Climbing instructor 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.
Thank you so much for sharing this article. I've recently completed a qualification in exercise for common health conditions (including Type 1 and 2 diabetes) so it's really useful to read how it actually works out on the crags.
Also wondered whether you'd tried a Mammut* Multipitch Chalk bag? Has pockets big enough to hold a phone and a couple of high sugar snacks. Would probably answer your needs on a 2 or 3 pitch route, though you might still need a small rucksack for longer routes.
* Other similar products may be available - I'm not sponsored by Mammut, honest!
Hopefully my friend Pete will be along to add his expertise too- he seems to have being a type 1 diabetic and climbing multi-day winter alpine routes dialled. His system involves a plastic pouch on cord worn around the neck, stuffed down his front to keep it warm.
He says that his body reacts differently to insulin once you've been on the move for more than 30 hours or so alpine climbing...
Have a look for some Articles by Jerry Gore he is a type 1 and climbs all over the world, summer winter and high altitude. I am not sure if he has done an article for winter but he would be the man to talk to. https://www.jerrygore.com
As folk have said, great to see this article up and ace to see you're planning with your partner for some winter climbing. I'm keeping my finger's crossed for an epic Scottish season this year too.
As another type 1 who does a bit of winter climbing, I can also wholeheartedly recommend Jerry's input on this matter. After discussing with him the challenges of it, he is certainly one of my inspirations! Although every type 1 will have certain quirks and personal twists to their condition, I find the following 3 part structure really useful for a long winter climbing day.
1) The most important factor (as Ailsa mentioned above) by far, is dose adjustment of your background insulin. You get a feel for how much you need for a big winter climbing day and will involve some personalised trial and error, but I usually go with 15-20% of a non-active day dose depending on the size of the walk in. Compared to 40-50% of a non-active day dose for a summer multipitch day.
2) The powerful combination of cold temperatures, physical exertion and mental stress all drain your body's blood glucose supplies, so it's imperative to be well fuelled and insulin dose adjusted. Getting to know which food supplies work best for your partner will take a bit of time and is a whole topic on it's own unfortunately! For me, I don't like to stop that much when winter climbing, so I load up with a big non-carbohydrate based breakfast to account for my natural morning glucose rise before setting out; then I just constantly graze over the course of the day at belays/gearing up points or any static moment to keep my blood glucose in the 'green zone' and to avoid hypos. Every time I pause for any reason, I try to test my BG too. As Ailsa said in the article, I try to avoid injecting fast acting insulin over the course of a day in winter. Too many layers to adjust in Scottish winter and too high a consequence for any kind of error.
3)Finally, in order to test regularly your meter needs to work! The modern CGM meters are a dream compared to the old finger pricking ones I used to use, but they are still vulnerable so take a back up one too. My CGM is linked to my phone which I have in a cycling bum bag (fully charged at start of the day and with small spare power pack in reserve) which I have orientated round the front, inside my outer shell jacket and mid layer. This houses all my diabetic essentials and keeps them warm and functioning.
I could probably discuss this for hours and is too complex for a small post but feel free to get in touch if you want to chat about it. Good luck for the winter and hope it helps!
Thanks for such a comprehensive reply, it will definitely be a great help. I think she'll be happy know there are others out there getting out in winter. Her main concern is insulin freezing but that can be mitigated by the bum bag you mentioned or plastic pouch round the neck I reckon. I'll give you a shout if she needs some more advice. Have a good one!
Do you mean a 15-20% reduction of background insulin or 15-20% of the normal dose? I always find my body less receptive to insulin in cold temps so tend to go with more than for the equivalent activity in summer.
What CGM system have you got running? I'm using xdrip with from a freestyle libre 1st gen, and while it is great most of the time, when sensor/bluetooth/ calibration errors happen it can be a bit of a nightmare.
Thanks for the feedback, and I mean 15-20% of the back ground insulin dose I would take on a non-active day. So instead of 8 or 9 units of Levemir background insulin first thing in the morning, I'd normally only take 1 or 2 for a winter climbing day. That's interesting to hear about your body's receptiveness to insulin in cold temperatures. I've not experienced that myself; but have largely been restricted to single day winter trips for quite a while so maybe could come into play a bit more if I had some more multi-day stuff. Will keep an eye on that for sure.
I use a freestyle libre 2 also and have it linked up to my phone as the main reader. Aye, as you say they are awesome most of the time but can let you down when need it most. Usually keep an old Abbot blood one in reserve and hope not to use it! What do you tend to use for fuel on your days out?
Interesting to hear about the insulin - do you normally take background twice a day and just reduce the morning dose? It seems like you are less reliant on background anyway as I take ~20 units/day on a non active day.
Yes about the temperature dependence - I've noticed the same thing in summer, that I need to reduce in warmer temps. Apparently its related to the rate at which your body absorbs the insulin, but honestly I'm not expert aha.
For fuelling days out, normally not so different than usual. Slow release carbs in the morning, glucose tablets in the pocket and cereal bars for breaks. Actually thanks to the CGM I found that haribo tend to shoot the blood sugar up a faster than glucose tabs so have been taking little packets of these out and it seems a bit better.