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Caching with diabetes


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I am a newly diagnosed diabetic (type 2) and control mine with one pill per day and watching diet closely. I figured since there are diabetes travel bugs, and I'm sure a lot of cachers deal with this, it might be a cool topic for discussion.

 

I have "gone low" (hypoglycemia) on several occasions, so far only one of which was whilst on a cache trail. I realise that going low is extremely dangerous and can quickly lead to death if not recognised and treated quickly (usually simply by intake of sugar).

 

If one were to go low whilst a mile out on a trail, with no sugar available, I would think the fat lady done sung.

 

I am one that does everything on "spur of the moment" and thus I will often take off down a trail not knowing how far or how long I'll be gone and usually with just my "pocket stuff."

 

i realise that being alone and without sugar is very dangerous and I'm trying to change this and a lot of other habits as needed for the disease.

 

This topic of discussion is for those who have to deal with diabetes and who regularly prowl the good ol' outdoors.

 

Aside form the obvious - never going ANYWHERE without at least some readily ingested source of sugar, what do you do and what do you recommend for safety and health when out and about with a bum pancreas?

 

So far, every time I have gone low (lowest recorded reading so far 50mg/dl), I have recovered in a few minutes but my tendency is to really consume the sugar when I feel low. Does anybody know how many carbs one needs to reverse the trend or is this a wildly variable thing? Am I really doing the best thing by taking in a BUNCH of sugar (like a 20 oz pop) or is the small number of carbs listed on the "emergency carbs" pills (8g/tablet) sufficient?

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Neither of us have diabetes, however...TinyMoon has emphysema. We have to take special care when hiking up extended steep inclines (i.e. hills and mnts) in search of a cache. Frequent "coffee breaks" are a must, and I must pay special attention to her breathing, because she will try to ignore it and just keep on hiking :huh: . There's no way I could carry her back because both my knees were destroyed in a motorcycle accident! Ah the joys of middle aged cachers :( !

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although he doesnt cache my dad has diabetes (type 1) it was recomended to him to just take one kids sized juice box, but this doesnt work he needs a regular sized oj box. at least you know when you go low, he has had diabetes for 48 years an can no longer distinguish between highs lows or regulars, whenever he goes out he carries a 'bum' bag or 'fanny' pack with his testing supplies and an oj in it, this would be doable for a hike, and if you get used to carrying something like that it would be instinct to grab it when you leave!

hope this advice helps,

mm_dancer

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Perhaps I did make the topic too narrow. "Caching with special needs" might be a better title.

 

I am also one who will ignore body signals and keep on going. I too have had to stop and rest on trails lately that I would have just roared down a few years ago.

 

One of my coworkers said, "You get the first 50 years pretty easily. If you want the second, you have to be real careful how you treat your body."

 

Ah the joys of middle aged cachers!
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although he doesnt cache my dad has diabetes (type 1) it was recomended to him to just take one kids sized juice box, but this doesnt work he needs a regular sized oj box. at least you know when you go low, he has had diabetes for 48 years an can no longer distinguish between highs lows or regulars, whenever he goes out he carries a 'bum' bag or 'fanny' pack with his testing supplies and an oj in it, this would be doable for a hike, and if you get used to carrying something like that it would be instinct to grab it when you leave!

hope this advice helps,

mm_dancer

When I girst got the diagnosis I got a fanny pack and stocked it like you said, but after about 2 weeks of carrying it all day I gave it up because it is just too bulky and heavy (gets constantly heavier as it becomes a "catch-all").

 

I would really like to find a "hard-shell" pack that is just the right size for the meter kit, some snacks, my miniature digital camera, log book and my knife. This would be an all-in-one and could replace all the separate items on my belt now. I did this with the pack i got from WM, but it quickly "sagged" and became a bulky mess. I'm thinking something in hard leather or nylon but I hate ordering online... I like to touch what I buy, exchange money, and use what i bought.

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Seems to me caching with others who know about your condition would be a good idea.

"Never go alone" is always really good advice. That is something I really SHOULD change about my "ways" but honestly i am alone in remote areas at work 95% or more and the risks are pretty much the same as caching.

 

There is not much I can do about it at work and making sure i have someone with me caching, while it makes all the sense in the world, would only improve my odds for a small minority of my time.

 

The "alone" thing is something i pretty much have to deal with, like it or not.

 

Just having someone know where i am would be a plus- at least they would know where to look for the body. I always have a cellphone, but routine calls to someone just to say "I am at ..." seems to be a little overboard. Too, finding someone who gives a care could be an issue.

 

I saw a web page for a service that provides location and emergency response signaling devices with central monitoring (similar to On-Star® but portable). The price is very reasonable but reviews of the product lead me to believe it won't even work in the conditions it is most likely to be needed... indoors, under trees, etc.

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My husband is newly diagnosed, type 2. We attended a class just this week about living with diabetes. Here's what their info says: Eat something with sugar. When in doubt, it's safer to eat the extra food than to risk having a bad low blood glucose reaction. For 15 grams of carbs choose one: 3-4 glucose tablets, 1/2 cup regular soda (not sugar free), 6-7 small hard sugar candies (chewed), 1/2 cup juice (apple or orange), 1 cup of skim milk, or 1 T. of sugar. Repeat and retest every 15 minutes until your levels come up. Hope this helps.

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Eat something with sugar. When in doubt, it's safer to eat the extra food than to risk having a bad low blood glucose reaction.
"something with sugar" is vague, and there is no reason to eat extra food if it's the "wrong" food.

 

Let me start off by saying that every person with diabetes should be closely followed by a certified diabetes educator. There are lots of folks (even pharmacists) who aren't certified yet feel confident that they're giving the right information. The nurse and dietitian are generally covered by medical insurance--you just need a doctor to fax your order. They would be better equipped to answer your questions far better than any of us (even with experience) can.

 

Does anybody know how many carbs one needs to reverse the trend...? Am I really doing the best thing by taking in a BUNCH of sugar (like a 20 oz pop) or is the small number of carbs listed on the "emergency carbs" pills (8g/tablet) sufficient?
It's recommended to try and cut pop out of your diet; if you must treat with pop, the guidelines below say that only 1/2 cup is necessary, at first, to raise your blood sugar above "dangerous" levels. Glucose tablets are important to carry--they're small, and you can keep them in your coat pocket for other "emergency" occasions. Even better would be to carry some granola bars--they're more nutritious anyway.

