How would you go about proving that anything is possible with Type 1 diabetes? Outdoorsmen Patrick Mertes and Michael Shelver set themselves this very challenge, and settled on a doozy: they plan to tackle the highest peak of every U.S. state, and do it in 50 days. It’s only been done twice before.
We spoke with the ambitious gentlemen about Project 50-in-50, about managing their conditions during the extreme event, and about inspiring a movement.
How did you two find each other?
Patrick: Michael and I met back in 2015. We both ran high adventure recreation-based programs for a California-based T1D nonprofit that served kids, teens, and families affected by diabetes. We ended up going on a backpacking trip in between program sessions and since then have been getting ourselves into all kinds of adventures.
How did you settle on this particular mountaineering challenge?
Michael: Patrick had recently returned from completing the John Muir Trail and gave me a call to discuss the next big trip. We knew from the start that we wanted the project to involve members from the T1D community. After a lot of brainstorming sessions and phone calls, we explored a number of summits we were interested in tackling. We quickly realized one summit wasn’t going to be enough to fill our cup.
As someone who is heavily engaged in the outdoor community, I stumbled upon an article regarding the 50 High Point Challenge. We quickly took a deep dive into researching it and were drawn to the physical and logistical challenge of making it happen. While most people aim to do it over the course of their lifetime, we felt it would be a fun challenge to try do it in 50 days.
What do you primarily hope to achieve by documenting and sharing your story?
Patrick: As a team, we embrace the idea that an individual’s mental attitude plays a much bigger role in defining limitations than a broken pancreas ever could. We feel that diabetes should never determine the limit of what an individual desires to do. Project 50-in-50 is a movement to demonstrate this truth. With the help of our community, we are set out to prove to the world that anything is possible with T1D.
When you first started this type of extreme outdoor activity, did diabetes hold you back?
Patrick & Michael: Hold back? No. But it definitely involved a lot of experiential learning. “Learn by doing” is something we both encourage and continue to experience. Each trip out we learn slightly more about strategies that work (or don’t work in the backcountry) and add this to our toolbelt. If we both look back at our first backpacking trips or climbing trips and our current ones, there’s a huge difference in what we do, how we plan, and especially what we pack.
Is it fair to say that having Type 1 makes you more ambitious and driven?
Patrick: Absolutely. I firmly believe that everything happens for a reason. Michael and I both have an affinity for activities that can be miserable while it’s happening, but fun in retrospect, and love to challenge perceived limitations. To quote Nelson Mandela: “It always seems impossible until it’s done.”
I’m particularly interested in the nitty-gritty of glucose management while you’re on the mountain. Can you tell us briefly what techniques and technology you use?
Patrick: In addition to route planning, this is one area where Michael and I dedicated the most amount of research. We will both be using Tandem’s t:slim X2 system in conjunction with Dexcom G6 CGMs. We’ve found the Dexcom is essential in managing our glucose on the trail, especially because we can see where our numbers at and where they are trending. Combining that with Tandem’s Basal IQ helps us mitigate lows. The T-slim works well for us since it’s so small, so we can throw it in any pocket without it interfering. We’ll be using a ton of temporary basals to get us through our trip.
Additionally, we’ll be packing out insulin pens and glucagon kits in the event of emergencies.
Can you talk about your diets during the big hiking days? When I hike I find I need to bring twice as much food as I should need because I don’t know if I’ll need carb-heavy fuel or not.
Michael: We are going to be eating a ton on this trip both on and off the trail. For heavy hiking days we’ll rely pretty heavily on carbs as a main fuel source as they’re easy to digest, tasty, and help maintain our blood sugars. We’ll also be relying on both fats and proteins for more sustained “long term” energy. Trail food is a mix of bars, gels, trail mix, jerky, and other fun snacks like Snickers. During Denali, along with some of the bigger peaks, we’ll be using Mountain House dehydrated meals to get some warm “real food” to fuel up and stoke motivation. Our diets are pretty flexible although Patrick is living with celiac disease which throws some complexity into everything. As a general rule, we always carry liberal amounts of carbs. We’d rather have food and not need it than need food and not have it.
Summiting Denali must burn about a billion calories. How do you keep your energy levels up while also managing your carb intake so as to keep your glucose in check?
Michael: On summit day in 2017, I burned about 10,000 calories getting up and back down to basecamp, so it takes a huge toll. To keep energy levels high we’re focused on calorically dense foods that we enjoy eating. We also stick to a schedule, making sure to eat every hour as sometimes altitude or fatigue slows down hunger. We’ll also be giving much less insulin to cover these carbs.
On the biggest days, do you kind of need to accept that your control might not be as tight as would be during a normal day?
Patrick: Safety is always going to be our number one concern during the entire expedition. With that in mind, we anticipate running our blood glucose levels on the higher end of our ranges in hopes of preventing too many hypos. The beauty of having the CGM data easily accessible allows us to make management decisions in real-time, before stepping on the dreaded blood-glucose rollercoaster.
Does extreme altitude monkey with your blood sugars?
Patrick: Every time. Extreme altitude will cause your body to release a stress hormone called cortisol. Typically this will make blood sugars sky rocket, but when heavy exercise is added to the mix it becomes a fine balancing act.
I’ve also heard that altitude sickness can resemble hypoglycemia.
Patrick: You’re absolutely right. Dizziness, fatigue, and nausea accompany both acute altitude sickness and hypos. Fortunately our CGMs play a huge role in preventing us from treating false lows.
Some of these mountains are pretty isolated places, not an ideal place to experience a severe hypo. What safety measures and redundancies do you have in place when you’re on the trail?
Michael: We check in with each other often. It’s worth the extra 5 minute break to eat a snack than to face a hypoglycemic emergency. Both of us carry glucagon kits as well as fast acting glucose gels to treat any severe lows. We also have backups to our pumps in case they were to fail. The benefits of hiking with a fellow T1D is they know exactly what you may be experiencing and how to treat it. This gives us added confidence in the backcountry.
Please tell our readers what the best way to follow your progress is:
We’ll mostly be focusing updates via social media: https://www.instagram.com/project50in50/
You talk a lot about sparking a movement. Am I right to guess that you’ve got plans to keep people engaged after this hike ends? And are you already thinking about the next big challenge?
Michael: More to come, Patrick and I have 50 days to hammer out the details – clock starts at the summit of Denali :)
I noticed that only about 300 people have summited all 50 high points. About 1 in 300 Americans has T1D, which means that after you finish, we’ll be able to conclude that people with T1D will now be “twice as likely” to achieve this than the able-pancreased.
Patrick & Michael: Love it.