ULSA has a prospective new caver who also has type 1 diabetes. I am currently worjing with her to develop a risk assesment covering her condition. We are trying to work out how to make caving as acessible and safe for her as possible. I am looking for advice from people who have experience as or with a diabetic caver. What are the main things to be aware of as a leader? Are there any limitations? Or any other advice? Much appreciated!
Caving with Diabetes
- Thread starter Tinywoman
- Start date
rhychydwr1
Active member
Make sure she carries with her: Blood test equipment, insulin and sugar. The later can be in the form of chocolate. A good meal before the trip and no alcohol. [perhaps a little after the trip]. Common sense really.
I am an active caver and CIC--with type 1 diabetes--controlled by an insulin pump. The caver will need to carry cereal bars, dextrose tablets, and the orange glucagon kit (for disabling hypos). Chocolate has limited sucrose and sweet cereal bars would be more beneficial to carry as an additional food source.
I find the walk in has the most significant effect on my BG. Test on arrival at the cave and eat if necessary. But don't inject for the cereal bar if one eaten.
If the caver can reduce their basal rate of insulin, I personally reduce by 20% for a 2-3h trip and 40% if a more strenuous trip. (But this is obviously a matter of trial and error).
If the BG is high when leaving the cave (unless super high i.e., above 20mmol) ignore it as it will come down in a couple of hours as metabolic rate will be runing higher for some time. Alcohol after the caving trip can result in a significant decrease in BG so best to avoid until sure of how BGs react to caving.
BG monitors: most have batteries that do not operate very effectively in caves. I use a Freestyle Freedom Lite and this operates down to 4 degrees. But the caver will only need to use it down the cave if a longer trip.
Happy to answer any specific questions that you may have.
Helen
I find the walk in has the most significant effect on my BG. Test on arrival at the cave and eat if necessary. But don't inject for the cereal bar if one eaten.
If the caver can reduce their basal rate of insulin, I personally reduce by 20% for a 2-3h trip and 40% if a more strenuous trip. (But this is obviously a matter of trial and error).
If the BG is high when leaving the cave (unless super high i.e., above 20mmol) ignore it as it will come down in a couple of hours as metabolic rate will be runing higher for some time. Alcohol after the caving trip can result in a significant decrease in BG so best to avoid until sure of how BGs react to caving.
BG monitors: most have batteries that do not operate very effectively in caves. I use a Freestyle Freedom Lite and this operates down to 4 degrees. But the caver will only need to use it down the cave if a longer trip.
Happy to answer any specific questions that you may have.
Helen
AR
Well-known member
A good friend of mine is type 1 diabetic and has been for over 40 years, he never let it stop him from climbing, caving (he did Titan some years ago) and hillwalking, likewise my wife who used to do 20+ mile walks with me before other health issues intervened and she went over to horse riding. As long as the person in question has their diabetes under control, they shouldn't have any problems.
Speleofish
Active member
hhoops advice is v sensible. I know several people with type 1 diabetes who cave and climb serious mountains successfully. Critically, they all have good blood sugar control and a good understanding of their condition. If they don't satisfy both criteria, steer them towards another sport.
On UK trips, the biggest danger is hypoglycaemia (low blood sugar). Provided the caver recognises the early symptoms, and carries a ready source of sucrose/glucose, this can be averted. High blood sugar (and high blood ketones) will rarely be a problem on 'short' trips. As a rough guide, if you can manage a decent hill walk without trouble, you can probably manage to go caving.
Hypothermia is potentially problematic: distinguishing the symptoms of early hypothermia from hypoglycaemia can be difficult (and one can lead to or complicate the other). Pragmatically, the assumption should be that a muddled diabetic is hypoglycaemic (so give sugar) but, if they don't recover swiftly, assume they're also hypothermic.
Blood sugar control on long trips is much more complex - recommend building up very slowly!
On UK trips, the biggest danger is hypoglycaemia (low blood sugar). Provided the caver recognises the early symptoms, and carries a ready source of sucrose/glucose, this can be averted. High blood sugar (and high blood ketones) will rarely be a problem on 'short' trips. As a rough guide, if you can manage a decent hill walk without trouble, you can probably manage to go caving.
Hypothermia is potentially problematic: distinguishing the symptoms of early hypothermia from hypoglycaemia can be difficult (and one can lead to or complicate the other). Pragmatically, the assumption should be that a muddled diabetic is hypoglycaemic (so give sugar) but, if they don't recover swiftly, assume they're also hypothermic.
