Katrina Hemingway shares her experiences, with links to those of other hikers with diabetes. There is no one way to hike for everyone, so always follow the advice of your health professional if starting something new to ensure that any changes to your routine or activity are managed well. Read widely, then discuss promising ideas with your doctor to see if they could work for you, too!

Two women wearing backpacks on a hilltop with distant views of plains and more mountains in the distance — *Katrina Hemingway and her hiking buddy Helen Shepherd: Diabetes Type 1 is no barrier for either of them! (Image Credit: Katrina Hemingway)*

This article has been reviewed by a GP in consultation with an endocrinologist, as well as by senior educators at Diabetes Australia.

Diabetes is a serious, chronic health condition that is growing at an alarming rate. Worldwide at the time of writing, 537 million adults are living with diabetes, an astonishing one in ten people over twenty years old, with the number predicted to rise.

In 1994, I became one of those statistics. I was not pleased. With Type 1 diabetes, an auto-immune disease, the pancreas has largely stopped working. In Type 2 diabetes, often associated with weight gain, physical inactivity and other lifestyle factors, the body struggles to respond appropriately to the insulin produced. This is called insulin resistance, and eventually diabetes ensues. The good news is that you can treat diabetes, and avoid or delay its complications with diet, exercise, medication, and regular screening.

Silver Linings

View of mountain spine with track snaking to peak amongst patches of snow under blue skies — *Diabetes need not stop you from experiencing trails with views like this! (Image Credit: Katrina Hemingway)*

At thirty-three, I experienced the first signs of pancreatic failure eight weeks into my second pregnancy: insatiable thirst, frequent peeing, and overwhelming fatigue. A simple blood test displayed a displeasing blood glucose level (BGL) of 20 mmol/L; a normal reading for a non-diabetic is around 5 mmol/L. It was too early in the pregnancy for a gestational diabetes diagnosis. My endocrinologist was 99% confident that I had Type 1 diabetes.

What followed next was total information overload. First, learning how to inject myself by practising on an orange. Then familiarisation with diabetic terminology, knowing how to treat the most dangerous ‘hypos’ aka hypoglycaemic or low Blood Glucose Level (BGLs) episodes, and instructions on what to eat, when to eat and how many units of insulin to inject. Within three hours, I had a whole new language... and a few months later, my husband and I left for the US to take up his overseas posting. No way was I missing out on this travel opportunity, even if it required a new lifelong commitment to diabetes management!

Thirty years later, diabetes still confuses me. I constantly struggle to discover a path forward. Why do my sugar levels rise and drop surprisingly? How can I continue to avoid long-term complications? Must I watch my condition 24/7?

And yet… if I had not developed this condition, I may never have discovered my insatiable passion for long-distance hiking where I enjoy pristine wilderness and magnificent views in the company of other like-minded individuals. How could I ever have foreseen that I would become someone who pushes the boundaries of my abilities, someone who in 2019 headed out with a stranger to walk the 4,300 kilometres (2,670mi) of the Pacific Crest Trail in North America?

Smiling female hiker wearing cap and large backpack standing on rock outcrop with a lake, pine trees and mountain in the background — *Katrina, all smiles at Lone Pine Lake on the PCT (Image Credit: Katrina Hemingway)*

Today, I am so glad my husband and I went overseas all those years ago. We had a healthy baby, and we ended up travelling the world… and you can too. Diabetes management can test your patience and transporting insulin is sometimes a trial, but it’s workable if you treat the entire process as part of the adventure.

The following is what worked for me, but always consult your own doctor and/or dietician before embarking on any new activity or altering your routine.

Preparation for a Long Distance Hike

I try not to stress too much about my preparation. Essentially diabetes is part of who I am, and I take it along for the ride. I regularly test my sugar levels (BGLs) on the go. If it is too low, I’ll eat a fast-acting snack. Too high and I might need a little more insulin, but I’ll wait a while to administer this as continued exercise will lower my sugar levels. It’s important not to make corrections too soon. There are simply too many variables, in addition to diet and insulin management, that can impact your sugar levels. Weather conditions, mild illnesses, medications, even stress, can send your sugars spiralling. If you let this condition rule your life, it happily will.

