Hi Santaman2000, I'm using a frio bag for keeping my insulin cool.
http://www.genmedical.com/store/index.html?lang=en-uk&target=d66.html
The bags only need water to activate them. They rely on the process of evaporation for cooling.
diabetes and bushcraft/survival , any advice?
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Hi Santaman2000, I'm using a frio bag for keeping my insulin cool.
http://www.genmedical.com/store/index.html?lang=en-uk&target=d66.html
The bags only need water to activate them. They rely on the process of evaporation for cooling.
I use those bags too. Work very well and every 48 hours just put them in cold water for a 60 seconds and they are good to go for another 48 hours.
These look really good and are reasonably priced. I have to admit that, up until now, I've never bothered with keeping my insulin or blood sugar monitor cool. It has just lurked in the dark recesses of my pack and, despite Moroccan and Uzbek desert heat, Borneo, Pyrenean and Alpine summers, neither insulin nor monitor appears to have been too badly affected (i.e. it has still done its job, as far as I'm aware...); the monitor has struggled occasionally when cold but a few minutes next to the skin usually allows the electronics to kick into life again. These packs look the business. I think I'll go and get my credit card...
On the 'pear drop breath' factor and hyperglycaemia, I'm only reporting from (slightly bitter and scary) personal experience. I assume that the recently qualified dental nurse was right; this is backed up by my few years' experience that the blood testing machines always ask you to check your ketones if the reading is too high - something that does not happen when the reading is in the hypoglycaemic rangs (sort of 3 mmol per litre or less). Still, hyper- remains the rarer of the two states for us and, when outdoors, I reckon it is always better to run slightly high until you've got the measure of your rhythms of activity and eating when outdoors. It avoids scaring the bejeezus out of your companions if hypo should occur.
Thank you! I'll have to give that a try. I've been looking for something not dependent on electricity or ice that i could use on extended trips.
I think you'll find your protocols must have changed and the fruit smell (used to call it pear drops smell in the UK after pear flavoured sweets/candy no longer in fashion) is indicative of being hyper, its what I was told at university anyway.
Hey all, a bit late to the ball I'm afraid, but I'd like to put in my 10p.
I've only been a Type 1 for about 9 months, so I've got a fair bit to learn. However I've been hammering the management since the second day of diagnosis and learned a lot about how to make diabetes fit around my lifestyle.
Diet
Sorry folks, but this is the biggest factor and will make the biggest change to management of diabetes and future complications. Cut down on the Carbs, if you're not going to burn the carb calories, they're going straight to fat. Carbs are your fuel now, and it's up to you to eat only enough that you find the balance with accessible energy and ensuring you're not eating too little. The whole approach of eating what you want as long as you either take your meds, or inject your insulin is stale old management techniques, it's not addressing what causes and what accelerates diabetic complications which is deep rises and falls in blood sugar levels. This is being addressed A LOT better for Type 2 diabetics but sadly advice for Type 1's is bordering on dangerous. So what does this mean for a diabetic out bushcrafting?.
Bushcrafting
Take this scenario as an example and it's my own, since this is the only opinion of which I am sure of. I eat around 50g of carbs a day. The rest of my diet is either fiber or protein from fresh vegetables, eggs or meat and so on, but with enough Fat that I'm not calorie deficient. I know that as long as I eat no more than 50g of Carbs spread out thorughout the day I will have no drastic Blood Sugar rises, with the background insulin I take, along with the small amounts of bolus insulin shots (or metaformin or similar for T2's) that I will also not be experiencing any drastic lows since my margin of error is much lower due to the small amounts of insulin I'm taking. Which means that on an average day, with minimal exertion my diabetes is not a factor, I'm fundamentally non-diabetic. (Read: Low Carb Diet)
So?...
So? That means that you're now feeding your body additional carbs to fuel any additional activity you might undertake, This is a personal journey of sorts. I walk for an hour and test my blood sugar before and after, do this 3 times and you have a mean average. I take 10g of fast acting Carbs to raise my blood sugar by 1mmol/l. If I walk for 5 hours, and I know I drop 1mmol/l per hour, I need to take 50g of fast acting carbs to ensure I don't hypo. This amounts to about 6-8 glucotabs over 5 hours.
