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advice for diabetic skier

 Poster: A snowHead
Poster: A snowHead
going away in 3 weeks,first time since being diagnosed ,type 1.
appreciate any advice, what to do to prevent insulin freezing in backpack,
all new to this as its only been 2 months,love to hear from other diabetics
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martone, I have two children Type 1 and we have done loads of skiing both in europe and scotland, I dont think there are many major problems It,s just a case of lots of testing and carrying glucose at all times, You cant carry insulin in an uninsulated backpack, it has to be in a warm pocket preferably close to skin, Your consultant will prob suggest a lower basal rate but it,s a bit. suck it and see, I will think some more about it and see if anything else comes to mind and I'll post more later,
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keep your blood sugar machine wrapped up as it doesnt work whn it gets cold.

my little brother is type 1 and hes been away with me alone a few times, hes never really had a problem.

his blood sugar does drop very fast and we often have to stop mid piste so he can have some sweets.
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tx guys,

was just wondering if the altitude affects anything,and the research i found the biggest problems can be your feet.
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martone, my OH is type 1 and has been for centuries. He has switched to a different blood glucose meter which copes better with the cold - the old one had to be stuffed down my bra for a while before each test, if it was cold. Yes, test lots - the cold seems to make a difference. My OH reckons that the colder it is, the more often he needs to stop for a vin chaud. He just carries his insulin pen in an inside pocket - it's never frozen.

Make sure you take plenty of testing strips - they cost heaps in a French pharmacy.
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My mate is Type 1 and manages fine - i think he keeps his insulin in an inner pocket as close to his skin as possible.

He has no problems with the exception of a trip to Fernie a couple of years ago, we stopped in the wee cafe up the hill to warm up and he was due a shot. Thats when he realised his insulin was frozen solid. Then again it was 35 below (as they say in those parts) and everything and I mean everything was frozen solid including us.

Excercise caution, make sure your skiing buddies know what to do if you have a hypo and you will be grand.

Oh and have a grea trip Smile

P.S I am not a doctor... and never will be
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Quote:

make sure your skiing buddies know what to do if you have a hypo and you will be grand.


yes, important point. I find that if my OH is going a bit hypo he tends to fall in situations where he might not otherwise - then having to struggle up just drives the blood sugars even lower.
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There's a thread here from last winter, with some advice about which meter works best in the cold. http://snowheads.com/ski-forum/viewtopic.php?p=1449885&highlight=freestyle+lite#1449885
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martone, pm Scarpa - he knows all about this.
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martone, I use the freestyle mini (there is a new version out) as it's good with altitude and stupidly tiny, also has a little led night for testing in poor light. I just wear a small bumbag with the glucose testing kit, insulin pen and some glucose gel sachets (available from running, sports nutrition and cycling sites) but wear it high up under my coat. This keeps it warm... there is no way I'd keep insulin in a pack. I've been winter climbing in the Rockies (temps down to -29C) with no problems. I keep enough carbs i nthe pack to last a couple of days... you really don't want to run low on supplies up in the mountians.

I also keep some gels in outer coat and pant pockets... they don't tend to freeze... for quick access. There is one type which has about 45 carbs and a screw top... good for small top ups although it's pretty sickly. A few museli bars make up between meal snacks. Watch out if you have a skinful the night before... you can get some lows mid morning due to glycogen depletion and the hangover can mask symptoms.

Feel free to PM me if you have any specific questions or want links to the gels.
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martone, if it all sounds rather daunting on this thread, , don't let it scare you. I've been type 1 for some 35 years, and as long as you are sensible, take your pens and some carbs with you, you'll be fine. There's nothing us diabetics can't do without a little forethought: and frankly, often are safer and better prepared than others as a result.

To be perfectly honest, I used to be a terrible tester - probably once or twice a month if you were lucky. Went skiing for years like that without an issue.
Started out with glass syringes that needed sterilising each time you used them ffs (and scared stiff of dropping them on tiled bathroom floors) - imagine that as a 16 yo in a ski resort with a room full of classmates.
We only switched to disposables when the NHS started supplying them to druggies and the dibie community kicked up a fuss. And I only moved to pre-loaded pens about 18 months ago.

But. I'm still here, I don't have feet problems (yet) , I don't have glaucoma (yet) , blood pressure or other complications. I will admit, nowdays, as I've got older and move onto a different regime, and different testing equipment, I've got more back into the swing of things like the guys & gals above, I do test every day, two or three times, but you know what? - life isn't worth living if you are going to be frightened of it.

So behave sensibly, keep an eye on things, but enjoy the skiing.

J
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 And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
Quote:

life isn't worth living if you are going to be frightened of it.


