Type 1 Diabetes and Climbing

Lori Milas wrote: Hey guys... WOW.  This is impressive.  May I say without too much ego that it's a very impressive group that continues to climb WITH T1D.  You all are great!

May I ask why most of you do not use a pump?  Is it cost?  Or have you just found it easier to not pump?  

Jennie, you said "Tresiba is an incredible long-acting insulin, I’ve really loved the switch but I didn’t know to decrease my basal rates for active days. It built up in my system, and caused very strange low symptoms that I’d never encountered before."  While researching Tresiba I encountered an article written by someone who had some really bad reactions to it... and I'm wondering if it might be due to weird lows like you had?  https://www.diabetesdaily.com/blog/tresiba-insulin-troubles-578350/

Also, you said "I use a cylindrical insulated nalgene holder clipped to the back of my harness for multi pitch. "  Do you have a picture of this, or an Amazon link?  

I also find that I don't eat much when climbing, and don't know why that is.  I bring a sandwich and other food, and wind up bringing most of it home.  No big deal... just unusual for me to skip a meal.     But snacking... this is a great idea!  I think I've become so calorie conscious, I just don't snack much.  

And that's the other thing.  As climbers, we're always trying to keep weight low.  It's frustrating to eat it all back because of lows.  And no... Medtronic does not have any variable alarms for different issues.  They all sound alike.  WHY can't a company that's supposed to be on the leading edge do basic things like this?  

I’ve never tried a pump. I’m fairly active with climbing, soccer, bike commuting I’d rather not have another device attached to me. The down side to pens is obviously you can’t un-inject your basal if your plans change the way you can turn a pump off.  

Regarding the calorie-conscience snacking, nuts are super snackable, pretty filling, and low carb. 

I was on a pump in Middle school for a few years.  I didn't like it because it's a pain in the ass to manage the cord.  I roll around a lot when I sleep, it gets caught, etc.  Also I was prone to building up "scar tissue" at infusion sites which I hated.  Not a fan of having it constantly taped on me -- which also sucks with a CGM, but the benefit there is much greater.  Finally, it's much less portable for vacations or long back country trips in terms of backups.

I might reconsider in the future when closed loop systems get better

Eric Roe wrote:

This is sorta what I'm talking about when I say I dive down and then stabilize at a "low" level.  Often the approach is just as much work - or more - than climbing any single pitch.  Be sure to not over load on insulin when you know you're about to start being active.

Regarding turning off the basal and just doing a small bolus for lunch:  I have a lot more success doing the exact opposite.  By that, I mean doing Basal (at a lower rate as mentioned) and then NOT Bolusing for food.  This starts before the approach -- I'll have a breakfast, Basal appropriately (Not on a pump, so I inject in the morning.) and then do a very light Bolus to cover breakfast.  When snacking, I don't Bolus at all.  The small amount of slow metabolizing insulin is able to take care of the continuous, small amount of carbs.  If you look at the graph of Insulin on Board and Carbs on Board, you'll notice that they line up nicely.  The way you're doing it now sounds like it causes spikes and dips, which isn't what you want when exercising over long periods of time.  Ultra runners, for example, don't eat large meals every 4 or 5 hours -- they slurp energy goos and eat nuts continuously, or on an hourly schedule.

Side point:  As someone with a "life-changing, chronic disease" (Jesus H, you make me want to kill myself), I appreciate the effort to defend my delicate sensibilities.  But also I would appreciate it more if you don't get offended on my behalf ;)

Second this post (both skipping short acting during the day and supporting a good ol beetus joke). I am on lantus and have split my daily dose in half and do half in the morning and half at night. I think it helps overall stability, and I'll often reduce one or both doses prior to big days. I take about 1/2 dose for alpine days. I did the Grand Teton this summer in a 20 hour day and by the end I could barely keep my sugar above 60 even after 5 packs of fruit snacks.

I also want to encourage anyone who thinks things like big routes and getting in shape for top end climbing are off the table. I haven't done any traditional mountaineering but big trad days are fine with some preparation, and I'm consistently sub 10% body fat for hard sport and bouldering.

Also fanny packs are life

Does anyone else have BG spikes after getting a hit of adrenalin?

Ive also noticed having some scary lows if I take a normal amount of insulin in order to eat if Im exercising. And the insulin hits much faster than normal.

I also think altitude can cause insulin to work harder and cause lows at unexpected moments. My endo said that people who live at high altitude have lower occurrences of diabetes after I asked her about altitude surprises.

