Steep hikes

[davidj]

I'm a type 2 diabetic using metformin. I keep myself fit and enjoy hiking and moderate to difficult walks. Most of the time I'm absolutely fine and no differently knackered than any other hiker! However, a few times, on very steep, often short climbs, I've found myself running out of gas, finding oxygen difficult and basically wanting to lie down and sleep. It hardly ever happens but is concerning when it does. My partner feels that perhaps I haven't eaten enough before and my blood sugar has dropped. A sweet did get me going again once but I thought being on metformin meant this wouldn't happen. I recover again but wouldn't wish to be on my own. Anyone else experienced this?

 

[Ieva DUK]

Hi there David! Really good to have you posting, and hats off to you for keeping so active with hiking and those more challenging walks. It’s great to hear that you’re generally managing well, but I can totally understand why those sudden crashes in energy would feel worrying - especially when you're out on steep ground.
What you’ve described - feeling suddenly drained, sleepy, and short of breath on a climb - can sometimes be linked to a dip in blood sugar, even for people on metformin alone. It’s true that metformin isn’t typically known for causing hypos, but under certain circumstances (like intense or prolonged activity, especially if you’ve not eaten enough beforehand), it’s still possible for blood sugar to drop lower than your body is used to - even if not into “hypo” territory.
The fact that a sweet helped to perk you up does suggest there might have been a dip going on. Your partner may be onto something - some people find a light, balanced snack before a big walk (something with carbs and a bit of protein or fat) can help sustain energy more evenly, especially on steeper or longer efforts.
It could also be worth keeping something quick-acting on you just in case - a sweet, glucose tab, or juice box - and noting what you’ve eaten and how you feel during different types of walks. Sometimes keeping a bit of a pattern journal can help figure out if there's a connection between what (or when) you eat and those crashes.
You’re definitely not alone in experiencing this, and it’s smart of you to be tuning into it and thinking ahead. It might also be worth mentioning this to your GP or diabetes nurse, just to rule out other things (like blood pressure or iron levels), and check whether a bit of gentle blood sugar monitoring around exercise might be helpful for you.
Glad you shared - I think a lot of people will relate.

 

[Leadinglights]

I'm a type 2 diabetic using metformin. I keep myself fit and enjoy hiking and moderate to difficult walks. Most of the time I'm absolutely fine and no differently knackered than any other hiker! However, a few times, on very steep, often short climbs, I've found myself running out of gas, finding oxygen difficult and basically wanting to lie down and sleep. It hardly ever happens but is concerning when it does. My partner feels that perhaps I haven't eaten enough before and my blood sugar has dropped. A sweet did get me going again once but I thought being on metformin meant this wouldn't happen. I recover again but wouldn't wish to be on my own. Anyone else experienced this?

Metformin does not usually cause low blood glucose but exertion may do. It is worth having a home testing blood glucose monitor so you can check when this happens and if low then something like a jelly baby or small 150ml full sugar coke or small carton fruit juice. Normally the liver will release glucose to bring your level up.
However symptoms of high blood glucose and low blood glucose can be quite similar hence having a monitor is a good idea.
In some people exercise increases blood glucose, in others it will lower it.
You will often see the comment that everybody is an individual and their response to food, meds, exercise can vary

 

[sololite]

Hi David. Great to hear you are hiking. For me walking and cycling are a big part of managing my diabetes. I keep my walks to under 10 miles and mostly only 3-5 miles and don't run out of gas. 2 years ago an old mate pushed me to try a 20 mile hike and I was basically running out of snacks and then sweets in last 5 miles which taught me an important lesson on regular snacking on the longer walks. A couple of weeks ago I was in the Highlands and twisted my wife's arm to go up Ben Nevis. I'd last been up 25 years ago and was keen to know how I would cope now I am 65, have diabetes and minus a pancreas. I kept an eye on my BS all the way and basically snacked all the way through it. I couldn't fine tune my BS instead focused on getting the energy into my system with snacks and energy drinks as i dreaded going low and having to call on others for help. Apart from a few cramps near the top we made it. Hope that helps.

 

[rebrascora]

@sololite There is a big difference between your situation where you are using insulin and that of the OP who is just on metformin. Lots of snacking for a type 2 just using Metformin may be counter productive.

 

[Drummer]

I find I need to be careful about drinking enough when I am out with the morris dancers as it is in the warmer weather out in wide open spaces being busy.
As I eat a very low carb diet I suspect I don't hold as much water in reserve and so dehydrate faster.

 

[davidj]

Hi David. Great to hear you are hiking. For me walking and cycling are a big part of managing my diabetes. I keep my walks to under 10 miles and mostly only 3-5 miles and don't run out of gas. 2 years ago an old mate pushed me to try a 20 mile hike and I was basically running out of snacks and then sweets in last 5 miles which taught me an important lesson on regular snacking on the longer walks. A couple of weeks ago I was in the Highlands and twisted my wife's arm to go up Ben Nevis. I'd last been up 25 years ago and was keen to know how I would cope now I am 65, have diabetes and minus a pancreas. I kept an eye on my BS all the way and basically snacked all the way through it. I couldn't fine tune my BS instead focused on getting the energy into my system with snacks and energy drinks as i dreaded going low and having to call on others for help. Apart from a few cramps near the top we made it. Hope that helps.

