Final preparations

With only 3 days to go, as is usual for me, I've stopped worrying about all the things that could go wrong and am allowing myself to start getting excited. I do all my worrying (including many sleepless nights) about such things weeks or even months before. Which is great, really, as it leaves me free to enjoy the final preparations. I've been very lucky with the weather in the last week, as the recent snowfalls have enabled me to get in some last minute winter practice on the hills.

I'd been planning to do Snowdon with my two regular walking friends, Ann and Ian, for months, but somehow we ran out of time and good weather possibilities (and we were all terribly busy with work deadlines) so instead, we decided to head out into the wilds of North Yorkshire last weekend, both for me to get in a good long walk in tough conditions as final practice, and for us to let our hair down a little after all our various work deadlines (I'd been doing nothing but work and go to the gym for the last couple of months, including over Christmas, and every evening and weekend too, often getting up at 5 or 6am so I could fit in a day's work, go to a gym class, and then work again till 10 or 11pm). We headed off to the youth hostel in Ingleton (first time I'd been in a youth hostel for approximately 20 years - I must say, they've improved a little, though surprisingly there wasn't any wifi), ditched our bags, and headed to the pub for a few pints (or in my case, glasses of red wine, some food and more than a few games of pool). By chance, Ian had brought a bottle of Drambuie that a friend owed me, so we proceeded to make inroads into it once back at the youth hostel. Luckily we decided to stop drinking before it got too late and before we were too much the worse for wear, but despite not being hungover in the morning, I was very dehydrated (when will I *ever* learn about dehydration?!) This was also not helped by the fact that the heating was on full blast all night (WHY? Why does anyone feel the need to turn heating on at night? That's what duvets are for. It's ridiculous!), and the fact that I slept terribly (partly due to the heat, partly just because I get insomnia, and it happened to strike that night). So I was tired and dehydrated the next morning when we set off, though fortified by a fantastic cooked breakfast.

We climbed Ingleborough after only two false starts (walking pole issues and then a wrong turn) and the conditions got steadily worse as we ascended. I lent Ann my Yaktrax near the start as it was quite icy, and tried out my cheapie Ice Gripper things, which actually did a good job, though not really designed for rough terrain). We decided to descend rapidly after reaching the top - the wind was howling and my whole face was numb. I was also trying out some alternative equipment, and I soon discovered that my new buff kept slipping off my face (balaclava MUCH better) and that my gloves were not nearly as warm as my mittens. Regretted not bringing said balaclava and mittens! I was noticeably slower than Ann and Ian, which surprised me a little after all the fitness, but in retrospect I think it was the combination of lack of sleep and dehydration (not helped by the fact that my hydration bladder froze on the descent). In the afternoon we climbed Whernside and were met with similar conditions, though I was even slower on the final ascent (I probably also hadn't eaten enough lunch, and was definitely dehydrated - I realised later I didn't go to the loo between 1pm and 9pm that night, despite drinking 2 litres of water and several cups of coffee). On the upside, I had barely tested my blood sugar all day (it was too cold to stop), but it stayed pretty much constant at a good level, apart from one hypo on the second descent, averted with a few jelly babies, and my new thermal bag worked a treat, keeping my meter toasty warm!

Despite the freezing conditions, it was a great little trip and gave me some good practice in slippery icy snowy and windy conditions. I doubt it'll be that bad on the top of Kilimanjaro (at least, I doubt it'll be that windy) so I feel a lot more prepared. Apart from my hands and face which got very cold, my core stayed warm throughout despite having only 3 layers on (Under Armous base layer, windproof heavy fleece jacket and a wind/waterproof jacket). We never stopped for more than a couple of minutes at a time though. Showed the advantages also of not having too many layers and getting hot and sweaty on the uphill (in the Antartic, you can actually die from getting too hot as you then freeze when the sweat dries). I did, however, wonder how long it takes to get frostbite in your hands (my fingers went numb a few times, though I managed to stop, curl them up in my gloves and rub some life back into them). The day was also much improved by the consumption of some of the remaining Drambuie when we got back to the car, which I'd had to put into my spare Thermos flask due to the cork on the original bottle breaking. I can testify that Drambuie in hot chocolate goes very well! I had a few surreptitious slugs of Drambuie on the train back to Sheffield later too :-) Sadly we won't be allowed Drambuie on Kilimanjaro due to the altitude, so will have to settle for hot tea.

So, I'm now feeling very prepared, and have packed my main bag, with just a few bits and pieces to slot in. However, I'm still debating the Diamox question. More on this in my next post....

Pancreatically challenged trekking

Unless you're a type 1 diabetic, or you're a close friend/relative of someone who is, it's unlikely you have any idea how it affects your life. I've had diabetes since I was 8, and I try not to let it stop me doing anything I want to. But the fact is, it's a pain in the backside 24/7. You never get a break from it, ever.

OK, so you have to take injections and not eat sugar, how hard can that be?