I was diagnosed with T1 in april and it hasn't slowed my climbing down at all, but still sorting out the details of the best rhythms, and have just gone hungry rather than take insulin on the wall sometimes. Ive also found slow intake of slow acting carbs works well with the basal only. But this doesn't work as well if I get an adrenaline rush that causes my BG to rise, and then I don't want to eat without insulin. But I feel nervous to take insulin when its acting less predictable between the altitude and the exercise.

Jon Frisby wrote:

Second this post (both skipping short acting during the day and supporting a good ol beetus joke). I am on lantus and have split my daily dose in half and do half in the morning and half at night. I think it helps overall stability, and I'll often reduce one or both doses prior to big days. I take about 1/2 dose for alpine days. I did the Grand Teton this summer in a 20 hour day and by the end I could barely keep my sugar above 60 even after 5 packs of fruit snacks.

I also want to encourage anyone who thinks things like big routes and getting in shape for top end climbing are off the table. I haven't done any traditional mountaineering but big trad days are fine with some preparation, and I'm consistently sub 10% body fat for hard sport and bouldering.

Also fanny packs are life

Jon, thanks for this, and also for the positive encouragement to go for it with hard training and sport/bouldering.  

It's weird, as this conversation unfolds... I'm realizing the little things that hang me up.  Like fanny packs.  I've spent too much time wandering around REI, examining day packs, larger and smaller packs... just trying to figure out what is the bare minimum to wear on longer routes, or multi-pitches that could take several hours... what would make me feel confident in any situation off the ground?  

And where to stick that pump.   (not a problem you have.)

Karuna Holm wrote: Does anyone else have BG spikes after getting a hit of adrenalin?

Ive also noticed having some scary lows if I take a normal amount of insulin in order to eat if Im exercising. And the insulin hits much faster than normal.

I also think altitude can cause insulin to work harder and cause lows at unexpected moments. My endo said that people who live at high altitude have lower occurrences of diabetes after I asked her about altitude surprises.

I was diagnosed with T1 in april and it hasn't slowed my climbing down at all, but still sorting out the details of the best rhythms, and have just gone hungry rather than take insulin on the wall sometimes. Ive also found slow intake of slow acting carbs works well with the basal only. But this doesn't work as well if I get an adrenaline rush that causes my BG to rise, and then I don't want to eat without insulin. But I feel nervous to take insulin when its acting less predictable between the altitude and the exercise.

I haven't noticed spikes after adrenaline (or anaerobic challenge)... but I'll bet a lot here do.  It's pretty common.

What I HAVE noticed, for sure, is more sensitivity to insulin at altitude.  Even the 4500 feet at Joshua Tree takes some insulin adjustment.  When I climb in the Sierra, I have to shut down my basal when I start my drive to the mountain, or I will be low before even getting out of the car.  It's just one more layer of challenge as a diabetic, to add in altitude to the equation. (and weather). 

Excited there are so many T1D climbers!

New to climbing (~1 year), not as new to T1D (~11 years).

Currently I am (mostly) keto, using a t-slim pump, and a dexcom G6. When climbing, I wear my cgm on the back of my arm and my pump site on my low back (below the harness). I generally keep my pump in a pocket, and can fit my phone, test kit, and glucose into (big) pockets on my chalk bag.

Pen vs pump: Several months ago, I tried switching to pens, but I switched back to pump because I missed being able to easily take small corrections and use the temporary basal rates. I would do pens again for a long trip -- anything longer than two weeks requires a lot of pump supplies and has a lot of room for error. My pump and cgm have never been knocked off climbing, but I have had occasional occlusions and signal loss.

On a normal non-active day my goal is to keep my bg between 80 and 150. It's getting better, but when I started climbing it sometimes went over 300 (even 400) and could crash to 50 or 60. These are some observations so far:

• Adrenaline seems to raise my blood sugar, but very unpredictably. 
• Elevation seems to cause insulin resistance https://beyondtype1.org/altitude-type-1-diabetes/.
• Dehydration causes insulin resistance http://www.diabetes-book.com/diabetes-dehydration/. Water is heavy and there are no bathroom breaks on multi-pitch, but it's worth it. 
• Here was my most common recipe for disaster: (1) I start an approach, bg starts to go down, I lower my basal and take glucose (2) I start a climb: adrenaline + elevation + dehydration + glucose + low basal, = my blood sugar raises quickly. I take a lot of insulin, but it has little affect. (3) I finish the climb: adrenaline drops, I drink a lot of water. Suddenly the insulin resistance is gone and the insulin on board plummets my blood sugar. Eat glucose. Typical roller coaster.
• Climbing with someone that understands T1D makes all the difference in the world. Thanks to all the people in this thread supporting their T1D climbing buddies! 

