Hiking with insulin pump

Hi Y'all...

First backpacking trip I'm going on in I don't know how long! I am doing an 18 mile out and back hike with my son's Scout pack next weekend (17th-19th). One of the boys recently had an insulin pump implanted (2 weeks ago). AFAIK this will be his first major outing since the surgery. His mom says he is getting the hang of the pump and is doing well with it, but I know there is and can be a big difference when you're exercising. I know a couple people here have pumps... do you snack more or less constantly while hiking, or what do you do to keep your Bgl within a safe range? Also, how much extra insulin do you use? I have no experience in this area.

Thanks!!

MNS

MNS:

I'll jump in since I've got one on as I type. The pump, a Medtronic that I have, isn't implanted. It is worn with a clip on your belt. It has the insulin in a vial and all the electronic stuff that makes it work; it's smaller than a cellphone. It is attached by a thin hose to the infusion piece (a tiny insertion device), and that is what has the "cannula," what is a little tube that goes into you less than a half-inch and that is "implanted" by the user and replaced once a week or so with a new one, usually on the opposite side above the hip.

I surprisingly work with two other Type 1 diabetics and we all have the same pump and with it, the same problems. Does this Scout you're going with on the hike have a Medtronic? (It's a nice $10K toy.) My understanding is all the pumps sold in the US right now are the same basic type. Since I started using it 2 years ago, I've had some recurring, but not insurmontable problems while hiking:

Biggest problem when out backpacking, or even car camping/day hiking is that the infusion set/insertion device that is attached to your skin and delivers the insulin into you with the cannula works loose in strenuous exercise. (The pump is just fine clipped to the waist-belt of your shorts, although I've hiked with the pump in a sewn-in-pocket in a polyester t-shirt that has worked well, too.)

The problem with the cannula that is sticking into you is that it can work loose or be jarred loose. So it's important that it not be anywhere near the hip belt of a heavy pack, and that's solved by placing it on your side high enough above the padded belt.

The most important thing is to have back-up infusion sets in case it works loose, along with a vial of insulin to refill the pump's vial. And I ALWAYS take insulin pens if I can't get the cannula to stay on/in or if the pump should fail (it did on me at home last winter, sending me to the emergency room and ICU for two days, SIMPLY because I hadn't realized the pump was not delivering insulin. My situation could easily have been avoided.

I don't alter my basal delivery during hikes, basal being the set amount of insulin delivered by the pump every hour. I do make sure I'm eating a Clif or Lara bar at breaks, since I am burning a lot more calories on a good hike. And to make sure I'm keeping my blood sugar in a "safe" range, I test my blood glucose often with the always-needed, ever-present blood glucose monitor, especially at meal times. It's hard to keep up the food intake on longer hikes, so you do adjust by taking less insulin at mealtimes (the insulin taken at mealtimes is the "bolus.") This scout should have been testing often before he got his pump -- and should continue with it on, since that is what tells him how he's doing and where his blood glucose is at.

On the inaugural trip, I'd just make sure the adults tagging along are aware, and to keep an eye on him. He'll get comfortable with it, know how to protect that expensive toy (but it's so much more than a toy), and especially to make sure the cannula is staying on or needs to be replaced. A 3-day bp is a great start for this and all should go well, and he should come home with an even greater sense of independence.

Thanks, Kevon! Very helpful! I know the pathophysiology of diabetes, but nothing about the new technology to manage it. It is a little nervewracking, but his mom is supportive of the trip so evidently she feels that he is able to monitor himself appropriately, and that we adults will keep an eye on him for any behavior changes.

Glad you made it safely out of the ICU... what a scare that must have been!

MNS

MNS:

If his mom's not going, and you don't have a type 1 adult on the hike, with your background it sure looks like u might be the point-person on keeping an eye on him. I'm certainly no expert, just one (a diabetic), so feel free to ask me any more questions on this.

I don't know beans about diabetes or the technology supporting it victims (Thank God!), but this thread precisely demonstrates why I cherish this site so much......

My main hiking/camping buddy has worn a pump like Kevon's for at least 10 years. We used to race bicycles together and he wore it then too. The thing works great but like anything, monitoring blood sugar is key, which he does often. I only remember one problem when hiking on a big hot climb....a apple fixed him right up and off we went.

I've had a Medtronics pump for 5 years now but unlike Kevon, I put the infusion sites in my stomach a couple of inches from my belly button. Sometimes they do work themselves off but I have had them stick so good that it felt like it took 5 layers of skin with it when I had to change it out.

If the boy's sugars drop too low one of the best things to give him would be a couple of Jolly Rancher hard candies. They usually bring them right back up and taste a lot better than those glucose packs.

I've never been hiking with him, but I worked alongside a man for two years who had one. We did strenuous work, outdoors, climbing, crawling, lifting, etc.

