Conquering the Inca Trail with Diabetes

Let me start with the most important sentence in this entire post. You can absolutely hike the Inca Trail with diabetes. It’s not easy – with or without diabetes – but blood sugar and glucose monitoring and insulin injections should in no way stop you from hiking the Inca Trail. I’ve had a number of people with diabetes reach out to me and ask how I managed blood sugar while hiking, so I figured I would pass on my experience on the trek.

First, let’s be clear about exactly what we mean when we talk about the Inca Trail. The trail is a four-day hike through the Andes that starts near Cusco and ends at Machu Picchu, one of the great wonders of the world. If you want to see Machu Picchu but aren’t all that into hiking, you can take a train to the town near Machu Picchu, called Agaus Calientes, and then a bus to the ancient city. But my wife and I love the outdoors and challenging ourselves, and we truly enjoy exploring archaeological sites and immersing ourselves in history, so we opted for the Inca Trail hike.

The trail is no small feat. We started near Cusco at 10,000 feet, climbed as high as 14,000 feet on the hike, then descended to Machu Picchu at about 7,000 feet. The first three days involved 8-10 hours of hiking each, and even the final day took an hour or two before arriving at the wondrous city. At times, we were moving at a snail’s pace at higher altitude. Then we crested a hill and started moving downhill, using gravity to our advantage. But I never allowed myself to forget about my blood sugar. The Inca Trail put me very far away from medical care, and a mistake on the trek could have been very dangerous indeed. I didn’t feel like hyperglycemia wasn’t a major threat there since I burned through so much blood sugar, but I always watched out for hypoglycemia.

MY HIKING BUDDY

I hiked with my wife, and she carried my glucagon shot and extra sugar for me. She always knew what signs to watch out for if my blood sugar dropped too low, and we talked about what food to eat and how much I needed to keep me in good shape during the hike. The tour companies tend to cook pretty good food, so we had quite a few options. Our assistant guide also had some medical experience (though I’m not quite sure how much), so I told him that I have Type 1 diabetes so someone else knew to be aware if my wife and I separated for any length of time on the trail. Incidentally, we also had two nurses in our group, so I chatted with them a bit about their experiences treating people with diabetes. It was comforting to know I could rely on a few different people if something went wrong, but that didn’t change my initial goal: make sure nothing goes wrong!

MY SECONDARY GOAL

My goal on the trek was to run my blood sugar high. I wanted to keep my numbers above 120. I burned through energy so fast that I needed to replenish carbohydrates often. To me, the best part about hiking the Inca trail, other than the incredible view at the end of course, was the smorgasbord of Snickers I got to eat. But to eat lots of Snickers, I first had to buy lots of Snickers (or other similar chocolate bar), so I stocked up in Cusco. I ate two or three a day, in addition to all of the meals. I also had extra glucose gels which I’d brought from the States.

MEALS ON THE INCA TRAIL

I can’t speak for every hiking company on the Inca Trail, but I know most of them tend to put out pretty good spreads of food. Our chef even baked a cake on the final night of our hike! I didn’t take insulin for all of the carbs I ate. I took insulin for half the carbs and burned through the rest of the carbs hiking. So if I estimated that I’d be eating 40g of carbs, I took insulin for 20g. Normally, I tried to eat between 60-80g of carbs a meal. The meals were about four hours apart, and I made sure to eat a Snickers bar or a glucose gel between meals without taking insulin. I never found my blood sugar to be too high on the trail. Anything below 100 was too low, and I immediately made sure to eat something with carbs.

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My goal each night was to have a blood sugar of about 130 before I went to bed. That’s normally a bit high for me, but I knew I couldn’t risk being too low when I woke up. I dropped my basal insulin by about one third. I normally take 15 units of Lantus, and I lowered that to 10 units on the trail.

BREAKING DOWN THE TRAIL

The Inca Trail is a four-day hike. The final day is less than two miles of hiking, so it was really the first three days on which I focused my blood glucose management.

Day One:

I used this day to get accustomed to hiking on the Inca Trail. Right after we passed the first checkpoint, we began a short but steep climb. We hiked about eight miles or so on this day at fairly high altitude, so it was tiring. I tested and tested again. Before meals. After meals. Every few hours. If I had nothing to do for a moment, I tested my blood sugar since it was the best way for me to gain information about how my body acclimated to the altitude and the hike.

