The Outdoor Type: Paul Reid
Welcome to “The Outdoor Type” — a series of interviews with diabadasses who love spending time outside. We talk about the realities of outdoor adventuring with diabetes, tips and tricks for diabetes management, and most importantly, our love for the outdoors.
“But when you’re spending time just communing with the trees or the wind or the rocks and the soil with nothing else around, it’s kind of like there’s this rhythm that you feel between yourself and the natural world. And this chronic illness kind of takes a back seat for a lot of that. And you get the opportunity to live a little bit of life.”
- Paul Reid
This week we’re introducing Paul Reid, founder of Type One Outdoors and an avid adventurer. I don’t know if there’s anything Paul hasn’t done outdoors. What I do know is that with 34 years of experience managing diabetes while adventuring, he has learned a great deal about his body and this disease, and has some really great advice and insights to share.
Please note that any information shared by our interviewees should not be taken as medical advice. You should always consult your doctor before making any changes to your management plan.
PAUL REID
Founder, Type One Outdoors, Outdoor Adventurer
Years with T1D: 34 years
Technology: Eversense CGM, Afrezza, Tresiba
Favorite outdoor activities: Trail running, Climbing, Hiking, Road Running, Cycling, Soccer, Snowboarding
Favorite trail treat: Strawberry starbursts
Paul’s Top Tips and Takeaways:
Keep it simple. It takes time, but you’ll learn to trust yourself and your system, and that you can go on a long run without overpacking glucose or supplies.
When being active, know what’s on board (food and insulin): Protein for Paul doesn’t metabolize out until four hours later, and fat until six hours later. With both on board he knows his blood sugar won’t tank during a run.
The impact that outdoor activity has on your blood sugar all depends on the activity, and particularly what it does to your heart rate.
A pump break can not only be freeing but also interesting and explorative with new technologies like inhalable insulin
Start small, and don’t let diabetes hold you back
Community is probably one of the strongest, best, most resourceful areas you can find as a diabetic
From hiking to mountaineering expeditions, you’ve done it all. How has diabetes played a role in your outdoor adventures?
Every outing, every expedition, every excursion, kind of has that similar challenge that you face as a type 1. There’s all of this prep that you put into just the simplest of activities. I mean you run to the grocery store and you still have to put a little bit of prep, just to do that.
But then when you take it into a larger outdoor expedition where there’s a great chance that many things are going to fail, and you pile on top of that the additional diabetes things that are going to fail, you’re carrying like this extra burden of, oh great, I’m prepped for cold, I’m prepped for my gear and equipment, I’m prepped for sun protection, I’m prepped for just about everything and then it’s like okay, I should bring insulin. Is there enough power in my CGM? What if my CGM fails? Do I have a backup tester? Do I have enough test strips? Do I have an extra battery for the tester? And there’s this mountain of other stuff that comes into play.
So what I’ve kind of done is instead of thinking about it as this oppressive, annoying burden that’s always with you, I try to keep things simple. And we’re all victims of this, right? You’ve gone out on an expedition on this and found yourself over packing.
But the thing that you really have to put yourself into is a confident state of mind where you know, I’m going with a bare minimum here, but I’m confident enough that this minimum is going to do what it needs to do, and I’m going to keep things simple. Keep it simple, keep it basic.
And more than likely that’s going to eliminate that burden time and time again so the next time you go out you’re like I really don’t need to bring 25 gels in my pocket. I really don’t need to bring a whole package of batteries in case my devices die. I know how far I’m going, I know my contingency plan, I don’t have to overpack. So you can keep things simple and that kind of alleviates the burden.
It takes a couple of times to get through this, but eventually it’s like yeah, I think I got this.
It sounds like over the years, you were able to trust your body and the system you have more and more. How long did this take? What was that process like?
It does come with experience, and the only way that you can get the answers to those questions is to just do it. Make the mistake of overpacking. Just overpack again and again and again until you get to the point where you’re like I know better, I’m not going to bring 12 gels on this hike.
