(Note: Rachel Hemond, an 18-year-old from Acton, MA with Type 1 diabetes, spent five months in the Vermont wilderness, managing her blood sugar using the Omnipod System and with the support from a network of doctors, family, and friends. This is the sixth in a 10-part series of blogs Rachel wrote about her experiences.)
Though my diabetes seems to be ready to head out on my winter expedition with the Kroka program, my body is not.
Skiing quickly becomes my greatest foe. I can’t get the hang of it, despite days spent at the local cross country and downhill ski areas. Uphills I can do relatively well, though they are of course relatively exhausting. Wide, flat tracks are friendly too. But stick me on a downhill and I go into an intense snowplow position, sliding down the hill at what feels to me like a tremendous speed, but is in fact an inchworm’s pace. Add a backpack and most of my time on the hill is spent tumbling, sliding and bruising.
In spite of my skiing difficulties, everything else is in order to start the expedition. Backpacks are packed, sitting in an expectant row. Food has been divvied up, skis waxed one last time, final preparations made and remade.
We wake on the morning of our departure to the wing-soft sound of falling snow and churn into motion. We say goodbye to Kroka basecamp and turn to the fresh snow.
The days on winter trails are endless at first, a blur of exhaustion and frozen fingers. Even though my pack is lighter than nearly everyone else’s, I can’t keep up. Skiing is still a challenge, but slowly, ever so slowly, I begin to find it familiar.
My effort pays off. It is impossible not to love the Vermont wilderness in deep snow and I immersed myself in it. We sleep in an oval tent staked down with our skis and floored with boughs of spruce, hemlock, or fir. We rely on our surroundings for wood, water, and comfort. The cold is like another member of our group. Life becomes motion; we have no other option, surrounded as we are by bitter chill. I grow used to the cold, as one can become accustomed to the sound of a highway or the smell of a farm. It is just a part of life: unavoidable and, in the end, not all that terrible.
Perhaps it is this mentality of acceptance and ease that led me into a trap, or maybe I just lacked foresight. Whichever it was, I soon learned that although humans can adapt to the cold, machines cannot. After my first Omnipod change on trail, huddled next to the stove, switching my Pod to the other arm as fast as I could before I got too cold, my Pods begin to die, one a day.
I start playing ridiculous mind games: If I make it up this hill without falling, my Pod won’t die today. Or: If I gather firewood in this much time, my Pod won’t die today. Of course, it’s futile. Sometimes a Pod fails while we are skiing, sometimes while I am setting up camp. After the first failure I realize that to change my Pod outside the warmth of the tent is to invite hypothermia; being still in below zero temperatures is not a risk worth taking. So I put off changing Pods for hours, knowing that my blood sugar is rising but that there is nothing I can do.
Soon, the skin on my arms begins to show the wear of having adhesive ripped off every day and of unhealed cannula marks. There is nowhere else I can put the pods other than on my arms. The massive backpacks that we wear make it impossible to put anything on my hips and stomach, since the waist-strap rides exactly where I would place a Pod. About halfway through the first leg, I realize that I cannot stay on trail. I have to return to basecamp to figure out the mystery of the dying Pods.
And so I leave, return to Kroka for a few days. Placing call after call, I talk with Insulet, my doctors, everyone I can think of. I order an entirely new set of Pods that get to me the next day, suspecting that the last lot is bad. But while out skiing one afternoon, I realize my error.
Even though the Pod on my body is warm, the rest were sitting in my backpack in subzero temperatures for days on end, then put right to work with no re-warming. I decide to try an experiment since I’m sick of being off-trail. Finding a few scraps of an old sweater, I sew a Pod holder.
The idea is fairly simple; I need to carry all of my Pods on my body, not just the one I’m actually using so that their circuitry never gets below freezing. My body heat would keep them from getting too cold during the day, and I could sleep with the bag of Pods at night just as I already did with my PDM and insulin. The problem was not with the Pods themselves, but with my own folly in leaving them out and unprotected.
There is only one problem; I have to assume that my Pods would continue to die every day, since a little bit of pessimism is required in wilderness medicine. This means that I would need to carry a minimum of six Pods with me for the rest of the leg, and anywhere from fourteen to eighteen on the next two.
There is no way to carry that many pods and still be able to move. Also, the fact that I cannot ski for more than half an hour without falling made me decide that it is best not to put all my eggs in one basket – or in my case, all my pods on one tumble-prone skier.
So I sew another Pod carrier, this one out of a scrap of sweater. Pod holder 2.0 has no tougher exterior like my earlier prototype; I realized the only thing the rougher fabric did was make the package scratchy and annoying to wear directly on my skin. It holds three Pods, four in a pinch.
After just a few days I rejoin my group, conning a few of my unwitting friends into agreeing to be Pod-carriers. Lo and behold, the ridiculous-looking contraption works and we make it to our first layover, Pods happily functional once more.
(Next: More sugar management challenges and another hiatus from the trail.)