 

Causes

• Not enough food (skipping or delaying a meal or snack)

• More exercise than usual

• Too much diabetes medication

• Alcohol (if taken without food)

• Changes in the timing of insulin or diabetes pills

 

Signs and Symptoms

Shakiness, irritability, weakness, confusion, sweating, combativeness, dizziness, seizure, rapid heartbeat, and headache

 

Treatment

1. CHECK your blood sugar if possible. Eat something with carbohydrate (step #2) to raise your blood sugar if:

• It is below 100 and you feel symptoms (not everyone does).

• It is below 70.

• You have symptoms but are unable to test.

 

2. EAT 15 grams of carbohydrate.

• Glucose tablets--3 or 4

• Regular pop (not diet)--1/2 cup

• Fruit juice--1/2 cup

• Sugar or honey--1 Tablespoon

• Fruit--1 serving

• Lifesavers--7 to 8 pieces

• Skim milk--1 cup

 

*** For a blood sugar below 50, take a double serving (30 grams of carbohydrate) ***

 

3. WAIT at least 5 minutes. Resist the urge to continue eating. Most people feel much better in 5-10 minutes.

 

4. RECHECK your blood sugar in 10-15 minutes. If it is still low, eat another 15 grams of carbohydrate, and repeat every 10-15 minutes if needed, until your symptoms are gone, or your blood sugar is above 70.

 

5. SNACK only if it will be longer than one hour until your next meal, and you plan to be active. 15 grams of carbohydrate each hour will help keep your blood sugar from falling again during activities such as shopping, housecleaning, or yard work.

Edited by meralgia
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type 2 and 1 pill a day? what kind of med are you on? I am also a type 2 for about 1 year and take 1500 mg of Metformin and my doctor says that because it works with the liver and not the pancreas that it wont cause "lows". So far so good for me. my A1C when I started was 11.8 my last check with the Metformin and diet changed along with an increase in exercise (1 of the reasons for geocaching) came in at 5.7. Just in case though I always have some sort fo snack with me. Apple, snack bar, etc. Better to be safe than sorry.

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type 2 and 1 pill a day? what kind of med are you on?
It's awesome that your A1C came down so low--you must be doing something right! :huh: I think the doc wants to start Confucius out slowly--some don't tolerate the stomach and other... end-user... symptoms on the common diabetes meds. Diet and exercise along with the low-dose meds are an appropriate place to start from what I've read. Edited by meralgia
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type 2 and 1 pill a day? what kind of med are you on?
It's awesome that your A1C came down so low--you must be doing something right! :huh: I think the doc wants to start Confucius out slowly--some don't tolerate the stomach and other... end-user... symptoms on the common diabetes meds. Diet and exercise along with the low-dose meds are an appropriate place to start from what I've read.

 

One pill once a day is very low dosage, if he's getting low sugar from that I would bet he can control it with diet alone. I was also diagnosed a year ago, my sugar was 440 and my A1C was over 11. I take 1000 mg of Metformin twice a day and at my checkup Friday the 18th A1C was 5.7 and my sugar normally runs in the 110's to 120's, only once has it dropped as low as 98 and my Doc is so pleased he told me Friday I won't have to see him again for a whole year. Low sugar is normally associated with type one insulin users, type 2 patients still make plenty of insulin, they are just insulin resistent, so low sugar is far more rare but still possible. In my case my Doctor says I can eat anything I want, just in small amounts and occasionally instead of frequemtly. I've only had a couple of times where I felt my sugar was low, I got so weak I could barely stay on my feet, but a little Pepsi, less than half a can, and I felt I could take on the world.

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I've been living with Type II for about 6 years. It was scary at first. I monitored closely and was paranoid about what I ate. However, after a while I've learned to pay attention to my body and rarely have to monitor. I can guess within about 10 points what I sugar is doing. I dropped about 15-20 lbs simply from the diet change. I started having in the back of my mind my nearest source of simple carbs if I need it.

 

Now, I eat a few complex carbs on a regular basis, work out (mostly for my new job), I'm down to 200 lbs (a loss of almost 50 lbs.) and on my way to 180 lbs. I rarely get hit with low blood sugar and if I do I'm able to recover quickly. I've not ever got to the point of not being able to power through if I walked out the door without a source of carbs, but I did learn what I can and can't do over a long period of time. I still can't eat a bunch of carbs without getting lethargic, but that's the price I'm paying for not eating healthy all those years. I'm averaging an A1C of around 5.7 on each of my checkups. Triglycerides are way down, cholesterol is mid to low 100's.

 

While caching, along with my water I'll grab a couple of granola bars or a pack of trail mix--that's about it.

 

Diabetes shouldn't slow down your geocaching. In fact, if you concentrate even more on longer hikes that you can handle geocaching will help. Use it as a form of exercise. In fact, when checking on our caches I actually run the trail as much as I can.

 

A side benefit of losing the weight is I can get around a lot easier and my knees don't bother me as much as they used to. It makes geocaching easier. It's a vicious circle, but a good one!

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I have Type 2 Diabetes and My vision makes it hard for Me to Geocache, like reading the Geocaching website, My GPS ,and PDA, Does it get confussing like this for You?

Then when I get to a Cache site I'm dizzy, can't focus a foot away with My reading glasses then I put on glasses of different focal lengths till I find one that will let Me see 3 or 4 feet away, and this changes daily.

I learning not to go caching on the days when I feel spaced out.