I do a lot of trail running as well, and when I first started trail running I used to run with a vest and in the vest were hydration packs, gels, granola and extra battery power for my phone because my phone is my CGM receiver, and I was like I just need to pack everything that I’ll possibly need. That was a while ago. Now I’m not even going with a vest. I’m going out and I’m running 15 miles today, and I’m going to take 1 gel. Years ago I would never do that. I’d be like you’re out of your mind! You’re going to go low, you’re going to die out there. But it just takes that time to like say, okay if I go out there with one gel, what do I have to have on board to make sure I won’t use that one gel. So I’m looking at my diet. If I eat some protein right now with some fat content, protein won’t metabolize out until four hours later, and then the fat content won’t metabolize out until six hours later, and so I’m like okay all I’ve got to do is go out there with what I’ve got on board and I’ll be fine.
But it takes that experience.
What can you tell us about the different types of outdoor activities and how they impact your blood sugar?
It’s interesting because the activity that you’re doing and what it does to your heart rate really does change the way that your body metabolizes glucose too. Rock climbing, for example, is one of those kinds of things where you think you’re burning a lot of glucose but you really don’t. Your heart rate isn’t consistently elevated like in other sports like running, where a steady jog could elevate your heart rate to about 130-160, and lower your glucose. When I’m climbing I could have a blood sugar of 130 and climb up a couple pitches of a multi-pitch route and still be at 130.
Between the beginning and the end though, there’s going to be these rises and dips and rises and dips because of adrenaline. When our heart rates get above 160 to 170, 180, or maybe 190 our bodies release stress hormones like adrenaline and cortisol. So I feel the adrenaline pumping while I’m climbing and I’ll get this spike that comes out of nowhere. It’ll go from like 120 up to 190 in 20 minutes and if you wait another 20 minutes it comes back down. Some people describe it as a hollow high and I’ve heard that description quite a lot. And it’s a very apt description. It’s hollow, it’s like a balloon. It fills up and it looks big and it comes back down after the adrenaline is gone.
Your body is this weird balancing act/chemical factory that it’s in motion. It’s dynamic, it’s moving, it’s doing all of these things, it’s burning chemicals, adding chemicals, blood sugar is all over the place and it takes kind of a while to see what things do what to blood sugar.
Despite the craziness of sugar levels, you spend so much time outside. Why do you do it? What have you gained?
It’s kind of weird, and difficult to explain but there really is this intangible thing. I sometimes call it the intangible wilderness therapy. You can live your life indoors and be completely fine, but if you remove as much of that comfort as possible and let nature speak to you in this weird way, it’s kind of therapeutic.
There is also this temptation for us humans, the way that we live our lives today, to have this really fast technologically sped up pace with everything. But when you’re spending time just communing with the trees or the wind or the rocks and the soil with nothing else around, it’s kind of like there’s this rhythm that you feel between yourself and the natural world. And this chronic illness kind of takes a back seat for a lot of that. And you get the opportunity to live a little bit of life.
Do you have any tips or tricks on how to make preparing for outdoor excursions easier for diabetics?
Going along with the same lines of the whole unnecessarily overpacking thing, oftentimes what I tell someone who is just getting into the outdoors is to break it down into the three essentials. Because people who go into the outdoors always travel with their 10 essentials or their 12 essentials or whatever.
If I keep everything to my three essentials it makes life easier no matter how big or small the adventure is. It could be as small as going to the grocery store or as big as a multi-day excursion out in the desert. So, the three essentials:
Some way to measure. I always have my CGM so I’m always measuring. If it’s a quick trip I’ll just go with my CGM. If it’s a long trip I’ll bring my meter with test strips.
Glucose. If it’s a quick 20 minute run, one gel in my pocket is all I need. If I’m going out for a multi-day trip I’m bringing gels, maybe I’ll throw in some granola bars, or if I’m camping like car camping I might have a cooler so I might throw in some of those little orange juices.
