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[IP] Re: Backpacking with a pump (long!)

Did anyone out there do the Outward Bound trips for diabetics? I saw
something in Forcast about seven years ago. I was curious about who
instructed those trips and what they taught. Anyway...

In response to Bill's inquiries:

These are mostly constructed from notes I am putting together for a talk
for Carolina Wilderness Medicine (CaWM) about my experiences in the
wilderness with diabetes. I will probably give the talk at our conference
next May. Any constructive comments are appreciated (e-mail me directly
and cc the group if you want, otherwise I may miss your message).

	I think some of my suggestions might be helpful for pumpers 
traveling. These are the strategies that work of me that I think
are reasonably sane. I think I have had to use every item on my packing
list at one time or another (a few were pre-pump experiences for me), and
a few of the comments came from very, um...interesting experiences I would
not want anyone to repeat. 

As always with this type of advice, your mileage may (and probably will)

Sorry about the long message (which is far from over),

Jeremy Ackerman

	The rule of thumb for backpacking with diabetes is the same rule
of thumb anyone should use: be prepared (it works for Boy Scouts!).
You have to assume that things can and will go wrong and then try to plan
for them. Major things to think about (I will try to briefly address) are
your response to the trip, heat/cold, water, cleanliness, and the much
feared SNAFU (getting lost or worse).

	Your response is the hardest thing to predict. You will likely
become more sensitive to your insulin and need a decreased basal/bolus due
to the activity. Altitude may diminish or increase your response (I seem
to need more insulin for the first 3 days above 5000 feet) to insulin.
People sometimes have infusion set problems because of extra
motion/friction as well as additional sweat. The best way to know (as
suggested by Bob?) is to do a mini-trip before you are a four hour hike
away from anything. Oh, as noted last week, watch out for air bubbles ;^)

	There is a lot of debate amongst diabetics about heat/cold effects
on insulin. A researcher at Novo told me that insulin (their regular) 
often maintains over 90% potency after three weeks above 90F. I carry a
vial of insulin in my pocket (See packing list below) and the same vial of
regular has worked just fine after 10 months in my pocket. It also worked
after three days in the Negev with daily temps above 110F. On the other
hand, a vial of regular accidentally partially froze in a cheap
refrigerator and was totally ruined. Last comment on temp - be careful
with your tubing. A few minutes at high or low temperature may be enough
to cook or freeze insulin in exposed tubing (my experience was less
than five minutes at 10F).

	Water: make sure you have plenty of it that is clean for drinking!
We have a serious problem (more so than nonDMers) if we can't keep food
down or it is not adequately absorbed. It is not the end of the world, but
it will at the very least make for a very unhappy trip. Try to not get
sick form bad water!
	Also make sure you are adequately protected against unexpected
encounters with water. All the pumps are at least "water resistant"
(although MiniMed at least does not encourage you to test the theory) as
the stories about toilet dunking attest. Most meters are not water
resistant. Pack in plastic! All your stuff should be kept in plastic if
you can. Water can make your infusion sets slip too, so be careful.

	Cleanliness: kind of the same problem as bad water. Don't get
sick. Also you should probably take extra precautions before sticking
figures and putting in infusion sets. Even though I don't normally
recommend alcohol for cleansing, it can be useful to quickly clean a site.
It does not get it any cleaner than soap and clean warm water, but you can
carry a few strips of alcohol wipes in your pocket. For infusion sites I
recommend betadine swabs, others recommend various IV preps. Just make
extra sure you are clean where your site goes. (especially towards the end
of the trip)

When I backpack (which has been far to infrequent lately), I carry 3 sets
of supplies. One set is buried deep in my pack where it ideally stays for
the whole trip. The next set is in a day pack/fanny pack, is much more
accessible, and is my "main" stash. The final one is in my pocket. The
contents are as follows:

PACK STASH (packed water-tight):
Glucose Tabs (~2/day)
Snacks (vary - I use chewy granola bars b/c they are cheap & work for me, 
also they are individually sealed)
Pump Insulin: 2xwhat I should need (at least 2 separate bottles or vials)
	I like using the Novo PenFills or the Lilly equivalent because 
	they are smaller and more durable than the 10cc bottles. Downside 
	is it they cost more and only have 1.5cc (or 3cc) in each vial
Non-pump insulin: just in case your pump breaks! (a small syringes etc)
Back-up meter and strips: back-up!
Pump/meter batteries (I forgot these once..doh!)
Infusion sets/reservoirs
Cleansing swabbies
Extra glucagon kit(s)

DAY PACK LIST: This is the same as above except I often leave off most of
the non-pump insulin. I do carry a pen loaded with either regular or
Glucagon kit (if you trust anyone you are with)

POCKET (think of this as your diabetes pocket survival kit):
Glucose for 3 hypos
Meter/strips/finger sticker for 3 days
Non-pump insulin + syringe for ~3 days

If you pick your materials well, the first two stashes should each fit in
one of those small fanny packs if you are packing for ~8 days or less. The
pocket stash should be ~wallet sized. The idea is that if you loose your
main pack you have your day pack. If you loose your day pack you always
have your pocket stash. If your pump breaks, you can deal with it

If you want to keep things cool, use the sock method (good suggestion!) or
put things in plastic (no air) inside a small thermos with water (this
works keeping things warmer).

Lastly, treat your feet carefully. Most non-diabetics don't do a good job
of this on the trail and it can really ruin the fun for all us DMers.

Insulin-Pumpers website http://www.bizsystems.com/Diabetes/
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