He had to keep a check on his blood sugar, although less than if he'd had no pump. I always made sure to have crackers or something around so if he started to get wonky on me I could help him get it back under control. I also made darn sure he ate lunch as close to the same time as possible every day. He could outwork most people, and he'd go too far if we let him. He's a truly amazing guy, because not only did he have an insulin pump and work a physical job, but he did so with a prosthetic leg -- his left leg was amputated at the knee after an auto accident several years ago. He's also active in scouts, and goes on hiking trips with them.

So I know it can be done. I don't have any further information, though.

ETA: Thought of something else. He was more likely to have blood sugar problems in heat than in cold. And I'm not sure how dehydration played into it; I know we were all dehydrated most of the time, despite drinking a lot of water. 'Tis the nature of the beast. So I'd suggest making sure your scout is hydrated. Matter of fact, all of them need to remember it. If they don't have to go to the bathroom, they're not drinking enough.

Highs and lows in your blood glucose messes with your electrolyte balance and when you loose these electrolytes through sweating it compounds the imbalance even further. I would take along some of the powdered Gatoraide singles to help put some of the electrolytes back into his system.

I agree completely. The expertise on these boards, and the willingness to share, is a continual delight.

After the OP's concerns are answered, it seems to me this topic begs the question of what you should do if you come across a diabetic in trouble on trail. Because of what I used to do for a living, and the boy scout training, I have taken first aid close to 20 times (along with CPR, and a whole host of other classes annually) and do not remember diabetic's and their associated problems mentioned once. Granted, I have not taken a class in 10 years. Is this topic being included in first aid now? How about wilderness FA?

Thanks everyone for the great information! I will be sure to meet with mom and scout before we leave, find out what his plan is and what his back-up plan is. I will make sure to pack in some electrolyte mix (I have Emergen-C) because even though it is unlikely to be hot (We're in Alaska), we all may sweat more than we'd expect.

I have learned about diabetes in my wilderness first aid and WFR classes years ago... we were told to carry a tube of icing or a tube of honey because both can be squeezed into a mouth and do not require swallowing to be absorbed. I don't remember if it was "standard" curricula or if it was added by the instructor.

Any change in behavior (somnolent, confused, or agitated) can be a blood sugar problem, even if the person doesn't have diabetes. If there is no reason to suspect a head injury, the next easy thing to check is sugar/electrolyte. Heat can cause similar symptoms so you just go through a mental list of the things that might cause a behavior change... it is either going to be chemical in one way or another (toxin, sugar, electrolyte), thermal or electrical (which would generally be unconscious as the form of altered mentation).

MNS

MNS:

Interesting that u'll be packing some Emergen-C -- I've been having some hand cramping and was told to increase my electrolyte intake, so I was also told to drink a powdered-mix with water of something called Ultima Replenisher, a zero-sugar supplement that's vegan and gluten-free. It does seem to be helping.

It sounds like you've got your bases covered. I think you're last paragraph -- any change in behavior -- is the key.

Please let us know how the trip goes. Sure it will be fun.

We used to carry a tube of glucose paste on the ambulance 10 years ago to do just what the tube of honey or frosting is doing. Hard to choke on, just apply between the gum and teeth along the lower jaw.

Great questions and answers. I'm going to be in midnightsun's position soon... and this helps if I run into this problem.

Kevon, where do you find the Ultima Replenisher? I am constantly battling electrolyte issues because of my celiac (best guess is that I did too much damage to my gut even though I've been GF for 10 years now, but I HAVE to supplement my electrolytes or I get totally out of whack for no OBVIOUS reason).

Thanks again for all the info!!! I feel a ton better, though I'm still a little nervous. Won't let it show though

MNS

Met with mom last night. Sounds like they have a good plan, just need to make sure he is eating regularly and checking his sugars often and I think we will be alright. Will be carrying glucagon "just in case." It will certainly make this outing interesting, but good for him for going and learning what he is capable of.

I will report back when we get home! Thanks again for all the information!

MNS

MNS:

Check at ultimareplenisher.com for stores. I get it at Whole Foods (where I work.) It seems to be helping. They make packets with sugar and without.

My kid did GREAT, no problems with his sugars, no concerns at all on that side of things. The problem that DID present itself was that his port site was directly under his waist belt and to wearing it bothered him considerably. After we lightened his load he was able to use it some, but still somewhat annoyed. He was able to add back some of the weight on the hike back out today. He was not at all into the trip at first, but once we helped with his load he ended up having a VERY successful trip. I think he will benefit from the lightweight backpacking lessons I hope to be passing on to these boys if/when I move back to AK.

Thanks again for all the info, it really made for a much better trip!

MNS!!!!

Glad to hear it went well. Each trip he'll get better at preparing. When he hikes next, he needs to locate the cannula nowhere near where his hip belt will be prior to the trip and that problem's solved.