Diabetic Climbers: Tips and Tricks!

I’ve been climbing for a while now and still haven’t perfected the art of climbing with this stupid disease. I still run into issues with CGM scraping off during chimney climbs, pump sites being yanked out when falling, and of course storage of snacks for unexpected lows on multi pitch climbs. Fellow climbers-sans-pancreases, I would love to hear any tips and tricks you’ve picked up, or any clothing brands with nifty diabetic solutions. Mine: sewing a buttonhole on the inside of pocketed shirts and keeping my pump in the shirt pocket so that pump tubing never has to leave the shirt, thus keeping it out of the way of the many things dying to get tangled in it. 

Can't help you with what you asked, but one my kayaking partners has Type 1. Before each trip he would give a short review what to do if goes deep into hypoglycemia - how to recognize symptoms, feeding him glucose tablets,  emergency application or glucagon pen, where to find that pen. Probably worth doing refresher even with the same partners  once and again

Put your cgm site on your upper thigh, about under your front pants pocket (so your leg loop would be above it).  I've had zero issues there.  That move was a game changer.  I also try to put my pump site as close to the center of my abs as possible, with the theory that there is a gap there when you weight the harness.  That's not 100 percent successful, but I'll give it 90 percent.  As not-fun as they are, the highest carb to cost/calorie/weight/volume ratio food I've found are cliff bars.  They fit good in your pocket for big days on the wall (its the year 2024, no one has a backpack anymore on multipitch rock climbs).  I also try to avoid eating an actual meal, and just graze on food throughout the day.  Depending on what pump algorithm you're running and how insulin sensitive you are when your metabolism increases with activity, it kind of takes care of itself, which is nice.  Huge days in the mountains are fun, cause its literally a free for all with food!  

All good advice here.  Biggest key for me is the buttonhole through a zippered pants pocket for the pump.  If it's more than a half day outing I'll carry a spare infusion set in case I rip it out (came close a couple of times before doing the buttonhole thing).  Fast acting carbs in a thigh pocket for quick access (a handful of jelly type candies in a Ziploc; I don't feel the need to pay for stingers or specialized gels).  Bigger supply of candy in a bigger Ziploc for reloading if it's a longer trip.  Bagels have lots of carbs in a relatively compact and trail friendly format, so they're good for snacks/lunches.

I can't really speak to the CGM sensor getting scraped because I'm an ice climber and clothing layers tend to mitigate that for me. Maybe over tape would help, if you don't use it normally?  As a future rock climber, I'll  watch this space for other tips.

My BG tends to fairly regularly crash 5 minutes from the parking lot on the approach, for reasons I haven't fully discerned, but I'm getting better about fuelling up at the trailhead.  Obviously, we should be taking any opportunities presented to check the CGM and take any appropriate measures to adjust things (waiting for leader to build an anchor, for example, when I  can check my CGM very easily one-handed).

Err on the side of high BG rather than low, within reason of course.

I don’t use a pump so I can’t speak to that, but i’ve yet to have issues with my cgm staying in place. I’ve been using patches called “skin grip” off amazon that are patches of kt tape. Trick is to deep clean the applied area with alcohol wipes before putting on the patch. I’ve had no issues and I do jiu-jitsu as well, which is probably a tougher test. My hack for snacks has been the hyperlite versa fanny pack. It weighs nearly nothing and is super durable and fits nicely in the low of your back above your harness. Carries a tiny collapsible water bottle and a few snacks.

Loving the advice here! I’ll have to try the thigh CGM spot—as long as the leg loop is above it, that seems like it would be really out of the way

+1 for explaining your condition to partners. We have a local badass with Type 1--still crushing in his 60s. I find that hopeful and inspiring. Guessing one of the reasons he's still going strong is that he's willing to equip his partners to help him. 

Logan Petersonwrote:

#1 for explaining your condition to partners. We have a local badass with Type 1--still crushing in his 60s. I find that hopeful and inspiring. Guessing one of the reasons he's still going strong is that he's willing to equip his partners to help him. 

This is a great point.  My climbing partners are more attuned to my CGM alarms than I am, almost certainly due to alarm fatigue.

I've been a T1D for 36 years and climbing for 16 years.  I use a Minimed pump so keep that in mind.  