No, absolutely no need to be frightened of it and none of the comments above suggest anything other than sensible precautions. Most diabetics are, indeed, well organised because they need to think ahead and be that bit more prepared. But it's only fair on others skiing with you to make them aware - and they can help look out for symptoms of hypos.
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JimW, I remember those syringes. Check out Jerry's article below (top climber dx'd at 40 yrs old with type 1). I do test about 10 times a day but I do a lot of sports and never know what I'm doing from one day to the next Madeye-Smiley

http://www.diabetesvoice.org/files/attachments/article_20_en.pdf
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 You know it makes sense.
You know it makes sense.
And did you also have to do tests by peeing in a test tube then dipping a stick thingy into it - told you what your blood sugar had been some hours previously. Try doing that beside a piste.
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 Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
We changed to the Scarpa-recommended meter last winter - made a big difference.
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 Poster: A snowHead
Poster: A snowHead
pam w, I remember the test tube where you add so many ml of urine and water and then dropped a fizzy tablet in it... it went boiling hot and the solution changed colour. Couldn't do that on the slopes Laughing
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Scarpa, inspiriational and spot on. Thank you for sharing. Does MAD still run?

I used to row for the school as a diabetic - 3 rounds of 1500m at full bore on regatta days, and a training regime that would frighten most other sportsmen. However, a slightly more controlled environment than Jerry I suggest!

And of course, I didn't have the switch to make late in life - OK when you are diagnosed at 15 it might seem like a major problem, but then again, never really knowing what it was like without it so in some ways, easier to handle.

pam w, you are right, you do have a duty to make sure others are aware of the symptoms - for their peace of mind if nothing else. I guess I take that as just being part of the standard arsenal of precautions and preparations, so don't think about it in those specific terms.
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One thing I remember from mountaineering trips... wobbly leg syndrome... it always seemed to be the hike back at the end of the day when my levels would drop and the old legs would start getting a touch wobbly feeling. When you are alert and active you notice as soon as your blood glucose drops to about 4. Knackered and tired it can get down to 2ish before you realise.
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Scarpa, pam w, ahh the good old days eh? Those bloody urine dips... no wonder I gave up on them. And then when I did get a meter I think it took about a minute for a reading Kids today.. they don't know they're born..
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Wobbly leg syndrome = time to stop for a vin chaud. wink
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pam w wrote:
Wobbly leg syndrome = time to stop for a vin chaud. wink


And that can lead to a whole new vicious circle
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JimW, Yeah.... I went to the first MAD conference at Plas Y Brenin but haven't been to the others since.
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 After all it is free Go on u know u want to!
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I'm in the same boat - diagnosed Type 1 at the start of August, so this will be my first ski trip with needles in my pocket. I'm pretty happy with my control and my response to exercise, though I'm a bit nervous about the cold and altitude. Suck it and see I suppose...

Only thing i'd add that no one has mentioned is that things might be a bit more difficult to manage if you're not on a basal-bolus regime. My DSN swapped me off the crummy mixed insulin onto basal-bolus as soon as we started talking about snowboarding Smile I'm basically planning to be sensible and test lots, and make sure the rest of the group knows what's going on. One thing my nurse did mention was to be aware that the effects of exercise on your glucose can carry over from day to day, which sounds interesting...

anyway, fingers crossed and all that - a fantastic week should be had by all. Biggest worry at the moment is whether the flights will be cancelled!

Tapstick
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the industry standard claim (for testing) for altitude will be 10,000 feet, but even at that, most of the big players will have only done short term simulated testing for this (baro chamber). Temperature is important - but within the range of the published/recommended working temp, equilibrium is key - strips and meter close together. Lots of folk tended in the past to stick their strips in the fridge - the innacurate results they'd get werent necessarily due to the cold strips, more due to the cold strips vs. room temp meter. Ever take your camera/phone/whatever out of your pocket/it's case too quickly in a mountain restaurant? if so you'll know the condensation that forms on the surfaces - this is bad news for your strips - they're stored with desicant in their little pots/packets. So make sure you give everything a few minutes to settle before a test to avoid any moisture getting at the strips

Another possible thing to consider is blood supply when testing - the extremities can get a bit cold of course which may hinder getting a good sample from your finger - has your HCP shown you "alternate site" testing (arm, fleshy palm)? - not every brand is indicated for it and there are subtle differences in the readings you get

finally, i would say of course ask your HCP about some specifics beacause they'll know, check out Diabetes UK as there will be a wealth of knowledge on there too, AND dont be afraid to speak to Patrol on the hill - many of them have a doc on staff and they'll definitely have dealt with an occasional hypo on the hill

and read Redgrave's book - that level of training and calorie requirements is simply staggering for someone with diabetes!