Some people living with diabetes keep a logbook during preparatory hiking to determine changes to their BGLs. If this data helps you better plan how to deal with the challenges of long-distance hiking with diabetes, then try this method. Personally, I feel I have a comfortable handle on my condition, accept it will go haywire occasionally and I’m 100% committed to having the food, safely stored insulin and the equipment I need to treat inevitable unpredictable sugar readings appropriately. A quick check of my BGL levels, using my Freestyle Libre Continuous Glucose Monitor (CGM) usually confirms my suspicions of a low reading trending down. I immediately treat my ‘hypo’ with a quick hit of fast-acting carbohydrate, glucose, usually in the form of jelly-based lollies, followed by a slower acting carbohydrate like half a muesli bar for sustained energy. With these supplies easily accessible from my fanny pack I can usually continue walking at a slower pace until energy levels rise. I am never without these additional supplies. They are a life saver.

If hypos become more frequent during training as I increase my pack weight and lengthen my daily distances, I reduce my insulin dosage and/or increase my carbohydrate intake before exercise (ideally low GI foods for slow sustained energy release) to reduce their occurrence. Conversely, if my sugar levels remain high after periodic BGL testing throughout my training hike, I give myself a unit or two more insulin. It should be noted that I can’t feel a high BGL reading without testing. It doesn’t impact my ability to hike but it contributes to long-term complications, so maintaining optimal BGL readings is the goal for good lifelong diabetic management. It all sounds a bit daunting as outlined in the Medline link, but improved diagnostic tools and insulin delivery methods together with your commitment to good management of your condition shouldn’t lead to these worst-case complications.

High view of river snaking through forested terrain under cloudy skies — *Views of the Hawkesbury River in one of Katrina’s local National Parks (Image Credit: Katrina Hemingway)*

So how do I personally prepare for long-distance hiking? I simply hike, in my local area (Berowra and Ku-Ring-Gai NPs) gradually increasing the pack load, distance, and frequency of my hikes several months before the actual hike. These parks mimic well the Pacific Crest Trail (PCT) with their uneven and varied surfaces and varying elevation. It’s also an excellent opportunity to test out gear, footwear and allow sufficient time for changes, if need be, to ensure a comfortable and enjoyable long-distance hike.

What can a Type 1 diabetic not live without? Fanny packs. I’m a big fan of this extra pocket which provides easy access to crucial gear: especially sweets, my ‘hypo’ treatments for times when I start to fatigue unexpectedly, stumble more and generally feel not quite right. Easy access allows me to keep walking when I’ve set large mileage goals and don’t want to stop.

Overseas Travel

For overseas travel, carry a letter from your doctor stating your condition, prescribed medications, and the consumables you need to manage your condition. This letter will help in clearing customs, particularly if you are carrying sharps such as pen needles. Personally, I’ve never been questioned about my diabetic supplies.

Insulin on Trail

Picture of Frio sharps package for storing insulin — *Frio cooling wallet (Image Credit: Frio)*

Insulin is a temperature-sensitive medication you must keep cool to avoid spoilage. How will this work if your long-distance hike lasts longer than a month? With planning, that’s how! There’s always a solution. Insulin you are actively using can keep for up to 28 days unrefrigerated, as long as it does not overheat or freeze. Special cooling wallets, like the FRÍO® brand, overcome this problem and allow you to transport your insulin on any multi-day hike. Using specially developed crystals which activate when immersed in water, these wallets safely keep your insulin at room temperature even when hiking in extreme heat. The evaporative cooling wallet continues to work efficiently if you reactivate the crystals with water every 45 hours. To ensure the evaporative cooling mechanism works, you must keep the wallets exposed to a little airflow on the outside of your pack (some hikers store them loosely inside the top of their pack) rather than tightly packed in a stuff sack. It is a small weight penalty to ensure that your vital medicine will work as intended. You can mail any remaining insulin to an enroute trail angel for safe storage in their refrigerator and later collection.

