Pik Lenin at 23,406 feet (7134 meters) on the Kyrgyzstan-Tajikistan border was the objective for the International Snow Leopard Expedition of Type 1 Diabetics (ISLET 2005).  I was happy to be invited to join this project: excited to visit a part of the world and a big mountain I had never, ever thought I’d see.  This would also be the highest place I’ve reached by almost 1500 feet (500 meters).

In all honesty, though, it wasn’t the mountain or its height which drew me in.  It was the fact that Marco Peruffo and Vittorio Casiraghi were organizing and I looked forward to seeing them along with other friends, climbing a big peak.  I knew them from IDEA 2000, the International Diabetic Expedition to Aconcagua, a project which consumed more than two years of my time and energy.  Rewards were reaped from this investment when on January 12, 2001 seven insulin dependent diabetics from five different countries, including ISLET members Marco, Vito, Doug, Lisa, and Jordi (honorary diabetic) stood on Argentina’s Cerro Aconcagua 22,834-foot (6959-meter) summit. 

I was the IDEA 2000 expedition leader and the only team member to not reach the top.  The expedition was a success on many levels even for me personally without tagging the summit.  We showed what was possible with a well-prepared group.  Expedition members all returned home safely and continued to dream about climbing mountains together.  The IDEA 2000 project raised nearly $100,000 for helping diabetics in Latin America.  Dr. Mario Zolli, member and brainchild of ISLET 2005 claimed that if it wasn’t for IDEA 2000, DISK (the Italian Diabetic Expedition to Kilimanjaro) and ISLET would never have come to fruition.  IDEA 2000 has been a model for future projects and this makes me proud.

ISLET 2005 was a large expedition.  It included nine type 1 diabetics from Italy, UK (including the Welsh rescue heroine Nikki Wallis), and the USA.  We had six non-diabetic climbers and one trekker, all from Italy.  Then there were two expedition doctors from Catalunya.
And finally we had six Italian diabetologists, four of whom went beyond advanced base camp.  Only eight of us reached the top during the course of the expedition.  Illness, altitude, and poor weather conditions kept many parties from summitting or even progressing up the mountain.  The ISLET team would establish Camp 2 at 17,000 feet and Camp 3 at nearly 20,000 feet in order to acclimatize and be in position for a summit attempt.  An advanced base camp (ABC) was established July 24 on the glacier below the nine thousand-foot high north face of Pik Lenin, close to the start of the crevasse-ridden route to Camp 2. Meals and tents were provided at base camp and ABC by our outfitter and above that we were on our own.
Before our departure for Kyrgyzstan, Marco Peruffo (ISLET’s expedition leader) put it another way: “The seed of IDEA 2000 planted more than five years ago has sprouted a new international project of friendship and cooperation – ISLET 2005.  This one is higher, more demanding, and will require a new level of commitment from each of us.”

Marco was right.  Reaching beyond the base camp of Pik Lenin required a great level of commitment and responsibility.  This was because of the very remote setting (days of travel to reach a hospital over 150 miles away) where the beauty and vastness of the Pamirs was beyond our wildest expectations.  The mountains surrounding us made us very happy to be alive and inspired us.  Our love to climb mountains is what we continue to hold up to the world as an example of what a person with diabetes – in cooperation with their health care team - can accomplish when they have access to the essential tools of diabetes supplies and education.  Mountaineering is a challenge with inherent risks for all climbers.  As diabetic climbers we need to be good mountaineers as well as good managers of our diabetes.  We must monitor blood glucose levels and deliver the proper amount of insulin in potentially extreme environments.  This is simply an extensionof the challenge we face everyday of our normal lives.

On July 30, 2005 I reached the summit of Pik Lenin about twenty minutes behind Welshman diabetic Doug Bursnall. Two other non-diabetic members of the expedition also summitted that day -- Beppe five minutes behind me and Giampaolo (with at least two 8000-meter peaks to his name) an hour and a half behind us who described Doug and I moving up the mountain as “steam rollers.”  Perhaps a compliment.  Conditions on top were cold (minus 5 deg F, minus 20 C) with light winds and reasonable visibility after a delayed departure from Camp 3 due to high winds and poor visibility.  Due to the climb’s lack of technical difficulty (we like most, climbed unroped above Camp 2) this a very underestimetd 7000-meter peak.  The mountain has been the scene of many tragedies including that of a 24-year old Polish climber who died around July 25, 2005 and whose body we sadly passed during the July 30 summit push.
High altitude presents risks for everyone and increased risks for those with diabetes.  It  was a challenge dealing with my diabetes during the trip but the experience and knowledge I have gained over the years provided me with essential skills.  On summit day (and my first carry to Camp 3) my insulin pump gave me major problems.  I ended up ignoring the cascade of alarming and vibrating once I was able to take some insulin glargine mooched from Doug.  So, in the end I was able to improvise and keep blood sugar levels within a good enough range to safely reach the summit and get back to Camp 3 in less than eight hours. The ISLET project was a success not because some of us reached the top, but because we all returned safely home and showed that diabetes doesn’t need to stop you from reaching your goals.I am indebted to the six Italian diabetologists involved with ISLET:  Doctors Corigliano (DESA supporter of many years and president of the Italian chapter), Zolli, DeFeo, Di Mauro, Maldonato, and Poccia who worked tirelessly to make the project a reality.  More importantly, they believed in us: that diabetics had just as much a right to struggle up big mountains as “normal” persons.  For the doctors, I think,  it was an opportunity to climb alongside “patients” and see first hand the day-to-day challenges and what is possible when people with diabetes can successfully manage their own health.

Some Personal Notes

1.        Climbing fast to very high altitudes is a big risk whether you have diabetes or not  Having the time and logistical constraints of a big expedition can push one in this direction.  For me it wasn’t a problem, but altitude is a strange beast (see No. 2 below).  Lesson to share:  Acclimatize properly (stick to your plan!) and keep in mind that small groups can be more efficient in accomplishing this.

2.        A diabetic suffering from high altitude crebral edema (HACE) can’t properly manage their diabetes.  This was based on one expedition member diagnosed with initial stages of high altitude cerebral edema and thankfully was able to descend on their own power (with assistance).  Sympotoms of HACE can be confused with a hypoglycemia, so make sure someone checks blood sugar to confirm what’s up.  Lesson:  See No. 1 and make sure expedition mates know how to check your blood sugar.

3.        Diabetic climbers can perform as well or better than non-diabetics.

4.        Overall glycemic control is worse during expeditions.  This is based on my hemoglobin A1c pre-departure of 6.6% and a return with 7.2%.  A few reasons for this.  Lesson:  Impove control which is easier saying than doing.

5.        Need backup systems as well as the backup insulin.  I had pump problems which was probably not related to altitude (not cold either, as it was kept warm) but perhaps to a software glitch.  Lesson:  In addition to regular insulin and syringes, have some glargine available for simpler basal insulin backup.

6.        Proper storage of insulin important.  By the time I got home, one vial of my insulin aspart was cloudy and lousy.  Lesson:  Use Frio diligently and take precautions to keep supplies out of direct sun (even if in the bum sack) when in the heat of Central Asian summers at low altitudes.

7.        Need to be diligent to keep all diabetes management related wastes (used strips, etc) contained and ready to take home for disposal.  I found used strips when walking around base camp.  Lesson:  Bring a few ziploc plastic bags from home to be used for your take-home garbage.  Shouldn’t need to leave any packaging, strips, sharps in places which don’t know how to manage such things