Skip to main content

Ski touring in Silvretta from T1DM + CGM point of view

List of abbreviations:
T1DM - Type 1 Diabetes Mellitus
CGM - Continuous Glucose Monitoring


When I come home from a ski tour, my parents always ask - how was the trip? My usual answer is - good, we have survived.
This time we have survived the ski touring in Switzerland. As for me, I really mean survived. Lukas has already published nice and simple travel article on his blog - Ski touring in Silvretta. Therefore I do not want to write much about the tour itself. I would like to focus more on my blood sugar monitoring during our physical activity in the Alps.

Preparations of the sensor and insulin pump


I am using Medtronic Paradigm insulin pump with Apidra insulin analogue. After I shaved and cleaned the skin, I placed the sensor little bit over my right hip to avoid the a proximate contact with my ski pants (left image). The sensor fortunately paired with the pump and from that moment on I got 6 days of continuous blood sugar monitoring.



Day 1 - 27.3.2014: Tour to Chamonna Tuoi hut (2250 m)



Before entering Switzerland, we slept in Austrian village Pfunds. I got hypoglycemia early in the morning, after which my blood sugar escaladed to 15 mmol/l and stayed there for the rest of the night. The whole tour to the Chamonna was fine. For 2 hours I stopped the pump because I was feeling a little low. 
But as we arrived there, the sugar started to rise up to 20 mmol/l. I expected actually just the opposite because the demand for blood sugar remains higher for some time after the physical activity. However around the dinner and some avalanche rescue training I got back to normal. But I was high again at night.

Day 2 - 28.3.2014: Tour to Hintere Jamspitze (3156 m)



I managed to lower my glycemia towards the morning. The spike in the morning represents the breakfast. After the breakfast I set my basal insulin to cca 15% with duration about 6,5 hours. The tour was fine. I was eating some sweets along, but not much - just to maintain the sugar in the reasonable range: 7 - 10 mmol/l.
But again as we arrived to Chamonna, the sugar rose up to 15 mmol/l. I thought there has to be something wrong in the system so I replaced the cannula. I felt the sugar is more constant later. So probably that was the problem (or the adipose tissue, hm).

Day 3 - 29.3.2014: Tour to Silvrettahorn (3244 m)



We left our hut early (6:00) and the tour started with some steep ascent. Without any surprise I was feeling low somewhere in the middle. The sensor told me 6 mmol/l, but because of the 20 minutes delay between the actual blood sugar and interstitial fluid values, from where the sensor gets the information about the sugar, I thought I was having the hypoglycemia. I needed to make a break. And I stopped the pump.

There was some big ski tour ahead of us, so with my not-pumping pump we crossed glaciers and climbed up Silvrettahorn. During the descent of Silvrettahorn I was feeling a little weird. I started to be more tired and breath more rapidly. Of course it could be because of the air at the higher altitude and a lot of physical activity. The blood sugar was still around 10 mmol/l so I though everything was just fine. Before the last downhill to the hut we made a small break. After 10 minutes of resting on the sun I was still breathing rapidly. Till that time, the pump hadn't pumped for about 7 hours. Then I turned the pump on again.

DKA?

When we arrived back, all I wanted was just to go to bed and sleep. I dug into the quilt and blanket and tried to sleep. I needed to make some heat because I was feeling cold. But I couldn't sleep and I was still breathing rapidly. I was just lying there covered with everything around that could make me warmer and Lukas was reading something on his smartphone next to me. After 1 hour I got some idea. I asked Lukas to google Kussmaul breathing. When he finished reading the wiki out loud to me, I took my Diaphan urine test stripes and went straight to the toilet. The result: the ketones and glucose markers totally black. That means a lot of glucose and ketones in the urine. Not good. (Actually some level of ketones during the sport is normal, because you are burning the fat tissue)

I did what I remembered from the hospital. I asked for a cup of tea and sugar. I put a lof of sugar (cca 50 g, maybe even more) in the tea and I drank it slowly. And I injected 5 IU fast bolus. Then I just waited. Basically I just told my body: I have a lot of insulin, do not make glucose from fat. To turn the glucose metabolism around. After one hour I felt much better, the rapid breathing was gone and during the dinner I was already OK. Actually I had a super-great time because the whole time we were coming back to the hut I was afraid of the worst scenario - diabetic ketoacidosis (DKA) and transport to hospital. 

The experience

This experience was priceless, but I wish this happens to no one. Especially in the high mountains without medical personnel around. It was my mistake and this was the lesson I do not want to forget.
The CGM did a great job. Unfortunately due to a higher price I cannot wear it always, but at least I tried to extract as much informations as I could from these blood glucose measurements. For every person with diabetes climbing up a mountain is always the double win. Doing it again and safe is perhaps more than double the effort. But ski touring is worth that effort.

Photos from Silvretta - Lukas' Google+


A right leg of a diabetic person with our 2 pairs of ski together and Piz Buin in the background:

Comments

Popular posts from this blog

First Hawaii, then Oregon

Why? Hawaii - the international conference on MR (ISMRM) happened to be in Honolulu in 2017. Oregon - to counterbalance volcanic islands with sunny beaches and volcanic mountain with snow.

Part One: No Glamping in Hawaiian Islands

Island One: Kauai



After comfy 24-hour economy flights with Eva and Fabian, and just as I started to watch Moana, we landed in Lihue (Kauai). I assembled with Pedro, we took a rental car and quickly found our room in cosy Kauai Palms Hotel. For lunch next day we met Andrea in Kapaa and together we headed to see Wailua Falls, not far from Lihue. We left Andrea in Kapaa later that day and for our next night we were going to camp at Koke'e State Park Campground (thanks Evka for help with fixing my tent!). The night was very cold, roosters were loud and views from Kalalau Lookout were astonishing! It was time to warm up and see some beach so we decided to get a nice cup of coffee and visit a beach with restricted access for rental cars - Barking Sands Beach in 

Yamaha S08 - sticky keys repair

My keyboard Yamaha S08 suffered from several "sticky keys" disease already a year, perhaps more. That saying, I am pretty bad piano player. However, I like to have my devices fully functional for any cases.
I have found a very helpful guide, but with no photos. I made some for better visualization of the repair.
First, I unfastened all screws from both sides:

Second, I unfastened all screws from a wooden base plate which were holding the part with electronics.


Then I unfastened the golden screws holding the whole keyboard to the wood. The keyboard was now accessible from both sides.

The last step is described in the following video. It was just removing the sticky keys and reinserting them without a metal spring coming inside. The end of the metal spring has been left outside of the key:


So far it works well!

Inspiring music in Casey Neistat's vlogs

After watching a few vlogs by Casey Neistat on Youtube, I couldn't help notice the well-chosen music in the background. Particularly music by one artist named Julian Avila. Here is his music: https://soundcloud.com/julian_avila
Inspired, I took several months old videos I shot on GoPro Hero 2 when I was biking to Kahlenberg in the rain. After a few hours and two whiskeys, this came from my computer: