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The Appalachian Thru-Hiker

Intelligent news and entertainment for lovers of the simple life.

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Friday, September 22, 2017

Managing insulin on 2,200 miles of Appalachian Trail


In late January I was sitting awkwardly on a paper-lined examination table in my endrocinrologist’s office trying to come up with the right words.  I had been working too much, a major factor in my decision to thru-hike the Appalachian Trail this year, and I knew it was going to affect the A1C test results she was about to give me.
These results, of course, would be nothing compared to the revelation I was about to hit her with: That I would be hiking 2,200 miles up the eastern United States, Type I diabetes be damned.  Still finishing up the last couple classes for my degree in psychology at the time I had access to pretty much every academic medical journal in print — talk about webmd-induced hypochondria on steroids — so I knew that there was virtually no research in this area.  Insulin-dependent athletes are studied frequently, but we were talking about six months straight of strenuous activity, great variability in temperature, and an average caloric intake of 5000-7000 calories a day for male thru-hikers, a large percentage of which would be carbohydrates.

I’m not sure what I expected her to say, but I felt like I was sitting in the principals office.

I suppose I was at least expecting to hear that I should have taken her advice on switching to an insulin pump given upon every visit, but as someone who hates needles, the idea of having one, even a tiny plastic one, stuck in me 24 hours a day was not appealing.  Even this turned out to be an unnecessary concern.

Finally the moment arrived, and after quickly explained to her that it did not surprise me in the least that my A1C was up to 7.2 (It had never been above 7), I told her I knew exactly why it went up, I knew exactly how to fix it, and neither of these things were going to matter in about two minutes after she heard how I would be spending the six months starting in late March.

When all was said and done, most of my fears were unfounded.  It was too late to get an insulin pump anyway, and once my specialist made her recommendations I was glad I never had. I had been on a combination of long-acting Lantus and short-acting Humalog since diagnosis, first using the old-school vials and syringes, and eventually succumbing to the pens. 

During my test hikes, I had been taking only the long-acting Lantus and no short-acting humalog, but she prescribed the exact opposite. Once the long-acting insulin is in, she explained, there’s no way to get rid of it. If you take too much during strenuous activity, you could be dealing with lows for 24 hours.  If you take too much short-acting insulin, at least you only have to deal with it for a few hours.

The result? My Lantus was tossed, and my humalog carb ratio was changed from 20:1 to 50:1, and only if my blood glucose was over 200. 

Of course, she made it clear that this was a starting point, and I would have to make adjustments as necessary. Now that I’ve been on the trail for almost a week, I can tell you what an AT thru-hike actually does to your glucose levels. 

I took one unit of insulin the first day because my blood glucose was 220, and later that day had a low. Since then, I have taken zero insulin because I burn up every carb I eat. Sometimes in the morning my big might have gone up to 220 overnight, but I don’t dare take insulin because I know in an hour I’m going to be packing up my tent and hiking 12 miles. During the day, my blood glucose usually ranges from 75 – 130, with anything below 90 feeling like a low coming on. I am still building my “hiker hunger,” but I can tell you when I ate an entire pizza myself when passing through civil action two days ago, my numbers were unaffected. 

Remember, everyone’s body is different, but in short: If you want to eat anything you want for six months, thru-hike the Appalachian Trail. Of course you won’t find many pints of Ben & Jerry’s in the woods, but when you go to town, you can really “go to town.”

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About Kevin McCourt

Kevin McCourt is an entrepreneur, writer, and reformed geek who challenged agoraphobia and insulin-dependent diabetes by thru-hiking the entire 2200-mile Appalachian Trail in 2016. He is currently working on his first non-fiction book, a philosophical and scientific look at how modern life became so complicated and the persuasive influences that created the world we live in today. He currently lives in Ocean View, DE and wherever his tent is set up.

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