Can you walk with a chronic illness?

I did, I do, and I will continue to do so. I have Type 1 diabetes.

There is a lot of crap that comes with living with diabetes – injections, constant monitoring of blood glucose levels and knowing how to treat hypoglycaemic ‘hypo’ (low blood glucose) episodes. If you are heading for a diabetic coma because of seriously low sugar levels, you need sugar really fast, administered by yourself via mouth or with help via injection. We call this ‘treating a low’. The threat of this can scare the bejesus out of anyone, even an old hand like me who has lived with diabetes for 27 years.

The first thought most of us have is avoid any activity that might bring on ‘a hypo’, such as following a healthy low-sugar diet and becoming more active.

Risking hyperglycaemia (high blood sugars), as opposed to hypoglycaemia (low blood sugars), is far less debilitating, in the short term. Dire complications arising from hyperglycaemia develop slowly. You can continue making poor food and lifestyle choices and suffer the significant consequences of poor diabetic management later. The list of complications is endless. Follow the link to this reference site if you want to know more https://medlineplus.gov/ency/patientinstructions/000327.htm.

All you need know is that a nasty death beckons sooner if you ignore your condition. If you accept your diabetes diagnosis, learn as much as you can about it, and make plans to improve your outcome an adventurous life is definitely possible. Adopting a healthier lifestyle instead of binge-watching Game of Thrones over a pizza and coke, in my humble opinion, is the way to go.

The first step is to consult your General Practitioner or Allied Health Professionals for their suggestions on what you can do to improve your health outcomes. Often, the parameters they give you may feel restrictive, but if you are unfamiliar with regular exercise, it’s best to adopt the slow and steady approach first.  

I bet my bottom dollar they will recommend walking. It is the perfect low impact exercise that only requires a comfortable pair of shoes and loose clothing and a path to follow. Start with your local footpath. This is what I did. I had just had my second child. I wanted to be around to watch my children grow so taking care of myself became a priority. From the day I was diagnosed, I started integrating regular walking into my weekly exercise regime. Nothing too strenuous – just local walks of only 30 minutes’ duration.

I loved it so much I started walking with other ladies who were equally motivated to stay fit and healthy. No one else had diabetes but some had other conditions which could benefit from regular exercise. Regular monitoring of my condition showed I was doing the right thing.

The HbA1c test, which stands for glycated haemoglobin, is a useful, simple, and inexpensive blood test for diabetics that gives an indication of the overall control of blood glucose levels over the previous three months. It looks at how much sugar (glucose) is bound in your red blood cells. A raised HbA1c correlates with an increased risk of developing diabetes complications. My results varied often, as many other factors can affect good diabetic management, but I always strove for a good result. Frequent exercise was one of the few options available to help keep my HbA1c results in a safe, acceptable range.

This is what I did for 15 years while raising a family and working part-time. When the kids became more independent, I had more free time. Walking grew on me. It took me to a happy place and invigorated me in addition to the health benefits. I sought more challenging, longer walks. I started bushwalking and discovered the beauty of nature in my own backyard. The paths were steep and rocky and required supreme concentration, but it was great fun. With traffic sounds muted, I felt I was in the remotest wilderness, although civilisation was never far away. Still, if I sustained an injury or had a serious hypo (low sugar) episode, immediate help was not readily available.

You might think my fear and worry of complications in the wild would return me to those trusty suburban footpaths. No way! I was having too good a time becoming proficient outdoors. The desire to explore further, do longer day walks, even consider multi-day hikes blossomed. I became hooked, but I could not be complacent. While my fellow walking companions travel lightly, I always carry more essentials. Experts always encourage you to carry a change of clothes and rain gear for changing weather, a basic first aid kit, navigational aids, water, and food. I do this, but I also pack my diabetic supplies.

Just before I detail these essential diabetic supplies for a multi-day hiking trip, be aware diabetes is a complex disease with a wide range of different diagnoses and treatment regimes. I encourage you to visit a reputable site, such as Diabetes Australia here, for more detailed information. 

In Type 1 diabetes, which I have, the pancreas produces little or no insulin, a vital hormone for converting glucose into energy. People with Type 1 diabetes need to do the job of the pancreas and replace the insulin via insulin injections or an insulin pump. I choose to administer insulin via pen injection, and I base the following consumables list on this delivery method only.

