It’s officially summer! As the world seems to be hotter than ever, and life goes back to a new normal with social activities commencing, it can be surprisingly easy to forget about having diabetes during group play dates in the great outdoors.
I think it’s safe to say we all feel an extra level of pressure, and to an extent mindlessness, when we’re with our friends and family that we haven’t been in the company of for so long. I find myself being less in-tune with the physical glucose signals, and you know what they say about time when you’re having fun, right? Hours seem like minutes and a lot can happen to our diabetes before we realize it. Miscalculations are just waiting to sneak in, timing injections are likely to be less than ideal, and even how we react to the normal stuff might be different when we’re buzzing about full of our environment’s energy.
Along the T1D journey, we will experience things and gain new perspectives that help make diabetes management more understandable. In this constant period of trials and errors, I have found some “food for thought” that helps my decision making when embarking on summertime excursions with friends.
So that everyone can have the best possible time, I’ve compiled a handful of tips to stow in your supplies pack.
Stash Smart Snacks:
Since there are so many options now for emergency and activity-friendly snacks, take a moment to find ones that you actually enjoy. It’s so easy for T1Ds to look at food as merely a necessity, but food is also nourishment for the soul. Even for emergency use, we don’t have to just rely on choking down dry tablets – there are gummies, syrups, liquid shots, and powders that can be used in a variety of ways that suit several needs. I find powder glucose the most versatile and takes up the least amount of space.
I also like to carry high carb granola bars, ones that are at least 40 grams per bar. I find them to be extra helpful in that you can split the bar into more than one use (depending on how much you need, of course). Dried fruit does a similar trick – the idea is to consider carbohydrate rich options that provide enough nutrition with just a bite or two.
Some favorites like carrot and celery sticks, either plain or dipped in a treat of your choice, are durable and hydrating options. Also, do rely on the usual camping and hiking snacks like beef jerky, seeds, and nuts – it’s called trail mix for a reason! Focus on high protein and fat to delay carbohydrate absorption.
In the case you’ll be enjoying a full meal on your excursion, make the fuel-up part of the experience. Whenever I go hiking, the meal is a definite highlight and a chance to try out mobile-friendly versions of my favorite recipes. Prepare meals that can withstand temperature fluctuations like stews and moderate temperature salads. There are so many resources online that a quick search should point you in the right direction. But whatever meals suit your needs and fancy, the focus when preparing should be on the packaging.
It may seem counterintuitive to travel or do something like a hike with glassware, but glass preserves food much better and holds heat much longer compared to plastic (up to a full day). Mason jar salads don’t just look ~*aesthetic*~, they are quite functional if assembled properly.
Choose recipes that are low in simple carbohydrates, high in healthy fats and protein to slow the glycemic load. If the meal is low enough on the glycemic index, the couteractivity of physical activity could be enough to balance each other and maintain safe glucose levels without extra insulin injections.
Pack a Backpack of Backups:
Technically I only need to carry my phone (to read my Dexcom), my InPen (Humalog), glucose and a granola bar for a day trip. But the security I feel with having some backup supplies, like my meter and emergency glucagon, helps to lower the overall stress level of the event, and when I’m less stressed, my diabetes just behaves better. Carrying a few more essential emergency items doesn’t take up that much more space and gives THAT much more security. A fanny pack or mini backpack is plenty of space and full of convenience.
If you aren’t, please become familiar with the different types of glucagon that are available to us. Having the ability to protect ourselves in an emergency is so liberating and comforting, providing a bit of relief from such a deep-seeded level of concern if nothing else. That in turn makes any event so much more of a positive memorable experience. Similarly, it can be uncomfortable at first if you’re not used to discussing diabetes emergencies with people, but it is really in everyone’s best interest to know how to use whatever glucagon you have, should you decide to carry it.
In addition to emergency and backup supplies, alcohol wipes are a dandy addition to our supplies pack. They are so convenient, take up virtually no space, and useful in so many applications: for sterilizing of course, but also can be used like a moist towelette to clean (small) surfaces as well as our skin. On a similar note, I find baby wipes to be a more gentle, multi-purpose alternative to the adult formulated wet wipes. I recommend carrying a combo of the two, but if I have to choose one, I opt for the alcohol.
Heed the Heat:
I keep all of my diabetes supplies in a padded, insulated bag. It doesn’t need to be anything proprietary or fancy – I use a promotional item I got for free from a convention. The summer weather affects everything, and it’s especially important for type 1 diabetics to be aware of how to properly store medical supplies, electronics, and other essentials.
Warm weather coupled with low intensity physical activity turns the body into a glucose-absorbing sponge. Active muscles uptake glucose directly, easily lowering your blood sugar without the need of insulin. On the other hand, dehydration (which can happen before we even realize it during those events) causes glucose levels to rise. Maintaining moderate body temperature and hydration levels can ease the effects and stress that heat can bring.
Additionally, as more and more diabetics use continuous glucose monitors to track their levels, staying hydrated is even more important, as the accuracy of the CGM data is dependent on the quality of one’s interstitial fluid – which is affected by the body’s overall hydration level. Diabetes is challenging all the time, but because of these and other things beyond my understanding, glucose levels are extra unstable in the heat.
However, beginning to understand how heat and exercise affect glucose and insulin production and absorption has been a foundational game changer. So to combat it, I have these tips:
- If you’re on a pump, use a temporary lower basal rate or go on exercise mode (I haven’t pumped for 19 years, but this is the best option)
- If you can plan ahead, take a couple units less of your long-acting dose for the day (an amount based on your sensitivity factor)
- Frequently sip on a diluted electrolyte drink (a constant, low intake of sugar (<5g per hour) to help maintain levels
Enjoying the outdoors isn’t just physical, it gives us a much needed mental connection back to nature. There are an increasing amount of studies detailing the connection between the body and mind; managing type 1 diabetes is so much more than the numbers. Take breaks, breathe deep, smell the air, and feel the breeze. Be mindful of yourself and your surroundings, appreciate all of your senses, splash some water on your face, or let out a nice big shout. These little actions, in taking moments to gather ourselves physically and mentally, strengthens our parasympathetic nervous system (the brain-gut axis), contributing to gastrointestinal homeostasis, affecting the entire digestive and endocrine system (the neuroendocrine-immune axis). Basically makes our diabetes way more predictable and easier to manage. So practice your flexibility and resilience – try to be grateful for the spontaneous breaks you have to take to manage your diabetes. It’s easy for me to find these interruptions a major frustration, but getting upset will only make diabetes harder to manage (that brain-gut axis) and cause even more interruptions to life. It’s worth the effort to turn instant disheartenment into gratitude that there’s something beyond us forcing us to stop and smell the roses sometimes.
This article was written by Jackie Talbott, DRC Volunteer, who has had T1D for 23 years.