Hiking with Needles:

A Diabetic’s Journey

Photos and Story by Melissa Magnuson-Cannady

Safe and successful adventure for Will and Melissa.

“Ugh, my blood sugar is still high,” I said, in a tone that clearly signaled my disappointment. “It’s okay! You’ve bolused, and you’re about to do a lot of hiking with a heavy pack. It will come down. Just give it a little time,” my husband Will replied bracingly.

I didn’t always have these worries and concerns. Although traditionally most Type 1 diabetics are diagnosed in childhood, I was diagnosed as an adult. A variety of symptoms, including frequent urination, extreme thirst, and blurry vision, had led to a visit to the ER. A diabetic educator revealed the truth: I had diabetes and would have to manage it for the rest of my life. My autoimmune system had mistakenly destroyed the insulin-producing beta cells of my pancreas. Gone were the carefree days of eating and exercising, not worrying about my blood sugar.

Rather than finger pricks and a glucometer, I use a continuous glucose monitoring system. A sensor inserted under my skin, usually on my abdomen, senses my blood sugar and transmits the value to my cell phone and insulin pump. Instead of two types of insulin (a rapid-acting to cover food consumed and a long-acting to cover normal body glucose activity) injected through a needle and syringe or pen needle, I use a rapid-acting insulin loaded directly into my insulin pump, administered through tubing and a cannula, and infused into my body. My insulin pump is programmed to deliver a small amount of insulin all the time to cover normal body glucose activity. It can also deliver a larger amount of insulin in a shorter timeframe as needed based on food consumed and blood sugar level. The insulin pump calculates insulin amounts based on information I enter into my pump combined with additional data and programmed ratios.

Diabetes supplies laid out for inventory and inspection.

Even with these advancements helping me live a more normal life, diabetes is still something I always think about. In the 15 years since I was first diagnosed, my management of this disease has significantly improved. I am not perfect and neither is my blood sugar, but considering the relentless nature of it, I don’t let it stop me from doing most anything, especially those things I love the most.

“My pancreas no longer functions, but I will continue to function.”

We were about to embark on our annual backpacking trip. Three days, two nights in the beautiful Two Medicine area of Glacier National Park on the Pitamakan-Dawson Loop. We packed the requisite items for backpacking and more, including a Garmin InReach, just in case we actually needed medical assistance, despite all the planning, packing, and preparations. Since there is little or no improvising in the backcountry with medical equipment or pharmaceuticals, we prepared a lot. Larger and heavier packs accommodated the extra medical and food supplies I needed. Type 1 diabetes is a relentless disease that requires constant care and attention. I needed various diabetes supplies and back-ups for everything. My very life depended on it.

Diabetes supplies packed and ready to go.

With my blood sugar a bit high, but headed in the right direction based on the arrow on my screens indicating a decreasing blood sugar level, we left the trailhead and relatively easy access to medical care behind. As we followed the trail and made our way further into the backcountry, we alerted wildlife of our presence through chatter and numbers indicating my blood sugar.

After a few hours, we stopped for a light lunch at the base of a talus slope off trail. My blood sugar levels were good, as Will predicted. I added up the carbs of what I’ll eat and drink (trail mix, fruit bar, meat stick, and hydration drink) and entered them into my insulin pump. I made a slight manual adjustment to decrease the amount, since I’ll be physically active for the next few hours and deliver the dose.

After finishing lunch and hearing several pika “eep” sounds, we packed up and continued on our way. Since I just ate and took insulin, I even more closely monitor blood sugar levels. The easiest way to check is with my smart watch. The alternative methods — looking at my cell phone or looking at my insulin pump — not only take longer, but also could result in snagging tubing on something (branch, hiking pole, etc.), causing an emergency in the middle of the backcountry.

 Blood sugar graph on my smart watch.

Making it to Oldman Lake campground, we took a load off at the food prep area and set up our tent at the only site left. At the pit toilet, I deftly moved my pump from my pants pocket to my bra for safekeeping — my pump CANNOT fall into the toilet. After doing my business and properly sanitizing, I moved my pump back to my pants pocket. At the food prep area, we started to prepare our meal of risotto with chicken. We were using freeze-dried meals, due to their low weight, clearly-labeled nutritional information, and easy prep. While the meal is rehydrating, I programmed my blood sugar and carbs into the pump and took insulin.

Blood sugar levels can swing like a pendulum sometimes. Having low blood sugar at any time is uncomfortable. I get shaky and sweaty as my body is literally starving for fuel. But clumsiness and confusion are also typical, and any place where a fall could be deadly presents added dangers. If your blood sugar is too high and is corrected with too much insulin, it goes too low, and then too high again if over-corrected with sugar. Blood sugar oscillating from high to low to high is stressful and dangerous, especially in the backcountry where additional supplies and medical help are at least hours or a whole day away.

