Project 50 in 50: Lived Experiences with T1D and Pushing Limits with Patrick Mertes & Michael Shelver

Ask an Expert
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Hi Dessi,

We had quite the adventure and unfortunate accident on Granite Peak in Montana!

Patrick and I were both descending down from the summit over some tricky snow where it was icy on the surface but soft underneath. Patrick slipped first and slid about 25 yards down the slope. As soon as he came to a stop, I too lost my footing and slipped but kept going and picked up quite some speed (my Garmin indicated about 25 mph!). After trying and failing to stop myself with my ice axe, I tumbled into a field of boulders and luckily came to a stop on my back.

I didn’t move too quickly and wiggled my toes to make sure I could still move my legs and then took off my helmet which had a huge dent in it. Pain came quite soon after and I waited for Patrick, who arrived and did a quick assessment. With the fall and impact being a big one, we opted to call search and rescue using our Garmin InReach and began communicating with them.

During the fall, both my sensor and my pump site were pulled out and I developed high glucose and likely ketones. Luckily being with another person living with T1D, Pat had me covered and got insulin on board as well as a new sensor and site, while we waited for the helicopter to show up. Having someone who understands diabetes, especially in emergency situations, is invaluable.

After a few hours, the helicopter came and the paramedic who got me into the basket and out was also a person living with T1D! I was in the hospital soon after and aside from some major bruising, a cut that required a few staples, and a minor pneumothorax, I was okay. After a few weeks I rejoined the team in Colorado to begin hiking again!

Patrick and I both have wilderness emergency experience, and I highly recommend taking a Wilderness First Aid course prior to any large trips.

It’s also important to discuss what to do if things don’t go to plan prior to starting the trip.

As they say, the mountains will always be there - being conservative in the mountains keeps you safe, mitigates unnecessary risk, and most importantly, allows you to return.

I have turned around from a mountain summit many more times than I have made the summit and am totally fine with that - if things don’t feel right, or it’s getting too uncomfortable, that means it’s time to turn around!

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22

Lindsay! It’s great to see your face on here! Mike is going to tackle this one! I hope you’re doing well!

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WHAT!!! :open_mouth: thanks for sharing this Mike! What a wild story.

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Wow, that’s quite the story :joy:!!! So great that Pat was there with backup diabetes supplies. And cheers to a good helmet - always protect the head! Glad you were both safe.

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Hi Lindsay,

Ketones have certainly been an issue on the bigger peaks (such as Denali) where altitude and dehydration, as well as the stress response has let to ketones.

Added to that, due to the high intensity of exercise, we’ve sometimes reduced our basal and bolus too low to where we’ve had insufficient insulin on board.

Ketones in the mountains suck! Sometimes they can be hard to figure out because the symptoms of ketones are very similar to altitude sickness (nausea, headache, upset stomach). When I first summited Denali in 2017, I thought I was experiencing altitude sickness at 20,000ft when it was actually a ketone event.

We both carry ketone meters to check our blood ketones and will test if we are experiencing symptoms even if our glucose is in range. In most cases, if we do have higher ketones, we’ll opt to stop, take additional insulin (usually via an injection) and take on additional water and electrolytes. If glucose is within range, we’ll also take on additional carbs as well. This is also a time where we may opt to replace our infusion set as sometimes climbing harnesses our our backpacks can dislodge them without us knowing.

I highly recommend ketone meters over urine strips as they’re a truer representation of current ketone values and a lot more convenient, especially in the outdoors. I recommend asking your endo to get these meters and strips. If insurance doesn’t cover, there are options on Amazon that may be a good alternative.

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Favorite Low Supply - Trolli Peach Rings (has to be the brand name though!)

Second favorite is Jelly Belly (but has to be the 46 flavors!)

I’m picky when it comes to my mountain low supply of candy :rofl:

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Cold can be tough at night, as tend to run lower when I’m sleeping, likely because I’m using so much energy to stay warm! I’ve found some nice milk chocolate before bed tends to mitigate this as well as a temp basal if it’s been a tough day of climbing.

Hot weather has definitely been a bit trickier. In our last adventure of biking from Death Valley to Whitney and then climbing Whitney, heat made things extremely tough for me where I was running low but because I was so hot and dehydrated it felt impossible to keep low supplies from coming back up.

I ended up shifting completely to liquid low supplies such as Gatorade and ginger ale to keep myself going as well as focusing on getting my core temp down and fluid levels back up.

Dehydration tends to make my BG go on a rollercoaster ride, likely due to reduced blood volume and therefore more dramatic changes so my best advice for heat is to keep on top of hydration and not just water, electrolytes and carbs are key to keep yourself going when things get tough (and toasty!).

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Thanks so much for all the excellent questions! Michael and I are always happy to share advice or tips with anyone living with T1D who wants to spend more time outdoors (reach out on IG @project50in50). A huge thank you to DiabetesWISER for organizing this and inviting us to be part of the conversation.

Michael and I are both products of an incredibly supportive diabetes community, and we’re so grateful for forums like this that remind us we’re not in it alone! The sky is the limit with T1D!

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Thanks so much for being here Patrick and Mike! Maybe we’ll see you at camp in the future? :wink:

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Thanks all! As Patrick stated, feel free to reach out to us at anytime and keep posting any questions here (we’ll keep answering!). We love helping to get others outside and doing amazing things with diabetes.

@LaurenF always happy to attend camp - send us the invite!

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We have now concluded our Ask the Expert session with Patrick Mertes and Michael Shelver. From the DiabetesWise team, we would like to thank our experts and everyone who participated in today’s discussion!

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