My blood sugar numbers:

5:00 a.m. 113 wake-up

10:15 a.m. 94 pre-snack

2:40 a.m. 84 post-lunch

5:15 p.m. 89 pre-dinner

With the possible exception of the 113, those numbers are all too low, which means I ate a Snickers bar or a glucose gel immediately after seeing those numbers. I have no idea why I didn’t test once more after dinner.

Day Two:

This was the hardest day on the trail. We hiked up to nearly 14,000 feet. No matter how you look at it, that’s outrageously high. A four-hour hike up to the highest point on the hike, called Dead Woman’s Pass, dominated the day. After that, it was mostly downhill to our camping site. No woman has ever died at this pass. At least none that I know of. But from a certain angle, the pass looks like a sleeping woman. They decided to name it Dead Woman’s Pass instead of Lying Down Woman’s Pass, which has a far less exciting ring to it.

Again, I kept testing my blood sugar. I took breaks often on the climb to the top. Everyone in my group rested, so I wasn’t at all bashful about stopping for a breather.

My blood sugar numbers:

5:30 a.m. 121 pre-breakfast

8:45 a.m.114 post-breakfast

11:30 a.m. 86 pre-lunch

2:20 a.m. 103 post-lunch

5:50 a.m. 94 pre-dinner

9:20 a.m. 151 post-dinner

Some of these were right where I wanted them, and some were too low. That final number is perfect before going to bed on the Inca Trail. I dropped 40 points overnight, so I had needed that huge cushion to stay safe.

Day Three:

This was the longest day on the trail. We hiked nearly ten miles. The hardest part was at the beginning, when we had to hike up two successive passes, but after that it was a lot of downhill. We were descending towards Machu Picchu, and I was getting used to my blood sugar numbers on the trail. I didn’t test as often on this day, but I still made sure to test before and after meals. I knew I needed some sort of glucose two hours after each meal, so I didn’t test. I just ate. The day itself wasn’t that hard. It was just long. Incredibly long, and I needed to keep my blood sugar levels elevated to get through it. At the end of the day, we finally relaxed. We only had a bit more hiking to go before walking through the Sun Gate and catching an incredible view of Machu Picchu.

My blood sugar numbers:

5:00 a.m. 106 pre-breakfast

7:35 a.m.85 post-breakfast

11:30 a.m. 78 pre-lunch

4:20 p.m. 110 post-lunch

6:10 p.m. 87 pre-dinner

Day Four:

This day required the earliest wake up. The sooner you get to Machu Picchu, the smaller the crowds. Most tour groups wake up at 3 or 4 in the morning to get moving. It’s painful, but it’s absolutely worth it. Compared to the other days where we’d hiked eight or nine miles, we only hiked two miles on this day. It felt like a quick jaunt, and it was over before we knew it.

My blood sugar numbers:

3:30 a.m. 89 pre-breakfast

6:45 a.m. 85 post-breakfast

12:30 p.m. 82 post-lunch

5:30 p.m. 101 pre-dinner

The hike effectively ended before lunch, but those first three numbers were very low on an endurance hike. If I had slept in, that 3:30 a.m.number would have been dangerously low by the time I woke up.

A BIT OF ADDED HIKING

We added on the Huayna Picchu hike, which is the mountain that towers above Machu Picchu. This is a quick 45-minute hike that offers an incredible view of the ancient city. For me, a quick Snickers bar before the hike was all I needed. We spent about two hours on top of Huayna Picchu before descending to Aguas Calientes for a much-needed beer.

Salud!

If you have any questions or need a bit of extra encouragement, shoot me a note I’d love to hear from you.

Oren Liebermann is an award-winning journalist, pilot, and traveler. He was diagnosed with Type 1 Diabetes in Nepal while backpacking around the world with his wife. His favorite book is the Hitchhiker’s Guide to the Galaxy, and his favorite movie is The Princess Bride. Oren lives in New York City with his wife and their two cats.

Also by Oren Liebermann:

• 10 Amazing Diabetes-Inspired Challenges (My Diabetes Bucket List)

• Surviving, But Barely: A Type 1 Diabetes Diagnosis in Nepal

Oren Liebermann

Oren Liebermann is an award-winning journalist, pilot, and traveler. He was diagnosed with Type 1 Diabetes in Nepal while backpacking around the world with his wife. His favorite book is the Hitchhiker’s Guide to the Galaxy, and his favorite movie is The Princess Bride. Oren lives in New York City with his wife and their two cats.