Thanks for posting this topic

aronnie

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Chip is a diabetic (takes insulin) who has already had a kidney transplant and I have spina bifida and use a wheelchair. We have been together since 2001 and have been caching together since 2003. Chip is also one of those diabetics who doesn't do like he should and on quite a few occasions his sugar has gone low while caching. Since we always cache together I am usually the one carrying the sugar product in my purse (usually the nerds candies since that seems to work fast for him). Just recently at an event we went to do some of the caches in the park and Chip had to venture into the woods to get a cache while I had to wait on the trail since it was not accessible for me. When he went off he started sweating and had to get back quick so we could go get something to eat at the picnic because we had forgotten to replenish the nerds. Since I am the one who usually downloads and picks the caches we do I try to pick the more urban ones that we can both do or something where I can actually see him find the cache since we do tend to just decide to do caching on the spur of the moment. Once we decide we are going to cache now, I make sure he has had plenty to eat before going out and we try to keep some type of candy on us (me) at all times. We also use our cell phones to keep in touch with each other if he does happen to go out of my site. We stay on the phone the whole time he is gone, this also helps me experience the "find" with him and he can tell me what he sees in the cache. As you can tell by our profile, we do not have that many caches but that is because we have to be very picky about the ones we do. Chip also has diabetic neuropathy and vision problems but the exercise and fresh air does do us some good.

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I have Type II for a couple years now...I first took Actos but stopped after a friend died from taking pills for about 10 years (liver damage)...so now I go to wallmart and buy that injectable Relion Type "N" and "R" insulin to use (No Prescription Needed).

 

When I go Geocaching, I always carry a tube of those Glucose pills to chew on...just in case. I keep it in my camera pouch...that I take with me on all the caches.

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I have been a Type 1 for 47 years and I am on an Insulin Pump. I have gone out on hikes for caches by myself. The key thing to realize is when the blood sugar starts to drop you aren't going to think clearly. So it is best not to get to that point. Always at the very least carry glucose tablets with you. They come in convenient small packs. Depending upon the hike always take some type of food. A little secret most Diabetics do not know is that potatoes make the blood sugar go up even faster then a candy bar! Now you aren't going to carry a baked potato with you but a small bag of potato chips will work just fine. If I am going on a long trek I go with someone else. It has saved me a number of times. Don't let the condition deter you from caching! It is great exercise and a lot of fun.

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This is a great discussion.

Thanks to all for your posts!

 

One pill once a day is very low dosage, if he's getting low sugar from that I would bet he can control it with diet alone.

That is my thought too. i was diagnosed a few years ago and changed diet and got my readings down where they should be. The doctor then listed it as a bad diagnosis rather than "diet controlled diabetes."

I got lax for a year or so and stopped testing, lapsed into frequent "just this once" sugary treats (several times a day).

 

I think i probably could go back to completely diet controlled, but i am following doctors recommendations. Indeed I think he has done right starting me out on very low dosage. i take glyb/metform 2.5/500 1/day. I faithfully log everything that goes into my mouth and test twice per day (or more often if I feel funny).

 

I went low 4 times before seeing the doctor for followup one month after starting the pills. We discussed my logs and he said, "the closer you control your diabetes, the more often you will go low... pay attention to the symptoms and treat it quickly."

 

I have "played with" the timing of the pill and meals a little and find that has resulted in a few lows. I'm getting the hang of it, but I still get surprised every now and again.

 

On the next doctor visit the prime topic of discussion WILL be going off the pills, but i am willing to accept that I might not be able to do so.

 

I have Type 2 Diabetes and My vision makes it hard for Me to Geocache, like reading the Geocaching website, My GPS ,and PDA, Does it get confussing like this for You?

Then when I get to a Cache site I'm dizzy, can't focus a foot away with My reading glasses then I put on glasses of different focal lengths till I find one that will let Me see 3 or 4 feet away, and this changes daily.

I learning not to go caching on the days when I feel spaced out.

Thanks for posting this topic

aronnie

I have a similar condition, though not as bad as you describe, but my vision changes are a natural result of my RK surgery from over 10 years ago. My corneas are weakened by the RK cuts and their focus changes from day to day / hour to hour, but the changes are no more than a little annoying. Recently (last year or so) I have had increasing difficulty in reading without glasses- it still comes and goes somewhat and if push comes to shove I can read without glasses but it is a strain. I have never been able to get a really satisfactory glasses prescription since the surgery, but on the + side my vision is very good without glasses anyhow- but steadily deteriorating as years go by (which is pretty much normal).

 

I wear "no-line" bifocals to read, that allows varying powers which compensate pretty well for the variations in my focus. Cases where i cannot read normal or slightly small print with them are very rare.

 

I have been somewhat concerned that recent vision changes could be diabetes related but the ophthalmologist I just saw last month says no. Thank God!

 

I have been a Type 1 for 47 years and I am on an Insulin Pump. I have gone out on hikes for caches by myself. The key thing to realize is when the blood sugar starts to drop you aren't going to think clearly. So it is best not to get to that point. Always at the very least carry glucose tablets with you. They come in convenient small packs. Depending upon the hike always take some type of food. A little secret most Diabetics do not know is that potatoes make the blood sugar go up even faster then a candy bar! Now you aren't going to carry a baked potato with you but a small bag of potato chips will work just fine. If I am going on a long trek I go with someone else. It has saved me a number of times. Don't let the condition deter you from caching! It is great exercise and a lot of fun.

I have found that if I want to finish the day with an extremely high reading (I don't of course), all i have to do is eat an order of McDonald's fries pretty much any time during the day!

 

Potatoe chips do not make a good emergency food IMO because they do not "keep." If you carry a bag around for a day or two, you have "potatoe crumbs."

 

Granola bars are a favourite because they are just the right amount of carbs and they keep pretty well. Though they turn hard and crumbly after a lot of carrying, but since they are good routine snacks they can be "rotated" in the pack by buying fresh but eating the ones in the pack

 

I do try to eat a granola bar or something similar BEFORE starting a hike. So far this has worked pretty well.

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I agree with you Confucius Cat, I wouldn't change anything you are doing without your Doctors OK.

 

Egami, I can't speak for the Cat but I can tell you my story. It started fall of 06 when I started getting extreme drymouth at night. This advanced to constant thirst during the day and I noticed that after eating I had to pee about every 20 minutes, and it was always urgent. This made the constant thirst even worse as I limited my water intake in an attempt to extend bathroom breaks on the road.

I was losing 10 pounds a week and had severe full body cramps every evening, I mean every muscle in my arms, legs, hands and feet screaming with nothing I could do but wait it out.