Repeat this mean average for any activities that you know you undertake regularily. I know my average for cycling, hiking, running, walking and general heavy lifting. These numbers will become your empowerment. As you cover the activity you're undertaking with the correct amount of carbs you KNOW that you're going to be safe 99% of the time (nothing is a certainty). Still check your blood sugars hourly, but put it out of mind you've done the thinking you need to do, so don't let it hang over you. If you need to take an extra sugar tab every now and again, do it for peace of mind, the raise will be minimal you're trusting your body to let you know when you're dropping. Sugar tabs are great, they're high glycemic so the raise in blood suagr will kick in, in about 10 minutes and linger for about an hour or more, so they're your best friend for adjusting Blood sugar levels and obviously hypo's, the gels are slightly faster but taste horrid, they also might pop and leak in a pocket or your bag. Don't bother with them.
Evening meals (for T1's)
Every evening meal, eat about 50g of slow release carbs when you're bushcrafting, this is about a handful of rice or pasta, and don't I repeat DONT take any insulin. The reason for this is that as you're going about your day you'll be using your body and raising the metabolism, you'll burn calories and utilise the energy stored in your body, most of that energy comes from what you've eaten but you'll also be using energy stored in the liver and the muscles called glucogon. Once activity has stopped your body will replenish any reserves that have been used, eating slow release carbs (like pasta and rice) means that all of those carbs will be replaced while you're alseep, they'll be delivered slowly into your body because it's slow release (low GI) glucose and will not spike you, but be available to your body to utilise for reserves. Interestingly this process does not need insulin to remove the glucose from your system, which is why you can exercise your blood sugars lower rather than take medication to a point. This process is also managed throughout the day by reducing your background insulin shot (bolus) by about a third to allow your blood sugar to raise slightly throughout the day, since your body will attempt to replace small amounts of glucose into muscles and the liver throughout the day, the rest of your glucose needs are being managed by your magic numbers remember? good.
Hypos
They suck badly, you don't want one while you're out and about. But by ensuring you're fueling your body correctly, while reducing the massive fluctuations in blood sugar you're only mistake will be in not providing enough fuel to balance your activity, by checking hourly you're going to capture these lows, yeah! you're kicking diabetes bottom!! T2's will not have an interupted glucose response from the liver to counteract hypo's so it's much ,much less of an ongoing issue, but in some rare cases medication will cause this in T2's too. This is just one area where T2 is easier to manage than T1, you lucky (ish) people you.
Storing Insulin
Double everything, yep take double of everything, have someone else carry one set for you. If you break something, get something wet, or get yourself incapable of making rational decisions someone else will have your back. In the least, if you're on your own, still take double, **** happens out on the trail and this is a deal breaker. If its hot and you're worried about medication overheating buy something called a frio pouch. Soak them in water for 5 mins and they'll keep your stuff safely cool for up to 3 DAYS via evapouration. That is really a excellent amount of flexibility, and they're pretty cheap too and come in a variety of sizes or colours if your into your fashion.
Food Prep
This is the only other change, I prepare everything myself before I go. As mentioned above carbs are low on my diet needs, most easily hydrated food is going to be ALL carbs. And we can't do that. So what does it mean for a diabetic bushcrafter, well prep time is higher but we can still fill our packs with food that will last 2 weeks Root veg is excellent and mostly low carb and slow release, dried meat is brilliant for calorie intake. I usually dry 1 kg of mushrooms and 1kg of meat in a dehydrator and it weights next to nothing. a handful of dried muchrooms, some dried meat and half a sweet potato and you've got a stew if you add an oxo cube. still a very light meal to carry. On foot you will need something with a mix of quick and slow release to snack on, make your own trail mix, hydrate your own berries and add dried coconut and almonds, this will provide you with essential calories and small amounts of availabel carbs incase your body needs them. Blueberries are excellent as are sliced strawberries, Raspberries are too sweet and become brittle. Good for sweet replacements though. Be warned a dehydrator will become your best friend, store brought dried fruit will contain sugar as a preservative, so go ahaead and make that investment.
I hope this helps someone, Diabetes burnout is a real thing, and you should NOT be limiting your life because of it. I think I wrote this in a bit of a rushed format, I'd be happy to expand if it helps anyone. Or perhaps re-explain something.
