Climbing

Climbing is a wonderfully exhilarating sport combining prolonged intermediate level exercise with periods of intense exercise. It is a good sport for people with diabetes as the necessary kit can be easily carried and help is at hand. At high levels the effects of altitude and cold need to be considered. As you go higher, the muscles must use a greater proportion of glucose as the fuel because of the reduced pressure of oxygen. Blood glucose can therefore fall more rapidly. There is a worry that low oxygen pressures with cause deterioration in retinopathy and that acidosis is more likely. A recent report in Diabetes Care about climbing in the Andes suggest that retinopathy does not deteriorate, but glycaemic control does because more unstable. Clearly attention must be paid to carbohydrate intake and fluid intake.

Seastian Sassevile

When I first trekked to Mount Everest base camp in 2001, I promised myself that one day I would come back and climb Everest all the way to the top. I was young, probably over confident but very ambitious. What was initially a dream quickly became a project and I went back to Nepal four times in the following seven years. Along the way, I was given the gift of Diabetes and I say that with no irony what so ever. Both the obstacle that I chose, Everest, and the one I didn’t choose, diabetes, made me stronger.
Climbing in high altitude is a demanding and risky endeavor. Add managing type one diabetes to the mix and it becomes a monumental challenge. I believe three key words can make everything a lot simpler and safer: Education, preparation and experimentation. In that order and in a continuous circle.
Education. To complete my journey it has been crucial to take owner ship of my diabetes and proactively educate myself on it. Two minutes in my doctor’s office three times a year wasn’t going to cut it. I decided to learn as much as I could on type one diabetes from as many sources as possible. When exercising, understanding how everything works is fundamental. When insulin peaks, how long it is active for, understand the concept of insulin on board, how blood glucose monitors works, their limitations, know how to count carbohydrates, know how different types of carbohydrates absorb, understand how my pump works, etc. The list goes on indefinitely, so it is easy to get overwhelmed. Be patient and never stop learning. Learn one new thing about your diabetes every week and you’ll do just fine.
Preparation. Climbing Mount Everest is a 60 days expedition. Needless to say a lot went into planning my diabetes strategy. I packed about 15 blood glucose monitors, 2 pumps, 12 months worth of insulin, insulin pens, 1500 test strips and a LOT of treatment for hypoglycemia. Having back up plans is one thing, but the strategy doesn’t stop there. Transportation, storage and repartition of the supplies are all very important. For example, no matter how much insulin I have, if it’s all in the same place and freezes I’m in trouble. During the expedition, I broke down my insulin stock in three thermos. I kept one on me at all time, one at base camp and one in a clinic in Katmandu. No matter how short you exercise for, always have something to treat hypoglycemia on. When prepared properly, hypoglycemia is simply a discomfort. On the other hand, if unprepared, hypoglycemia can be catastrophic if not life threatening.
Experimentation. Now that you know your diabetes and that you are prepared, it’s time to get out of your comfort zone! Try things you have never done before and trust yourself. Every time I do something new I learn a lot. Be patient, go one step at a time and build on your experiences. It took me 5 years of preparation to feel my diabetes strategy was ready to scale Mount Everest. I started with weekend camping trips, then went for short expeditions, then started climbing more seriously, then added altitude in the mix, went on several 30 days expedition and eventually felt ready. By building slowly but surely, the next step is always just a little bit higher and seems achievable.
I stood on the summit of Mount Everest on May 25th 2008. Three days later we walked back into base camp, trekked back to the city, had a steak and a beer and I never climbed again. Two months after I got back from Nepal started to train for my first Ironman.
The Ironman race is grueling : 2.4 miles swim, 112 miles bike ride and a 26 miles marathon. Needless to say that training for such an event with type one diabetes is a challenge. Starting slow is key. You need to figure out what to do on a 30 minute run before going on a 2h run. The more you measure something the more you understand it. I could not imagine testing my blood glucose less than ten times a day. I test pre and post meals, before, during and after exercise and whenever I’m not sure of what my blood glucose is. Never test if you are not going to think. Figure out why you are high, low or within range. Take notes, identify what you have done right and what needs to be changed. In a race that can be as long as 17 hours, preventing a low blood sugar often starts hours before the race. On the flip side, my current blood sugar impact how I will perform in several hours. I completed my first Ironman in 11 hours and fifty minutes. My blood sugar dropped under 70 once and never went above 180.
On a final note, one thing is crucial to understand and to accept: diabetes is different for everyone and different every day. Therefore there is no magic recipe. Do not approach diabetes and exercise in a way that you are looking for the “right way” of doing it. What works one day isn’t likely to work the next day. Instead, think of diabetes and exercise as an equation with variables that constantly change. Some variables are obvious, duration and intensity for example. I have listed more than 20 different variables that impact on my diabetes during exercise. Some variables don’t have an actual impact on my blood glucose but they impact my strategy and the way I prepare for the outing. Time of the day, type of activity, overall goal (recreation, weight loss or performance), stress, insulin on board, recovery, risk of disappointment, risk to safety and temperature are just a few. Every day the equation adds up to a different strategy.
Let’s not be foolish, this is hard. But it can be done. I still have high and lows and make mistakes. I get better at it every day, focus on my successes and learn from my bad days. The key to success is hard work, dedication and perseverance. Make your diabetes an ally and not an enemy, and exercising should be a walk… or a run in the park.