Enjoy your trip, a bit of forethought and research like you're doing and you'll be grand Very Happy
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barry, Good points regarding meter... that's why I like the tiny ones, easy to carry everything. I drop my 24hr insulin from 14 units to 12. Morning dose is usually 12 units... on a really active day I drop this to 3 or 4 and have big breakfast of porridge or similar just before heading out.... double normal carbs.
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Tapstick, Yup.... a heavy day of exercise will usually mean a 10% to 20% insulin requirement reduction the day after... and then if that is a big day too rolling eyes


But... an adrenaline filled day may produce some rises in blood glocose levels.. a scare can cause glycogen release from the liver... good old fight or flight response to put it simplistically
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 And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
thanks everyone,
one last thing,insulin and needles in hand luggage,do i need some sort of doctors note.
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So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
Make sure you tell your Bootfitter, if they don't discuss it further with you to some degree, then walk/hobble away.
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 You know it makes sense.
You know it makes sense.
Fascinating thread, which I've read because I sometimes ski with a friend who isn't always able to regulate his Type 1 ideally well. We've all learned to keep an eye open, so it's OK.

Scarpa,
Quote:

Watch out if you have a skinful the night before.
Toi? Surely not? Toofy Grin

Quote:

wobbly leg syndrome..
Know it well (from day-long hikes, more often than skiing) and I'm not even diabetic!

SMALLZOOKEEPER, interesting you should say that. I've also been wondering about the people who've recently been posting about getting frostbite/frostnip in the last week or two of very cold weather. Damn dangerous with diabetes.
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 Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
martone, yes to needles and insulin note - sensible to have one. Also if you are travelling/skiing with people who don't know you are diabetic - consider getting a medic-alert bracelet/tag. Might also be worth carrying glucagon.
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 Poster: A snowHead
Poster: A snowHead
Scarpa wrote:
JimW, I remember those syringes. Check out Jerry's article below (top climber dx'd at 40 yrs old with type 1). I do test about 10 times a day but I do a lot of sports and never know what I'm doing from one day to the next Madeye-Smiley

http://www.diabetesvoice.org/files/attachments/article_20_en.pdf


I met Jerry's wife Jackie at a French lesson in Savine-les-Lacs a couple of years ago.
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Hells Bells, a Michael Caine moment? Laughing
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Hurtle, Laughing Laughing
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Hells Bells, good on you, I knew you'd get it! Toofy Grin
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Hi all

I'm a T1 diabetic too and have just returned from Scotland on my first trip away on my own; I usually ski with a friend who knows about my condition and will keep an eye on me.

I would echo the points made so far; keep your insulin from freezing; likewise with the test meter. Carry easy to digest fast acting carbs (my preference is jelly babies and peanut M&M's fwiw) and test regulary. Nibble little and often. Also, it may be prudent for the people you're travelling with to carry a glucogel set and a Glucagen Hypokit in case of a severe hypo.

I attended a week long DAFNE course earlier this year which really invigorated me in terms of regular testing and recording of my results, my overall BG control and the long term management of my diabetes. I followed the DAFNE advice with regard to exercise and reducing my QA by up to 50% and BI by 20%. Touch wood, it seemed to work well with no issues and BG readings in line with a normal day.

Defo mention about the condition when having a boot fitting.

FWIW I have never carried a doctors note when flying and I ALWAYS carry it in hand luggage, but I may be the exception to the rule. I also carry the insulin pens without any needle attached, in case any member of airport staff decide to investigate any of the kit and start to take it apart.

If in any doubt, then consult your HCP

Nick
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A couple of things I would suggest

Some diabetic advice seems to be very didactic about what to do when skiing we were told you must do this/ that.
As is suggested by much of the above it is very much a suck it and see thing. I suspect that people have very different carbohydrate and insulin requirements when skiing as people ski very differentlly doing a bit of a boot up a hill and skiing untracked snow will have a hugely different metabolic demand than pottering down a blue run with many variants inbetween. You have to know what kind of skier you are before thinking about how you might adjust your insulin and carb intake. Frequent testing particularly at first is the answer.

As most people dress fairly sensibly I am not sure that in most ski resorts for most of the season temperature plays a particularly big role in altering insulin requirements or the fairly modest altitudes that alpine skiing is usually done.

A couple of practical things form experience chair lifts do get stuck have some carbs easily to hand just in case, have a second set in a different pocket in case you drop the first.

Although a doctors letter is sensible for flights I wouldn't worry too much if you forget it, we have only ever once been asked the purpose of the syringe/ needles and never had to produce a letter once explained.
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martone, I always took the view that it was essential to have insulin , needles, test strips and lancets in hand luggage in case the airline lost your hold luggage, I have always carried a doctors note and a prescription, but in years of travel have never been asked for them, We have been asked what the needles are for a few times but when you say diabetic they just nod you through.
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 After all it is free Go on u know u want to!
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DaveMcSki, I wear a bum bag and carry the med stuff in that. Always with me.. someone could always walk off with the wrong hand luggage after all. Never been asked for a doc's note anywhere in hte world but I do take a copy of a prescription with me. The Frio gel bags are great for storing insulin in hot temps but they also work well for cold too.
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just returned from a great holiday with no problems at all,
would just like to say tx to everyone for the advice which helped considerably to put us at ease and enjoy our time on the slopes,
once again tx snowHead s,
what a great and helpfull bunch u all are,
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martone, Good to hear.. glad you enjoyed it Very Happy
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