What does it mean to be diabetic in the outdoors?
Well, while it obviously depends what you are doing, I think a few things are pretty universal.
First, and most importantly, we have our blood sugars to worry about.
Second, we have to be super on top of our food; we don’t have the food freedom that non-diabetics have.
Third, we have to accept a slightly higher level of risk.
And fourth, we have to acknowledge there might be an impact on the people we are with if our blood sugars don’t behave.
All of these are added extras other people don’t have to worry about, but they can greatly affect our enjoyment of the outdoors. Having worked through these things over a number of years, now, for the most part, I can enjoy what I do without my diabetes getting in the way. But it’s taken a lot of time, mistakes and support.
This World Diabetes Day, I want to talk through these aspects of what it means to be a diabetic in the outdoors, both for the benefit of those living with diabetes and for those wanting to support diabetic friends, family members, colleagues or clients.
When you’re diabetic everything comes back to blood sugars, so I am going to start by talking through the other three points, as they all tie back to blood sugar management in the end.
First, food and food freedom. Now, depending on how your body reacts to different foods and the activities you are doing, how you approach this will vary. Activities that are more anaerobic can put blood sugars up, meaning insulin might be taken and eating carbs before or during the activity is a bad idea. Other activities are really good at bringing blood sugars down, so you will need to make sure you have enough sugar with you to deal with this and eat carbs as you go.
I find when I am out for long days in the hills I like to eat different food depending on what my blood sugars are doing. If I am running stable at a good number or a little high, I will eat foods that have very little carb such as nuts, dried meat, boiled eggs and cheese. These foods have a minimal effect on my blood sugars so I don’t need to take any fast-acting insulin with them, allowing me to reduce the chances of a hypo. When my blood sugars are getting low, I have boiled sweets, chocolate and fruit and nut bars that will bring my blood sugars back up again. I choose to eat this way as I prefer to take as little insulin as I can get away with when I am out on the hill. And I know it won’t work for everyone.
But no matter how you choose to approach this, every diabetic has to make constant decisions about what they eat and how they eat throughout the day. While our friends happily tuck into whatever lunch they fancy, we have to weigh up the activity we are doing, the exertion required from us and the likely impact on blood sugars. We decide how much insulin to take and what to eat to best fuel ourselves based on more that what we just want at the time. What we eat matters, and when we are out in wild unforgiving environments it matters more than ever.
The second thing I want to talk about is risk. We all know outdoor activities carry a certain amount of risk - the type and severity depends on the activity. For climbing, skiing, mountaineering and paddling, severe injury is always possible. Everyone who takes part in these activities has to accept the risk they are taking.
But diabetics have an extra risk to manage: low blood sugars! They are a risk for us and also for the people we are with. A bad hypo at a bad time can cause serious problems. Hypos while climbing may cause a fall or bad judgment when placing gear. If a hypo on a mountain slows us down or causes a delay, the weather could close in and people could get cold or become lost. It might mean finishing in the dark and, in the worst case scenarios, cause people to fall unconscious and need rescuing. This risk can be largely mitigated when we look after our blood sugars, but it can’t be eliminated completely. Like all other risks associated with outdoor sports, it’s one we have to accept if we want to participate.
This ties in closely with the point about the impact our diabetes can have on other people and what we as diabetics can do about it. I always think this issue is overlooked. More often than not, it is psychological. Not wanting to ‘show weakness’ or be slower than other people or acknowledge that our blood sugars aren’t behaving is pretty normal. I think some of it comes from the idea society has that diabetes isn’t a particularly serious illness and one that you simply learn to live with. We are taught early on not to complain or make a big deal out of the added difficulties we face. We are expected to manage everything just as well as everyone else, despite the fact we also have a never- ending, ever-changing and incredibly complex condition to deal with at all times.
When we are doing outdoor activities with other people it’s natural not to want to let the diabetes get in the way. On a hill I don’t want to slow everyone down by having to stop for a hypo. Climbing, I don’t want to be the person that prevents us doing the extra climb because of my blood sugars. I want to be able to do what everyone else does! I worry about the impact a hypo would have on my clients; would they trust me less? What would they think if I, the guide, was the one who needed to stop? These are considerations we always have to take into account. When diabetes does affect the plan for the day, I tend to feel guilty and enjoy my day less. While I do everything I can to prevent it, it does happen occasionally and I do worry what other people think.
All of these things ultimately come back to our blood sugars. If we get it right and our blood sugars behave, then it’s easy to have a great day. We are less worried about impacting the enjoyment of other people and the risks are minimised. When our blood sugars are on a rollercoaster it’s much harder to make the right decisions and to keep ourselves safe.
There are some places where hypos are really not ok and it’s up to us to learn how to avoid them. Flash and Continuous Glucose Monitors have made a big difference on this front, and I love the fact my CGM has alarms that go off to let me know my blood sugars are getting low and that I need to do something about it. For me, this is a really helpful way of making sure I can keep myself and the people I am with safe. But even with modern tech, being a diabetic in the outdoors can be hard, no matter how much you love the activity you are doing.
I hope this blog post has helped highlight the things diabetics have to manage every time we head out, and that if you are not a diabetic it has helped your understanding of what someone with diabetes will be dealing with when in the outdoors.
I wish everyone a great World Diabetes Day and hope to see you on The Diabetic Outdoors website again soon!
Thanks
Ailsa
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