The real kicker though was when my vision went screwy, I lost all depth perception, could not even see the numbers on speed limit signs, but strangly enough if I looked at the road I could see every pebble as if through a magnifying glass. By this time I had long since diagnosed myself but put off visiting a Doctor because I figured the weight loss was worth it temporaily. The vision loss though sent me in, I drive for a living and I can't do that if I can't see. By then I had lost 80 pounds and I've kept it off since but losing more has proven very challenging, I'll lose 10 pounds and then I'm hungry constantly until I gain it back again.

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Confuscius Cat,

You need to talk to your doctor about going metformin alone. There is never a reason to go too low. That is not acceptable treatment in my eyes unless everything else has been ruled out. metformin works with the liver and not the pancreas thus you will never get too much insulin in your system creating a low. that was my doctors explanation to me. He wanted to try the least problem causing drug first and see what happens before trying anything that forces the pancreas to create more insulin. 500mg of metformin is not that much, you could try going 1000mg, 500 morning and 500 at night and see where thqat takes you. numbers don't have to be perfect right away you just need to keep tweaking to find the dose that works for you. For me its 500 moring and 1000 at night but I could probably go down to 500/500 if I was stricter with the diet and exercise. time will tell. good luck and don't take my word for anything but use it for talking points with your doctor.

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Egami,

Mine started with the thirst and constant urgent pee also but I ignored it and stayed in denial until my feet started acting up. Toes on my feet became oversensitive to touch. It always feels like my socks are bunched up around my toes when wearing socks and shoes. Barefoot they feel fine but I don't go barefoot and shouldn't. Doctor says its a sign of peripheral neuropathy and if I get my numbers in check may reverse. It's been a year and still the same so I think the damage has been done I am now just trying to keep things from getting worse.

Good luck

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I go geocaching with my 12 year old daughter...she was diagnosed with Type 1 about 18 months ago.

 

We make sure and have a meter and strips, and some "slow" carbs for snacks (breakfast bars) and some "fast" ones in case she goes really low (honey packets, small juice boxes, glucose tabs).

 

It takes a little more planning, and a little more stuff to carry, but the benefits far outweigh any dangers.

 

We just did about a 4 mile cache route today, and dropped off a Unite For Diabetes t/b at one of them. She had an easier time than me!

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I apologize if I missed this skimming, but what lead to your diagnosis, if you're inclined to share.

For me it was just routine screening. No doubt I had symptoms, but they were mild and easily ignorable as I am wont to do.

 

i was originally diagnosed several years ago simply from a routine blood test and it showed a fasting blood sugar of 130 or so. Doctor explained that there were new guidelines for diagnosis and that that reading was borderline and would be considered "pre-diabetes" depending on other testing. I was told to get a monitor and cut back on sugar.

 

I stuck my fingers about 5 times a day and figured out what to change diet wise. it worked pretty well and after a year or so and my tests normalising, I quit monitoring and relaxed. Then back it comes.

 

Like Blackbeard, i drive a LOT. I drive the entire State of Indiana, often driving several hours out, doing a simple test or resetting a board, and then I drive several hours back. This involves several "drain and fill" stops. Before i was diagnosed, each stop was rewarded with a 32 or 44oz Dr. Pepper and usually a Little Debbie. Can you even IMAGINE the gross carbs i was taking in?

 

Initially i was able to turn the disease completely around by simply switching to diet coke and saying goodbye to my little girlfriend that lives at all the convenience stores *snif*.

 

I went to a new doctor last October (long story involving my old doctor who was IMO a wonderful doctor but unfortunately has been on the local news a lot lately- nuff said). After the initial visit and labs, I get a call "you're diabetic- I'm calling in a prescription..." We talked a little while i dug out my meter and my expired strips and sure enough, at 2100 I read 191. Coincidentally my fasting glucose in the lab test was 190. so much for the idea of a bad test.

 

I think the insidious thing about the initial diagnosis of diabetes is that the symptoms are vague and nondescript. I still have not figured out how to tell when I am running high, but my highs (fortunately) are in the range of 250 max- and readings that high are rare for me unless I test too soon after eating. i have heard of people getting readings that are too high for the personal meters to even measure antdthey typically max out at 450 or so. My father-in-law was recently diagnosed in the hospital and he had readings of 800 as I remember.

 

(In my understanding, normal readings are 90-110 more/less with diabetes diagnosis starting at 120 after 8 hours fasting -this is not medically accurate information, don't diagnose yourself)

 

I guess I would recommend routine screening.

 

In Indiana (don't know about other states) you don't need a prescription for testing supplies (nor for insulin I am led to believe but don't go buying it if your doctor doesn't say to use it- IT CAN KILL YOU)

 

WM sells a meter for $8 and their strips are $25/ box for 100, so if one wanted to do one's own pre-screening it really is rather cheap (compared to lab work). I would discuss it with my doctor first though, and DEFINITELY before doing anything about the readings.

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Confucius Cat,

 

I have had type 2 diabetes for 3 years. It has never stopped me from hiking, hunting or caching alone. I have even worked the high iron 500' above the ground with no problems.

 

That doesn't mean that I am not prepared though. I always carry some complex carbs with me when out.

 

Meralgia gave you some very good advice along with CoyoteRed.

 

KJcacher has a good point about trying the metformin alone (with doctors consent of course).

 

Metformin works with the liver to not digest the carbs as much as well as with the body's cells to help them to use the insulin better. It was explained to me like this by my pharmacist:

 

The gate that lets the sugar into the cells is rusty and doesn't open well. Insulin opens the latch to the gate. Metformin acts like lubricating oil on the latch and hinges to help them open easier. But without exercise to work that gate and get it operating better metformin won't do its job as well.

 

Glyburide works on the pancreas to make it produce more insulin. Too much and your body can go low like you are experiencing. Lows can be as bad as highs for you. One needs to strive for a balance.

 

Metformin alone along with diet changes and exercise may work well for you.

 

I do not follow a diet!! It has the word DIE in it!!

 

I follow a LIFETIME eating plan.

 

My first A1c was 13. I got it to 5.5 for a couple of years. Last week it was 6.0 so I guess I better get out there and do more hiking caches. I take 750mg of metformin twice daily.

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pretty cool to have all of us diabetics finding and using caching to increase our exercise. :unsure:

 

Well, actually I started caching nearly two years before that. I noticed early on though that if I skip my evening walk, which I seldom but sometimes do that my readings will be 10 to 20 points higher the next morning. Lucky for me I have a dog who loves his evening walk and won't let me skip it without an argument, which he normally wins.

