Climbing instructor and diabetic Ailsa Graham shares tips for managing diabetes in various climbing contexts...

I started climbing when I was nine years old. Ten years later I was diagnosed with insulin dependent diabetes. It was a very surreal time: in the few weeks building up to my hospitalisation, I had been in Canada finishing a ski season, then all of a sudden my mum was flying across the Atlantic to bring me back to the UK. I found myself in hospital being told by a cheerful junior doctor that I was diabetic. My resounding memory of that moment is the thought that I wasn't going to let diabetes stop me from doing anything.

To be fair, it hasn't really stopped me, but I was a little naïve at that point. I didn't realise how much of a constant burden diabetes would be, the way it never really leaves your mind, the fact that I am now tied forever to machines and injections, that I can't be with out my insulin or blood sugar monitor. I hadn't factored in the way you have to plan things to make sure you get the right amount of insulin or that unexpected exercise can cause rapid and unpleasant lows. Or the way food becomes a mathematical equation. Diabetes never goes away. And neither did my love of climbing.

Learning how to manage the diabetes in different climbing environments has taken a bit of time. Indoors, it's relatively simple — everything is near to hand, there are no walk-ins to worry about and dropping off a climb to check sugar levels is at most slightly annoying. But outdoors it becomes a whole new kettle of fish.

Here are some tips on managing diabetes outdoors, based on my experience of living and climbing with the condition.

Walk-ins

For some crags this is a quick hop across a car park and isn't even going to need to be considered, for others is a two-hour uphill slog carrying a heavy pack is very likely to have some effect on blood sugar levels. Walking can do a lot to blood sugar levels and everyone will approach this slightly differently. I drop my insulin if I know I'm having a big walk in and aim for lower carb food during the day to make up for not injecting as much. This tends to work and also helps protect against lows if I'm having a big mountain day. For shorter walk-ins it's less of an issue and I go for normal insulin throughout the day and maybe a snack if it looks like I'm going to go low.

Single-pitch crags and bouldering

Single-pitch covers such a wide range of environments; it can be roadside cragging or remote outcrops with long walk ins. Some places are hardly high enough to need to place much gear and you stay close to your stuff at all times, while other crags tower above you meaning that when you leave the ground you can be away from your bags for a longer period of time. Bouldering is generally more straightforward, of course, since you're unlikely to venture too far away from food and a meter.

I use a continuous glucose monitor (CGM) a small device fixed to the back of my arm that reads my sugars and sends them via Bluetooth to my phone, providing I'm within 6 metres of my phone to get readings. On short crags I often leave my phone and food at the bottom. As long as I have checked my sugars before I go and they are running stable I'm confident that my bloods will behave until I get back to the ground again. Climbing for me has minimal effect on my blood sugars and so for short climbs I don't worry too much.

That's not to say I haven't had a few scares. On one of my early trad climbs I got scared and was convinced my bloods were running low. But I was able to get my friend to check them for me and it turned out I was just getting shaky with nerves. Whether or not to take your blood sugar meter up with you is going to come down to personal choice and the climb you are about to commit to. The same goes for food. There is reassurance in having your stuff with you; you can check if you need to and when you get to the top you are not separated from your supplies. But you also have to carry it up there.

For some climbs this isn't too much of an issue. Shoving your phone/scanner in your pocket along with something sugary isn't going to make any difference to how you climb. Some climbs even have rest points you can check your sugars at if needed. But on others, particularly slabby, balancey things, having a phone scraping along the rock isn't what you want. On colder days I sometimes put stuff in my hood as that keeps it out of the way, but on hot days it can be hard to know where to put things, especially if you don't have pockets on your clothes.

For the most part single-pitch crags aren't too different to the indoor environment — sure there needs to be a bit of added thought as to how you are going to manage things, but mainly you can go out and enjoy your climbing, even if you do need to have a sugary snack hanging about in your hood as you go.

Multi-pitch crags

On smaller multi-pitch crags taking a similar approach to single-pitch works most of the time. Having previously got really low whilst seconding, I now make sure I take at least my phone and something sugary up with me whenever I'm doing a bigger route. I use a small running backpack just big enough for my phone and a few snacks. It is easy to carry and doesn't get in the way at all and means I have what I need to check my sugars and treat lows.

On big mountain routes things change. Firstly, it's likely that at least someone will be carrying a backpack; this gives room for a few options in terms of food and blood sugar meters. If you have a pack then there's only the normal decisions about what to bring, how much you want to carry up with you and what can be left behind. How arduous is the climb going to be? How quickly are you going to be climbing? All these things will play into food choices and like all things diabetes it's going to be down to how your body reacts to big climbs when it comes to choosing what you put in the bag.

When someone else is carrying the bag there is a decision to be made about whether you bring a small amount of stuff with you. I carry a small running pack just so I can keep my phone and a few snacks with me. I know I will have access to more stuff when I get to belay stances, so I try to keep as little as possible with me.

The type of climbing being done is also going to have a big impact. Long easier climbs involving more of a steady aerobic effort is much more likely to bring my blood sugars down than those where I am climbing at my limit and working anaerobically. All this plays into the decisions I make about what to take with me and what I need to have on me personally versus what can go in a backpack that might be changing hands throughout the day.

On big mountain days, getting down also has to be considered: is it a walk off or abseil? Walking is going to have bigger effects on blood sugars than abseiling will. So, making sure there is enough food for a low on the way down is important.

Top tips:

Know yourself: how do your bloods react to climbing? Is it different when you are pushing yourself compared to taking it easy? Do you typically stay steady? Go up? Go down? Play at an indoor wall and find out what you should expect of your body.

How long is it going to take for you and your partner to top out? Are you confident you'll make the top? How long can you go without food/ a blood sugar check? If in doubt carry food and a blood sugar meter.

Don't have pockets that can be used? Try a small running backpack, they are slim and don't tend to get in the way. (Unless you're in a chimney!)

On big mountain routes having food that doesn't require insulin can be helpful as that means no tentative injecting 150m off the ground!

If in any doubt I will tend to run my sugars a bit high. I have hypoed on climbs before and it's a horrendous feeling and I don't think anyone would appreciate if I belayed while low either.

When out in the mountains I treat anything below 5 as a low; this ensures I can catch a true low before it happens and keep myself and those I am with safe.

Climbing with a Diabetic?

Most of the time it's not going to be anything to worry about, but it's worth knowing how they monitor their blood sugars and what to look out for it they go low (Hypo). Make sure there is time in the day to check blood sugars and eat and be aware that there might need to be unscheduled stops. Also don't be surprised if they turn up with a kilo of sugar and insist on carrying it all with them!

The main thing I have learnt is that it takes a little practice but it's possible. I find that the idea of trying something new is normally worse than actually doing it and so far I've been OK. I like to be open with the people I'm out with so they know there is a chance I might have to stop and treat a low, and giving them the information about what is going on means that I'm less likely to ignore my blood sugars playing up. It can be hard sometimes and I do worry about what might happen if my bloods don't behave and I have to stop and the effect that might have on the day and anyone one I'm with, but if I have learnt anything it's that a little openness goes a long way and nothing is impossible!

Ailsa is a climbing instructor, coach, writer and diabetic. Visit her website and follow her on Instagram.