tandem T-slim X2 insulin pump.

Durable Medical Equipment

Because I use a Tandem T-slim X2 insulin pump I have several different insulin profiles, including one for backpacking. The Tandem X2 insulin pump also pairs with my Dexcom G6 continuous glucose monitor to prevent hypoglycemic events using Basal IQ technology. I have found that Basal IQ does a great job at preventing hypoglycemic events while I’m asleep. Additionally, my Dexcom G6 is set to notify me when my blood glucose levels are dropping faster than 3mg/dL/min to facilitate an appropriate response to prevent a hypoglycemic event. To charge these devices I will use a RAVPower 10,000 mAh portable battery bank. 

Food Consumption

To prevent hypoglycemic events I eat snacks regularly. Specifically, I eat snacks with low glycemic indexes to maintain steady glucose levels even while hiking over rigorous terrain. My decisions are strongly influenced by my Dexcom G6 CGM readings and trends. If my Dexcom trend shows one or two arrows down I will respond by eating food with high glycemic indexes such as skittles, jelly beans, or gummy bears.

A Normal Day on Trail

The day always begins the same way as it ends, by checking my Dexcom G6. Then I check the terrain I plan to hike until lunch. What elevation gain and loss should I expect? How many miles will I hike? These factors influence how many carbohydrates of my breakfast I will not give account for. I want my blood glucose to rise as steadily as my exercise brings it down. A few miles into the day, maybe 3 to 4, I check again and this is when I either correct hyperglycemia with some insulin or increase my blood glucose by consuming a low glycemic index snack, such as a protein bar.

At around half of my total mileage for that day I will find a nice place to take a siesta and lunch break. During this break I once again look at what elevation gain and loss, as well as what mileage I hope to achieve before deciding on how much insulin I should deliver for the carbohydrates I will consume. Then another 4-5 miles after lunch I check my blood glucose levels and decide if any compensation is required. Often I find that I need more carbohydrates to prevent a hyperglycemic event, this is often another protein bar.

Finally, once I have arrived at camp for the night I eat dinner, and deliver the appropriate amount of insulin for the amount of carbohydrates I’ve eaten. Before I slip into my cozy quilt I check my Dexcom G6 one last time and make sure that I will sleep through the night uninterrupted. In case I do have a hypoglycemic event during the middle of the night, I always keep a sports gel nearby in an odor proof bag. My Dexcom G6 will alert me, if I haven’t already awakened, and sugar will be readily available in a form that is easy to digest. Additionally, my backpacking partners are all aware of my needs and are willing and ready to help me reach my sugar should I need their help.

Resupplying 

On the trail I will carry insulin, pump reservoirs, insulin syringes, infusion sets, and Dexcom G6 sensors. Obviously, I will carry what I think I will need for each section of the trail plus some extras in the case of some delay such as injury, weather, or trail closures. I will have my diabetes supplies mailed to myself for general delivery at post offices along the way. Additionally, at grocery stores I will resupply plenty of carbohydrate rich snacks as well as hypoglycemia medication, candy! 

Backups

What if my insulin pump breaks? What if my Dexcom G6 sensor fails? These are both great pieces of medical technology, but I must be prepared in case they should fail in the middle of a 100 mile wilderness section. That is why I will carry my glucometer and test strips and a humalog insulin pen. If my pump does break, I will have to inject myself with humalog every 3 hrs to prevent the formation of ketones and keto acidosis.