Blood sugar control on long trips is much more complex - recommend building up very slowly!
mrodoc
Well-known member
Agree with last comment. Not only did my wife and I run the practice diabetes clinic, one side of my family has members with a range Type 2 diabetes to Type I. They are all very active - one is a film actor (he has a pump). The advice I have seen so far is excellent. There is nothing someone with Type ! cannot do. They should be doing their own risk assessment by the way - they don't need mollycoddling. I have caved with several people with Type 1 diabetes and know at least one successful cave diver with it. The BSAC has allowed people with diabetes (with provisions) for a number of years. If you can dive you can certainly go caving. The only case I know of where diabetes might have contributed to a fatality was in a cave diver who had been recently diagnosed with Type 1 diabetes who was using unfamiliar equipment in exterme conditions and that was over 20 years ago. He was, as far as I know, not part of the monitoring system we now conduct in the UK on sport divers.
Just 2 additional thoughts...
a. electronics, cold and water don't mix. I carry my additional food, dextrose, glucagon in a wide mouthed nalgene bottle--it's 20 yrs old and has never let in a drop of water. If carrying a BG monitor, this will also need to be kept dry. If in the nalgene bottle I find it needs a couple of minutes in my armpit (!) to return to workable temperature. Most of the more complex electronic devices for BG monitoring have working temps that are not suited to caving--if they become a regular caver they will need to make the case with their GP for a Freestyle lite.
b. Things the leader should look out for--good point about hypothermia by the way--if the caver starts moving more slowly or in a clumsy manner (this could be difficult to distinguish before they find their caving legs!) ask them if ok, suggest a couple of dextrose tablets/cereal bar (maybe 'because the next section is a little energetic')...diabetics going into hypoglycemia may reject the notion that they have low BG--but will thank you after as they recover and become more aware.
a. electronics, cold and water don't mix. I carry my additional food, dextrose, glucagon in a wide mouthed nalgene bottle--it's 20 yrs old and has never let in a drop of water. If carrying a BG monitor, this will also need to be kept dry. If in the nalgene bottle I find it needs a couple of minutes in my armpit (!) to return to workable temperature. Most of the more complex electronic devices for BG monitoring have working temps that are not suited to caving--if they become a regular caver they will need to make the case with their GP for a Freestyle lite.
b. Things the leader should look out for--good point about hypothermia by the way--if the caver starts moving more slowly or in a clumsy manner (this could be difficult to distinguish before they find their caving legs!) ask them if ok, suggest a couple of dextrose tablets/cereal bar (maybe 'because the next section is a little energetic')...diabetics going into hypoglycemia may reject the notion that they have low BG--but will thank you after as they recover and become more aware.
shortscotsman
New member
back in 2013, the South Wales cave rescue had a rescue complicated by the casualty being hyPERglycaemic
http://smwcrt.org/j32/index.php/newsmainmenu/170-draenen-020513
I don't know if anything could be learnt to avoid similar problems
http://smwcrt.org/j32/index.php/newsmainmenu/170-draenen-020513
I don't know if anything could be learnt to avoid similar problems
Good point--I also carry a syringe in my nalgene bottle as the pump can become disconnected. On this note, if sited in the abdominal area, twisting srt motions can cause disconnection. The best site is upper buttocks with a long infusion set lead--again may need arguing for as long leads cost the NHS a few pence more per set!
Thanks for the suggestion but short acting insulin needs to be injected at least every 2h if you are usually on a pump system (pumps do it every 15 mins) and, for those who are not on a pump system, needs to be combined with a longer acting insulin (as I'm sure you know). This make-shift short acting alternative should really only be used as an emergency solution as it's a nightmare injecting/BG monitoring while caving (both of which would need to be done even on a shortish trip) and as BGs are harder to control...personal evidence: last month's Cantabria trip--a caving trip but my pump stopped working when I swam in the sea (didn't realise it was cracked!)--various infections occurred as a result of 2 days without a pump on the lispro only regime.
But don't let this conversation put your diabetic caver off! Nothing is inaccessible for a well-controlled diabetic (but it does help to make sure the diabetic is not the only one on caving trips with potentially life saving technical knowledge at their disposal).
But don't let this conversation put your diabetic caver off! Nothing is inaccessible for a well-controlled diabetic (but it does help to make sure the diabetic is not the only one on caving trips with potentially life saving technical knowledge at their disposal).
Some may choose to go down this route but, as a regular caver it wouldn't work. My insulin pump is detachable for tight squeezes, the Dexcom system is quite a large bundle of of transmitter and adhesive tapes and can't be removed at a whim. Plus the mobile device is not waterproof (my pump is completely waterproof)...I am keeping my eye on this development but currently I would say unsuited to regular caving use--well in Yorkshire anyway.
I'm happy to chat to the new caver with type 1 diabetes (via email rather than public forum) if they feel it may be useful in any way. Helen
I'm happy to chat to the new caver with type 1 diabetes (via email rather than public forum) if they feel it may be useful in any way. Helen
Cave_Troll
Active member
i'm T1 and don't have a pump or an implanted meter.
have done several long trips like cueto-coventosa and the berger and come out with a BM of 5.x
i also cave dive
have done several long trips like cueto-coventosa and the berger and come out with a BM of 5.x
i also cave dive
