Greetings, from a Rainforest Junkie...
I just recently found this site, and I'm glad I did! I've been a Type-1 Diabetic for years, and have always found it difficult to find other diabetics who share my passion for remote & strenuous endeavors. Simply put, I'm a "rain forest junkie."
I love nothing more than spending weeks at a time exploring the world's last great unspoiled woods... the dripping-wet temperate rainforests of the Northern Pacific Coast (Oregon, Washington, British Columbia and SE Alaska). Most my trips involve trekking and bushwhacking, usually solo, deep into little-traveled wilderness. Usually the routes I take are self-designed, without trails or guidebooks. My last trek was 17-days solo in SE Alaska's Russell Fjord Wilderness, a little-known area on the Alaskan coast, just south of Wrangell St. Elias National Park. It's the native home to the ultra-rare Glacier Bear, many miles of the world's Northernmost Rainforests, as well as some of the largest non-polar glaciers & ice-fields on the planet.
I don't say all this to brag... simply to give an idea of what I'm into. As you might imagine, it's taken years of trial-and-error to find a routine of diet & insulin that works for me, keeping me safe for weeks at a time away from fellow humans. Last year I posted a small page on my personal website ("Hiking With Diabetes" at RainForestTreks.com), in order to help fellow diabetics overcome the mental barriers (and physical barriers... but mostly mental!) that keep people from pursuing such treks on their own. Before long, that page has drawn more online traffic than the rest of my site. I'd obviously struck a need! I would love to expand the page's content with a wider variety of material (for instance, remote trekking with an insulin pump, of which I know very little), but I've had a dearth of experience to draw upon.
Which is why I'm so excited to find this site! Before asking a bunch of direct questions, I'll spend some time perusing the content already here... there's a wealth of knowledge to be tapped. And then, I look forward to talking with y'all. I hope I can learn a lot from everyone here, and maybe make a contribution to the inspiration & knowledge of fellow active Diabetics that accumulates here.
Anyway, I just wanted to say hi! Talk to y'all later, and maybe we'll meet someday under a damp green understory.
- Mike
at RainForestTreks.com
A single syringe can get one out of a lot of trouble (of course back up insulin makes sense)! If the pump is not working for whatever reason, you can remove the reservoir and pull insulin directly out of there and inject until the insulin is out. Yes, that would be a lot of little shots of whatever pump insulin you are running. Heck, I have even pulled insulin out of TUBING when the reservoir was empty and wouldn't deliver. I figured there was at least 17 goood units left in there (and the bottle of lispro was a few hours walk away). If one were a super minimalist, one cartridge (from a penfill) of *regular* insulin could be used both as bolus and basal insulin, although that in a pinch. A whole vial of lantus as back up seems a bit extreme, perhaps just one cartridge....
I'll give you the link to the Peak Lenin pump debacle soon. Ciao, dp
Thanks for posting, Mike! Great to hear about you as well and interesting pages you have. Please start lobbing those direct questions as soon as you want!
In terms of a little history, a lot of this project is an outgrowth of www.idea2000.org and Nikki Wallis' UK-based Mountains for Active Diabetics (MAD). A truly international diabetes and outdoor adventure place.
UK-based Andy (husband of Liz, active Type 1) has been kind enough to design and maintain this website. We also have a yahoo group called madidea. You should check that out, too.
Welcome.
dp
Thanks, dp!
One question I do have (it's probably been discussed here a few times) is about insulin pumps. For my entire life I've used syringes (4 shots a day currently) with pretty good success. But my doctor is really pushing me to talk about starting an insulin pump to get tighter control of my sugars. I don't doubt that it'll help my day-to-day control, but I'm worried about using a pump on long remote treks.
Most the "big" treks I take, I have to be extremely self-sufficient for weeks at a time. Should something break, I have to make do on my own. My clothes, raingear & pack have to be extremely durable when bushwhacking through the thick wet rainforests of the Pacific Northwest & Alaska, and even then, I often spend a lot of time making field repairs to torn clothing, raingear and backpacks. Through no desire of my own, I've become quite accomplished with a needle & thread in the bush.
Those two worlds don't seem to mesh well. I'm very worried about the durability of those pumps (and the tubes & syringes attached). In the thick of a trailless rainforest, I'm often crawling, scrambling and thrashing through miles of intense thorns & thick brush. Anything I'm wearing takes a beating in the process. If I smashed (or tore up) an insulin pump, 10 days or more from civilization, I could really find myself in a heap of trouble. And so, for years, I've hesitated.