 

I use the Acensia Breeze 2 meter and have a prescription for the strips, I think it's more for the insurance though. Box of 100 after insurance is $20.00 which isn't bad.

 

Dad was a bad type 1, his was 780 when he was diagnosed and we almost had to carry him him, but he was always stubborn about seeing Doctors. He just carried the glucose tablets with him everywhere and never hesitated to head out into the woods coon hunting alone all night long, and before cell phones were around.

At home he prefered grapes when he dropped to low, or a glass of Oj if he was out of grapes.

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pretty cool to have all of us diabetics finding and using caching to increase our exercise. :blink:

I have never really considered just walking a half mile or so down a park trail to be "exercise"- at least not until i got "over the hill." :unsure:

 

I LOVE the outdoors and a half mile hike is indeed a GREAT thing. i still don't know my personal limit but I avoid really hilly terrain of late. Miles? I assume I am unlimited- just a matter of how much time i have. The hardest thing for me is slowing down. I am still a teenager at heart and I want to "run" all the time.

 

Quite frankly, the biggest fear I have is of being trapped in a body that simply CAN'T.

 

I genuinely empathize with those who are "there" and I hope everyone understands that the "CAN'T" club has a universal "draft" and anyone can be forced to join the club at any time.

 

It makes me thankful for everything I CAN do.

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I am a newly diagnosed diabetic (type 2) and control mine with one pill per day and watching diet closely. I figured since there are diabetes travel bugs, and I'm sure a lot of cachers deal with this, it might be a cool topic for discussion.

 

I have "gone low" (hypoglycemia) on several occasions, so far only one of which was whilst on a cache trail. I realise that going low is extremely dangerous and can quickly lead to death if not recognised and treated quickly (usually simply by intake of sugar).

 

If one were to go low whilst a mile out on a trail, with no sugar available, I would think the fat lady done sung.

 

I am one that does everything on "spur of the moment" and thus I will often take off down a trail not knowing how far or how long I'll be gone and usually with just my "pocket stuff."

 

i realise that being alone and without sugar is very dangerous and I'm trying to change this and a lot of other habits as needed for the disease.

 

This topic of discussion is for those who have to deal with diabetes and who regularly prowl the good ol' outdoors.

 

Aside form the obvious - never going ANYWHERE without at least some readily ingested source of sugar, what do you do and what do you recommend for safety and health when out and about with a bum pancreas?

 

So far, every time I have gone low (lowest recorded reading so far 50mg/dl), I have recovered in a few minutes but my tendency is to really consume the sugar when I feel low. Does anybody know how many carbs one needs to reverse the trend or is this a wildly variable thing? Am I really doing the best thing by taking in a BUNCH of sugar (like a 20 oz pop) or is the small number of carbs listed on the "emergency carbs" pills (8g/tablet) sufficient?

 

I too have Type II Diabeties, and 2 metal knees (thus the 2BionicKnees) I have no really good advise other then get a waist belt/pack and stock it with spare batteries, GPS unit, and your emergency supplies (always restock on your return to home) and always carry water or a soda. I find hard peppermints are good and of course the nasty (but enjoyable) candy bar are always a good emergency item. Take a cell phone and/or call someone before you hit the trail to give them your starting point etc. Best of luck and keep on caching.

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I've had type 1 diabetes for just over 40 years. Almost 15 years ago, I edited, and wrote most of, the FAQ for the Usenet newsgroup misc.health.diabetes. It's still posted biweekly to the newsgroup, and is available at a number of archive sites. (Unfortunately the best known archive site, faqs.org, inexplicably stopped updating about four years ago and almost all FAQs archived there are out of date.) Usenet? Before the World Wide Web, it was the second reason people got on the net, after email. Now it's best known as Google Groups. In an earlier day, this forum would have been a newsgroup.

 

But I digress. To respond to many of the posts at once:

 

I agree with others that a type 2 dropping to 50 mg/dl (which if anyone outside the US and Romania is reading this, is about 2.2 mmol/L) indicates an urgent need to adjust the treatment. You do have one misconception. You say

 

I realise that going low is extremely dangerous and can quickly lead to death if not recognised and treated quickly

Going low (in the range encountered by diabetics) is uncomfortable but not dangerous in and of itself. The main danger from hypoglycemia is trauma resulting from loss of coordination or consciousness. You say you drive a lot, so going low while driving should be your main concern -- you are in far more danger on the road than in the wilderness. Even should you go unconscious from low bg, eventually the drugs will wear off, insulin levels will drop, bg will rise, and you will regain consciousness -- as long as you don't have an accident in the mean time. You may have the mother of all hangovers, and should you lose consciousness during severe/cold weather, the danger of being out in that weather is greatly magnified. This is not to say that you should take hypoglycemia lightly, but you should not live in terror of it either. (Of course, sufficiently low bg WILL result in brain damage and death. It's just that without a major overdose of insulin or other special circumstances, this serious a low doesn't happen as a result of diabetes treatment. You only dropped to 50 mg/dl? Piker. :unsure: All long-time type 1s have gone at least down into the 30s. I've measure myself under 30 a couple of times.)

 

Yesterday I spent six hours with a large group doing trail maintenance, and then declined the ride back to the meeting place, electing to hike and geocache my way back, alone and only seen by maybe a dozen people in five hours. I got back to the car 2-1/2 hours after sunset, a great full-moon hike. Part of the moonlit hike was on easy and familiar trails, part was on a rough trail I'd never seen before. I put on my headlamp at dusk but didn't turn it on until I did a bg check about an hour and a half later. I felt no more danger than I would have without diabetes. I was a lot more worried about my feet, which were not really happy doing a long hike in the boots I wear for trail work. I have taken far more difficult hikes in far more remote locations.

 

OK, yes, I plan more than I would need to without diabetes. I carry more food than I would otherwise -- yesterday perhaps two or three extra food bars of various kinds, plus glucose tablets. All my diabetes stuff fits easily in a small stuff sack, which is where is always lives except when I'm in one place and it sits on a desk or counter. Two kinds of insulin, two syringes (one in use, one spare), vial of test strips in use and a spare vial, vial holding used strips, bg meter, finger sticker, pen, log book, and a vial of glucose tablets. Takes some thought at first, then becomes routine. I have far more often had to be concerned with adequate water, staying warm and dry, comfortable footwear (you can get seriously trapped if your feet hurt too much to walk). Guess what ... those are all the things that all hikers have to think about. Really not that different after all.