I thought I'd add that I took quite a bit of initial guidance from this fella, he's a T1 diabetic and is about as adventurous as they come
http://www.rainforesttreks.com/diabetes.asp
I've only been a Type 1 for about 9 months, so I've got a fair bit to learn. However I've been hammering the management since the second day of diagnosis and learned a lot about how to make diabetes fit around my lifestyle.
Diet
Sorry folks, but this is the biggest factor and will make the biggest change to management of diabetes and future complications. Cut down on the Carbs, if you're not going to burn the carb calories, they're going straight to fat. Carbs are your fuel now, and it's up to you to eat only enough that you find the balance with accessible energy and ensuring you're not eating too little. The whole approach of eating what you want as long as you either take your meds, or inject your insulin is stale old management techniques, it's not addressing what causes and what accelerates diabetic complications which is deep rises and falls in blood sugar levels. This is being addressed A LOT better for Type 2 diabetics but sadly advice for Type 1's is bordering on dangerous. So what does this mean for a diabetic out bushcrafting?.
Bushcrafting
Take this scenario as an example and it's my own, since this is the only opinion of which I am sure of. I eat around 50g of carbs a day. The rest of my diet is either fiber or protein from fresh vegetables, eggs or meat and so on, but with enough Fat that I'm not calorie deficient. I know that as long as I eat no more than 50g of Carbs spread out thorughout the day I will have no drastic Blood Sugar rises, with the background insulin I take, along with the small amounts of bolus insulin shots (or metaformin or similar for T2's) that I will also not be experiencing any drastic lows since my margin of error is much lower due to the small amounts of insulin I'm taking. Which means that on an average day, with minimal exertion my diabetes is not a factor, I'm fundamentally non-diabetic. (Read: Low Carb Diet)
So?...
So? That means that you're now feeding your body additional carbs to fuel any additional activity you might undertake, This is a personal journey of sorts. I walk for an hour and test my blood sugar before and after, do this 3 times and you have a mean average. I take 10g of fast acting Carbs to raise my blood sugar by 1mmol/l. If I walk for 5 hours, and I know I drop 1mmol/l per hour, I need to take 50g of fast acting carbs to ensure I don't hypo. This amounts to about 6-8 glucotabs over 5 hours.
Repeat this mean average for any activities that you know you undertake regularily. I know my average for cycling, hiking, running, walking and general heavy lifting. These numbers will become your empowerment. As you cover the activity you're undertaking with the correct amount of carbs you KNOW that you're going to be safe 99% of the time (nothing is a certainty). Still check your blood sugars hourly, but put it out of mind you've done the thinking you need to do, so don't let it hang over you. If you need to take an extra sugar tab every now and again, do it for peace of mind, the raise will be minimal you're trusting your body to let you know when you're dropping. Sugar tabs are great, they're high glycemic so the raise in blood suagr will kick in, in about 10 minutes and linger for about an hour or more, so they're your best friend for adjusting Blood sugar levels and obviously hypo's, the gels are slightly faster but taste horrid, they also might pop and leak in a pocket or your bag. Don't bother with them.
Evening meals (for T1's)
Every evening meal, eat about 50g of slow release carbs when you're bushcrafting, this is about a handful of rice or pasta, and don't I repeat DONT take any insulin. The reason for this is that as you're going about your day you'll be using your body and raising the metabolism, you'll burn calories and utilise the energy stored in your body, most of that energy comes from what you've eaten but you'll also be using energy stored in the liver and the muscles called glucogon. Once activity has stopped your body will replenish any reserves that have been used, eating slow release carbs (like pasta and rice) means that all of those carbs will be replaced while you're alseep, they'll be delivered slowly into your body because it's slow release (low GI) glucose and will not spike you, but be available to your body to utilise for reserves. Interestingly this process does not need insulin to remove the glucose from your system, which is why you can exercise your blood sugars lower rather than take medication to a point. This process is also managed throughout the day by reducing your background insulin shot (bolus) by about a third to allow your blood sugar to raise slightly throughout the day, since your body will attempt to replace small amounts of glucose into muscles and the liver throughout the day, the rest of your glucose needs are being managed by your magic numbers remember? good.
Hypos
They suck badly, you don't want one while you're out and about. But by ensuring you're fueling your body correctly, while reducing the massive fluctuations in blood sugar you're only mistake will be in not providing enough fuel to balance your activity, by checking hourly you're going to capture these lows, yeah! you're kicking diabetes bottom!! T2's will not have an interupted glucose response from the liver to counteract hypo's so it's much ,much less of an ongoing issue, but in some rare cases medication will cause this in T2's too. This is just one area where T2 is easier to manage than T1, you lucky (ish) people you.
