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.