(Note: Rachel Hemond, an 18-year-old from Acton, MA with Type 1 diabetes, spent five months in the Vermont wilderness, managing her blood sugar using the Omnipod System and with the support from a network of doctors, family, and friends. This is the seventh in a 10-part series of blogs Rachel wrote about her experiences.)
Layover: a delightful, warm, clean indoor place where a bunch of cold, dirty, hungry semester students take up residence for a day and two nights and frantically organize everything for the next leg of the Kroka winter semester journey. For me, this means checking all my diabetes supplies, sewing four more holders for my Omnipod insulin pumps, and pressing four more of my semester mates into service carrying them for me. When we leave on March 1, my 18th birthday, I am full of excitement for a leg of our trek through the Vermont wilderness free from diabetic-related worry.
But the best laid plans tend to go awry. The problem started innocuously enough. Even though everyone had lost weight on our first leg, most leveled out on this second leg of the expedition. With the exception of myself and three boys, everyone else was putting on muscle.
I wouldn’t care all that much, except for the fact that losing weight on winter trail is a serious strength sapper. The four of us are given chunks of raw butter every now and then to add to meals that already totaled between 5,000 and 6,000 calories per day. But it is soon evident that in my case, at least, calories are not the problem.; instead, my blood sugars are to blame. It is my blood sugar.
Absently flicking through my records about halfway through the leg, I notice an alarming trend; my blood sugars had not been within my target, 120-150, for weeks.
Though this may not seem all that terrible, let me give this a bit of context. At home and ever since diagnosis, I have been in excellent control of my blood sugars. My A1C has been 5.9 at its best, and always below 6.2, rarely above 6.5. My blood sugars are almost always in range, tending to be low if anything. Before expedition, a single reading above 200 would have sent me into a vague but very real panic. And now, stuck in the middle of the remote Vermont wilderness with no way to call in to my doctors and nobody in the group who knew enough to help me, I can’t seem to get my blood sugar below 200.
I change my basals first, then start to experiment with my carb-to-insulin ratios and correction factors. But at the same time, I know I can’t afford to be low while we’re on trail. It would mean 15 minutes of sitting still in the cold, holding up the group, and being shaky for the next half hour or so. Even worse was the idea that, in the fatigue of going up a hill or the adrenalin of going down one, I wouldn’t notice a low until it was too late.
In short, I am so afraid of going low that my attempts to decrease the high blood sugars are crippled from the start. Worrying about my blood sugars consumes more and more of my day, to the extent that I nearly have a panic attack one morning. I have to take off my backpack, sit down and drink hot water from a thermos before I can breathe again. It is clear that something has to change.
I need to break the cycle of fear that has begun to take over my life – fear of my own body and the blood sugars that I just can’t seem to get a handle on. The anxiety and highs are clouding my mind and slowing down my body. I know that I have to leave the trail for a second time.
I corner teachers and friends, talking through all of my options and searching for one that doesn’t involve leaving the trail. I try checking my blood sugar every hour for a few days, monitoring ups and, well, more ups. I adjust settings, but to no avail.
Finally, I am forced to look at my position logically. I read and re-read the graphs of blood sugars on my PDM, check the statistics it spits out, realize that everything except my ego is telling me to go back to basecamp a second time. In the end, it is a competition between logic and ego. My entire life has centered on beating my diabetes, controlling it, not letting it take over my life and yet here I am in a potentially life threatening situation where such an attitude is no longer viable. I mope around for the last few days, knowing the decision I must make.
And so, after our second leg is completed, I go home to Kroka, leaving my semester behind for a second time.
(Next: Adjusting sugars and attitude pays off.)