Looking back, we probably should have brought a tent … and sleeping bags, but as I lay there freezing under my emergency blanket (which I had packed, but never thought would actually use) I was jumping with excitement. While admittedly extremely uncomfortable, I was also ecstatic to be halfway up the mountain that I had dreamed of climbing ever since beginning mountaineering years earlier, Mt. Rainier. It all started with a move to Oregon for college. During the drive up Interstate 5, I got my first glimpse of Mt. Shasta and further up the highway, Mt. Hood. Both mountains are part of the Cascade Range, a series of volcanic peaks that run along the West Coast from northern California all the way up to Alaska.
To summit them, you need extremely warm clothing, insulated boots, crampons, ice axes, and no small measure of tenacity are prerequisites. Having no idea about where to start, signing up for a mountaineering class through the University of Oregon seemed like a good stepping stone and a few weeks of classes taught us about the many hazards, how to avoid them, proper knots and lashing techniques. All of this was topped off by a class trip in the vicinity of Bend, OR. We spent three days sliding around in the snow, learning how to use the all-important ice axe, navigating crevasses in roped teams, and how to perform a crevasse rescue. Towards the end of the trip we summited Ball Butte, a (relatively) small hill. I absolutely loved it. After the course I began to collect gear and work to develop my newly minted climbing skills. My first summit was Mt. Hood, the tallest and most popular climb in Oregon. Standing on the top, after having to kick steps into hardened snow and ice, gave an overwhelming feeling of joy and accomplishment. I spent time on Mt. Shasta, North Sister and many other peaks. As I prepared for each climb, a question kept arising: How do you do it with diabetes?
The answer as it turns out was simple yet daunting: Trial and Error. Fortunately, competitive cycling for most of college taught me a great deal about Type 1 management while training for endurance sports. I felt comfortable with temp basals, how much and when to eat, but mountaineering was a very different challenge. Unlike cycling, mountaineering involves large variations in physical effort. One hour can include a relatively easy walk up a ridge while the next could involve a nearly vertical ascent up a wall of ice. This unpredictability forced me to switch my strategy completely. Instead of relying purely on a low temp basal and constant carbohydrate intake I would lower my basal slightly and rely more on food intake, upping it before tougher sections and lowering it during flatter, easier climbing.
To do this I usually reduce my basal to around 75% about two hours before the start of the climb and return it to 100% on the summit, as descending is far easier. I’ve been fortunate to have the support of Hammer Nutrition and use their gels, bars, and powders to regulate my blood glucose. Usually I have a couple gels (which each have around 25g of carbohydrates) before and during each of the tougher sections and use bars, which have a higher fat content, as the main fuel on the day of the climb, some of which can last 16 hours or longer. Even with all of this preparation, the unexpected still occurs and my blood glucose can vary greatly, especially with the effect of altitude on insulin sensitivity (thanks cortisol!).
Another challenge is the environment. In many cases, climbing on snow and ice involves cold, wet and windy conditions. In most cases, especially when windy, I can’t take my gloves off too often or for too long or else my fingers get dangerously cold. This makes for challenging and often unrealistic blood sugar checks. To overcome this I rely almost religiously on my Dexcom CGM to monitor myself throughout the climb. I keep it either in my chest pocket or front pocket of my pants and it gives me real time data as to where I’m at. The cold also puts my insulin and temperature sensitive technology at risk. To prevent my insulin supply from freezing and to avoid the frustrating “temp error” on my meter, I keep them next to my body throughout the climb and sleep with my insulin, meter, and Dexcom all inside my sleeping bag.
Although I have to take a few extra steps to manage my diabetes, I am still able to climb just as well as those endowed with a fully functioning pancreas. This brings me back to the beginning where I lay on a sleeping pad, in all the layers I had with me, still freezing. My climbing partner and I were attempting to climb Mt. Rainier, which involves 9,000 feet of elevation gain to the summit at 14,416 feet, in a day and a half. With the weather window looking good we skipped the weight of a tent and sleeping bags, deciding instead to rest for a few hours’ just on sleeping pads wearing our layers. Fast forward a few hours at 11,500 feet with the sun down and the weather much colder than predicted, we were freezing. So cold in fact, that we started our summit bid 2 hours earlier than expected which in turn led to an amazing experience.
The climb involved a long slog up a snow slope to 10,000 feet, then a quick traverse of a glacier to 11,500 feet where we camped and ate dinner. After that, we crossed a much larger glacier with seemingly bottomless crevasses and scrambled up the disappointment cleaver, a rough section of volcanic rock. A final steep climb up to and across the crater, got us to the true summit. We started at 10 a.m. and rested from 6 until 10 p.m. when we left for the summit. After 6 hours and constantly fighting off a string of high blood sugars we reached the top as the sun was rising. Graduating from the University of Oregon later that week, I quickly threw on my cap and gown, something I decided was worth the extra weight and snapped a picture in 60mph winds. Mt. Rainier … check. Graduation … check. Thriving with diabetes … check.