Actually neither of those things are remotely problematic, but what's much more difficult is maintaining good control, and having to plan everything you do. Things have improved vastly in the last 30 years, we now have home blood testing, on machines that take 5 seconds, rather than peeing in a test tube, adding a fizzy tablet and checking which colour it turns, we have insulin pumps that allow us to regulate our insulin intake far more effectively than injections, and some lucky people have CGMs (continuous glucose monitors) that track their blood sugar levels right around the clock, every few minutes (though they still have to do blood tests too in order to calibrate and verify this).

I won't bore you with all the details, but here's a summary of how it affects my day on a trek. The first thing I do when I wake up in the morning is check my blood sugar. Stab my finger, apply blood to a test strip, wait 5 seconds, check the result. If it's on target (4-7 mmol/l) I can rest happy. If it's low, I need some form of sugar urgently (I keep glucose tablets and/or Haribo sweets to hand 24/7 in case). No, I can't wait half an hour till breakfast is ready, by that time I could already have collapsed unconscious. If it's high, I need to take some insulin, and hope that it's dropped sufficiently by the time breakfast comes (it can take anything from 30 minutes to a couple of hours for this to happen). If I have to take down my tent and pack up my things, this burns energy, so this can make my blood sugar drop (hmm, better have a haribo or two before I start).

I then have to consider what I'll be doing that day. If I'm going to be exercising of any sort, I'll need ro reduce my basal rate (amount of insulin that slowly trickles into my body and keeps me alive) or my blood sugar will drop. How much I need to reduce it by depends what I'll be doing. I'll assume I'm going uphill for the next 5 hours, so I'll reduce it by 50%. On to breakfast.....now I need to count the amount of carbohydrate in my food, and take the appropriate amount of insulin to match. A bowl of porridge, well that's normally 30g carb which requires 2 units of insulin. But wait....did they make it with water or milk? That changes things. How much sugar did they add? Taste it and guess..... How do you know how much carb is in a food? Years of experience and a lot of guesstimating, but yes, sometimes it goes horribly wrong.

But wait....if I take insulin right before I go walking, it'll get absorbed faster than normal. I'd better change the way it's delivered so that it goes in slowly over the course of the next 2 hours, rather than all at once.

Right, we're all set, now I can start walking. Throughout the day, I'll need to keep an eye on my blood sugar levels, to see if they're rising or falling. If they fall below the magic number 4 mmol/l, I'll start to feel dizzy, hungry, sick, tired and generally weird. If I leave it for more than about 10-15 minutes in this condition, I'll become totally incapable of walking and have to stop. Leave it more than about 30 minutes, and I'll probably be unconscious. If my blood sugar levels rise too high, I'll feel thirsty, tired and need the loo frequently. Leave it too long, and I'll end up unconscious too. Talk about a rock and a hard place. And if I get it wrong and over-correct, or have the wrong basal doses, I can switch from one situation to the other within 30 minutes. Nice. So as I walk, I try to monitor how I feel. Hmm, I feel hungry, is my blood sugar low or am I just hungry? Oh, I feel a bit tired, is it high or just the effect of walking uphill a lot? Every time we stop for a snack, a rest, or a check of the map, I'll generally check my blood sugar to be sure. The more tired I get, the less likely I am to  notice the symptoms, or to be able to differentiate them from normal tiredness/hunger/thirst feelings. I make sure I always have sugar easily accessible so I can grab a few Haribo as I'm walking, if necessary. It's terribly embarrassing to have to make everyone in the group stop while I eat a cereal bar and recover, but sometimes I have to. It can take up to half an hour to recover from a bad low blood sugar, so I obviously want to minimise this risk. Luckily, people are usually very understanding, but it doesn't make it easier, especially if you're in a hurry to finish before dark!

In the evening, I have to keep monitoring carefully, as funny things can happen to my blood sugar. Sometimes after I stop, it'll shoot up high within 30 minutes, as a result of all kind of chemical processes that go on in the body. And sometimes, it'll gradually start to drop, in the sneakiest possible way so I won't be aware it's happening, especially if I'm tired after a long walk. This is when I rely on others to keep an eye on me for "acting strangely". Since I am known to act strangely most of the time anyway, this can be quite tricky! Even during the night, I have to monitor my blood sugar too. If I wake up and feel strange, I'll test again. If my blood sugar rises, I'll wake up desperate for the loo (which is never great when you're camping). If it's low, I'll have to fumble around for the glucose tablets, and often I don't wake up till it's already pretty low, which means I'm not very compos mentis (who is, in the middle of the night, at the best of times?) and it may take a while before I'm feeling better and can go back to sleep.

Every few days, I have to change the infusion set and refill the cartridge of the pump with new insulin. I also have to keep an eye constantly that the tubing doesn't become blocked, get air in, or the needle fall out, all of which would result in severe high blood sugar levels and potential unconsciousness within 12-24 hours.

