No turning back

Gulp. I have finally bitten the bullet and actually booked my Kili trip with Exodus, after I've read the trip notes at least 20 times and kept an eye on the reviews of past travellers and the availability of the trip, just in case I discover anything unexpected. But faced with an (unusual) free weekend, idly sitting at my computer pretending to work but looking for distraction, I decided to have just one more look at the website and found myself making the booking. My biggest dilemma was whether to pay the extra £200 to have a room and tent to myself. I've done it both ways in the past. I usually book a single room/tent but on my last trip, I ended up having to share a tent after the first night due to another person's tent breaking and them not having any repair kit or spare tents. I'm always a bit nervous of sharing especially as I don't sleep very well, which means  I wake up the other person moving around and getting up in the night, and/or I get annoyed because they wake me up doing the same thing. In Morocco, however, I couldn't have asked for a better tent partner. She never stirred during the night (while I was up at least once if not several times) and she wore earplugs so wasn't at all disturbed by me.  It was also rather reassuring to have someone else there with me in the rather scary howling winds which kept us awake - not just because of the noise but because of the very real danger that the tent would break or collapse (the main dining tent did exactly that on several occasions). Since we also had to erect and dismantle our own tents every day, it was a definite bonus to have someone to share that task with. But on reflection, and since we don't have to erect or dismantle our tents on Kili, I opted for the luxury of being able to sleep the way I want, move around as much as I want in the night, and arrange my kit with plenty of space without having to worry about anyone else. On top of £2,000, an extra £200 isn't that much, and I figure since this is going to be a pretty tough trip, I might as well go for a few little luxuries such as being able to sleep without someone snoring down my left ear or emitting noxious gases.

The beauty of going on a trip with strangers

After my experiences in Peru with altitude and dehydration, and on the advice of some seasoned Kilimanjaro guides, I decided to try out another high altitude (above 3000m) trek before embarking on Kili. I recently got the all-clear from my medical team to tackle Kili so this was the last hurdle to overcome before booking the trip. When I mentioned this to someone recently, they were stunned - not that I got the all-clear, but that I have a whole medical team to look after me, not just a GP! In case you're interested, I have a GP, a diabetes consultant, a retinal specialist, and a pump-trained DSN, all of whom I see regularly, and should I require it, I also have a chiropodist, dietician and psychiatrist at my disposal - that's one good thing about having a serious medical condition, there are specialists hovering around your every move! Anyway, I digress. Finding a week free in my busy schedule, and wanting somewhere fairly cheap and not too far away, I decided on Mt Toubkal in Morocco. The trip involved a week in the Atlas Mountains, with the ascent of Toubkal (4216m) as the toughest part. Apparently it's ranked #280 of 953 things to do in Morocco by Lonely Planet travellers, though I can't imagine 279 things to do in Morocco that would be more fun. 

The trek was classified by Exodus as a C grade trip, so I knew it would be tougher than the previous treks I've done with them, which had all been classified as B, although the most recent one was definitely (even according to the guide) more like a C grade, with long days in the mountains and a lot of ascent. This time my fears were slightly different from those on the Inca Trail. The camping aspect didn't bother me at all, in fact I was looking forward to that above all else, and perhaps surprisingly, the altitude wasn't a major concern as I figured I now knew how to deal with it after my Peruvian experience. All I needed to do was drink lots (of water) and then drink some more, and try not to think about the horrors of having to get out of the tent in the freezing cold at night and wander around in the dark on top of a precarious cliff edge to pee. I thought if I could avoid getting ill, everything would be fine. However, as I monitored the weather forecast in the preceding days, and saw the thermometer sitting at a toasty 45 degrees in Marrakech (an extra 10 degrees hotter than usual for this time of year) I realised that the heat could actually be my biggest problem. How was I going to keep my insulin cool on trek? And what would happen if I couldn't? All my spare insulin would be equally hot - and ruined. Because our kitbags were being transported by mule this time, there was also the danger that something would happen to my medical supplies. What if a mule were to fall off the mountain or decide to escape? I also suspected that the muleteers would throw my bag around even more violently than the Royal Mail, so everything needed to be bomb-proof if my medical supplies were to remain intact. More about those aspects in a separate post about managing diabetes in hot weather on a mountain, but in summary, I managed what I consider to be excellent diabetes control under the circumstances (actually way better than I often get at home!).