I'm curious how bg affects your climbing ability. What range do you try to stay in? What range do you feel you perform your best?

I'm convinced being T1D while climbing is a skill you can learn! Here are some things I'm working on / trying:

• Eating very consistent breakfasts (high protein, high fat). This helps remove one variable.
• Eating consistent items to raise bg. I used to eat any candy or cliff bar. Now I only use pure glucose gel packs. Another variable removed.
• Having only zero / low carb snacks, and keeping bg up by lowering basal. 
• Water. Not just more water, but better hydration. Using water with electrolytes so that less volume is more effective. 
• Trying to get a prescription for a nasal spray glucagon: https://www.baqsimi.com/baqsimi-basics. Seems a lot easier to use on a climb.

I love hearing all of your strategies! Keep crushing, diabuddies!

Emily Damato wrote: Excited there are so many T1D climbers!

New to climbing (~1 year), not as new to T1D (~11 years).

On a normal non-active day my goal is to keep my bg between 80 and 150. It's getting better, but when I started climbing it sometimes went over 300 (even 400) and could crash to 50 or 60. These are some observations so far:

• Adrenaline seems to raise my blood sugar, but very unpredictably. 
• Elevation seems to cause insulin resistance https://beyondtype1.org/altitude-type-1-diabetes/.
• Dehydration causes insulin resistance http://www.diabetes-book.com/diabetes-dehydration/. Water is heavy and there are no bathroom breaks on multi-pitch, but it's worth it. 
• Here was my most common recipe for disaster: (1) I start an approach, bg starts to go down, I lower my basal and take glucose (2) I start a climb: adrenaline + elevation + dehydration + glucose + low basal, = my blood sugar raises quickly. I take a lot of insulin, but it has little affect. (3) I finish the climb: adrenaline drops, I drink a lot of water. Suddenly the insulin resistance is gone and the insulin on board plummets my blood sugar. Eat glucose. Typical roller coaster.
• Climbing with someone that understands T1D makes all the difference in the world. Thanks to all the people in this thread supporting their T1D climbing buddies! 

I'm curious how bg affects your climbing ability. What range do you try to stay in? What range do you feel you perform your best?

I'm convinced being T1D while climbing is a skill you can learn! Here are some things I'm working on / trying:

• Eating very consistent breakfasts (high protein, high fat). This helps remove one variable.
• Eating consistent items to raise bg. I used to eat any candy or cliff bar. Now I only use pure glucose gel packs. Another variable removed.
• Having only zero / low carb snacks, and keeping bg up by lowering basal. 
• Water. Not just more water, but better hydration. Using water with electrolytes so that less volume is more effective. 
• Trying to get a prescription for a nasal spray glucagon: https://www.baqsimi.com/baqsimi-basics. Seems a lot easier to use on a climb.

I love hearing all of your strategies! Keep crushing, diabuddies!

In an upcoming post I want to ask folks here if anyone is interested in sports/diabetes nutrition.  It would be great to talk about that.  

I've found that, for me, if I want to climb hard, I need solid protein meals.  In the past I would never have sat down to a plate of scrambled eggs and bacon for breakfast, but if it's going to be a long day, I belly up to the big breakfasts now... and finish the day with a steak or other red meat after climbing.  (my cholesterol and all lab values are perfect these days.)  

This summer I experienced having sudden severe inner thigh spasms in the middle of the night that did not go away.  They had me on the floor for over and hour each time... couldn't rub them out.  So, eventually I called my doctor who did some testing, and then suggested I pre-load with electrolytes and lots of water before climbing, and then stretch and soak in epsom salts after.  So, I've been making a hydration drink of Nuun tablets and an Ener-C packet... plus sometimes adding in a pinch of sea salt to that first liter of water.  I also drink the same mixture at the gym on climbing days.  There have been no more severe spasms.  I think this is an added issue with diabetics, we lose minerals faster than non-diabetics.  

My best climbing range is 80-100.  Obviously, that's like a unicorn.  When it happens, I'm on fire.  When it doesn't, my performance is somewhat less.  

PS.  Glucagon nasal spray!!!  I love this idea! 

Q: ....This summer I experienced having sudden severe inner thigh spasms in the middle of the night that did not go away.  They had me on the floor for over and hour each time... couldn't rub them out....
A: Pickle Juice, you drink it and the cramps vanish quickly. No idea WHY it works, but it really does. This is not BS. I have been using it all season and the difference is night and day. For Type 1s I would suggest a non sweetened juice (AKA any pickle besides bread and butters, way too much sugar) but a few unpleasant gulps before bed and you rest an entire night without cramps. I have played around with it prior to climbing as well and it keeps long multi-pitch climbs cramp free. Nothing else for me has worked as well. Drinking it sucks... but it suck far less than cramping while climbing or cramps while sleeping. Good luck!!!

