Day 2: Lemosho Forest Camp to Shira One Camp (3550m)

"Bed tea" is the best thing about trekking! Our morning routine is to be woken up by one of the guides at 6.30am with "bed tea" served in our tents, followed by a bowl of hot washing water in our tents at 7am and breakfast in the mess tent at 7.30am. I could get used to such luxuries! The disadvantage of living on your own is that you have to make your own tea in bed. As on other treks, this ritual, aside from being very welcome, is an important part of the day as it enables the guides to check on how you're feeling, in the privacy of your own tent.

The day's walking wasn't hard, although for the first half hour I felt my heart hammering and the breathlessness started. But experience has taught me how to control my breathing at altitude, and I was soon fine. Interestingly, everyone else began to struggle today -- I think the altitude hit them all for the first time, and for most of them, it was their first experience of it so a little unsettling. The pace for me was perfect as it was so much slower than I'm used to walking at home, so I had no problems at all with the steep climbs, although it turned out that many of the others were finding it difficult.

Today I realised my astonishingly stupid camera mistake. After having taken only half a dozen pictures, my camera had run out of memory. How was this possible? Usually I can fit about 150 pictures on it! I finally discovered the problem  -- I had actually forgotten to insert the SD card before leaving home! What a complete idiot! I was crestfallen at the thought that I'd have no photos, and despite the others promising to send me theirs, I knew it was not the same, especially as photos are so personal and because I like to take quirky ones particularly. Thankfully Annie came to my rescue that evening and dug out a spare SD card to lend me.

After reaching the Shira Ridge, we turned a corner and caught our first glimpse of Kilimanjaro in all its glory. The summit was just under cloud but we could clearly see the snow-capped peak. Suddenly the realisation hit me that we were really here. This was it! Mixed emotions rolled over me for the next hour as the mountain towered in the distance. My first thought was "it doesn's actually look that high, surely this is easily achievable?" Of course this is only semi-true: what makes it difficult is the altitude. Next came a tremor of excitement about being finally so close to our destination, closely followed by an almost anti-climactic sense of regret that I'll never experience this moment again in my life. Even if I return, it won't be the same as my first sighting. I'm sure this is nothing compared with the enormity of actually reaching the summit, when I am sure a mixture of emotions will flood the senses: relief, excitement, a sense of history, and of course utter exhaustion.

The campsite lay beneath the foot of the mountain, which afforded us stunning views from even within the tents. Everyone was shattered tonight, and after an early dinner we were all in bed by 8pm, which pretty much set the pattern for the rest of the trek. It was freezing in the mess tent, even with several layers of clothing on, and we debated who would be the first to crack and put their down jacket on during the trip!

Day 1: Londorossi Gate to Lemosho Forest Camp (2650m)

We were all eager to get going this morning. I was wide awake at 5am, and shortly after, the rain started hammering down, but by breakfast at 7am it had thankfully stopped. The bags were weighed (some with a set of scales, others by the scientific method of "this feels light enough") and there was a frantic bit of repacking by some who were over the regulation 15kgs. Packs of cereal bars were hastily distributed amongst those with lighter bags. I felt a little smug that mine came in at 13.5kgs, given all the medical equipment I had to carry! Then came a two-hour drive along typical African "roads" (bumpy dirt tracks), more bag weighing and registration at the checkpoint, and then a short drive to the starting point.

We set off at midday and the pace seemed agaonisingly slow, but after a couple of hours when we stopped for lunch, it had already become very natural. The afternoon became a little more challenging with some steep, muddy and slippery inclines, and those who were not used to walking struggled. By 4pm a mild headache had set in, although I had drunk 2 litres of water in the afternoon and 2 in the morning. I started feeling odd waves of nausea and a horrible dread seized me, but they seemed to be short-lived. Oddly, I seemed to be the only one suffering. It's hard not to let such thoughts consume your every waking move. I decided to concentrate on the analogy someone had once told me about pretending to be an elephant squashing pieces of cardboard and stamping out negative thoughts. I know, it sounds weird, but it made sense, and what better place to pretend to be an elephant than in East Africa?

On arrival at the campsite we were served tea and popcorn in the mess tent and I started feeling much better. I made sure I drank 3 cups of tea and took plenty of water to bed that night. We were all in bed immediately after dinner, at 9pm,  though none of us slept well. Terrified still by thoughts of altitude sickness, I drank a litre of water in the night and consequently had to get up to pee 4 times. You begin to wonder what the point of drinking at all is, when it seems to come straight back out again.