Thank you. Glad you are enjoying the outdoors.

 

[harbottle]

I'm a type 2 diabetic using metformin. I keep myself fit and enjoy hiking and moderate to difficult walks. Most of the time I'm absolutely fine and no differently knackered than any other hiker! However, a few times, on very steep, often short climbs, I've found myself running out of gas, finding oxygen difficult and basically wanting to lie down and sleep. It hardly ever happens but is concerning when it does. My partner feels that perhaps I haven't eaten enough before and my blood sugar has dropped. A sweet did get me going again once but I thought being on metformin meant this wouldn't happen. I recover again but wouldn't wish to be on my own. Anyone else experienced this?

Metformin has been linked with fatigue in some people during exercise, maybe due to the way it affects the way cells generate energy. But in others it doesn't have this effect. It can also lower B12 which can cause fatigue. Are you on a high dose?

Do you have a blood glucose tester? If so, take it with you and test when it happens to see if it caused by low blood sugar (I find climbing hills sends mine spiralling down!) I find that carbs + exercise also sends it spiralling down as well.

 

[Robin]

Doesn’t Metformin work partly by stopping the liver pumping out so much glucose? (I seem to remember being told this when I was on it briefly). I just wonder if that means your liver doesn’t pump out extra glucose when you need it to fuel strenuous activity.

 

[harbottle]

Doesn’t Metformin work partly by stopping the liver pumping out so much glucose? (I seem to remember being told this when I was on it briefly). I just wonder if that means your liver doesn’t pump out extra glucose when you need it to fuel strenuous activity.

Yes. I believe research has shown that a combination of glucose loss due to the inhibiting of gluconeogenesis and inhibiting of ATP production can lead to fatigue. It also improves insulin sensitivity so may create something of an imbalance in the body's natural energy production mechanisms.

 

[sololite]

@sololite There is a big difference between your situation where you are using insulin and that of the OP who is just on metformin. Lots of snacking for a type 2 just using Metformin may be counter productive.

Thanks for clarifying Barbara. I let my enthusiasm run away with me and hadnt considered there might be differences. Thanks for being there for us all.

 

[Taffyboyslim]

So would you suggest a bag of peanuts or Brazil nuts or an energy bar or plain old snickers etc? , if you feel a bit weak on a walk ?

 

[Lisa65]

So would you suggest a bag of peanuts or Brazil nuts or an energy bar or plain old snickers etc? , if you feel a bit weak on a walk ?

I always have a packet of glucose tablets in case I go low and need a quick pick me up.
I don't walk more than 2-3 miles at a time because my back and hips start to hurt, plus I have a lazy bulldog cross who doesn't like to walk too far. But if I was heading out for a long hike I'd probably take a banana or energy bar for sustenance.

 

[Taffyboyslim]

I always have a packet of glucose tablets in case I go low and need a quick pick me up.
I don't walk more than 2-3 miles at a time because my back and hips start to hurt, plus I have a lazy bulldog cross who doesn't like to walk too far. But if I was heading out for a long hike I'd probably take a banana or energy bar for sustenance.

Lazy bulldog

They are such funny dogs

 

[Proud to be erratic]

So would you suggest a bag of peanuts or Brazil nuts or an energy bar or plain old snickers etc? , if you feel a bit weak on a walk ?

Probably not nuts for deliberate snacking amidst exercising. Also (nice as they are) too many Brazil nuts are not good for most people, since they can bring about selenium toxicity. Getting the dietary balance right is confusing and complicated, even without allowing for each of us being different and responding differently to any one treatment or food type.

It's worth trying to pin down exactly what works best for you, @Taffyboyslim. In an ideal (often impractical) world you'd pause during the steep hike when you felt weak, finger prick to establish your BG at that moment then try an energy bar, or cereal /protein bar, or toffees / boiled sweets and see which helped most. Different trials - not all at once. Hopefully that would lead YOU towards practical snacks that were easy to carry, open and get stuck into for quick recovery - in sun, drizzle or torrential rain.

The plain old Snickers / Mars bars are likely to fall into the "probably not" category since the fat in the chocolate can be slow to digest for many people and if you're feeling noticeably weak ("running out of gas" as @davidj said) then you are after a quick response. But you might be fine with one of those. For me things like boiled sweets or Wurther's toffees provide that speedy response: sucking them is faster digested and into your blood, than chewing/crunching and swallowing and waiting for stomach digestive juices do their stuff. I love a bag of crisps, but the contents are easily turned into crumbs and become packet opening hassle, soggy in any rain - so crisps (for me) need a deliberate, sheltered, hiking pause. As does a sandwich. Bananas can work, if reasonably well protected in my backpack; but pausing, getting the banana out and unpeeling it isn't always a slick process.

