Having type 1 diabetes is not just about controlling blood sugars day in and day out. It is about living life to the fullest, but also staying SAFE. For some, like Will Cross, it may be climbing the highest point on every continent; for others, like Bruce Linton, it may be dog sledding in the “toughest dog sled race in the world.” For most of our patients, it may be a week-end backpack trip in the mountains, a raft or canoe trip on a waterway, or car camping in a National Park. But wherever someone goes who is insulin requiring, there is some extra preparation that must be considered, especially when entering the back country.
Because I live in the beautiful state of Montana, many of my patients choose to explore the outdoors, miles from the nearest hospital or medical clinic. I spend time with each of them as they share their planned adventures, and discuss what extra supplies to bring. If the adventure is a physically active one, my list includes: extra infusion sets for pumps (twice as many as they think they would need), an extra vial of insulin, 2 glucagon kits, 12 test strips per day, a back up glucometer, and enough glucose tabs and energy bars for 4 lows per day. The energy bars can double as additional snack food at the end of the day if they are still available.
I emphasize the importance of clean hands prior to checking, and using an alcohol wipe rather than hand sanitizer if fresh water is not available. Checking blood sugars frequently with unfamiliar activity is so important, because physical activity can act like insulin and drive blood sugars down quickly. A small first aid kit with items for foot care is also important when going for a long hike. On a recent raft trip with 42 teens, we added a water proof case for all the pumps we collected. We labeled a ziplock bag with each child’s name, and put them in a hard water proof case. The case was then put in a waterproof bag and secured to the raft. We figured we better take good care of that case as it had almost $300,000 worth of pumps! In addition, I encourage the use of a communication system. Cell phones are generally non functional in many out-of-the-way places, so use of a satellite phone (heavy) or a light weight one-way communication system like “Spot” is advised.
Even though the volume of supplies appears a bit overwhelming, the weight of the total items is minimal, and the knowledge that the supplies are readily available increases the joy of the trip. I hope you and your patients are enjoying the great outdoors, safely and well prepared! If you have any tips for enhancing safety for patients in the back country please share them with us!