Arrival in Tanzania

So there are 9 of us on the trek: a trio of friends, a father and son, and the rest of us singles, totalling 5 men and 4 women ranging in age from 19 to 60. All British except for Giulio the Italian. The first night we spent in a beautiful lodge in the middle of a coffee plantation, in typical African style individual huts. A couple of hours relaxing in the sun by the pool, and a wander around the grounds, followed by a long briefing from Abraham, our guide, who seems lovely -- competent but very friendly. I had a word about my medical conditions and he reassured me that I'd be fine and that in his capable hands there would be no problems. There are two ways of saying this: one is where the person doesn't care or doesn't appreciate the significance of it, and the other where the person is fully understanding of the issues, but is quite used to dealing with them. I could tell instantly that the latter applied. My only concern was that -- and some of my friends will find this highly amusing -- he had me down as being allergic to wheat instead of yeast. I hoped this wasn't going to be a problem, but I sensed he didn't really understand when I explained the mistake. Otherwise, the usual advice was given about drinking lots of water and walking slowly. The group started to gel over dinner and the toilet discussions started (best to get any embarrassment over quickly, in my opinion!). An early night at 10pm after repacking the bags yet again! I didn't sleep very well due to excitement, or maybe sheer terror at what I'd let myself in for, plus having to use a mosquito net which I hate.

Departure day

Having finalised my packing at the weekend, it remained only to charge my electronic devices and pack the last bits of hand luggage on Wednesday morning. As I clipped my walking poles to my daypack, an uneasy feeling rose from the pit of my stomach. Walking poles have spiky ends, even if they are encased in rubber tips -- hmm, this might make those nervous chaps in airport security a little concerned. A quick Google search confirmed my fears. The problem was that the poles didn't fit in my suitcase and I'd definitely need them on trek. Only one thing for it, repack everything back into the Exodus kitbag. I knew they'd fit, but previous experience had shown that lugging a 17kg kitbag through the streets of Sheffield, St Pancras and the tube is not for the faint-hearted (or weak-bicepped). Ah well, I'd just have to hope that all those gym sessions had paid off, or failing that, treat it as the final piece of fitness training. It seemed that as usual, half my luggage was diabetes-related: glucose tablets, jelly babies and cereal bars in case of low blood sugar, spare blood sugar meter, plenty of insulin, test strips, infusion sets and other pump-related paraphernalia, emergency syringes, spare batteries for all the electronic stuff, plus cool bags and thermal bags to keep everything at the right temperature. Just think of all the luxuries I'd have room for if I didn't have diabetes! Best not to think about it. The other minor snag with no suitcase was that I'd have nothing to store my spare kit at the hotel during the trek. Oh well, a strong plastic bag should do (actually it fell apart later, but that's another story).

When I got on the Tube to Heathrow, I clocked a few fellow travellers wearing walking boots and clutching heavy-looking rucksacks, and idly wondered if any of them would be on my trek. What a ridiculous notion! The chances of that would be pretty slim -- millions of people travel through Heathrow every day. But once at the checkin desk, I thought I'd be bound to spot a few fellow intrepid Exodus explorers. A bleach blonde 40-something from Essex with a huge rucksack was blathering into her phone about what a terrible ordeal she'd just had going through airport security. The worst part of her ordeal? That she had had to remove her trainers. My heart sank. She was bound to be on my trip, and I'd find it hard not to kill her after 5 minutes, let alone 10 days! I had her type pinned to a T: recently divorced, looking for a new challenge, didn't have a clue about the realities of slumming it on a gruelling trek, without washing for more than a week. No doubt she'd be applying her inch-thick mascara every morning before breakfast and eyeing up the virile young Africans. Thank goodness I'd decided to opt for a single tent, so at least I wouldn't be sharing with her!

The plane turned out to be only half full, mostly of people with rucksacks and walking boots, but who oddly all seemed to know each other. I mentioned this to the young Ghanian chap seated next to me, and he explained that they were all part of a VSO group going off to work in various parts of Sudan. Thank goodness!

Oddly, having been full of excitement in the last couple of days about my impending doom (trip, I mean), by the time I got on the plane the excitement had been replaced by frustration and tiredness. Probably due to the fact that I'd only slept about 3 hours the previous night. Given my inability to sleep on flights, and the short  time I'd get to sleep on the plane anyway, this did not bode well. But years of insomnia have taught me to go with the flow, so I eagerly embraced the disgusting red wine for medicinal reasons, trying not to make comparisons about the last supper before the gallows. Since we wouldn't have any alcohol on trek, I felt I should celebrate the start of my journey somehow at least!

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!