Chapter 4 – Diabetes Blood-glucose planning from Germany
The journey of a thousand miles begins with a single step – Lao Tzu
While I was describing the beauty of Singen Hohentwiel in chapter 2 I forgot to talk about my diabetes blood sugar prep work for my hike for the hilly 23 km walk. There is a lot of prep work involved before taking such task as walking for more than 4 hours since blood sugar really depends on the energy available, insulin taken and the difficulty of the path (hilly terrain).
I had a good German breakfast – muesli w/ low fat milk (complex carb) cold cuts, cheese and a boiled egg (protein, fat) and low fat yogurt – about 60 g CHO (carb) and I Bolused for 50% of CHO and set temp Basel for 8 hrs in case I run out as I have in the past. Average walk for me is about 5 km for an hour and 23 km shouldn’t take me long but then again we are talking about walking around Hohentwiel with steep hills and the beauty of the wild forest and the native animals that come to say hello, so it took longer.
We started at 10 am and we got back at 4pm – that’s 6 hrs and we took two long breaks each being over 30 min plus stopping to take pictures, just stopping to enjoy the beauty of the land. So 6 hours for as predicted.
Many snails crossing
Rabbit enjoying grass
My blood sugar was perfect the whole trip as I sipped mostly Gatorade and water every half hour as I was sweating a lot to replenish my salt (electrolytes) and hydration. I also found fruit bars in Singen as they didn’t have granola bars and they were good without too much sugar as each piece was about 6g CHO. Gatorade, fruit bars substituted as my fuel for every hour – since there were few parts of the path that were very steep and challenging. Bigger snack – here it goes pretzel broken into 4 pieces and I ate it throughout, couple of apples, and a sandwich filled with ham and cheese. So all in all it was a true Camino training walk – walking through the forest covered in mosquitos, ticks, snails, deers, rabbits and wild birds – beauty all around.
Frog crossing sign (during migration)
When I finished my walk my blood sugar was 7.2 mmol – perfect and my temp Basel was almost running out. I had to be careful that I wouldn’t have a low sugar within the next hour so it was important for me to have a protein, sugar drink after I got back to the room so had something similar to Boost. I had a lake pickerel with roast potatoes and a large salad and I Bolused only 90% and my blood sugar was perfect before bed as it was 7.6
Awesome day indeed and looking forward to the Camino doing this every day and hope my blood sugar will be okay as it was this day but testing is key for every hour if possible and not push but taking the time. Camino is not about how quick you can do the walk but the quality of the walk – indeed it’s the Camino after all.
In my previous post I had talked about the history of the Camino de Santiago and why I decided to take the challenge and in this post I will discuss how I got my training started.
“It does not take much strength to do things, but it requires great strength to decide on what to do” – Elbert Hubbard
It’s easier to make a decision to do anything but where it gets challenging is the execution of it. I had no idea how to start the training. Having type1 diabetes (T1D) I have insulin sensitivity, low blood sugar (hypoglycemia), high blood sugar (hyperglycemia) these are all common symptoms in my body on a regular basis. My biggest fear is low blood sugar. My legs become like noodle and unable to do anything until my body is recovered with glucose. I carry glucose tablets everywhere I go along with juice and snacks. Walking 30+ km a day is about 6 to 7 hours (5 km per 1 hr. estimating on flat surface, no hills) plus lunch and breaks. It’s a long day for the body to be put through that type of fitness regime if you haven’t done it before.
How do Athletes train?
I asked my friend Michael who does marathons and Ironman and how he trains for it, his answer was “you don’t think about the whole race, you think about the next km and the next and so on and let the training guide you”. Motivational speaker, super athlete Sebastian Sasseville with T1D (climbed Mr. Everest summit and ran 250 km Sahara race) and Endocrinologist Dr. Perkins and the team from Mt. Sinai Diabetes Education Centre have been a huge help providing their insight and telling me to figure out “my numbers” before I get to Spain.
Sasseville said “figure out all your numbers before you get to Spain including plan A, plan B and plan C so that you are prepared for every kind of emergency and you go on autopilot when you get there”. Great advise because that’s exactly what I have to do, figure out my basel insulin setting (slow acting insulin intake) for the entire day including hourly intake during the walk.
Its all Numbers
I started my walk with 6km around my neighbourhood using an iPhone app called “MapMyWalk” which is great for walking (training) – and will keep track of your steps, km and calories burned plus the map of your path so you can save it for future use, tweet it/ facebook it for bragging rights. I started my walk every other day in early March, it was so cold and raining and I got sick. It took me 4 weeks to recover – recovering from cold/fever with diabetes takes longer. Then started training again in April – every other day and slowly increasing to 10, 12 14 km … and eventually walking every day. By mid June I was walking 30 km with no problems. Hiking training few weekends with my husband was a huge payoff – including going to Rattlesnake Point and Bruce Trail really helped with me the rough terrain, uneven surface plus it mimicked some parts of the Camino.
Its been tricky and hard to walk a full day of training with a major renovation going on in my house for the last 3 months and ignoring my personal life – but I had to put my training as priority as I had committed to the Camino and booked the ticket. In some ways it was good to have a target and train for it and sticking to my commitment as it helped me to focus. Part of it was due to being just scared as I didn’t want to get into trouble in during my climb if I ran into trouble.
“Nothing is more difficult, and therefore more precious, than to be able to decide” Napoleon Bonaparte
As I said on my earlier post about the first day of Camino is to trek from St. Jean Pied de Port to Roncesvalles 20 km straight up the Pyrenees and decent 5 km to Roncesvalles. The ancient Napoleon path goes through the middle of the mountain as there are other options of taking gravel roads with less strain. But the whole idea to train was to see the summit on top and to find out about my body.
Climbing straight up for 20 km on a tough terrain to maintain healthy blood sugar without having too high or too low sugar (chances are low sugar) as it’s a tough exercise is a challenge. So my training had to be 99.9% figuring out numbers (how much insulin to take for the day and during meals).
During my trainings I reduced my insulin to 40% to 50% during exercise and during rough terrain even reduced more and no insulin during meals which kept my blood sugar perfect. Of course I had many low sugars but it was all part of the training to tweak the numbers.
Here is a video from my hike at Rattlesnake point
The Plan, the plan
Well I think I have my numbers figured as I will post them later. In terms of snacks and energy Dr. Perkins, my dietitian and nurse at the hospital agree that I should be having a good snack and replenishing my fluids every hour.
Snack = .5 g of Carb (CHO) x total body weight in km for every hour
During my training I ate trail mix and drank coconut water (carb, salt – great electrolytes) but my dietitian indicated that nuts are great for day hikes but not for everyday 30 km hike, so I need to skip the nuts and go straight for the sugar and carb combo since it will give me more energy like Fig Newtons . And it would be difficult to find coconut water in Spain so I will settle for Gatorade (as I plan to carry Gatorade crystals and make them as I need them).
I am so eager to put all my training and things that I just learned the last few months into production as the days are getting closer to our trek, like my friend Melinda said “my training started 3 months ago here in Toronto”.
I am so excited to be sharing this with you and I hope you’ll join me on my journey as I will try to post our progress (internet permitting) of course!