Oh I also get the adrenaline induced highs, but mine are often followed by a crash. I also have that particular phenomenon where exercise sometimes raises my sugar and then drops it hard.

Shaniac wrote: Q: ....This summer I experienced having sudden severe inner thigh spasms in the middle of the night that did not go away.  They had me on the floor for over and hour each time... couldn't rub them out....
A: Pickle Juice, you drink it and the cramps vanish quickly. No idea WHY it works, but it really does. This is not BS. I have been using it all season and the difference is night and day. For Type 1s I would suggest a non sweetened juice (AKA any pickle besides bread and butters, way too much sugar) but a few unpleasant gulps before bed and you rest an entire night without cramps. I have played around with it prior to climbing as well and it keeps long multi-pitch climbs cramp free. Nothing else for me has worked as well. Drinking it sucks... but it suck far less than cramping while climbing or cramps while sleeping. Good luck!!!

Amazing what desperation will do!     I have heard of pickle juice.  Also, a fellow climber advocates for packets of mustard.  I found Hot Shots... amazon.com/gp/product/B01DE…;psc=1   I keep this on my nightstand, because when a spasm comes there is no possibility of walking to a medicine cabinet.

But to the larger question of why they happen... I think it's more of a problem for diabetics, especially climbing hard, in the sun, without adequate hydration.  Trying to nip this before it starts.  

I'm T2 and control as much as possible with a ketogenic diet.  I mention this because your needs for additional electrolytes shoots way up when you're on a low carb diet.  If you're eating LC and not supplementing with sodium, potassium and magnesium, you're probably somewhat deficient.  If any of you getting cramps are also low carb, I'd look into this.

On another note, I definitely get the adrenaline induced high blood sugars.  You can look at my CGM readings and tell exactly when I was on the wall and when I was resting in between climbs.

skik2000 wrote: I'm T2 and control as much as possible with a ketogenic diet.  I mention this because your needs for additional electrolytes shoots way up when you're on a low carb diet.  If you're eating LC and not supplementing with sodium, potassium and magnesium, you're probably somewhat deficient.  If any of you getting cramps are also low carb, I'd look into this.

On another note, I definitely get the adrenaline induced high blood sugars.  You can look at my CGM readings and tell exactly when I was on the wall and when I was resting in between climbs.

Why is low carb deficient in those salts? I eat pretty salty food and don't think of bread or pasta as full of those salts. Are there other supplements I should pay attention to on a low carb/keto diet? I was diagnosed with T1 in April and have gone keto and am still figuring it all out. Im definitely getting the leg cramps. How long do I drink electrolytes before I start noticing a difference? 

Karuna Holm wrote:

Why is low carb deficient in those salts? I eat pretty salty food and don't think of bread or pasta as full of those salts. Are there other supplements I should pay attention to on a low carb/keto diet? I was diagnosed with T1 in April and have gone keto and am still figuring it all out. Im definitely getting the leg cramps. How long do I drink electrolytes before I start noticing a difference? 

Check out this link.

https://robbwolf.com/2019/07/30/electrolyte-imbalance-symptoms-how-to-fix-it/

I don't think it'd take too long for the leg cramps to go away once you get your electrolytes in balance.  The figures on that link for how much to supplement seem crazy.  You might not need as much as are recommended but the only way to find out is trial and error.  I typically salt my food heavily, add up to 1-1.5tsp salt each day to my water as well as probably 1/4 tsp of potassium.  I also take a magnesium supplement in pill form (magnesium glycinate).

skik2000 wrote:

Check out this link.

https://robbwolf.com/2019/07/30/electrolyte-imbalance-symptoms-how-to-fix-it/

I don't think it'd take too long for the leg cramps to go away once you get your electrolytes in balance.  The figures on that link for how much to supplement seem crazy.  You might not need as much as are recommended but the only way to find out is trial and error.  I typically salt my food heavily, add up to 1-1.5tsp salt each day to my water as well as probably 1/4 tsp of potassium.  I also take a magnesium supplement in pill form (magnesium glycinate).

Great link!  In this day of low-salt everything, it's sometimes hard to remember to add salt.  Some days I don't feel like I can get enough salt... I just crave it.

One thing I do know is that T1's tend to run high in potassium.  That balance can be easily upset with high blood sugars, where often sodium is excreted and potassium can stack up.  Before becoming diagnosed (20 years ago) I ate daily fruit, and sometimes took potassium supplements.  All that had to stop with T1D.  