Climbing Denali (Mt McKinley), 6194 m (20,320 ft) by Neil Hunter



Denali (or Mt McKinley) is located in the central portion of the Alaska Range, which spans much of south central Alaska. It is approximately 130 miles north-northwest of Anchorage.
The mountain is characterized by extremely cold, severe weather, and also by an unusually high risk of altitude sickness for climbers, not only due to its high elevation, but also its high latitude. At the equator, a mountain as high as Denali would have around 50% as much oxygen available on its summit compared to sea level, but because of its latitude, the pressure and therefore oxygen level is even lower.
After assembling in Anchorage, the team (four from UK, two Canadians, one each from US, Poland and Denmark, plus three guides) drove to the small town of Talkeetna where the air taxi would fly us out to the glacier and our starting point. There was a short delay and overnight stay in Talkeetna in order to wait for an appropriate weather window allowing us to fly.

The Route.

After a spectacular 40 minute flight out to the Kahiltna Glacier, we established our first camp at 2200 metres. Here we rigged our rucksacks and sleds for glacier travel, and went through procedures regarding crevasse rescue which is a very real threat during this first part of the trip.
Our packs and sleds were fully loaded with both personal and group gear, including all food and fuel required for our time on the mountain. Due to these heavy loads, we employed a strategy of load carrying up to a point and burying a cache of supplies, then descending back to camp before moving back up the mountain to establish a new camp and pick up our buried supplies. Although necessary in order to ease the load burden, employing this routine aids the acclimatisation process; climb high, sleep low.
The height gain from Base Camp to Camp 1 was negligible, so a full load was taken for this part. We traversed the glacier during night hours to decrease the risk of crevasse fall due to soft snow conditions in the heat of the day. At this time of year (late June/early July) in Alaska it never gets totally dark, but the sun dips low enough on the horizon to allow a significant drop in temperature, giving us our best chance of an incident free traverse of the glacier. 

We spent two nights at Camp 1, having spent the second day carrying a load of supplies up to Kahiltna Pass in poor weather conditions, burying a cache and returning to camp.
Next step was to climb beyond our cache and Kahiltna Pass in order to establish Camp 2 at 3400m. From here we spent an active rest day dropping down to retrieve our cache from the pass. The camp is situated in a basin at the bottom of Motorcycle Hill and from here there was an awesome view of Mount Foraker, at 5304 m high it is the second highest mountain in this range. Over the following days however, it seemed to get smaller!

We hauled another load of supplies from this camp up and around a point called Windy Corner, which fortunately for us never lived up to its name or reputation.