Back view of hiker with large backpack on a trail with mountains in background under white clouds in blue sky — *I used a blue FRÍO® Cooling wallet, here peeking out of a pocket, for safe insulin storage (Image Credit: Katrina Hemingway)*

In very cold temperatures, some diabetic hikers carry their insulin close to their body to keep it warm.

Equipment and Backup Supplies

I strongly recommend you carry extra supplies. Consumables can be troublesome to locate, insulin can be expensive (particularly in the United States), and pharmacies may not stock the brand of insulin you are familiar with. Even in your home country, problems can arise. The day before I was due to start the Larapinta Trail in the Northern Territory in July 2024, my fast-acting and slow-acting insulin pens were stolen from my hotel room. Fortunately, I found them strewn in the corridor undamaged, and could continue using them. But I also had an insulin pen and two weeks’ supply of additional insulin stored safely elsewhere that would have seen me through the hike if I hadn’t found those pens.

If you lose your supplies for any reason, you have no means of managing your disease. You cannot stop eating to avoid rising blood glucose levels (BGLs) and hope you can manage it for a short time without complications. BGLs will continue to rise whether or not you consume food. You need insulin to stay healthy and alive.

An insulin-dependent diabetic has a lot of consumables to bring. This applies if you are employing a Multiple Daily Injection (MDI) approach like me, using pens, needles, insulin vials and a continuous glucose monitor, or if you are using pump technology for your insulin delivery.

Smiling woman in blue t shirt holding up arm with a paqtch on it holding phone nearby to take a reading, with tent in background — *Using my iPhone to get a BGL reading from my Freestyle Libre Flash Glucose Monitoring Sensor (Image Credit: Katrina Hemingway)*

My hiking partner Helen and I use different regimes to treat our diabetes when hiking. We both use Abbott’s Freestyle Libre Flash Glucose Monitoring Sensor, to test our sugar levels. Helen uses a reader device and I use a phone app. We scan a small white sensor disc attached to our upper arm. The scan immediately tells us our current sugar levels: far easier to manage outdoors than the old finger-pricking method which required a heap of equipment, a finger prick, a drop of blood, a test strip, a reader, and then a five second wait for results. This hassle-free, on-the-go FGM testing method allows us to treat low sugar levels at once with a quick snack without constantly needing to stop and eat.

Blood glucose sensors last ten to fourteen days before they need replacement. They come in bulky packaging, and you need to carry at least one back-up sensor as these devices can fail. They may also dislodge if you accidentally knock them off their anchor point on your body. I wear mine on the back of my arm, always under a long-sleeved shirt to avoid dislodging it, particularly when bushwhacking through dense foliage. The devices may also fail if they get knocked about in your backpack or they experience fluctuating temperature changes – cold nights, sweltering days – while you’re out on the trail. It has happened to me several times, so I come prepared.

The same goes for insulin pens and, while I am not familiar with insulin pumps, they come with issues too: technical faults causing hardware, battery and software failure, and blocked cannula or snagged tubing. The only way around these potential failures is to carry spares; many diabetic hikers carry double, others carry more. This could add 1-2kgs to your already leaden pack weight. Diabetic consumables are non-negotiable. They must come or you potentially end your hike if complications arise.

Food

Closeup of two pizza slices on paper plate with distant mountain views in background — *Cold leftover pizza seasoned with grand views (Image Credit: Katrina Hemingway)*

Which leads us to the question of how will you feed yourself when bulky food, predominantly fresh food, is out of the question? It’s possible, but there are compromises to make.

How do I keep my food carry as lightweight as possible? Once again, there are non-negotiables in this mix. If I suffer a severe hypo (hypoglycaemic reaction) which is a low blood glucose level of 4.0 mmol/L or less, I need to treat it immediately by eating or drinking at least 7-15 grams of fast-acting carbohydrates. These are the sugary foods or drinks without protein or fat that provide the glucose that is needed. For me, that means stowing heaps of pre-prepared ‘hypo’ zip-lock bags full of my favourite glucose jellies to gobble down whenever my glucose levels plummet. I have one of these bags prepared and easily accessible for every day of my hike. I also carry Glucose Chews, electrolyte sachets and allow for two to three energy/protein snack bars each day.