Is anyone here on a pump?

I had an appointment with my endo yesterday and she is now insistent that I change over to what is called “Auto Mode” on my Medtronic 670g pump.  I don’t want to do it. Auto Mode is designed to take over your diabetes management, regulate basal rates through algorithms after it “learns” the body and deliver boluses.  It is designed to maintain BG levels between 120-180. It won’t allow lower.

It also doesn’t do well with Dawn Phenomenon or exercise. Or changes in daily schedule.  If anyone has a different experience or has tried auto mode and has an opinion I hope you can share.  I’m considering changing doctors. 

Lori,  I'd recommend against using auto mode if you're an active person.  You're right, the algorithm in auto mode tries to learn from each day and create a pattern out of your blood sugars.  This is problem for an active person who performs moderate to hard exercise daily as your blood sugars will change differently depending on what we're doing.    What I have found that works really well  is staying in normal mode during the day and switching to auto mode at night when I sleep.  I recover better and don't have the night lows that post workouts can cause.  

I hope this is helpful.    

Chad Miller wrote: Lori,  I'd recommend against using auto mode if you're an active person.  You're right, the algorithm in auto mode tries to learn from each day and create a pattern out of your blood sugars.  This is problem for an active person who performs moderate to hard exercise daily as your blood sugars will change differently depending on what we're doing.    What I have found that works really well  is staying in normal mode during the day and switching to auto mode at night when I sleep.  I recover better and don't have the night lows that post workouts can cause.  

I hope this is helpful.    

Thank you so much Chad!  Do you get highs in the early morning?  My blood sugar starts to rise about 4 am every morning so I have programmed my pump to double my Basal rate starting at 3. Most mornings I wake up at 90 and stay there through my morning coffee and workout.  Can overnight auto mode handle this?

Jennie Matkov wrote: Lori, here’s a link to the case I use, I’m sure there are other better options out there but this has worked well for me: https://www.steepandcheap.com/mountainsmith-insulated-bottle-holder

Something like a fanny pack would have better pocket dividers, but the padding and stiff shape on this kind of protects things nicely.

This is an awesome setup. It's super clever.

To answer your question about not using a pump, for me it began with being really active in high school and not wanting to have something attached to me, and I figured I’d just mind the injections less than having a site that could get infected and tubing that could get kinked. Then when I got into climbing it kind of reinforced the same idea; I was afraid to have something that could get ripped out in a fall or that could fail leaving me without what I needed. I’m open to it though and may try it at some point in the future, especially as closed systems seem to be gaining momentum.

I completely agree with you sentiments regarding a pump. I was always afraid to break the pump, catch the tubing, or otherwise damage the system and then have my sugars be compromised especially while climbing or other outdoor activities. If a robust, closed-loop system comes to market, I'll be down, but until then, I really like the the pens and a CGM.

I'm now over 18 years with T1D and use Tresiba and Novalog insulin pens with a Dexcom G6 CGM linked to an iPhone. For a single day of climbing without long approaches, I tend to keep my basal normal. Days with long approaches in and out, I'll tend to lower by basal dose by one or two units. I am currently at 14 units of Tresiba daily. I really have to watch the timing and dosage of any bolus doses as if I get that wrong, I'll drop. If I get that right, I keep my sugars up with small snacks throughout the day and have faster acting sugars on hand to correct any lows.

I take time to adjust my alarms on my CGM when I am out climbing, hiking, running, etc. I normally keep the low alarm at 75, but during activity, I set the alarm at 100. I also up the high alarm as I am not concerned about being a little high during activity. I'll set it to 220.

Keeping my overall fitness level and my weight steady is really important for my overall glucose control and this translates into good control during activities like climbing. I'm happy to say after a few years of being overweight and not as fit, I've turned that around and things are improving. I'm getting out more in all activities.

One difficulty that I have for climbing is keeping my novalog warm on days ice climbing or mountaineering. I carry it with me since I don't want to leave it behind in the car, where it will definitely freeze. My current layers don't have a chest pocket large enough to carry it. My solution last winter was to put a piece of tape to keep the cap secured and clip it to a fleece layer with a zip neck. Not ideal, but it worked. I'm curious to hear what you all do if you carry your insulin pens into cold environments.

Thanks,

David

Lori Milas wrote:

Thank you so much Chad!  Do you get highs in the early morning?  My blood sugar starts to rise about 4 am every morning so I have programmed my pump to double my Basal rate starting at 3. Most mornings I wake up at 90 and stay there through my morning coffee and workout.  Can overnight auto mode handle this?

Yes it can. I’d turn it off before you work out though.