Insulin. I have my long acting insulin. I only take my Tresiba which is my long acting shot. But with my quick acting insulin which is my Afrezza which doesn’t need refrigeration so I have my insulin covered.
Do you have a favorite trail treat?
Yeah so I actually wrote a blog post on this two years ago, called, trail treats! It was exactly the same name. So my number one trail treat to keep blood sugar up is starbursts. The reason why is because (1) they’re awesome and (2) they come individually wrapped in paper so you can keep them in your pocket and they’re not going to melt into this sticky sugary mess. Unfortunately, I love m&ms but they melt way too quickly. I’m always like, I wish you could come along but I’m sorry. Strawberry starbursts I think are my favorite.
Can you tell us why you’ve opted out of the pump?
Right, so a year ago I was still on the pump, and I had been wearing a pump for 21 years. Tethered to that brick, for 21 years. I used to think this was the greatest thing ever. I was like okay this eliminates shots, cool. But every three days I’d have to change the infusion set which I didn’t like, but it was a small price to pay.
But then when you couple this technology with trying to live a very active life in outdoor environments, you start to realize that the pump thing is great for helping a diabetic but it’s not great for helping a diabetic in weird outdoor situations, and it was becoming more of a burden.
So I asked my doctors over at Kaiser and the best that they could do was say well, we could give you Lantus which you might have to take two shots a day, and then you could take this humalog pen and use humalog for all of your meals and corrections. So now I’m back onto shots and I’m like I don’t know about this.
Then I saw another doctor — the endo who does the implants for my CGM, since the Eversense is an implanted CGM.
And it’s great because it’s implanted for 3 months. But in the next few months they’re probably going to come out with their new model for the Eversense which is an 180 day sensor so 6 months between changes, how cool is that? So I’ve been using the Eversense for about a year now, maybe a year and a few months and I love it. It’s accurate all the time, and the cool thing is that the transmitter will vibrate on your arm so if your blood sugar is rising, dropping, if it’s low, if it’s high it will give you different vibration patterns so once you know what each vibration pattern is, you don’t even have to look at your phone to know what your blood sugar is doing. There is a beep option as well but I just silence that because the vibrate option is totally fine.
So my second endo knew that I was into all of this outdoors stuff and was like I have a solution for you. I’m going to give you this Tresiba. What we’re going to do is give you the same dose that your pump was giving you as a total basal per day — take that once a day. So it turned out to be like 12 units of Tresiba.
One shot a day — that’s awesome. But what about my meals and corrections? He gave me this big sample bag of Afrezza, which is the inhalable insulin. So he was like yeah try this, It’s going to take a little bit to get used to because it’s not like liquid insulin. But you can go out there with your Afrezza in your pocket. It’s like these really small cartridges that don’t need refrigeration so you can keep them in your backpack and go as far as you want.
Your Tresiba, for a multi-day trip just keep it in a frio pack. So now I’m like no pump, I’m on Afrezza for meals and corrections, I’m on Tresiba for my baseline, I no longer have to mess with a pump. Like I used to have to mess with basal patterns, if I was going on a super long run I’d drop my basal down and then at the end of the day I’d bring it back up. And I’d have to do all of these weird things. But even when I made those changes they wouldn't happen for another three hours.
The cool thing about Tresiba is that it breaks down in your body so slowly that it acts as a true background insulin. It doesn’t do anything to your exercise, it doesn’t do anything to what you eat throughout the day. All it does is background. It allows cells to do what cells do. Bring in glucose and do what they do. And all my Afrezza does everything else.
How do you measure out how much you inhale with Afrezza?
So in these little blister packages are these cartridges, and they’re really small. You just put the cartridge into the inhaler, and you close it, and I won’t do it now but, you just breathe it in.
These come in three dose packages (4 unit, 8 unit, and 12 unit). That’s what it says on the box but it’s not really 4, 8 and 12 for me. So like the 8 is more like 6 and 4 is more like 2 and a half or 3. And the 12 is more like 9, but I never really use a 12 anyway.
