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!