The other thing is how steep is the hike? I.e. has a long walk become intense anaerobic exercise rather than extended, regular aerobic exercise? I suspect anaerobic conditions are managed more urgently by our brains. Our body's response mechanisms are triggered by an array of different hormones and for people with normal pancreatic functions our brain uses the glucagon hormone in the pancreas to trigger the liver to release extra glucose when needed. [Brain can't talk directly to the liver. Who knew its not that clever?] I'm T3c, have absolutely no pancreas so no source of glucagon hormone (as is @sololite). But if I've run out of gas, my brain might look for a different mechanism; perhaps make me anxious and trigger adrenaline or stressed and trigger cortisol - finding a way of getting some sort of glucose release from the liver and thus recovery. If the liver has anything left in the store. In extremis, my brain might make me collapse, fall down and get my head lower than my heart - just to maintain blood flow to my brain.

Before this extreme scenario the boiled sweets are simpler (but not if they're in that impossible to open tin) and keep me ahead of possible events, even if the wrappers are inadequate and the sweets have too much fluff around them! The hard boiled egg still in its shell is less convenient. Trial and learning is a big feature of managing our D and our physical limitations even for people without D.

 

[JimG]

I've nothing to add to all the various posts here but my wife always asks at the end of a steep climb on a walk, "Where's the oxygen?" A couple of times we have walked down and up Sutton Bank in North Yorkshire. We walked all the way up without stopping for breath. Well that is what I tell people. I usually confess that we did stop a few times to admire the view, even if we were among trees and couldn't see very much.

 

[rebrascora]

So would you suggest a bag of peanuts or Brazil nuts or an energy bar or plain old snickers etc? , if you feel a bit weak on a walk ?

I would suggest testing to see if you actually need something before eating a snack. Sometimes dehydration can make you feel weary and increase your BG levels. I can feel fatigued when my levels are above 8 and I wouldn't want to eat more carbs at that level.
It is counter productive to eat carbs if you don't need them, particularly if you need to lose weight to help manage your Type 2, so in my opinion, best to test and see if you really do need something first and then keep it to a minimum.
If I do need something I generally use jelly babies as they are cheaper than glucose tablets and are roughly 5g carbs each and it is surprising how far you can go on just one jelly baby! Whereas an apple is about 15g carbs and a banana 20+, so it might be 3-4 times what you actually need.... to say nothing of a Snicker bar and I can only imagine what a melted mess one would be in this heat!

 

[Taffyboyslim]

Probably not nuts for deliberate snacking amidst exercising. Also (nice as they are) too many Brazil nuts are not good for most people, since they can bring about selenium toxicity. Getting the dietary balance right is confusing and complicated, even without allowing for each of us being different and responding differently to any one treatment or food type.

It's worth trying to pin down exactly what works best for you, @Taffyboyslim. In an ideal (often impractical) world you'd pause during the steep hike when you felt weak, finger prick to establish your BG at that moment then try an energy bar, or cereal /protein bar, or toffees / boiled sweets and see which helped most. Different trials - not all at once. Hopefully that would lead YOU towards practical snacks that were easy to carry, open and get stuck into for quick recovery - in sun, drizzle or torrential rain.

The plain old Snickers / Mars bars are likely to fall into the "probably not" category since the fat in the chocolate can be slow to digest for many people and if you're feeling noticeably weak ("running out of gas" as @davidj said) then you are after a quick response. But you might be fine with one of those. For me things like boiled sweets or Wurther's toffees provide that speedy response: sucking them is faster digested and into your blood, than chewing/crunching and swallowing and waiting for stomach digestive juices do their stuff. I love a bag of crisps, but the contents are easily turned into crumbs and become packet opening hassle, soggy in any rain - so crisps (for me) need a deliberate, sheltered, hiking pause. As does a sandwich. Bananas can work, if reasonably well protected in my backpack; but pausing, getting the banana out and unpeeling it isn't always a slick process.

The other thing is how steep is the hike? I.e. has a long walk become intense anaerobic exercise rather than extended, regular aerobic exercise? I suspect anaerobic conditions are managed more urgently by our brains. Our body's response mechanisms are triggered by an array of different hormones and for people with normal pancreatic functions our brain uses the glucagon hormone in the pancreas to trigger the liver to release extra glucose when needed. [Brain can't talk directly to the liver. Who knew its not that clever?] I'm T3c, have absolutely no pancreas so no source of glucagon hormone (as is @sololite). But if I've run out of gas, my brain might look for a different mechanism; perhaps make me anxious and trigger adrenaline or stressed and trigger cortisol - finding a way of getting some sort of glucose release from the liver and thus recovery. If the liver has anything left in the store. In extremis, my brain might make me collapse, fall down and get my head lower than my heart - just to maintain blood flow to my brain.

Before this extreme scenario the boiled sweets are simpler (but not if they're in that impossible to open tin) and keep me ahead of possible events, even if the wrappers are inadequate and the sweets have too much fluff around them! The hard boiled egg still in its shell is less convenient. Trial and learning is a big feature of managing our D and our physical limitations even for people without D.

Jelly Babies or a small energy bar seems