It turned out that fitness was actually my biggest problem on the trek. Apparently we had an unusually fit group, and it was rather disconcerting to be the slowest person on the tough days, not just uphill but sometimes downhill too! I soon realised that I needed to go at my own pace, even if it meant holding up the others, but it made me feel terribly guilty to do so. On the day we summitted Toubkal (more about that in another post) I was devastated when we finally got back to base camp at the thought that I had been slowing everyone down and they were annoyed at me. I was assured by a couple of people later that this wasn't the case, and that they were just concerned if I was OK, but I'm still not so sure. One thing though, I was definitely feeling the effects of dehydration and altitude (which oddly no one else seemed to be) despite making a conscious effort to drink a lot. Another lesson learnt. What I think is a lot of water is not nearly enough. And going to the loo in the freezing cold on the edge of a mountain in the pitch black at night with mules wandering around - no matter how many times - is still better than feeling ill from ascending a mountain when dehydrated. Even though it never feels like it at the time. 

Despite the fact that summiting Toubkal was the toughest thing I think I have ever done, I'm glad I did it as it made me realise that I have some hard work to do before February, but at the same time these things are achievable if you have the right attitude. I never doubted for a minute that I would get to the top of Toubkal, no matter how long it took and how annoyed with me everyone else was for being slow. I know this is the most important thing I'll need when climbing Kili - that determination to succeed no matter how much pain it involves. I did this trip and I'll do Kili, not to make friends and have a good time, but for myself and for the greater good of JDRF. In addition, I learnt a lot, both about myself and about trekking up mountains, and have some wonderful memories. The thing I find hardest is remembering this and trying not to spend so much time and effort worrying about what other people think. Even if everyone hates me afterwards, well that's the beauty of going on a trip like this with strangers - they never have to speak to me again if they have got fed up with me. I still hope they like me though.

Diabetes on a mountain

One of the biggest worries about my trek in Morocco was the heat (a toasty 45 degrees in Marrakech, though progressively cooler as we got higher). How was I going to keep my insulin cool on trek? And what would happen if I couldn't? All my spare insulin would be equally hot - and ruined. Because our kitbags were being transported by mule this time, there was also the danger that something would happen to my medical supplies. What if a mule were to fall off the mountain or decide to escape? I also suspected that the muleteers would throw my bag around even more violently than the Royal Mail, so everything needed to be bomb-proof if my medical supplies were to remain intact.
 

I decided to pack all my insulin in a Frio bag, except it turned out that the Frio bag I have is actually designed for an insulin pump (a rep gave it to me about 15 years ago, and I've never used it) so not really designed to fit several vials of insulin. Removing the packaging meant I could fit one vial and some cartridges in the pouch, the other vial I had to just hope for the best. The beauty of a Frio bag is that it's activated by cold water so I could reactivate it mid-trek if necessary. I then put this in a Ziplock bag, wrapped it in a spare buff, and wrapped that in my waterproof jacket which lived at the bottom of my daysack all week on trek. The rest of my medical kit I packed (well-wrapped) in the middle of my kitbag wedged in between clothes, and crossed my fingers. You have to live life a little dangerously on these trips or you'd never get anywhere. 

As for the pump itself, I used a SpiBelt (see pictures) to attach it around my waist under my tshirts (as I usually do) and hoped it would stay cool enough. These precautions turned out to do the trick perfectly. I also packed a spare blood glucose meter and strips in my kitbag (after reading Jerry Gore's story about his meter packing up while climbing in the Alps), although - like Jerry - I only had a handful of strips that fitted that meter, so I was trusting to luck again that I wouldn't need it from day 1! Based on previous experience, I reduced my basal insulin on the trek to approximately 50% during the walking itself, starting an hour before we set off in the morning and finishing, where possible, an hour before we finished. I then set it to 70% for the night and 80% for the rest of the daytime when not walking. This strategy - with a bit of fine tuning along the way - worked incredibly well and I had the best blood sugar levels of any trip I've done! I only needed to adapt a little when there were long downhill sections (where I didn't use so much energy), and kept the Haribo handy in my waistbelt pocket for regular small topups on the climbs. Luckily, we had an identical breakfast of (pretty horrible) porridge every morning, for which I bolused my usual amount but over an hour instead of all at once, and again this worked perfectly. For lunch I reduced the bolus by 50% but without the square wave, and this also worked well.

The fact that most of the meals were relatively low in carb with lots of vegetables (mainly carrots), and were quite consistent (some would say boring) actually helped a lot and I had pretty good control throughout with no major lows or highs until, oddly, the day after the trek ended when I had some terrible lows! Figuring out how to gradually raise the basal back to normal seems to be a black art - for the first few days you're obviously expending less energy but your body still burns a lot of fuel until it gradually begins to realise it doesn't need to. Something to be wary of next time. But all in all, a great success diabetes-wise, which was actually my biggest fear. Fitness-wise, another story....I definitely need to step up the training before Kili!