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The Appalachian Thru-Hiker

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December 9, 2019

Appalachian thru-hiking on insulin: What happens on zero days?

I mentioned in a previous post that I haven’t needed to take insulin since starting my thru-hike, usually hiking between 10 and 15 miles a day. This has remained true as I slowly increase my calorie intake, but my calorie intake still has a long way to go.

Earlier this week, however, I had to take my first and then second zero “no hiking” days, consecutively no less. I know from previous experience that physical activity can have long-lasting effects, but also that eventually my pancreas would realize I had stopped hiking. 

I made it through the first day with little change, and my blood glucose stayed low enough that I didn’t deem it necessary or wise to take insulin yet. That night, however, after waking up for the third time to stumble down the trail to the “bathroom,” I knew it had finally caught up with me.  Sure enough, my bg had suddenly skyrocketed to 400. 

I began taking doses of insulin, being very conservative at first and slowly increasing the number of units. In the middle of nowhere, a slightly elevated blood glucose level is much less scary than a bad low, and my worst lows have always involved physical activity. This can be dangerous when normal fast-acting carbs such as juice are nowhere to be found, and a bad low sucks all of the energy out of you even once it’s treated, making a long-distance hike that day an unlikely proposition. 

Giving myself a shot for the first time in two weeks was strange. My skin felt paper thin, and I could tell I had continued to lose weight after the five pounds I lost the first week. When you take shots four or five times a day, you learn to appreciate a little pudge in the belly, but mine was gone. 

I managed to get my blood glucose back to a manageable level, but with only two days to experiment, I couldn’t come up with a conclusive dose for zero days. 

I have also been experiencing the expected increase in appetite, not to mention making a concentrated effort to eat more hungry or not else I lose so much weight I don’t have the muscle mass to continue on.  For this reason, I have been concerned that the hiking would eventually not be enough and I would have to start taking insulin even on regular hiking days.  This would not necessarily be a problem — taking shots are routine — but the sliding scale dosage will come down to experiment. Also, while zero day activity levels should be fairly constant, once I need to take insulin on hiking days it will be much more difficult to nail down a sliding scale ratios. Every day the mileage is different and every day the terrain is different. The physical exertion required to hike 10 miles of mild up and downs will be different than hiking 10 miles involving a 3000-foot vertical climb over a short distance. 

Finally, dehydration is something every hiker should be cognizant of, but high blood glucose levels can exacerbate things. If a high BG forces you to “expell” (running out of euphemisms) 1.5 liters, that’s 1.5 liters of water you need to chug down in addition to what you should already be drinking.

I suppose my first lesson of insulin on the trail is that the trail too has a “honeymoon” phase, and it appears I am almost out of it. Before I know it the honeymoon will be over, and it will be time to face the next challenge of this adventure. 

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