 

When I hike alone, I make sure that someone knows where I'm going and when I'm expected back and when to call SAR if I don't show up. This is no different from what I would do without diabetes.

 

I am lucky in that I have no diabetic neuropathy. There is evidence that a susceptibility to complications is inherited and is independent of diabetes itself, and it seems that my susceptibility is low. If you have any diabetic neuropathy, then you will need to pay a lot more attention to your feet, to the point that you realize that monitoring your bg was the easy part. If your doctor has not done a filament test on your feet (aka LEAP test), insist on it. There is a self-test described on the US HHS web site but personally I would recommend having someone else do it -- doctor or nurse -- because it's too easy to skew your own results. You've had diabetes long enough that you could have complications already. (Sadly many type 2 diabetics are diagnosed because of complications involving permanent damage, such as neuropathy or a heart attack. Luckily the symptoms you have described are transient.)

 

Source of sugar: realize that "sugar" is a category, not a single chemical compound. The sugar in your blood is glucose. Table sugar is sucrose, a disaccharide; during digestion it decomposes into half glucose and half fructose. Fructose, despite its name, is not the only sugar found in fruit. Of critical importance, though, is that fructose does not raise your bg (that's blood glucose) at all. As a result, table sugar (or milk, whose lactose is half glucose) is only half as effective, per calorie ingested, in raising your bg compared with glucose tablets. Most of us don't need those extra calories. The Wikipedia article on disaccharides might give you some ideas. Starches break down into pure glucose, and so although they take longer, they end up raising bg just as much as glucose. This is the source of the well known phenomenon whereby white bread raises bg quite a bit more than table sugar.

 

Much sugared soda/pop is sweetened with high fructose corn syrup. You can look up the details, but in practical terms the effect is much like table sugar: you ingest about twice the calories to get the same rise in bg. (My wife prefers the flavor of the "artificial" sweeteners to that of sugar. I put "artificial" in quotes because there's nothing natural about processed concentrated sugar. We think of soda as either "regular" or "sugared" and we don't buy sugared.)

 

The usual recommendation for treating low bg is 10g of glucose, wait 15-20 minutes. If it's mild I'll use 8g (two tablets); severe, up to 20g. Waiting can be hard. It's especially bad in the middle of the night; many times I've been awakened by low bg and eaten 700 calories when 50-75 calories and a little patience would have done. And yup, I'm in the category of those who don't need the extra calories.

 

Candy bars are a really poor source of glucose, since the calories in candy bars are predominantly from fat, which isn't worth beans in terms of raising bg (literally -- beans raise bg but rather slowly, fat doesn't raise it all all).

 

when out and about with a bum pancreas?

Note that as a type 2, your pancreas is perfectly OK, at least initially. Type 1 and type 2 are totally different diseases linked by the common symptom of elevated bg and the sequelae of that elevation. Type 1 is loss of insulin producing capability. Type 2 is, at least initially, a failure to use insulin properly, along with (usually) a variety of other metabolic issues. Due to this insulin resistance, type 2s often have elevated insulin levels. At least in concept, type 1 is simple -- we still don't know what initiates the autoimmune response which destroys the beta cells, and replacing the endogenous insulin with exogenous (injected) insulin is harder in practice than in theory, but in concept it's simple. We do not yet have any such conceptual understanding of type 2; we only know that even in concept it is far more complex. (At later stages of disease most type 2s do lose some or most insulin production. The reasons for this are just as unclear as everything else about type 2.)

 

So since the primary problem in type 2 is failure to use insulin properly, the ideal treatment is to increase insulin sensitivity. In part this is a happy situation, because the single best thing to increase insulin sensitivity is ... ta-da ... EXERCISE! Not so happily, but effective, the next best thing is controlling diet and (much more difficult) reducing body weight. Then come drugs.

 

Sadly, the cheapest (and therefore most prescribed) drugs -- the older sulfonylurea drugs such as gyburide -- merely goose the pancreas into producing more insulin. In a type 2, increasing insulin levels tends to lead to weight gain. Metformin mainly inhibits the liver from releasing its stores of glucose -- makes the liver more sensitive to insulin. This is helpful but the effect is mostly limited to the liver. The newest drugs, Actos and Avandia, actually make the entire body more sensitive to insulin, and are thus the best line of drug treatment. Their cost is high and therefore insurance companies and especially HMOs hate them with a passion. Their interests are, to say the least, decidedly different from the interests of patients.

 

On vision: it has been frequently observed that rapidly changing bg can cause major vision problems. This means that very often bringing bg into control initially results in poorer vision. Luckily this problem (unlike diabetic retinopathy) reverses quickly when bg is stabilized. Once you have verified that the vision problem is not retinopathy, the treatment is to keep bg stable and wait a few days or weeks. (And all type 2s should have an exam by an ophthalmologist upon diagnosis.)

 

Drooling Mongoloid says

I first took Actos but stopped after a friend died from taking pills for about 10 years (liver damage)...so now I go to wallmart and buy that injectable Relion Type "N" and "R" insulin to use (No Prescription Needed).
This is potentially a very poor choice for several reasons and is a good argument that the old beef and pork insulin should not have been grandfathered with OTC status. (All new insulins since about 1970 require a prescription, including probably 99% of the insulin used in the US today.) First, treating type 2 with insulin often results in weight gain, which makes it harder to control bg, so you take more insulin etc etc. Second, the link between Actos and liver damage is extremely weak, a one-in-a-million risk -- compared with the one-in-five or so risk of heart or kidney disease from diabetes. Given all the things that can cause liver damage, saying Actos caused liver damage in a particular person is impossible. Yes, there is a very slightly increased risk in the population, but it's incredibly tiny compared with the risks associated with diabetes. Heck, the most dangerous part of taking Actos or Avandia, by far, is driving to the drugstore to pick up the pills.