Infusion set / Sensor placement:

As other have said - try putting your infusion set in your upper thigh.  You can place your sensor in the same location on the other leg.  That or place your sensor in your triceps.  You can even place your sensor within 1" of your infusion set but I don't like to do this - too much tape in one spot.  Us a good sports adhesive when attaching your infusion set and sensor.  Try out flexible adhesive patch from Not Just a Patch.  I think they hold better than the stuff that comes from the pump suppliers. 

https://notjustapatch.com/

Pump placement

This sounds weird but stay with me - cut a small hole in the liner of your front pockets.  The hole should be at the top front of the pocket inner lining. You can stich around the hole to make it more durable and to keep it from expanding.  The hole should be just large enough to get your revivor though.  Take your reservoir out of  your pump and thread it through the hole in your pocket.  Now reattach the revivor to your pump.  Your pump will now be in your front pocket.  If your infusion set is in your leg then everything is contained within your pants (insert joke here). You can pull your pump out of your front pocket.   After you put on your harness your pump will be below you leg loop and everything will be held in place.  I've been using this method for a decade without my pump falling out.  I find I can still get access to my pump while wearing the harness, even while hanging.  

Carrying Stuff

I carry a second chalk bag that is used to hold: energy gels for low blood sugar, insulin and a needle (in case of pump failure), glucagon kit, and meter.  But you have a CGS, why carry a meter? See below. 

Blood Sugar and Climbing

This is only my personal experience, please consult your doctor before making any changes to your treatment

The best CGS is about 15 minutes behind what your actual blood sugar is.  Due to the anaerobic nature of most climbing it can impact your blood sugar in odd ways faster than your CGS can accurately process.    

Climbing hard pitches can cause temporary spikes in blood sugar. If I  experience a high bs while climbing  I wait 15 minutes and test my blood.  If it's still high the I give bolus 70% of what is recommended by my pump. 

Low blood sugar while climbing can be tricky as well. The anaerobic nature of climbing can cause low blood sugar to 'creep up' on you.  Your bs will be just fine, then you top out and are enjoying the view.  All of the sudden you have fast dropping or low blood sugar.  Weather it's fast dropping or low blood sugar I treat them the same.  I eat an energy gel (I like Gu, the caffeine helps clear the brane fog associated with low bs).  I wait 15 minutes then test my blood sugar.  If still low, or if my CGS says I'm still dropping I eat another energy gel.  

One final thing:  If you're using a pump with an 'Auto Mode' to deliver your basil rates -I would turn that off while climbing.  Auto modes are horrible at managing blood sugar while your climbing.  The issue is that the Auto Mode program tries to figure your basil rates assuming your active and sedentary blood sugar levels. Because of this the program tries to find a 'happy medium' between your active and sedentary blood sugar levels.    

Communication - the most important

As others have said - tell your partners about your condition BEFORE YOU GET THE WALL.  I'd recommend you tell potential partners about your diabetes before they even agree to go climbing. Not everyone will be comfortable climbing with a diabetic.  That's OK.  If they are OK climbing with you then show them were on your body your glucagon kit, insulin, and food are.  Explain how to use your glucagon kit.  Keep a laminated card on your person with you basil rates, sensitivity factor, and carb ratio on them.  This card is incase your pump is destroyed and you need to be hooked up to an insulin IV.  It will really help out your ER staff.  (trust me on this)  

I am 70 and climbing hard in Joshua Tree.  I’m also a type one diabetic with a Dexcom CGM and t slim pump.  Everybody is offering you great suggestions.  I try to cover all bases before I leave the house and I am always over-prepared.
1) On Climbing mornings I try to stay low-carb high-protein so I am not on a roller coaster. I ideally I arrive at the crag with a BG of 120. My pump has a “high exercise profile“ that delivers minimum insulin and corrections throughout the day. I turn off auto mode because I don’t want it delivering corrections that I don’t know about and getting surprise lows.
2) I have a little bag that I keep in my backpack that has a glucagon inhaler called Baqsimi which works like a charm, and anyone can administer it. I also have an extra meter, insulin, and syringes just in case. A couple of batteries. And something I never thought of before, but I’m glad I do it now, I keep a couple of Zofran on hand in case there is an accidental high blood sugar and the nausea that can come with it. there’s nothing like being 2 miles from your car and throwing up your guts on the ground. Zofran stops that.  

3) I bring redundant sugar… I have Maple syrup packets in my chalk bag and small cans of ginger ale in my backpack.  I learned the hard way that you want cans of soda and not the plastic bottles because if the cap on the bottle won’t open you can’t get to the sugar you need. Anything I think I might need out there, I carry triple.  If you fell or got stuck much longer than you expected, it’s good to know there are ample fluids and sugar with you.
4) I carry a Garmin with an SOS button. I’ve never used it, but it gives me peace of mind.

5) and yeah, I always tell my partner that I’m diabetic and what to do if I were unconscious or unable to help myself. We used to have to teach partners how to use a glucagon syringe and needle, but now with Baqsimi it’s literally just put the nozzle in your nose and push a button and man, It works fast!  

Best of luck! You’ll get it all figured out and it’ll be smooth.  

Oh, and I also wear my sensor on my upper thigh, never a problem.