I’m currently in Chamonix for my first skiing Christmas. I was ridiculously keen to go skiing again. But also aware that it was my first time skiing with type one. One of the main reasons I started all my running was so that I could understand my blood sugar control better to prepare me for skiing. I’d like to do things like this again safely with type 1, so I’m really motivated to control the condition.
My first day on skis was difficult
Well, it was really fun, and included the view above. Laura, the research nurse at my trial (who has been absolutely legendary), has managed to track down an insulin pen with which I can give myself half unit doses. Deciding what insulin/eating regime to use for the first day was all about an educated guess. Which I got spectacularly wrong. I took the minimum insulin I could for breakfast: 0.5 units. The target blood sugar range is normally 4 to 8 mmol/litre, but above 5 when exercising. My blood sugar was 4.3 at the bottom of the mountain, so I ate a sandwich. I then spent an hour standing in queues waiting for cable cars to get me to the top of the mountain (altitude 3300m). So no exercise and I wasn’t expecting my blood sugar to drop – especially as I’d had the sandwich.
My wife was distinctly unimpressed when I decided to test my blood in a freezing, howling gale at the top of the ski resort. First challenge: extract blood from freezing fingers. This actually went okay. I was however, amazed to see that my reading was 1.8!! That was by far the lowest it’s ever been, and so I immediately gobbled up six jelly babies. We couldn’t wait around because we would have frozen, so we skied off, with me eating jelly babies as I went. I took another reading half way down and it was 4.3, so I ate a snickers. By the time we got to the cafe at 1800m altitude, my blood sugar was 15 – the highest its been since about a month after my diagnosis. So a pretty awful start to my T1D skiing career!
I found the numbers so surprising that I suspected my glucose monitor wasn’t working due to the altitude. I did some experiments taking readings at the top and bottom of lifts, but had to admit that my blood sugar had just been really volatile.
You can see from the chart below, that after that I managed to keep my blood sugar above 4 for the rest of the day. And it returned to normal range from 15 really quickly. The difficulty was knowing how much I needed to eat.
Hypo awareness – another challenge
The next day (yesterday) I went cross country skiing. I’ve only done it a handful of times over the past five years – and it showed! It took me a good five minutes to figure out how to get my skis on, and another five to work out how to hold the poles. Relieved to have finally figured it out, I skated away from the bemused looks of the group of professional looking skiers next to me. And lost my balance, windmilled my arms and legs like some kind of demented stick insect, and landed on my arse.
Luckily things got better from that point, and it was really fun to do something new, and I’m really keen to keep my aerobic conditioning up ahead of the London marathon. Cross country skiing is a bit like going for a run, but more tiring. I skied for about half an hour before first testing my blood. I felt fine skiing, but when I stopped to test, I realised that I felt like I had low blood sugar. It was 4.3 – not a hypo, but low. The next time I tested twenty minutes later it was the same.
So I’ve learnt that when up a mountain in a howling gale, and when zooming round a cross country ski track, it’s harder for me to feel low blood sugar. This is annoying. People who suffer from “hypo unawareness” are at significant risk of experiencing severe hypos. At least I know that I find it harder to feel low blood sugar whilst skiing. This means I’ll need to test more frequently while I’m on the mountain.
It also makes the integrity of my glucose reader all the more critical. It has a battery – which fails in freezing conditions – so I am experimenting with effective storage options. Breast and trouser pockets both seem to work. Avoiding losing circulation in my fingers will also be critical – and this does happen from time to time in the mountains.
Insulin regime when skiing – no short acting until dinner time
After my experience on day one, I decided that when I’m exercising constantly all day, my body is just too sensitive to insulin to risk taking any short acting insulin before I’ve finished exercising for the day. So the past two days I’ve had a smaller breakfast than I used to do – and eaten more protein and fat (like eggs and ham) and less carbs (no cereal). I have also reduced my long lasting insulin (which I take before bed) to 4 units, which is almost nothing! My lunch then starts straight after breakfast, and continues all day – constantly eating small amounts of carbs to keep my blood sugar topped up. This has worked reasonably well.
It also means the days of massive mountain-side lunches are over. I’m secretly pleased about this – it means I don’t have to stop skiing!
I started my day today but walking uphill to the first lift. (This is called “skinning” – you basically attach carpet things to your skis which enable you to walk straight up hill.) It was a 750m ascent which took exactly an hour. But again I couldn’t feel low blood sugar. I needed to eat 60g of carbs so I now have a much better idea of what I need to do to keep blood sugar high enough next time I walk uphill.
The research continues!
I’m sure I’ll get on top of it, and I’ve had such a brilliant few days. Chamonix is so much fun. Today our first run was a 1000m descent with fresh powder and not a single other person. This, despite the fact that it hasn’t really snowed properly for weeks and it’s peak season. We felt ridiculously smug to have escaped the crowds to find such brilliant skiing.