 

Monitoring: I have often recommended to people at risk for type 2 that they not depend on the doctor's tests. Instead, get a monitor and strips (which are OTC as long as you pay out of pocket, in the US insurance coverage will require a scrip) and do a fasting test once a week. Or a postprandial test once a week; the thinking is moving toward the postprandial numbers being more important for diagnosis. For someone controlling type 2 with exercise and diet, pick one day a week and test before and 2 hours after each meal. If you see 110 or higher fasting or preprandial, more than once, or over 150 postprandial very often, step up the monitoring and if possible start watching your exercise and diet more carefully. Over 120 fasting or over 180 postprandial (more than once), call your doctor and report your results immediately. Some will say oh, don't diagnose yourself. I look at this as collecting a great deal more information to help your doctor with a diagnosis. The information your doctor normally has available is very thin for detecting the initial onset of type 2 diabetes, when it's easiest to treat.

 

Myself, I have one of the new continuous monitors (the Minimed Guardian). The technology has not reached that point of being reliable. When it's good, it's very very good, but when it's bad, it's horrid. In any case, this is much more useful for a type 1, whose bg can swing much faster than it does in most type 2s.

 

For my own diagnosis story, I was very lucky. I had none of the classic onset symptoms, but a urine test during a pre-college physical found glucose. That set off a chain of tests and initiation of treatment. For many years I had never had any symptoms of diabetes itself other than blood and urine tests. After 25 years I developed a bit of macular edema in one eye, which remains my only real symptom of the disease.

 

ironman114 quoted a pharmacist's explanation of the drug actions. Unfortunately the pharmacist had it wrong (or didn't speak clearly) about metformin. Metformin acts mainly on the liver, making the liver more sensitive to insulin and thus less likely to dump its glucose stores into the bloodstream. The new drugs, Actos and Avandia, act somewhat as the pharmacist described, making the whole body more sensitive to insulin but not lowering bg directly. The pharmacist was entirely correct that the sulfonylurea drugs (including glyburide) mainly stimulate the pancreas to release more insulin; the pharmacist could have added that although this can bring bg under control, it can also cause weight gain.

 

Anyway, get out and find some more caches, and take the hardest hike or bicycle ride that you enjoy while doing so. (But only as hard as you enjoy -- push too hard and you'll just end up quitting.) Make a few basic preparations, and then figure that the benefits from physical activity far outweigh the risks. Which -- back to this point -- isn't much different from the case for anyone else, just that the benefits are amplified.

 

Edward

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Thanks for sharing Cpt. Black / CC...interesting. I probably don't get physicals often enough, but where we work we do an annual screening that includes blood work and was wondering if it would show up that way if a person were to have it.

Fasting blood tests should show your A1C level which is THE indicator to watch. Ask for the test if you are concerned.

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Thanks for sharing Cpt. Black / CC...interesting. I probably don't get physicals often enough, but where we work we do an annual screening that includes blood work and was wondering if it would show up that way if a person were to have it.

Fasting blood tests should show your A1C level which is THE indicator to watch. Ask for the test if you are concerned.

 

I am not concerned...it was just more out of curiosity.

 

We get all of our results sent back to us...I have no idea if A1C levels are on there, but I am guessing so. We do that this time of year, so it just made me curious. I'll have to look and see.

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Thanks for sharing Cpt. Black / CC...interesting. I probably don't get physicals often enough, but where we work we do an annual screening that includes blood work and was wondering if it would show up that way if a person were to have it.

Actually all routine blood tests don't necessarily show it. the doc checks boxes on the order for what tests are to be done.

 

I asked specifically for my doc to chack a1c and fasting bg (the boxes were not checked on his original order). Had i not asked, the lab probably would not have reported the results.

 

One time I checked the boxes myself when the doc forgot. The A1c check box says "HGA1C"

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One time I checked the boxes myself when the doc forgot. The A1c check box says "HGA1C"

 

Well, these are nurses associated with our health insurance company...actually, the insurance company works through a local hospital, but at any rate...I have no idea if we have control over that or not. Thanks for the tip...I'll look and inquire about it.

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Fasting blood tests should show your A1C level which is THE indicator to watch. Ask for the test if you are concerned.

This is NOT correct. The ADA (American Diabetes Association) recommends AGAINST using HbA1c for diagnosis. The reason is that HbA1c has been found less reliable for diagnosis than FPG (fasting plasma glucose), and not even as accurate as random blood glucose when symptoms are present. HbA1c is good for monitoring known diabetes.

 

It is definitely true that it's easy to miss diabetes based on a single test, which is why I recommend that anyone at risk gather a lot more data points than the doctors normally ask for.

 

Edward

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I started reading this post earlier this morning while I was checking my glucose levels. As you can tell I am also a diabetic and enjoy geocaching for both exercise and as a hobby. You have received a lot of good information here and I can only add a little to what has already been said. I read where you can tell when your levels are going low, this is a good thing, I as well can tell, not everyone can, when my levels are going low and recommend you listen to what your body is telling you and not ignore it. I suffer infrequent lows but I also check my levels about 6 times a day. However, when I recommend that you keep your meter handy as well as a source of glucose. I always carry a tube of tablets or the liquid glucose with me at all times. When you feel yourself going low, treat the symptom and then take a reading. Note your activity level and how you felt when you first felt yourself going low. By doing this you can determine, by your symptoms, how low you are and be able to quickly treat it prior to a reading. You will also begin to see how your activity affects your symptoms. If I am on a mile or so I will check my levels at least once if not twice during the hike.

 

I carry everything in a small backpack or one of the nylon sport packs. In addition to the meter and glucose I will carry a snack of an apple or similar item. I also carry a couple of granola bars with me as well as a bottle of water. Talk with your doctor or nurse educator to see if you require any specific items based on your condition as well.

 

There was a question on what HbA1C was and this is the Hemoglobin A1c test or just A1C for short. This test provides your average glucose level for the prior rolling 3 months. This test, as has already been said, is not used for diagnosis but as a tool to monitor your overall “control” of diabetes.

 

As long as your doctor agrees with your exercise plain to include geocaching and your emergency items you should be able to enjoy geocaching for a long time to come.

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I agree that the A1C is more of a monitor for existing diabetics but if your A1c were to come back over 8 during a routine physical I bet your doctor would be talking to you about diabetes. I also agree that the fasting glucose number is probably a better indication of whats currently going on with you and blood sugar.