We stopped a short distance from what was to become Camp 3, buried another cache and headed back to Camp 2 to rest. Next time we passed Windy Corner, we were to have all of our remaining kit and supplies. We picked up our cache en route to Camp 3, making the last part of the journey to Camp 3, at 4360m, an arduous task, with very heavy loads on our backs as we had left our sleds at Camp 2 due to the steepness of the terrain.
Camp 3 was more like a base camp, with lots of evidence of previous teams from the abandoned walls they had built to protect their tents from any storms. These proved to be a good idea as on the day we flew onto the glacier, several teams were enduring an eighth day of being pinned down by a storm confining them to their tents. They all had to descend once the storm had passed due to lack of time for a summit bid.
We were much luckier and took advantage of the previously built shelters in which to pitch our tents. We took a rest day here, allowing us to eye up the headwall which was our next objective. We also witnessed a huge avalanche from here – another reminder of the might of the mountain.


Camp 3 was the staging point for the headwall which was a 600m climb, the uppermost part on fixed lines. We did this twice, again to carry supplies and cache at the top of the headwall, to be picked up on our way to High Camp.
Camp 3 was also a good place to take in a rest day before our move up to High Camp, aiding the acclimatisation process. Rest days can be quite boring, so ipods and books are a must, but a few of us took a short trek to the edge of the basin to what is known as the ‘Edge of the world’! From here you can see the majority of the route already taken. You also get great views of Mt Hunter & Mt Foraker.
After the rest day, the whole team was well acclimatised and raring to climb the headwall once more to get to High Camp.
After the fixed lines, the terrain becomes a little more tricky and exposed but not too technical. To aid this, there are a series of anchor points where the rope would clip into to arrest the faller in the event of a slip. This slows you down, and added to the continuing height gain, made for a long, tiring day.
Once at High Camp, we again utilised an existing site and spent some time on the following rest day reinforcing the walls built to protect the tents. Thinking this was adequate, we retired to our now cramped tents (normally two per tent, to save weight we have three per tent high up, leaving some tents at Camp 3) for a rest before summit day.
That night proved not only cramped but sleepless, as a storm came in a battered the tents all night. In the morning the decision was made to abandon a summit attempt and instead we battled the elements in order to cut more snow blocks to reinforce the camp walls.
Another sleepless night followed, but by morning the weather had abated sufficiently to allow us a crack at the summit.


Anticipating a long day due to the altitude combined with a total of 900m of climbing, we had an early start. Unfortunately this meant that for the first few hours we were climbing up to Denali Pass in the shade which made for quite a cold start. Once at Denali Pass we were in the sun once again and from here we made slow but steady progress up towards the summit ridge. The summit ridge is quite spectacular, with big drops either side and a huge cornice of overhanging snow all the way. Before we knew it, the ridge was traversed and the summit was reached. The weather treated us to an unspoilt panoramic view, being able to see for miles.


After spending a while on the summit, we headed back down to High Camp, spending a night before taking the next few days to travel back to the pick up point by Base Camp. The traverse of the glacier on the way out was even more tricky than the way in as a lot of snow had melted, causing a lot of snow bridges to disappear and opening a lot of crevasses. We gratefully arrived at Base Camp before the air taxi came to take us back to Talkeetna.

Diabetes Management;

Although I had been to altitude before my diagnosis (type 2 insulin bound), I had not experienced any height over 4000m whilst requiring insulin. New territory for me, but having experienced long winter mountain days in Scotland and big days in the Alps, I had a good idea how my body would react to the exercise. The unknown factor for me was how my diabetes management would be affected by the increase in altitude.
On the whole, it seemed to have little impact as my blood sugars were generally ok. I achieved this by reducing my basal (Lantus) dose to 60% of my normal and then 40% prior to summit day. I would usually take my bolus (Novorapid) with breakfast as normal, snack all day when underway without any insulin and then have my evening meal with normal doses of insulin too.
We were consuming around four thousand calories per day in a large variety of foods, and taking on copious amounts of fluid to combat altitude sickness and dehydration. Despite the increase in calories, I lost 17lbs in just under three weeks, but altitude has this effect on the body.
On only two or three occasions did my blood sugars drop below 4mmol, but each time easily remedied apart from on the glacier traverse on the way out, but this may also have been due to travelling at night. Although not debilitating, I was constantly trying to keep my sugar level up by increased snacking. Once my reading was over 17mmol, but this was down to a shorter than anticipated descent and being over cautious with my breakfast dose.
So, on the whole, my strategy for controlling my blood sugars, which was the same as I adopt for a Scottish mountain day, was largely unaffected by the altitude.