They include:

Abbott Freestyle Flash Glucose Monitoring System consumables
  • Blood Glucose Monitor to test my sugar levels

I have been using the latest Flash Glucose Monitoring system from Abbott since 2018. It is called the Freestyle Libre, and this recent technology assists me monitor glucose levels without drawing blood via the old finger pricking method using glucose test strips. I sometimes carry backup strips and a reader, but the Freestyle Libre system has proved exceptionally reliable.

Freestyle Libre Sensor

I have a small sensor attached to the back of my arm. I scan the sensor with an iPhone app or a reader device to get a reading of my current sugar levels. If low and trending downwards I need to stop walking and treat with a high energy glucose snack like jelly beans. Reliable, convenient, and easy to use the prompt sensor readings enable me to avert hypos before they develop and walk without interruption.

Reading my Blood Glucose Levels from sensor on arm with and iPhone app
Freestyle Libre Reader
Fast-acting glucose sweets like jelly beans to treat Hypos
  • Spare charged Reader should my iPhone app be unavailable. Apart from scanning the sensor, this Reader can also act as a standalone Blood Glucose Monitor accepting blood glucose testing strips for a result in 5 seconds.
  • Blood Glucose Testing Strips (a few) for the backup method described above
  • Lancet with Lancet needles for the backup method described above to draw a blood sample from fingertips
  • Fast-acting glucose snacks – jelly beans or glucose tablets
  • Slow-acting carbohydrate snack for slow release sustained energy with continued exercise like grainy muesli bars full of oats and nuts.
  • Insulin Pen
Insulin Pen with insulin cartridge

I still need to take insulin when I stop for lunch. Food always requires insulin, but with prolonged exercise I should adjust my dose downwards. With no insulin, my sugars may still become high again, which is so unfair when I am walking these long distances to support good sugar levels.

For overnight hikes I bring another Insulin Pen with my long-acting insulin. I feel like a pin cushion taking 5 shots a day. Three fast-acting insulin shots – one each for breakfast, lunch, and dinner – and 2 long-acting shots, lasting 12 hours each, one in the morning and the other just before bed.

Insulin Cartridge Pen Refills
  • Insulin (backup supplies for long-distance hikes)
  • Enough Water (rule of thumb is 1 litre for every 5kms)

Diabetics need to stay hydrated. Sometimes hot conditions can make it difficult to regulate your core body temperature, and heat exhaustion may result. I find I sometimes stop sweating and become distressed. Pouring water over my head and torso helps to cool me, but you still need to carry added drinking water for hydration or at least have ready access to reliable safe water sources.

  • FRÍO® Cooling Wallet
FRÍO® Cooling Wallet

Insulin must always be stored in a refrigerator until required. It can be safely used at room temperature for up to a month. The FRÍO® Cooling Wallet provides safe storage for temperature-sensitive medications, such as insulin, and is a valuable piece of equipment to have on any diabetics’ walking adventures.

  • GlucaGen® HypoKit®
GlucaGen® HypoKit®

I do not carry the GlucaGen® HypoKit® (glucagon) prescription medicine injection used to treat very low blood sugar (severe hypoglycemia), but some diabetics might. You will need to educate another person on how and when to use it should you lapse into a diabetic coma and cannot take sugar by mouth.  

Yes, I guess it’s a bit of a hassle to have these extras supplies with you when your friends often only carry a bottle of water. Of course, you can always give walking the flick and let them have all the fun. But withdrawing from society is a cop out approach.

I say embrace the challenge, bring what you need for your condition to make the walk possible, and just enjoy discovering the great outdoors. I find many of my regular walking friends are genuinely interested in my diabetes management and are keen to improve their knowledge of the disease should they ever need to help me. 

Can you walk with a chronic illness or condition? Absolutely you can. It just takes a little extra planning and preparation. Manage the impediments and continue to make your dreams come true.

Since taking up multi-day and long-distance hikes, I have walked over 4,000kms. In 2019 I was extremely proud of my ability to walk the Pacific Crest Trail in North West America for 152 days without complications. And I am not finished yet. I don’t regret one kilometre. The odd one or two days were challenging but the joys of discovering magnificient scenery far out way the hardships I experienced walking with a chronic disease. It’s up to you now. What will be your adventure?

The Double Ds conquer the PCT with Type 1 diabetes

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