And especially for someone who is pretty active...like I might go on a run later today. If I have an afternoon snack and I use 8 units, the cool thing is that this is out of my system in about 90 minutes. So if I took liquid insulin for a meal, I’d have to wait 3 or 4 hours before going on a run otherwise I’m going to just plummet. That residual insulin in the system is really going to crash me. But this leaves your body so quickly. So it’s in and it starts working in about five minutes, full activity in about 10, 15 minutes, and then 20, 30, 40 minutes later all the residual works out so an hour or so later it’s all out of my system.
There’s also this other thing too. My Eversense CGM transmitter on my arm is removable. So it all comes off. I have this adhesive, it’s just a sticky. So I can take a naked shower and that’s one of those things that you can’t do with a pump you know. I mean when’s the last time you took a naked shower? Maybe once every 10 days right? I get to take a naked shower every day. So how nice is that for just mental wellbeing.
Do you wear any medical IDs while on the trail?
Yeah so I got a new watch. This is the Suunto 9, and I’ve got this ID band on it from MyID. So MyID comes with these little sleeves and on the back is this barcode that has all of your medical information that you put in. So it says type one diabetic, here’s my contact information, all that stuff. And they have a lot of different condition sleeves like asthma, autism, type 1, type 2, so you can just wear this on your wrist.
Did you use anything before MyID?
Before that, no. I figured that I was wearing a pump, so if an EMT found my unconscious carcass somewhere on the trail they’d be like, ooh what’s this? An insulin pump? They’re probably a diabetic. But now that I’m off the pump, I have to bring something extra. Because if I’m on my trail and my CGm falls off, there’s nothing on me that says I’m diabetic so I have to take the extra step and put this thing on.
What would you say to a diabetic who might be hesitant or nervous to go outside?
Start small. Just do it. It’s most important to not let diabetes hold anyone back.
So, get into the outdoors and start off with a small hike in the city, or even if you live on the outskirts of town. There are so many apps. Even something like Google Maps. You can go on Google Maps and type in “hiking trails near me” and it’ll show you where all the hiking trails are. Find one that’s like a mile long. Go out there. Bring a backpack and overpack. Make all the mistakes. Do all the wrong things, BUT get out there and try it. Because you’re only walking a mile right? It’s something small, easy to do. You get back to the car and realize well, that was awesome, but I overpacked. Next time, I’m going to go a little bit longer, and pack less. Do it again, do it again, and do it again, and before long you’re looking at mountains and going, I bet I could walk up that thing. And more than likely yes, you can.
If you love it, you’re going to know soon enough. If you don’t love it maybe it’s not for you, but at least you know.
What’s next on your outdoors adventures list?
Ooh I have plans lined up for the next week so that’s a really tough question. I have a big birthday coming up in April so I have a plan to trail run across the Grand Canyon. So I’m training for that. I’m running hills and trails to hopefully get my endurance up to run that marathon distance across the canyon.
Will you have a support team?
I’m actually planning to do it solo. So I’m hoping that I can just go about running my own logistics and getting my preparation down so that I can carry everything in my vest. And I can refill along the way. There’s water on the trail so I can refill liquids and I can just go with my own plan.
Are there any other questions that you wish I had asked or any last thoughts you’d like to share?
I have so many thoughts I can’t narrow it down in time but you did mention community earlier and that’s one of the biggest reasons why I started Type One Outdoors. Community. The idea of community is probably one of the strongest, best, most resourceful areas you can find as a diabetic is the T1D community has probably been the most supportive, the most engaging, the most rich in wealth of ideas on doing diabetes things can be found in the community. So you got an idea about could I do this with diabetes? There’s an answer for you in that community.
Living with T1 Diabetes
Aya Tsuruta
Aya is a marketer, environmental steward, outdoorswoman, and member of T1D nation (since '97). Through life's ups and downs she's found joy, solace, and strength in the outdoors—on the trails, at the crag, and under the stars—and is passionate about helping other diabetics feel safe and confident outside.