Data for the trip

Day 1

Fly into glacier from Talkeetna.
Establish camp at 2200m.
2130 – BS 7.3 Ketones 0.1
2200 – 6 units Lantus

Day 2

0230 Rise – BS 7.6
Light breakfast – no insulin.
0500 Start traversing glacier.
0615 – BS 6.4
Various snacks on trail, no insulin. On move for 6 hours, no altitude gain.
1100 – BS 10.5
Establish camp (C1) and rest for remainder of day.
Normal insulin with all snacks and meals for remainder of day.
1850 – BS 5.6
2200 – BS 8.8
2210 – 6 units Lantus

Day 3

0700 – BS 6.8
0900 Rise.
Normal insulin with breakfast.
5 hour uphill carry (600m gain), bury supplies and return to C1.
Snacks en route without insulin.
1830 – BS 3.8 – took on carbs.
Normal insulin with evening meal.
2300 – 6 units Lantus

Day 4

0800 Rise
Breakfast without insulin.
1030 start. 7hour, 1000m climb with medium load to camp 2 (C2) at 3414m.
Snacks on way without insulin.
1850 – BS 3.2 – took on carbs.
Evening meal with normal insulin.
2300 – 6 units Lantus.

Day 5

0930 Rise. Breakfast without insulin.
Drop down 500m to pick up buried supplies and return to C2. 4 hour round trip.
Snacks on trail without insulin.
Afternoon snack and evening meal with insulin.
1600 – BS 6.1
2230 – 6 units Lantus.

Day 6

0800 Rise.
0830 – BS 7.7
Breakfast without insulin.
Load carry for 7 hours, climbing 700m, burying supplies and dropping back down to C2.
Snacks on way without insulin.
1745 – BS 6.9
Evening meal with insulin.
2200 – 6 units Lantus.

Day 7

0830 Rise.
0830 – BS 6.3
Breakfast without insulin.
7 hour climb to C3 gaining 1000m, picking up buried supplies en-route.
Snacks on way without insulin.
1800 – BS 8.1
Evening meal with insulin.
2000 – BS 4.7
2200 – 6 units Lantus.
Oxygen saturation of blood – 83%
Resting HR 107bpm.

Day 8

0930 Rise.
Breakfast with insulin.
1040 – BS 7.0
Lunch snack with 50% insulin dose.
1600 start. 5 hour load carry up headwall, 600m up and down again to C3.
Snacks on way without insulin.
Evening meal with insulin.
2115 – BS 7.5
2300 – 6 units Lantus.
Oxygen saturation of blood – 85%
Resting HR 86bpm.

Day9

1030 Rise
1030 – BS 6.1
Rest day.
Insulin with all meals & snacks.
1900 – BS 13.3
2200 – 6 units Lantus.

Day 10

0800 Rise
0815 – BS 5.6
Breakfast without insulin.
1045 start. Climb from C3 to High camp (5243m). 8 hour climb.
Snacks on way without insulin.
2000 – BS 6.7
Evening meal with insulin.
2230 – 6 units Lantus.

Day 11

Rest day.
1000 – BS 5.8
Insulin with all meals and snacks.
1900 – BS 5.1
2200 – 4 units Lantus. (Summit attempt following day)

Day 12

Enforced rest day due to storm.
0820 – BS 6.7
2200 – BS 5.7
2215 – 4 units Lantus. (Summit attempt following day)

Day 13

0730 – BS 6.7
Breakfast without insulin.
0845 – BS 13.8
0945 start. 1000m climb to summit and return to High Camp.
12 hour day, snacks on way without insulin.
Evening meal with insulin.
2200 – BS 5.3
2300 – 6 units Lantus.