So here I am. What kind of experience do you guys have with insulin pumps in demanding physical situations? How about the adventure racers out there... how do these things hold up under stress? I doubt they were designed for such abuse (few things are), but should I be as worried as I am to try them out? I really don't know, and it's one of the things I'm hoping to learn while hanging out here.
So anyway, there I go, my first "direct" question. Thanks for giving me the nudge, dp.
- Mike
~~ http://www.rainforesttreks.com ~~
Hi Mike,
I certainly can’t answer for dp and wouldn’t want to. After all, he’s not known as the Talking Pancreas for nothing! I’m sure he’ll get back to you soon but may actually be traveling at the moment.
In the meantime, here’s my 2 cents worth. I’ve been type 1 since 1979 and pumping since 2000. As a matter of fact, after kicking the idea around for a number of years myself – and many emails to dp – I finally got a pump specifically to deal with the challenges of climbing Denali. I had a successful climb, summiting in 2001. Would I have been equally successful using syringes? Possibly, but I’d rate my odds significantly lower and wouldn’t even consider it from my current perspective. When climbing Denali I brought a spare loaner pump, 10 spare battery changes (never needed any of them despite -20 F temps) and plenty of extra infusion sets, injectable insulin, other supplies, etc. Much like any climbing trip (or rainforest expedition), redundancy is key. I can’t really speak to the specific hazards involved with scrambling through thorny damp underbrush, but the pressure changes and cold I did encounter proved happily to be no real challenge to the pump’s durability. More recently I spent 35 days trekking and climbing above 20,000' in Nepal (using a different pump) with similarly uneventful results. Again, being nowhere near any emergency pump supplies, I carried back-up insulin sources but luckily never needed them. Had everything gone tits-up with the pump, I’d simply have gone back to syringes and insulin bottles. The additional weight of pump + supplies is negligible compared to everything else in your pack.
Thanks for the helpful links in your well written post. I’m already taking advantage of some of the vegetarian recipes from One Pan Wonders!
Jeff
Thanks for the thoughtful response, Jeff. That pushes me a little bit more in that direction. I have a question though... when you say "Had everything gone tits-up with the pump, I’d simply have gone back to syringes and insulin bottles", do you mean that you carried spare insulin bottles & syringes with you (in addition to the pump supplies & batteries)? Just curious.
My biggest durability concerns aren't so much about pressure & temperature. It's more about..
Obviously I can only go for your "best guess" estimation, but if you have any feedback in that direction, I'd love to hear it. Thanks again for all the input so far... this has already proven very valuable to me.
- Mike
~~ http://www.rainforesttreks.com ~~
Ahhhhhh....Jeff IS good isn't he?? I agree with him 100% as usual, expect for the Talking Pancreas moniker I do not deserve.....That explains why I can't climb anything too hard, though. Who has ever heard of a pancreas slotting themselves in a crack or cranking on a thin edge and hauling themselves up anything vertical or steeper still?
What makes a pump appealing, anyway? What a CDE or Doc says (or marketing generally) should not be the only reason to make a major change. If you are unhappy with your current regime and consider a pump as the best way to get better control, then I'd say it sounds reasonable enough and you may be ready. As Jeff said, there are many people doing quite well on MDI and many would not consider going to a pump. I'm not here to convince you of one therapy over another. The best choice is the one that gives you the greatest flexibility to do whatever you want to do and get the best control possible.
Abrasions - It's not like you are crawing naked through prickly vegetation, at least I hope not!! You have to protect your body, too, so it doesn't get ripped to shreds. Same for the pump. I've done an ugly Coast Range bushwacking (once thankfully!!) and that is insane stuff. Perhaps the constant scratching is helpful against all the insect bites! Obviously, you need to tuck everything (sets, pump) under your clothes so that it is as streamlined as possible. Same goes for when one is rock climbing, although, some buddies who are quite graceful and are onyl face climbing clip their pump to their harness (crazy in my mind).
Wetness - At least one manufacturer of pumps, Animas, makes truly waterproof pumps. I swam while wearing the IR1200 (similar body to the more recent 2020). The others (Metronic for one) make somewhat water resistant pumps which I would have no problem getting moist in a downpour when running, biking, or even trekking. I wore an older MiniMed pump (507c) trekking end to end along the Pyrenees in Spain (the GR 11 path) and finished many days SOAKED to the bone and thanking my gaiters for saving my lower extremities from the gorse and other sharp and stratchy vegetation.
