u/gotanychange

I have illuminaire and have checked every floor up to level 20. Anyone else experience this? Orcs have invaded my run if that makes a difference

Hello! Been mountaineering in one form or another for about 8 years now, and have been a type 1 diabetic for 23 years. Did Argonaut Peak's NW Arete last weekend and I had my typical struggles with blood sugar management, so figured I'd start this thread to see what others do and share my own experience.

In general T1 diabetes management in the alpine is very difficult. When I first started out I had three turnarounds on Mt. Hood and Saint Helens due to blood sugar issues. These days I've been consistently able to summit, though the "ease" of diabetes management in the alpine has good days and bad.

Firstly, "type 1" diabetes is a misnomer: the disease is a spectrum, and people's experience with it can be very different. My experiences and tips are not prescriptive and should be taken with a grain of salt (or sugar (or insulin)) in that other bodies may behave differently!

My experience:

• The first two hours of the approach are the toughest part and will define how the day goes. Keeping heart rate solidly in zone 2 and monitoring that blood sugar does not trend downwards is crucial. Where the blood sugar "lands" in hour 2 is generally where you will be able to keep it during the steeper pushes.
• Insulin needs to be cut, but not stopped. If insulin levels are too low, my body doesn't process sugar :( but it's a double edged sword where if you have too much you will be tanking. I cut my basal rate by about 70%.
• Keep eating sugar! Maintaining a heart rate of 140 I typically consume 30-40g carbs/hr.
• Sugar intake has a very delayed impact if your HR is too high. You will need to take a 15-30 minute break if you have been in zone 3 and suddenly need to claw back up from low blood sugar.
• My general metabolism and insulin response is very sensitive in the alpine, and especially so as elevation increases. Blood sugar trends are hard to correct, response times to insulin are highly dependent on metabolic inertia, and in general it all feels like a delicate balance.
• I'm still figuring out the active insulin problem, and it's a nightmare dealing with high blood sugars. If I can land at 200 I'm at an ideal spot in my experience, but if I somehow get up to 250+ I'm either too conservative in trying to get it down and keep going up, or I over correct and go back to lows. It's a tightrope to walk.
• Things can get hairy on descents. I'll often consume >300g of carbs if ascending for 6 hours or more, and when heart rate finally gets ~ 120 for over an hour it seems like there's a lot of unprocessed stuff in the stomach that all likes to kick in at once. 15 minutes prior to summit I like to increase my basal slightly and give myself a unit of insulin depending on where my blood sugar is at prior.
• Difficulty of management: Ski Mountaineering >> Talus/Trail Approach > Glacier Travel > Descent > Technical Climbing
  • SkiMo is most difficult because in my opinion it is the most difficult to keep reins on cardio exertion

What has your experience been? Curious to hear how others deal with diabetes management.

EDIT: forgot the most important tip! Have conversations with your partners before getting out there and make sure they’re aware and understanding of the added considerations diabetes will bring to the trip. Good partners are one of the biggest reasons I’ve been able to progress.