The food weight quickly adds up, but I must carry these hypo treatments and energy bars.

Selfie of smiling blonde woman in a supermarket with shelves of hiking products in the background — *Resupply on the PCT (Image Credit: Katrina Hemingway)*

Work out what you need to carry to survive, get your pack base weight as ultralight as possible, know the pack weight you can comfortably carry, train appropriately and, unless you are prepared to dehydrate good food prior to your hike, this is where I save weight.

Different hikers manage their diabetes differently on trail. For the duration of my PCT hike, I lived on calorie-dense food you typically find in a service station convenience store. Every morning was Instant Oatmeal or Pop Tarts, lunch was hard cheese and crackers, and dinner was mashed potato and/or ramen 2-minute noodles. If I could be bothered and the ingredients were lightweight, I added the following condiments to each of these meals – freeze-dried fruit, nuts, seeds, dehydrated vegetables, cheese, packaged tuna, salmon, processed ham, salami and/or chicken. Otherwise, I saved consumption of healthy fruit, protein and vegetables for town days, with a treat or two thrown in.

Smiling woman wearing baseball cap, hiking clothes and backpack standing in doorway of a supermarket — *Trader Joes for resupply (Image Credit: Katrina Hemingway)*

Sometimes on multiday hikes I give myself lower insulin doses to avoid recurrent lows. But diabetes doesn’t forget when you deviate from your usual diet. That small tub of Ben and Jerry’s I devoured the previous night in a track town still needs a decent dose to prevent rising sugar levels. Exercise helps, but it has little impact if you take insufficient insulin for scrumptious dietary deviations like ice cream. So I use artificial sweeteners and avoid adding sugar-laden Vitamin C (e.g., Emergen-C) supplements to drinking water. They just cause my sugar levels to spike. Diabetes management is such a balancing act!

Two smiling women on seat holding large glasses filled with ice and margharitas — *However, there is always time for treats, such as margaritas in a track town! (Image Credit: Katrina Hemingway)*

Helen’s diabetes educator has taught her the DAFNE (Dose Adjustment for Normal Eating) method suitable for diabetics administering insulin via injections and not using pump technology. This approach allows her to eat any foods she likes, including high GI (Glycaemic Index) fast-acting carbohydrates such as white bread, pasta, potatoes, and sugar. Dieticians recommend diabetics eat high-GI foods in moderation. On the trail, sourcing low-GI foods, such as genuine sourdough bread, basmati rice and sweet potatoes can be difficult. Overall, Helen’s dosage is higher than mine, but the DAFNE method offers her this flexibility.

If you have health insurance and/or are young, pumps are nowadays recommended for many as they may provide better control. However, a hiking friend with better control than me and who has been on a pump for many years says she still struggles with the disease’s complexities. More concerning is the frequent overnight alarms on her devices that have left her with chronic sleep deprivation. I get eight hours good sleep most nights.

Ideally, it would be good if those calorie-dense foods were slow-acting carbohydrate foods with a low GI that promote slow and sustained energy release for optimal control and walking pleasure. Mostly they’re not, but I adjust my insulin doses accordingly to ensure they don’t cause upward spikes in my BGLs and poor diabetic management. When I return to a normal life, healthy eating habits resume.

Other diabetic hikers split their food into carbohydrate and non-carbohydrate groups and consume whichever is most appropriate depending on their BGL categories to help them avoid hypos.

So, each approach has its merits. I am a creature of habit and don’t mind eating the same meals the entire journey. It’s more limiting but, if I eat the same food, I know I’m applying the best diabetic management practices for me. Helen prefers meal variety, so DAFNE is the perfect approach for her. We do our best to follow these plans, but they often come unstuck. We simply adjust our doses accordingly. It never defeats us. It’s just one logistical part of the trail that demands close attention.

[As you’ve just read, different hikers have different temperaments as well as disease parameters, so seeing lived experiences from other diabetic hikers is valuable to illustrate what approaches might be available to you. A different system to your current one might work better if you aim to do a lot of multiday hiking, but always check any changes with — and be guided by — your doctors, who know you best! Ed.]