Day 14

0930 Rise.
0930 – BS 7.7
Breakfast without insulin.
1200 start. 1000m drop to C3, 3.5 hours.
Snacks on way without insulin.
1540 – BS 17.1 Ketones – 0.1
1540 – 4 units Novo due to high BS.
1715 – BS 6.7
2040 – BS 5.7
Evening meal with insulin.
2200 – 8 units Lantus.

Day 15

0700 Rise.
0700 – BS 4.9
Snack for breakfast without insulin.
0915 start. Drop down to C2, 3 hours.
Lunch with insulin.
1320 – BS 8.5
Rest for remainder of day.
Evening meal without insulin (Early start and long day to follow)
2100 – BS 5.0
2230 – 6 units Lantus.


Day 16

Midnight start. C2 to Base Camp. 10 mile glacier traverse, 8 hours.
Snacks all the way without insulin.
0200 – BS 3.8
0430 – BS 4.1
0700 – BS 2.7
1020 – BS 6.8
1200 fly out of glacier back to Talkeetna.
1730 – BS 9.3

Please check out the MEMBER WEBSITE for MAD - which can be reached via www.mountain-mad.org  Kind regards, Nikki Wallis     Nikki Wallis, President & Founder,Mountains for Active Diabetics (www.mountain-mad.org, Phone (UK) 01286 872125, Fax (UK) 0845 127 4218, Other relevant websites you should check are:

By Thomas Beesley

Tom is a 21-year-old diabetic patient who is a keen mountain climber and is on Novorapid and recently transferred onto insulin Glargine.

He wants to optimize his climbing performance and to improve his blood glucose control when climbing. His problems are mainly that he finds very rapidly falling blood glucose during his climbs but also a tendency towards hypoglycaemia in his post-climb with insulin injections and hypoglycaemia at night. He also thinks that insulin Glargine ceases to work after a couple of days of climbing.

Climbing in the Dolomites

He typically has a breakfast at about 9.00 am, usually just a couple of pieces of bread with no insulin treatment. He then describes that he calls a gentle walk, which is between a 2-3 hour assents on paths at a fair speed of about 1,000 metres. They then traverse using ropes which may last 2-3 hours, this may involve climbing and a further 500 metres but again is quite energetic. They then stop and then make a 2-hour descent and have an evening meal.

He has noticed that his blood sugar falls continuously during the climb and may start at 15 and drop to 4 or 5. He does not take much in the way of carbohydrate while he is climbing. He eats some food at the top of the climb with no further insulin injection. Once he returns back to the accommodation, they have their evening meal and he notices that he is often hypoglycaemic with his evening meal.

With insulin Glargine transfer, he has noticed that his blood sugars are not so high in the morning but tend to fall more rapidly during the climb. He also notices that after 2-3 days his morning blood sugars starts to rise and he notices that he gets ketones, and he thinks that this is because his insulin Glargine has stopped working.

What he has been doing on climbing days is reducing his insulin Glargine dose by a half, which is the same that he used to do with his Isophane insulin.

A plan to deal with these issues might be:

1. The most obvious is that he should take regular carbohydrate intake of between 30-60 grams per hour on ascent. This should be taken in the form of either a glucose containing drink such as PP2 or in the form of Dextrosol tablets or pastilles. He could take this in the form of a carbohydrate rich containing snack which would be lighter to carry, but may take longer to digest.

2. Glargine is providing too much background insulin level on his climbing days. It is likely that this will impede his mobilization of fuel, particularly free fatty acids and impair gluconeogenesis, and he may actually need to go back to his Isophane insulin in the week before going on his climb and whilst climbing.

It would seem that from a climbing point of view that these problems could all be rectified by an insulin infusion pump, although there are funding issues regarding these pumps, However, the pump does seem very attractive in that he could adjust his basal and bolus components appropriately to deal with this.

Thom's Thoughts on Diabetes and Climbing

When I was diagnosed as diabetic in February 2002, my first thought was that the trip to Mont Blanc I was planning that summer wouldn't go ahead.