Some potential issues with stickiness of infusion sets if you factor in the sweatiness wetness business, but this challenge is also surmountable. Another discussion area.
Durability/Toughness - It is really surprising how durable these things are. I certainly have scratched screens (preventable) and cracked pump bodies (also preventable due to over tightening of battery compartment). It's not very likely that I would actually survive a situation where my pump gets crushed to smitherines. If an elephant stepped on top of me, my pump might just survive except I probably wouldn't.....
Sanitation - schnanitation. I can't tell you the places I have changed sets, etc....I'd take the backcountry over the developing world anytime in terms of "sanitation". With reasonable, common sense approaches it is (likely) not a problem, especially if one is currently a diabetic on MDI therapy. One still needs to poke oneself plently on "traditional" therapy and infusion sets likely minize the poking.
OK. Enough blathering and I will be away from computer for more than a week starting tomorrow. ENjoy your peace and quiet!! Ciao. dp
Hi Mike,
I just realized I never answered your question re: carrying syringes & bottled insulin in addition to back-up pump supplies. On expedition, any trip lasting more than 1 day and certainly whenever I'm someplace fairly remote... yes, I would definitely pack bottled insulin & syringes. In 8 years I've been pretty lucky with pump reliability - I can't recall ever being left hanging with a dead pump. But luck is just that. David (dp) has a classic story of his pump failing just below the 23,400' summit of Peak Lenin in Kyrgyzstan in less than ideal weather conditions. Doug B's Lantus became pretty handy at the time.
I typically carry a needle and partial bottle of Humalog in my meter bag, more often used for a reliable, quick high bg correction (as opposed to diagnosing what might have gone wrong to cause my 300+ mg/dl reading) than for actual pump back-up. But should I need to replace my pump's insulin delivery, I also figure I can squeak by on Humalog short term. For any remote or extended excursion, having both short and long-acting insulin along is prudent and smart.
Jeff
Hi Mike, and welcome!
Liz has been using a pump for 3 years and her BG control improved markedly. The pump was completely reliable, until last week when we were at the far end of a snowshoe trail in Jasper NP. One of the buttons had failed, so the pump reported an error and shut itself down. And she had just eaten lunch! Normally she carries some lantus and a syringe, but this was just a day trip. We hightailed it out (easier for me on touring skis!) to get back to the hotel for some lantus. The pace kept the BG down, but the lantus took half a day or so to kick in. We skyped Medtronic through my laptop, confirmed the error, and they Fedexed us a new pump at no cost. We received it within 2 days (because Fedex think Jasper is remote). It was a good thing we had written down all the settings, because with a button error the pump locks and tells you nothing!
On reflection, I think I'll make some calibrated spacers. If the pump fails, a spacer of known thickness placed between piston and reservoir would deliver a known bolus when the reservoir is screwed back into the pump body. Liz won't trust my engineering of course, so I'd have to distract her to make this work!
There's a (nearly?) waterproof box available for the Minimed pumps that would keep out the grime, but really these are nicely sealed devices.
By the way, the Fedex customs paperwork said the value of the new pump was US$227.
On rain forests, we once spent a fews years living on Vancouver Island and I completely see the attraction.
-- Andy Reynolds MAD Website Admin
Thanks for the feedback, everyone. I'm seeing an endocrinologist soon about looking into a pump, based partially on your guys' recommendations. I haven't made up my mind either way, but it's worth looking into. If nothing else, my sugars could use some tighter control during my normal routine at home.
Your feedback about ad-hoc engineering is interesting, Andy... it'd be really great to get the thing to still deliver insulin even if it busted. Obviously it's not a good *only* backup plan, but it's worth a shot if the need arises.
I appreciate how readily they'll replace a unit, but that's a secondary issue to me. Mostly, I want to make sure it doesn't break down in the first place. If I'm 10 days out in a 20-day trek (more than a week from another human), it's little consolation to know they'll ship me a new one when I get back to town. I need it then.
Still some unanswered questions for me, but I'll wait 'till I can see it in person to make a judgement one way or the other. Thanks again everyone... it's really appreciated. Best,
- Mike
~~ http://www.rainforesttreks.com ~~