Saturday, July 4, 2009

Bicycle Touring in Europe as a Type 1 Diabetic

After finishing a most amazing 5 week vacation in Europe I have so many memories, spectacular scenery and laughs to reflect on. It was an incredible experience riding with my husband Stephen; deciding on routes and passes to climb, finding places to stay each night and learning how to work outside my usual controlled and predictable daily schedule.
The Dolomites in all their spectacular glory

One of the Many spectacular passes we climbed in the Dolomites

We rode approximately 3000km (1850 miles) in 27 days with one day off (we actually rode 25km even on that day) and a couple of shorter days where we rode less than 80km. We did 2 century days (160+km/100miles) in our third week and averaged around 80-130km (60-90 miles) a day for the rest of the time. Our journey included total elevation gain of over 32,000 meters (over 100,000 feet).

Check out this link for the GPS track of our route

There is one word to describe how we felt upon arriving in Bad Wiesee, Germany which was the end point of our tour - "Cooked" but extremely happy.

What were the challenges?

The biggest challenge was needing to keep my insulin cold and having to ask people each evening at the places we stayed - including guest houses, hotels and inns - if they could put my insulin in their fridge and the ice pack we carried with it each day in the freezer. This is kind of tough when you dont speak the language - this included German, Italian, Slovenian or Czech depending on what country we happended to be in at the time. But I got brave and did it. We used our IPhone translation app and managed to get across the message that it was medicine and needed to be in the fridge. It all ended well and I came home with no frozen or ruined insulin or Symlin.

Late in the second week of the tour I did experience some extra high blood sugars which seemed to last all day. On day 2 of highs I took a closer look at my bottle of Apidra and realised it was cloudy and had gone bad. This is the bottle I generally dont keep refrigerated as it is the one I am using all the time. From this point I kept it in the pannier bags with the ice pack to try and avoid any further problems.

Finding places to stay - we did not have any reservations and played it day by day. We usually had a destination in mind but nothing set in stone in case weather turned inclement or we simply did not go as fast as we thought we would. We would then arrive at a town where we knew we were done and start knocking on doors of Gasthauses, Pensions and the occational Hotel when we were desperate. Often if we arrived in a town early enough the Tourist information offices would be open and they generally had great listings of open accommodations. We would find a few in our price range and ride there to see if they still had rooms. Generally at the time of year we were there it was pretty easy to find availability, however as soon as you go into larger towns and cities it was more difficult. One Sunday evening just outside of Graz, Austria we had checked several places and were not having luck finding anything affordable. We passed through 3-4 towns with no luck, it was after 7:30pm, Sunday so no stores open and we still had no bed and no food for dinner. We did find a nice place thanks to the Owner's of a guesthouse that was full - they referred us to a neighbor down the road - we had a super nice place to stay then dinner and straight to bed. The evening accommodation hunt was often our time of tension as neither Stephen nor I like knocking on doors asking for a room, but we survived and for the most part had excellent accommodations along the way.

I was on severe luggage/weight limitations as Stephen was carrying 2 panniers with all our gear. This included 2 t-shirts, 2 pairs of shorts, undies & socks and one extra set of riding clothes. Then syringes, test strips, insulin for a month plus extra in case of breakages, Omnipod POD's and an ice pack for the insulin. I decided to take only the bare minimum number of Omnipod POD's to just last the days we were away and if necessary I would just have shots if there were any malfunctions. I went only 2-3 days without a POD the whole trip which was great, definitely makes dosing with short acting insulin much more convenient.

The beautiful Town of Cesky Krumlov, Czech republic

How did I manage my food intake and insulin doses?

What is my normal regimen so you can see what I changed.

Omnipod Basal Rates
10pm-8am 0.05 units
8am-10pm 0.1 units


Morning Apidra dose - 2units extended, .75 immediately then the remainder over 1.5 hrs
Lunch Apidra - 2units
Dinner Apidra - 12 units extended - 5-6 units immediately then the remainder over 1.5-2.5 hours.