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Sorry if this has been covered in prior posts. My girlfriend and my primary caching partner was just diagnosed with Type 1 diabetes last friday. We are still learning about all of this, but luckily she is a very smart girl and is very concious of her health. I was wondering if there is anything that I should do when we go caching together. Should I always have some extra snacks in the car and geopack? Is it okay for her to go on the 80 mile bike rides that we did last summer (because we love biking and caching)? I have always cached right through lunch, but I'm guessing I'll need to stop for lunch from now on. What should I do as the caching partner, if anything, to ensure that she will be okay?

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I've been Type 2 for 2 years. (Diagnosed, I've probably been diabetic for a year or two longer.) The Snoogstress was diagnosed about 8 months later. She swears she caught it from me. :unsure: She's insulin dependant. I'm not.

 

I don't do anything special, but I try to keep a 3-pack of glucose tabs handy for the rare occasion when I get low.

 

Test strip containers make GREAT micro caches don't they? <_<

 

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My daughter is Type 1 and has been for about 4 years. She is 13 and caches with us just about every weekend. The length of our trip usually decides what we need to bring but she always has a glucometer, a jr. juicy juicy (15 carbs) and a granola bar type snack. I carry a tube of glucose incase she bottoms out. SHe is on a pump which makes it easier to make adjustments for the extra exercise but she has been as low as 28 and still walking down the trail! She no longer feels lows and we have to take note of changes in her behavior or "look" (mom's will know what I mean!).

 

If nothing ese, please wear a medic-alert bracelet so that if something does happen on the trail a passerby may be able to help!

 

To the person who askd if his girlfriend could still bike 80 miles...absolutely! Just have her tell her nurse what she is planning and they will help her make adjustments in her insulin for the increased exercise

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I've been Type 2 for 2 years. (Diagnosed, I've probably been diabetic for a year or two longer.)

When I was diagnosed I had pretty obvious symptoms and the Doc said I'd had it for about 6 years.\

 

Test strip containers make GREAT micro caches don't they? <_<

 

 

I wouldn't know, my strips are preloaded ten per disc, 10 discs per box. I don't even get the cool containers as a side benefit. :unsure:

On the plus side though it's a beeze to reload and I get ten tests before reloading. :unsure:

I only test once a day, as per Doctors orders, and if I occasionally forget to test, like I did this morning, I don't worry about it, mine stays pretty consistent unless I get sick, then it goes up until I recover.

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Bunganator, Your caching partner will be going to alot of changes depending on her prior life style. The very best source of information will be both her endocrinologist and diabetes educator. They will work with her to develop the best plan for her and her life style. If she is type 1 as you say she most likely is insulin dependent. If possible try to get her on the insulin pump if possible. I am on the pump and I have not had to take an injection, besides inserting the infusion set, for the past 4 years. The pump will allow you to adjust insulin intake (basal) to compensate for increased activity.

 

So you don’t give up hope there are many diabetic athletes both past and present who made the necessary adjustments so they could/can continue the sports they love. To name a few: Boxer Smoking Joe Frazier. Curt Frazier of the Chicago Black Hawks and four members of the 2008 Team One Professional Cycling team (Joe Eldridge, Fabio Calabria, Tim Hargrave and Phil Southerland) all diagnosed with type 1 diabetes.

 

The hardest part is over in that she has been diagnosed and treatment has or will start soon. Far to many people go undignosed until it is to late.

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I have always cached right through lunch, but I'm guessing I'll need to stop for lunch from now on. What should I do as the caching partner, if anything, to ensure that she will be okay?

Certainly caching through lunch is not good for a diabetic. I would avoid that as much as possible but then again it isn't the end of the world if she eats off schedule. The combination of unusual exercise level and unusual timing might make her balancing of meds and carb intake difficult.

 

I think the best thing you can do is to learn as much as you can about the disease and especially what to do and who to call if there is a problem. She will probably learn to regulate herself pretty well but it is nice to have someone around "just in case."

 

 

Personal note:

I went caching today and got one P&G and one with a "hike" of about 1000feet total. The outside temp was 30 degrees and I was wearing a thin nylon windbreaker, unzipped. I had gotten up late and had late breakfast, small lunch at normal time and a granola before going to the cache. I was a little shaky and sweating like a pregnant nun in the confessional. I did not test but I interpreted this as a mild "low."

 

I have a very high tolerance for cold (I have been known to be out at 40 below without a coat for short periods) and sweating when others don't is not unusual for me anyway. I'm thinking that the fact of the light jacket caused more energy expenditure and this resulted in the "low." Maybe i have to rethink my "dress code" a little because of the diabetes too.

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I have always cached right through lunch, but I'm guessing I'll need to stop for lunch from now on. What should I do as the caching partner, if anything, to ensure that she will be okay?

Certainly caching through lunch is not good for a diabetic. I would avoid that as much as possible but then again it isn't the end of the world if she eats off schedule. The combination of unusual exercise level and unusual timing might make her balancing of meds and carb intake difficult.

 

I think the best thing you can do is to learn as much as you can about the disease and especially what to do and who to call if there is a problem. She will probably learn to regulate herself pretty well but it is nice to have someone around "just in case."

 

 

Personal note:

I went caching today and got one P&G and one with a "hike" of about 1000feet total. The outside temp was 30 degrees and I was wearing a thin nylon windbreaker, unzipped. I had gotten up late and had late breakfast, small lunch at normal time and a granola before going to the cache. I was a little shaky and sweating like a pregnant nun in the confessional. I did not test but I interpreted this as a mild "low."

 

I have a very high tolerance for cold (I have been known to be out at 40 below without a coat for short periods) and sweating when others don't is not unusual for me anyway. I'm thinking that the fact of the light jacket caused more energy expenditure and this resulted in the "low." Maybe i have to rethink my "dress code" a little because of the diabetes too.

 

Since you mention it, For many many years I have worn the same style of uninsulated leather shoe summer and winter, no matter the snow or cold and my feet NEVER got cold, but last winter that changed and I'm wearing shoes with 1000 grams of Thinsulate this winter. Something diffenetly changed and the fact that my symptoms hit last fall makes diabetes the prime suspect.

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