All this means I also have to carry a lot of extra equipment, and I have to be sure to keep it cool, but above freezing, and dry. For a week's trek, I typically carry: 2 bottles of insulin, 7 infusion sets (needle with a long tubing attached to it), 5 reservoirs (similar to syringes), about 70 test strips, a blood glucose meter, a stabber to get the blood out of my finger, spare batteries, and for backup, a couple of syringes, more insulin, and potentially a spare meter.  About half of that has to go in my day pack for fear of it getting lost, broken, or too hot/cold. Then I also need 7 tubes of glucose tablets, a bunch of cereal bars, and a pack of Haribo or two. Most of it I won't need, but I have to take it just in case. Typically I'll get one low blood sugar episode per day, which might require half a pack of glucose tablets, but I might get several per day, and there's nowhere to get more if you run out. When you're restricted to 12kgs or less of weight in your kitbag, and your daypack is heavy enough already, this extra weight and bulk means careful planning is required. So if I smell on the walk because I've only packed one tshirt and one pair of socks to make room for vital medical supplies, I'm afraid it's a case of medical necessity.

But I've got friends with diabetes and they don't do all this stuff. Aren't you a bit obsessive?

You probably don't notice all the things they do. And yes, some people are more obsessive than others. I'm not particularly obsessive, but having already lost a lot of my sight due to complications, and seen my dad lose both his legs and finally die, from complications, I'm pretty keen to keep things under control as best I can. Thiry years ago it was impossible to keep such control without all the technology we now have.

Oh and by the way, having diabetes doesn't mean I can't eat sugar or drink alcohol. Or have a good time.

What? You must be a bad diabetic! Isn't that cheating?

Actually no, I'm not. Modern technology means we can do all these things, it's just that we have to know how to deal with them. I can eat sugar as long as my blood sugar isn't already high, and as long as I take appropriate insulin for it. I can drink as long as I'm careful not to overdo it, as that could lead to dangerous low blood sugar levels in the night. And yes, I can climb mountains, it just requires a lot more effort and planning.

In part 2, I'll tell you about the other reason this trek is going to be particularly hard for me, due to being partially sighted.

Diabetes kit for extreme trekking conditions

Back in September, I posted about diabetes on a mountain following my trek in the Atlas Mountains in Morocco in very hot conditions. For Kilimanjaro, I'll have similar conditions the first few days, but as we get higher, it'll get much colder, and the final few days will be at sub-zero temperatures, not only at night, but in the case of the summit attempt, during the day as well. This poses lots of additional problems for medical equipment and medications which don't like cold conditions. So I have to consider not only how to keep my insulin cool when it's hot, but also how to keep it from freezing when it's cold, and how to store my pump, blood glucose meter, spare insulin and batteries in the cold.

My only previous experience of serious sub-zero temperatures was a week's walking in the Austrian mountains where the daytime temperature reached down to almost -30 degrees C on a couple of days. However, the big benefit there was that we were staying in a heated house at night and we didn't have to transport kit with us each day, only our daypacks, so things like spare insulin didn't need to be carried in cold temperatures. I found there that carrying my pump and meter in an inside pocket were sufficient, and I had no problems with insulin in the tubing freezing as it was also underneath my clothes. This time, I intend to use a SpiBelt (as mentioned in the other post) for my pump, but I have a new mechanism for the meter and so on, as I don't like carrying a lot of things in my pockets. Inspired by some of my friends on the Mountains for Active Diabetics group (a bunch of pancreatically challenged nutters from all over the world who like to push their bodies to the limit), I decided to devise and make my own thermal medical bag. When I say "make", I mean I said to my mum over Christmas: "You like sewing, don't you? Would you like to make me a birthday present?" and she agreed. My first stop was David Panofsky's IDEA bag (pictured above), but since I like having my meter on the SpiBelt, and I don't like carrying too much round my neck, I decided to simplify it a bit and just have one compartment for everything.

Since my mum lives several hundred miles away, we discussed over email what the bag should comprise, and she hunted out some old fleece material. Being nervous about getting it right, she first designed a prototype made out of an old nightie. She was going to use an old glasses neck cord, but I thought that since it was going to bear some weight, it might be more comfortable to have a flat neckstrap, and I dug out an old conference badge holder with a flat strap which was softer. I cut off the ends and sent it to her, and she made the prototype pictured. I then had to figure out how long to make the straps. It turns out that because my rucksack has a very high waist belt, the bag needs to sit above that, so it needs to be quite high up. On the other hand, it needs to be below the level of the chest strap (which luckily is also quite high up). I pinned the straps in place and sent it back to her. She dug out an old fleece and made up the final bag. We also found that if you put the velcro right to the edges of the bag, it's hard to undo, so she made the velcro strip a bit smaller so there's room to get your fingers into the gap (important when it's cold and you have gloves on!). She then sent me the final product, and I must say I'm quite excited! Here's how it turned out. And I have the original prototype to use as either a liner or just to separate items in the bag. I'll use the bag not only in the day while walking, but also at night to keep the items warm in my sleeping bag with me. Oh, and obviously, I'll be wearing the bag under my clothes (on top of the base layer) not as in the picture! We're planning a long walk in the Yorkshire Peaks this weekend in sub-zero conditions, so perfect time to test it out!