Herbal Health

Water

If clean water is not readily available the group will also need to carry some. This is especially important in very hot weather as a large amount of fluid is lost as sweat, and dehydration can occur; I have had to treat heat stroke in the Lake District in Britain (in a non-diabetic). In very hot weather your food should also be very salty because salt is lost in sweat. People with diabetes are prone to cramp and need plenty of salt to replace what is lost by sweating. Quinine-containing drinks such as bitter lemon or tonic may help.

Hypothermia

The dangers of hypothermia and hypoglycemia are especially applicable here.

Janine suddenly became unconscious from hypoglycemia while eating her lunch after a cold, wet, windy mountain walk. She rapidly became very cold. She was revived by glucose rubbed inside her mouth, started shivering and then regained consciousness. It took some time to warm her in a sleeping bag with another group member and hot, sweet drinks.

Hypoglycemia and ketoacidosis

Hypoglycemia can be recognized by someone stumbling, slowing down, getting muddled about navigation, showing sudden exhaustion, argumentativeness or suddenly losing consciousness. Many people with diabetes, who are not used to walking long distances, lose their ability to distinguish between tiredness and hypoglycemia. If you are tired, eat something. A word of warning- you can overdo the eating. Obviously, you can check your blood glucose if you are not sure whether you are tired or hypoglycemic.

Prolonged exercise make ketosis worse. If you have high or moderately high blood glucose levels, or have not been feeling very well, check your urine for ketones. If you have moderate or heavy ketones do not go on an expedition. You may develop ketoacidosis and then you will be a danger to yourself and your friends. You need more insulin and should not exercise heavily until you have got rid of the ketones. As a general principle, if you are not well, stay at home. It is not fair to saddle your friends with someone who may collapse on top of a mountain many hours away from the nearest telephone. They are morally obliged to help you and they may be put at risk trying to sort you out.

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DIABETES

Safety in numbers, with good equipment

If you cannot read a map, learn how to do it or go with someone who can. The minimum size for a party is four- one person to stay with a casualty and two to go for help. The party always travels together, moving at the speed of the slowest person. Wear good walking boots and make sure that they do not rub your feet. Wear clothing appropriate to the area you are going to and the time of year, and carry windproof and waterproof clothes whatever the weather. Sun in the valley is not incompatible with pouring rain and howling gales on the mountain tops. The party should carry adequate overnight shelter for an emergency and the means to keep themselves warm in the shelter (for example, a tent and two sleeping bags for four people). They should also carry a stove and fuel. Everyone should have a map, compass and whistle, and know what to do with them.

Diabetic travel pack and food

Each of the diabetics should carry his own diabetic travel pack, twice as much food as he expects to eat for meals, six double snacks and emergency glucose. As a rough guide we use the MBE – Mars Bar Equivalent – for snacks (based on the standard size Mars Bar). Diabetic walkers should learn to eat as they travel, and remember that they need to travel slowly in the mountains because of this need for frequent snack stops. If you are in a diabetic group inexperienced in mountain walking, add at least an hour for every three you have calculated from distance and ascent that the journey will take.

The continuous exercise of mountain walking uses up a lot of energy and it is very important that you do not become hypoglycemic. The group leader should stay at the back of the group to pick up people who have slowed down because of hypoglycemic attacks or other problems, and make sure that no one gets left behind.

I have been astonished by the quantity of food that some students need to eat when out on an expedition.

Seventeen-year-old Bill, on twice-daily insulin – which he had reduced by 20 per cent – led a group of six people with diabetes over a steep ten mile route in the mountains. During the day he ate a huge breakfast, lunch and evening meal (each about double his usual calorie and carbohydrate content), seven Mars bars, six high fibre bars, a packet of glucose tablets and three apples. His blood glucose before bed that evening was 4 mmol/1 (72 mg/dl).

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DIABETES