After we finished our meal, we admired Oldman Lake at twilight — so beautiful and peaceful and serene. On the way back to the tent site, I glanced at my blood sugar just in case I needed a snack. Rather than a snack, a little bit more insulin is needed. After getting ready for bed and settling down for the night, I check my blood sugar one last time, and I see that I have too much insulin onboard. Playing it safe, I take a few glucose tabs to bring my blood sugar up, and serenely drift into a quiet backcountry sleep. My phone and pump will alarm, waking me up if blood sugar values are too low or two high, but not that night. Instead, the howling wind racing down the valley woke us up throughout the night.

The morning broke fair and beautiful, and we were excited for the middle day of our trip. It was certainly the most difficult and long, but also the most scenic leg of our trip. As we got dressed, I took the time to check my blood sugar, which looked excellent! Before breakfast, I took more insulin to cover my biscuits and gravy. As we completed our final packing, I glanced at my blood sugar, making sure it looked good. We slowly made our way up to Pitamakan Pass, reveling in the views along the way — looking down at Oldman Lake, which we had gazed at just a mere hour before, was such fun! Since it was all uphill and more physically taxing, I repeatedly glanced at my blood sugar levels throughout the hike up to the pass.

On a high pass.

All along the trail, we took in the beauty of these high places in Glacier far from the overflowing parking lots. We enjoyed a quick lunch and continued up to the Pitamakan Overlook where, until you look behind you up at Mount Morgan, you feel like you’re on top of the world: peaks as far as the eye can see, glaciers in the distance, and beautiful blue lakes dotting the landscape below.

We continued along the trail, occasionally gazing up at the NW flank of Mount Morgan and across to Tinkham Mountain. At various points I checked my watch. I noticed not only blood sugar values, but also our elevation of 8,019. Very cool to be above 8,000 feet and have a reading of 115, a perfect blood sugar level for hiking as long as it stays steady, although it doesn’t take much for it to drop into a dangerously low range.

We traversed along the various slopes to the saddle between Mount Morgan and Flinsch Peak. From there we could once again see Oldman Lake where we camped the night before! Checking my blood sugar, I noticed it was getting slightly high, but as we were actively hiking, I waited. Sure enough, it gradually decreased into a range I designate good for backcountry hiking. After traversing along the western flank of Flinsch Peak and descending to Dawson Pass, we experienced the most powerful wind of the day — enough to knock us over if we weren't careful and like nothing we'd ever experienced! As we dropped below the treeline into the forest and out of the wind, we warmed up and began looking forward to our campsite.

After arriving at No Name Lake campground, we set up our tent at our site and then ate lasagna at the food prep area. It was our last night in the backcountry after a hard day, so we splurged on raspberry crumble. I took enough insulin and kept my eye on my blood sugar so I could catch any major increases or decreases before they became a problem.

My blood sugar looked good before I fell asleep, but an alert woke me up just before 2:00 a.m. Taking a couple glucose tabs worked for a while with a small rise in blood sugar, but it fell again, and another alert went off around 4:00 a.m., and again at 5:30 a.m. Each time, I woke up feeling shaky, acknowledged the alert on my phone, took my pump off my waistband and tugged gently at the tucked-in tubing, looked at the screen on the pump, dismissed the alert, and saw what needed to be done. Did I need to take some glucose? If so, how much? Did the insulin pump suspend the basal (background) insulin? Do I need to make further adjustments?

If winds didn’t wake me up every couple hours, it was my blood sugar alarms! I do get frustrated with the alarms — they are a constant reminder to check things most people never have to concern themselves with. However, I wouldn’t have it any other way; all the additional data makes it easier to manage diabetes in a way that enables me to do the things I love to do.

After finishing our breakfast skillet, we headed out and back toward the trailhead and the frontcountry. This third day was a nice leisurely hike, mostly downhill and level and mostly along the north shore of Two Medicine Lake. As we hiked out, we reflected on the amazing time we had, despite the challenges we faced with my diabetes, and wished we had more time on this trip.

Despite the risks inherent with the backcountry, coupled with the risks of being diabetic in the backcountry, we prepare properly, using the expertise we’ve gained through years of diabetes management and numerous hiking and backpacking trips to push our limits to see and experience more. It took years to build up the confidence to know what to do and how to approach such a challenge. It takes amazing breakthroughs in medicine, science, and technology to be able tackle such a fickle and relentless disease. My pancreas no longer functions, but I will continue to function. There will always be challenges to overcome. Remaining vigilant is difficult but well worth the reward of doing what you love. It is liberating to know that given enough knowledge, skills, abilities, smart choices, the right equipment and diabetic supplies, along with a support network and an enabled partner who can help if things do go bad, I’m able to hike to remote areas of the park and experience all that Glacier National Park’s backcountry has to offer.