Storing Insulin
Double everything, yep take double of everything, have someone else carry one set for you. If you break something, get something wet, or get yourself incapable of making rational decisions someone else will have your back. In the least, if you're on your own, still take double, **** happens out on the trail and this is a deal breaker. If its hot and you're worried about medication overheating buy something called a frio pouch. Soak them in water for 5 mins and they'll keep your stuff safely cool for up to 3 DAYS via evapouration. That is really a excellent amount of flexibility, and they're pretty cheap too and come in a variety of sizes or colours if your into your fashion.
Food Prep
This is the only other change, I prepare everything myself before I go. As mentioned above carbs are low on my diet needs, most easily hydrated food is going to be ALL carbs. And we can't do that. So what does it mean for a diabetic bushcrafter, well prep time is higher but we can still fill our packs with food that will last 2 weeks Root veg is excellent and mostly low carb and slow release, dried meat is brilliant for calorie intake. I usually dry 1 kg of mushrooms and 1kg of meat in a dehydrator and it weights next to nothing. a handful of dried muchrooms, some dried meat and half a sweet potato and you've got a stew if you add an oxo cube. still a very light meal to carry. On foot you will need something with a mix of quick and slow release to snack on, make your own trail mix, hydrate your own berries and add dried coconut and almonds, this will provide you with essential calories and small amounts of availabel carbs incase your body needs them. Blueberries are excellent as are sliced strawberries, Raspberries are too sweet and become brittle. Good for sweet replacements though. Be warned a dehydrator will become your best friend, store brought dried fruit will contain sugar as a preservative, so go ahaead and make that investment.
I hope this helps someone, Diabetes burnout is a real thing, and you should NOT be limiting your life because of it. I think I wrote this in a bit of a rushed format, I'd be happy to expand if it helps anyone. Or perhaps re-explain something.
I thought I'd add that I took quite a bit of initial guidance from this fella, he's a T1 diabetic and is about as adventurous as they come
http://www.rainforesttreks.com/diabetes.asp
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If you are Type 2 and not on insulin or tablets (metformin or sulphonyureas, etc), your chances of suffering a hypo are absolutely tiny and to the point where I would not bother with glucose tablets. Your problem is not HYPOglycaemia, it is HYPERglycaemia; hence glucose tablets are the last thing you need as this will only exacerbate the problem and in the long term increase your risk of secondary complications. Also, it may screw your HbA1c readings.
The fact that you do not need drugs to control it (and are WAY off needing insulin!) means that it is currently well-controlled. What you need to do (and this is the formal advice advocated by NHS and Diabetes UK) is to have regular meals, healthy balanced diet, and have minimal intake of foods and drinks like Lucozade, full-sugar drinks, glucose, cakes, etc. Higher GI foods (fruit and veg, oats, etc) will slow-release glucose into your blood and so help maintain a constant bloos dugar level, avoiding spikes.
I would also look to get some education through a programme like DESMOND or X-PERT for Type 2. You should also get an automatic consultation with a dietitian and I suggest you raise the question with them too.
At present, I would say you are in a good position in that you don't need tablets or insulin to control your diabetes (although you will be on a statin) and should be able to manage via diet and exercise (reduces insulin resistance) for quite some time to come. Concentrate on avoiding blood sugar spikes and limit your hyperglycaemia - your HbA1c levels (annual blood test) should reflect how successfully you are doing this. And, above all, don't get fat! This will send you rapidly towards drug treatment and possibly insulin too - furthermore, you will be at a much higher risk of secondary complications of the eyes, kidneys, feet and nerves.
What qualification do I have to say all this? I am a final year student dietitian and I deal with dietary advice and education for Type 2 diabetes patients all the time - bread and butter stuff!
So, the good news is that you don't have to worry too much about any 'special foods', glucose tabs, etc. Just eat good food, avoid crap and you'll be fine. At the moment you have the opportunity to control your condition through diet and exercise so that's great. As you still have insulin being produced from your pancreas, you don't need to worry about hypos.
By the way, we need to be clear on the differences between Type 1 and Type 2 diabetes.