Heat Exhaustion and High Elevation

Photo of hiker on path across high scree slope with mountains in background under blue skies — *In the High Sierras (Image Credit: Katrina Hemingway)*

Other complications to watch out for on long-distance hikes are heat exhaustion and the impact of high elevation on your BGLs. Heat exhaustion can creep up on you when walking in exposed conditions in warm weather. Keeping hydrated, preferably with electrolytes, is a given, but diabetics can be more susceptible to heat exhaustion, and staying well-hydrated helps manage BGLs. I do not sweat sufficiently, resulting in rising core body temperature. Getting up that hill becomes harder and harder.

Smiling female hiker wearing backpack and holding a hiking umbrella on a high ridgetop — *Katrina with trusty umbrella (Image Credit: Katrina Hemingway)*

At the first signs of mild exhaustion and onset of nausea, I whip out the hiker umbrella. A broad-brimmed hat is not sufficient. I need total shade with air circulation and an umbrella works for me. EuroSCHIRM, logoed by many other UL hiking suppliers such as Six Moon Designs and Gossamer Gear, produces a sturdy light trek umbrella that even works well in windy conditions. I prefer the model made with silver reflective material. Other strategies are to douse myself in water from head to toe to cool my body and to seek shade and siesta during the hotter hours of the day.

It took some trial and error and several hikes before I realised that hiking at elevation, for me over 10,000ft (3,050m), not only gave me mild altitude sickness but also contributed to lower BGLs than I was expecting. I always reduce my insulin dosage on high mileage days because exercise helps keep your BGLs within range, but I didn’t realise walking at high elevation would lower my BGLs even further and increase the likelihood of hypoglycaemic (low BGL) episodes. I found I needed less insulin for high elevation hiking and adjusted my dosage accordingly. Other hikers adjust their dosage progressively for the first few days of a trek until their BGLs stabilise.

Smilng female hiker wearing red jacket and blue hat on high rocky pass with patches of snow — *Atop Donahue Pass at 3,373 m/11,066ft*

Hypo Unawareness

Hypo unawareness is when people with diabetes, usually type 1 diabetes, can’t recognise low blood sugar (hypoglycaemia) levels. When I have a hypo I’m confused, sweaty, I may have a headache, and I usually wake up if it happens at night. A recent hypo in the last day or two can lead to a period of frequent hypoglycaemia unawareness. Frequent low sugar readings during the day may explain why on the PCT both Helen and I regularly had overnight low readings without the normal warning signs.

Loss of hypo awareness is troubling and dangerous. Diabetic specialists recommend you take steps to regain hypo awareness: you want to avoid lapsing into a diabetic coma. Treatment for hypos is a glucose snack, like jellybeans, followed up with a slow-acting low GI carbohydrate to prevent another hypo. This is difficult to administer once you’re in a coma!

Closeup of glucose injection pen to treat hypoglaecemia — *Hypopen to treat low blood sugar emergencies (Image Credit: Gvoke).*

The only other alternative is to use a Hypopen which has an injection of glucagon that works by triggering the liver to release stored sugar, raising blood sugar levels. If you’re in a coma, someone will inject it under your skin. Helen and I had both foregone this life-saving medication in the interest of weight savings, but other diabetic hikers may prefer otherwise. We managed our diabetes on the PCT without going into diabetic comas but when hypo unawareness continues the risk increases too. I monitored carefully and either reduced my insulin dose or upped my carbohydrate intake to make sure I had enough ‘gas in the tank’ to continue safely.

Additional Considerations

Calling Triple 0 if you suffer a severe ‘hypo’ is not an option when walking in remote wilderness. If you get seriously low and have hypo unawareness, you will lapse into a coma. As I usually walk solo, I do everything in my power to treat low BGLs to avoid this outcome, and – touch wood – I haven’t ever suffered a diabetic coma.