AM 6 units
PM 16 Units


Pre-breakfast 6 units
Pre-Lunch 8 units
Pre-dinner 10 units

The Omnipod extended boluses have also been my saving grace as I use Symlin - which I only used primiarily at the evening meal during the tour. Being able to extend my insulin doses has prevented some of the severe lows I have faced when taking Symlin, a full dose of short acting insulin and eating a meal. The symlin slows absorbtion of food into the blood stream to help with the post meal highs that I experience, however as I was learning how it worked I had a several severe post meal low blood sugars. The omnipod extended bolus has allowed me the opportunity to have the insulin delivered in an extended fashion as the symlin wears off and the food starts being absorbed. For me the Symlin slows food absorbtion dramatically for the first 45 minutes then it begins to go in and my short acting extended dose can then cover the absorbtion.

So how did I change things while touring?

I cannot believe how much food I consumed for the entire duration of our tour. I was eating at least double my usual carbohydrate quota at breakfast, lunch and dinner and dropped my lantus doses from 6 units in the AM to 4.5 and evening from 16 units to 13-14 units.

During the day my Apidra doses were about 50-70% of normal. It took about a week of dropping doses at the beginning of the tour and then stabilised so I kept the doses pretty much the same for the remaining 3 weeks. Usually 1.5 - 1.75 units for breakfast; 1 - 1.5 units at lunch and usual dose for dinner as my food consumption at dinner was usually quite large.

My control was not ideal - a little higher average than I would have liked but at the same time things were quite stable and with the stressors of foreign countries, using a more obscure treatment regimen and riding bicycles everywhere with not car for transport this was probably a "safer" strategy for me. My A1C was not really any worse than my last Dr visit but not any better so now that I am back home in a routine my focus is still get down into the low seven % then hopefully six % by next year. It is as always a work in progress for me that I am not as good at as most of my Team Type 1 compatriots - they are great inspiration for me to keep striving to get to the ideal zone.

I am a non red meat eater, or the other white meat - this is definitely a challenge in Europe as the staple seems to be Pork served in all varieties ham, sliced meats, salami's and sausage. Aquiring Chicken and turkey meat pre-cooked was expensive and definitely not great quality, so instead I resorted much of the time to cheese. We also ate the many fresh baked bread options from the amazing bakeries in every town, cookies and powerbars for food while out riding.

I consumed more bread and cheese than you would think was humanly possible throughout our Journey - now I will have to cut back and hope that I can bring my cholesterol back to normal. It has been a little above normal for the past year so I may have to make some major adjustments or start taking medications to keep it normal. That bums me out as I love Cheese which of course is not the greatest for High Cholesterol.

My weaknesses - cheese and butter. I use the cholesterol lowering type and try to eat low fat cheeses but this does not seem to be helping my cause. Anyway that will be the next project to address with the Dr when I go back to the Barbara Davis Center for my next appointment in July.

Coffee at Lago del Predil, Italy
after our climb through Triglav National Park in Slovenia
then Passo del Predil Italy and back to Kranska Gora Slovenia

What happened after the tour...

I returned to my normal insulin doses almost immediately after we had completed our tour. I definitely had a few days of highs as my body was trying to figure out why I was not exercising, just like when I finished RAAM. Your body responds with a state of insulin resistance as it is not sure how to work when you cease exercising all day and return to a more "normal" existence. Not that I would classify my schedule as normal but my body still has to adapt to normal versus 4-7 hours a day of riding my bike.

We returned to Colorado and I was back on my usual training schedule pretty quickly but oh boy my legs were pathetic. They hurt pretty much all the time when climbing for the first 3 weeks after returning to our 8150 feet living environment. I think my body needed time readjusting to altitude. Despite lots of fitness, that did not make up for not being at 8000 feet for 5 weeks and then suddenly returning. I expected to be able to go mountain bike and climb passes immediately, which was not really the case.

4 weeks later things are looking up. Legs have stopped hurting and Mountain biking is feeling a little more comfortable now. My A1C was not stellar but not really any worse than before I left. I definitely kept things a little on the higher end being in unknown places and not knowing what medical care would be like if something went wrong. Now I am back on track and trying to get it down again. Cholesterol is still high but not as bad as I thought it might be after 5 weeks of eating tonnes of Cheese, that is a relief.

Please send any questions you might have on Diabetes and bike touring to me at

"Life is a journey not a destination..." Our trip was definitely an unforgettable journey and has left a longing in our hearts to return to Europe again, it is an amazing place for cyclists.

1 comment:

  1. Kerry...Congrats on such a wonderful journey. My jealousy is only surpassed by my awe of your ability to embrace life as a fellow diabetic! Travel safe and I hope we cross paths at an Athlete Day soon!