The dietary advice is effectively similar but the the difference is with insulin. In simple terms, Type 2 diabetes (with no medication/insulin), your pancreas still produces insulin but you may not be producing as much or your cells may not be as sensitive to insulin so your pancreas may be producing loads; so, your body does not use it as well. In Type 1, there is NO insulin production and so the patient has to inject insulin in order to control their blood sugar.
Type 1s may be using strategies such as carb counting, pumps, single/double injections, basal/bolus, etc. They are educated in how to do this and tend to be experts on carb content of meals in order to control their blood sugar!
Type 2s basically need to watch what they're eating (like I said above) and stay fit as these are the best ways for them to control their blood sugar.
The dietary advice is effectively similar but the the difference is with insulin. In simple terms, Type 2 diabetes (with no medication/insulin), your pancreas still produces insulin but you may not be producing as much or your cells may not be as sensitive to insulin so your pancreas may be producing loads; so, your body does not use it as well. In Type 1, there is NO insulin production and so the patient has to inject insulin in order to control their blood sugar.
Type 1s may be using strategies such as carb counting, pumps, single/double injections, basal/bolus, etc. They are educated in how to do this and tend to be experts on carb content of meals in order to control their blood sugar!
Type 2s basically need to watch what they're eating (like I said above) and stay fit as these are the best ways for them to control their blood sugar.
I know diabetes specialists who have been doing the job for 20 years who have never smelt pear drop in breath. It is a very poor indicator.
Hypos are usually recognised via someone knowing that the person has diabetes and a variety of symptoms like pale skin, shaking, sweating, nausea, etc. Best thing to do is to check for emergency ID or a card in the wallet, or presence of an insulin pen or blood monitoring kit. Do not give them insulin from their pen unless you are medically trained to do so. If conscious, help them have something like a glass of full-sugar (not diet!) lucozade or coke, they may have glucose tablets in a hypo kit. They need to check their blood sugar - if it hasn't gone above 4.0mmol/l in 15 minutes, have more lucozade, etc. If it has, they then need a snack like cereal, sandwich, etc, to prevent falling back into hypo. If they are unconscious, call 999 and keep them comfortable as possible.
Jesus! No! Let's get this right fellas - this is important!
HYPERglycaemia is high blood sugar, symptoms are frequent urination, hunger, blurred vision, etc. It is not life threatening in the short term!
HYPOglycaemia is low blood sugar (lower than 4mmol/l) and is life threatening if it progresses to ketoacidosis. In hypoglycaemia, there is a possibility of 'pear drop' breath due to build up of ketones in the blood - however, this is NOT a definitive symptom especially when the patient may have eaten a pear drop!!! I described symptoms above. People at risk of HYPO are Type 1s or insulin-dependent Type 2s or Type 2s on medications like sulphonylureas who have taken too much insulin, done too much exercise, not eaten enough carbs, etc.
I can see a huge amount of misinformation and some amazingly bad dietary advice in this thread (from both diabetics and non-diabetics), including some urban myths and legends I thought had died out years ago. I would suggest that anyone who wants the facts and the best advice discusses it with their GP, specialist diabetes dietitian or endocrinologist consultant. Maybe have a look at the DiabetesUK website or the NICE or SIGN guidelines if you want to get some background.
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Are you measuring blood glucose? The only real reason for you to have a low blood sugar is too much exercise and not enough carbs.
We must have read the OP differently. I was under the impression that while he is NOT on insulin, he IS taking tablets.
You only get the HbA1c annually? The old protocols here were for every 6 months; the newer ones (last 15 years or so) are for every 3 months. Along with the other tests checking your liver, kidneys, and lipids.
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Depends a lot on the patient Santaman, my old hospital trust would check some people monthly if needed.
There is no attempt to mislead folk at all on this one. I was merely recounting what I was told after my own, rather bitter personal experience in the 1980s. When I say that I was on two injections a day and, at that stage, there were no viable, accurate and reliable portable blood sugar monitors available, it might put it into some perspective. I relied on the input from someone who had greater 'expertise' than I; things HAVE changed out of all recognition - I'm the first to admit that with an enormous sense of relief. I don't claim to be an expert in any way, shape or form; I've just lived and been hampered by this bloody condition for 37 years, so it's only on those terms that I'm familiar with it...
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