Later on that day I worked out there were probably other problems I should be thinking about, but, knowing practically nothing about the disease I had no idea what to expect. Can diabetics do stuff like climb mountains? At the time I felt so ill I couldn't imagine ever even making it to the pub, let alone up a mountain.
I raised this with the doctors on the day and they had a rather sweet "wait-and-see" attitude but I knew they thought it was impossible. So, for a few days I had to concentrate on counting units of insulin, first hypos, where to jab my fingers so it didn't hurt and all that stuff, but I knew I couldn't put it off forever.

I went to my computer and typed in "diabetic" and "mountaineering". To my extreme relief, I found the IDEA2000 website and a group of diabetics who had climbed Aconcagua in that year. I sent a rather hesitant E-mail to one of the group who put me in touch with Nikki Wallis in North Wales.
She, and several people who had also been on the trip, were amazingly helpful and gave me the confidence and practical advice I needed to train for and complete the Tour du Mont Blanc, ahead of time and even take in an unsuccessful summit bid.

Support

Since then we have set up a web-based newsgroup, MadIdea (Mountains for Active Diabetics / International Diabetic Expedition to Aconcagua), where anyone from all over the world can talk about pretty much anything they want. This year we had our first international forum at Plas-Y-Brenin in North Wales, where we all met up and shared our experiences, gave lectures and, of course, went climbing. I would urge anyone reading this who feels they could do with any help at all to get in contact (I have included useful links below). I don't want to sound like an advert for them (us) but its the one thing that has completely changed my success as a diabetic mountaineer.

Problems in the Mountains

Diabetes is occasionally still a problem in the mountains. I have experienced both big hypos and ketoacidosis while on the hill and have found various ways to help this. Firstly, I bought a rehydration system to go in my pack with a drinking tube and bite-valve. This way, I can get a steady flow of sports drinks into my system as my blood sugar lowers with exercise. I found that I could vary the concentrations using either powdered drinks (which are horrible) or by simply diluting the existing drinks.

Also, I try to reduce the times between eating and climbing as much as possible. If my blood sugars go high then low I get sick. My background happens to be in human biology so I can often work out what's going on. I think the more you understand about metabolism the better. Its not the easiest area of science, but it is the key to understanding what your body's doing and why.
But the most important thing is to train. I was amazed at the difference between my pre- and post-diabetic self. Before, I smoked and never really exercised systematically. Now, I can get up a hill twice as fast, and still feel great at the top. And I've never gone running more than three times a week, even in my most intensive periods of preparation.

All the rules about climbing sensibly and responsibly that you learn when you start climbing and ignore because you want to get up bigger and harder routes become much more important. I have learned when to stop and when it is safe to carry on. My climbing partner has, similarly, accepted this and the days of being stuck on the side of a cliff in a storm trying to get the mobile to dial 999 are now well and truly over.

Since being diabetic I have been lucky enough to climb in the Mont Blanc area, the Alpes Maritimes, Scotland, Wales (oh, many times), And the Italian Dolomites. And I've been diabetic for less than two years.

I still meet people, on and off the hill, who think what I'm doing is mad or who are scared to be anywhere near me in case I suddenly drop down dead, and I think my doctors still expect me to give it up (I'm always greeted in the diabetes clinic with: "Oh, you're the mountaineer") but mostly people now accept why I'm doing it. And the reason is: Its the best fun you can have, it helps me cope with my diabetes, and, far more importantly, it reminds me that its not the end of the world being diabetic.


If anyone out there wants to climb a mountain, please feel free to contact me (tommy_tigris@hotmail.com) or get in contact with our forum (http://uk.groups.yahoo.com/group/madidea/).

For any further help, youll be amazed what you can find through www.idea2000.org
And, if you can speak Italian, these people have done amazing things:
www.adiq.org

Ref Extreme Altitude Mountaineering and Type 1 Diabetes: The Cho Oyu Alpinisti in Alta Quota Expedition Paola Pavan, Patrizio Sarto, Laura Merlo, Dario Casara, Andrea Ponchia, Renata Biasin, Donatella Noventa, and Angelo Avogaro
Diabetes Care 2003 26: 3196-3197.