With today’s tools available to know our BGLs and the onus on the person living with diabetes to take ownership of our condition, diabetic comas shouldn’t occur. That’s not to say they won’t, eg with ‘brittle’ diabetics, but I suspect that type of person would not be hiking in remote locations. I guess what I am trying to say is, don’t rely on outside help when diabetic management goes awry. Being tired, uncomfortable and out of your depth is similarly not a reason for calling 000. We need to plan carefully for outback expeditions, take responsibility for our actions, learn from mishaps and find ways to be self-sufficient. Extra planning is required if you live with diabetes and are reliant on insulin for survival. Like anyone else, you should not rely on emergency services to save you if you don’t regularly monitor your condition, test frequently and treat appropriately to avoid diabetic coma when undertaking strenuous hiking.

Nevertheless, other things can go wrong. For emergency help, make sure you also carry a satellite or Personal Locator Beacon (PLB) device. I carry a Garmin InReach Mini and am thankful I have never activated the SOS button yet.

Closeup of two seated female hikers wearing legionnaires hats and backpacks with satellite comms on the foreground shoulderstrap — Inreach Mini attached to the shoulder strap of Katrina’s pack. This GPS communicator allows you to send smses via satellite independent of cell reception, as well as press an SOS that activates emergency services. (Image Credit: Katrina Hemingway)

Helen and I are both confident we can manage our condition should we choose to hike solo. However, walking with another person who gets your condition and who can offer help if required is the more sensible approach. It’s definitely worth telling a non-diabetic hiking partner in advance what to look for and what they need to do should you need assistance; if hiking solo, a Medic Alert, health details in your Inreach/PLB plan, and/or with your emergency contact can be useful for first responders in the case of any accident, not just a diabetic-related one.

A Positive Mindset

Two smiling female hikers wearing caps and holding and Australian and British flag with pines and a snow covered peak in the background — *The PCT attracts hikers from all around the world. (Image Credit: Katrina Hemingway)*

When my hiking partner Helen or I suffered a ‘hypo’ or ‘low’ due to low blood glucose levels (BGLs) on the PCT, the other was always close by offering encouraging words and a tantalising sweet treat. It can take me at least fifteen minutes to recover from a severe low. Having a walking partner who knows what’s happening is most reassuring. And one who doesn’t treat you like a fragile human being is even more appealing. “Let me take the lead for a bit, you wuss,” from Helen or myself was always the perfect response. We weren’t on the PCT to groan and moan about diabetes. There were too many other ailments and discomforts to keep us occupied!

Walking 2,588 kilometres of the Pacific Crest Trail in 2019 for 152 days with another type 1 diabetic is an achievement I will never forget. We showed the doubters what you can achieve despite what life may throw at you. Diabetes did not dampen our hiking passion. It took courage to walk this treacherous trail with our condition, but we embraced the experience.

For diabetics, exercise is invaluable for good management and control of your condition. I encourage you to follow your dreams, pursue an active hobby, and take diabetes along for the ride. Each of my walks, whatever length, has filled me with joy. If I had let diabetes overwhelm me in those early days, I may have developed severe complications and missed out on quality adventurous living.

I stay fit and healthy. Hiking with diabetes is no more bothersome than arthritis and many other aches and pains associated with ageing. I may be slower than I was in my youthful body. I may need to carry a heavier pack than most to store my insulin and snacks to treat low BGLs, but I am out there.

Treasure what you have while you can. I assure you that diabetes, and many other chronic conditions, will cause inconvenience in the great outdoors, but they are only a disability if you make them one. I encourage you to be positive in how you approach life’s hurdles and climb that mountain. Look after yourself. Embrace your adventure. Dare to dream. Hike well! Be well!

For more details, Read Katrina’s free story ‘Infinite Raspberry’ on how she conquered the Pacific Crest Trail with Type 1 diabetes and a stranger.

We aim to add Multiday Hiking with Diabetes Type 2 to the Lived Experiences section on our not-for-profit website. Do you or someone you know do multiday hikes with Type 2 diabetes, either insulin dependent or not? Please, get in touch — we can interview you and write it ourselves, or you can write it with editorial input from us! Genuine hikers only please, no "advertising guest post” offers.

Long-Distance Hiking with Diabetes Type 1: Practical Tips and How-To’s