Peaks and Valleys

Today was an absolutely gorgeous June day – bright, clear, low humidity, and warm. There was no way I was going to pass this day up for some kind of work around the house, so after a late breakfast we piled in the car and headed out for a hike.

I’ve been making an effort to get us out into the woods more regularly – at least once a week if the weather cooperates. We used to hike all the time as a family, but we’d slacked off the last couple of years – insert standard lame excuses here. But hiking is a really great prep when you get right down to it – it trains the body, it trains the mind, and most importantly, it bonds the family.

IMG_20150614_154223180The hike du jour was to the top of the highest peak in Connecticut, Bear Mountain. At 2,300′, it’s laughable by the standards of where we hope to be hiking soon, but for these parts, it’s plenty impressive. We’ve “summited” Bear Mountain before, and my recollection was that it was a pretty easy hike, if a bit long, and ended in a grand view of the Taconics and the Catskills from a squat stone tower at the top. But as it turned out, our previous hike had taken a far easier route, and today we were faced with a very steep, rocky scramble, which required handholds at some points. It was a heart-pounder, to be sure, but we all made it to the top, even the dog.

But the real challenge turned out to be managing a nine-year old diabetic on a strenuous five mile hike. People often associate diabetes with excess blood sugar, or hyperclycemia, and that indeed is the main cause of all the long-term health issues faced by diabetics. But in the short term, hypoglycemia is the bigger threat. Diabetes, ever the trickster, leaves a person unable to transport glucose from the blood into the cells, where it can be used, which results in hyperglycemia. So we give insulin, a hormone that diabetics lack, and that provides the key to unlock the cells and let glucose flow in. Unfortunately, we can only poorly approximate the body’s natural modulation of insulin levels, because even with advances in testing and cool tools like continuous glucose monitoring (CGM), we’re always looking at the blood glucose level in the past. As a result, diabetics often overdose on insulin, which scours all the glucose out of the blood, leading to hypoglycemia. That leaves a kid tired, pale, sweaty, shaky, and generally miserable.

Strenuous exercise, say like climbing a mountain, exacerbates the situation by increasing the demand for glucose – the harder the work, the more fuel you need. So after about 20 minutes on the trail, Ginger was a hurting unit. She had no energy and grumpily sat herself on a rock, refusing to move. Actually, she probably couldn’t move – she was out of gas. Luckily, we have her on CGM, so we were able to see her blood glucose level. It wasn’t pretty:

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After being at almost 350 mg/dl after brunch – which included a sinfully delicious glazed cronut that we apparently did not compensate for very well when calculating her insulin – within two hours she was in the 40s, which is low enough for some people to start passing out. Luckily, she doesn’t get that bad until maybe the 20s, but at the rate she was heading down, and the steepest part of the hike still ahead of us, we had to do something. She ended up having 44 grams of carbs – a juice box, four glucose tablets, and an apple, along with a bunch of diluted Gatorade from my hydration pack. That’s almost as many carbs as most of her meals, and we shut off her insulin pump to boot.

As extreme as it seems, it worked. After a few more minutes of rest, she felt better, bounced to her feet, and started a sugar-fueled rampage up the hill. She smoked all of us, beating even her long-legged big brother who can cover a dozen feet in three steps. She was out of our sight for most of rest of the hike, taking point with Gambit the Wonder Dog, her constant companion – being a Border Collie, he thinks of her as his sheep, and he is strangely able to tell when she goes hyperglycemic; he starts licking her incessantly. I guess she tastes sweet to him.

There are, of course, prep implications I can draw from this. First and foremost, we need to be very well prepared when we take these pleasure hikes. That means plenty of snacks with known carbs, plus some protein to smooth out the inevitable glucose spike and lessen the crash. Also, we need to carry MUCH more water on our hikes. I’ve got a Camelbak with a two-liter bladder, but that’s it for serious hydration for the five of us. My son’s birthday is coming up, and he’s asked for a decent hydration pack, so we’ll probably spring for one for each kid, plus one for Mrs. P (shhh, Grace – don’t say anything!)

But what about an unexpected hike, like a fast bug out? What happens if we’re forced into a cross-country walk without being able to properly prepare? Tough one. We have a go kit for Grace that includes insulin and supplies, plus some stuff to treat hypoglycemia. But a real shred through the woods could be a problem, if sufficiently strenuous and timed to coincide with a low. See that pre-wakeup dip at around 9:00AM? If we were forced to bug out then, we might not be able to keep enough carbs in her to keep her going. That would mean rucking her on my back, or her brother’s or sister’s, and since she’s currently running about 90 pounds, that’s going to make for a hard trip now, and a damn near impossible one within a year or two. It might be a good idea to learn how to rig some sort of field-expedient stretcher and practice using it so we can spread the load among the three of us, just in case she gets too low and we can’t stop to recover her.

Yeah, a forced march without proper preparation is a long shot, but the consequences are high enough to warrant a little pre-planning. And with all the time we’ll hopefully be spending in the woods this summer and fall, chances are we’ll get a chance to identify more of the challenges of hiking with a diabetic, and practice working around them.

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