Yawash Sar 1
Photos by Nicholas Hurndall Smith

by Nicholas Hurndall Smith

Nicholas led an expedition in 2022 to Pakistan supported by the AAC(UK) Expedition Fund and writes about lessons learned in 7 years of climbing with type 1 diabetes. We hope his article will act as an inspiration to others afflicted with this potentially debilitating condition.

On my first alpine outing as a new diabetic with insulin ‘on board’, it was only a matter of minutes before I was reaching for my supply of sweets. With a heavy sack, I had taken too much insulin before the long approach to the Bivouac de l'Envers des Dorées (2983m). I had not sufficiently reduced my dose. I struggled to keep up with my friends, and within a few hours had eaten my entire supply of sweets for the week. The guardian at a hut we passed en route took pity and supplied me with a bag of sugar lumps to munch. It was a steep approach and a steep learning curve for this impatient student of diabetes mellitus.

After the sudden onset of type 1 in April 2015, I had begun to jab myself with insulin five or more times per day, constantly pricking my fingers to test my blood sugar. I hoped to prove wrong those who had told me my life would change. During the three months which followed, as my pancreas slowly went on strike, I found I was lighter on my feet due to the weight I had lost before my diagnosis. I experimented, and tried to learn from my glucose spikes and lows, training every day. I attended a weekend for ‘sporty diabetics’ and took part in a drug trial for the newly diagnosed which helped me learn more from the experts. Then, on the Island of Hoy, I ran my fastest half marathon to date. But I was clearly not yet experienced enough to cope with long alpine days.

I set out to have a go at changing this but suffered more hypoglycaemic episodes in awkward spots, one on the Alphubel’s Eisnase (4206m). With my confidence sometimes in tatters, or whilst feeling shaky and out of sorts, I was blessed to have climbing partners who were patient and supportive. Through trial and error with technology, different insulin and different tactics, things slowly improved. Now I have four trips to the Greater Ranges behind me and have climbed 32 of the 4000m peaks in the Alps (using Martin Moran’s list), of which seven were done before my diagnosis. I cope well, for the most part.

This year, with support from the AAC(UK), I led an attempt on the 6250m Yawash Sar I in the Ghujerab Mountains in northern Pakistan. After an approach which took almost a week, we established basecamp, then an advanced basecamp on the unexplored NW Ghidims Glacier and a route through the icefall above it. From the hanging glacier above that, the team then made three attempts on the summit, up to a high point of 6000m. Each time we retreated via multiple abseils after being stopped by loose rock or ice. In the end we opted to make a couple of easier first ascents from our advanced basecamp. We began the long march back to Shimshal, delighted to have had the chance to explore an untrodden area of the Ghidims Valley close to the Chinese border.

For the team, the climbing challenges were considerable as were those of acclimatisation. From a personal perspective, it was good that all went relatively well on the diabetes side, and that the setbacks we had were simply the usual ones encountered by any mountaineer pushing the boundaries of exploration at altitude. The sugar lump episode seemed to be ancient history, and it is good to know I can now control my blood sugar much more successfully and operate with the confidence I had before diagnosis. There is still much to learn!

A hypo, where blood sugar sinks too low, can make you lose your train of thought, stumble, and appear slightly drunk. These are generally things which do not help climbers stay attached to mountains. Climbing with slightly high blood sugar (for a short time) is not such a big issue. The goal is to avoid lows at all costs. Now, after ticking a few boxes with the NHS (with whom I share my initials and to whom I owe a huge debt of gratitude), I wear a wireless insulin pump on my arm, which gives me regular small doses of fast acting insulin. This I can top up when I eat, or reduce when I exercise, with the help of a rather retro battery-operated monitor. Also on my arm I wear a sensor which I can swipe with either my iPhone or a reader, to reveal a blood glucose level and trend. This means no finger pricking to test the blood and no injections. On a climb, I quickly scan to test my blood several times an hour, especially at the beginning. Trends become more predictable once into the swing of things and my sweets are always at the ready. The key is regular testing, easily done with a quick swipe.

On our final attempt on Yawash Sar I, before first light, I dropped the reader of my blood glucose monitor from an uncomfortable belay. I had just switched it on, and as it accelerated downwards we watched it illuminate the steep ice, only slowing as the angle eased on the glacier below. We failed to find it 14 hours later when we next passed by after an ‘emotional’ retreat. My iPhone served as a backup. That day my insulin pump failed too, and I was happy to have a backup pen, which enabled me to inject insulin when required. Experience has taught me that it is all about the backups, and I carry everything in triplicate.

Diagnosis with type 1 diabetes is a game changer, and presents challenges to the active mountaineer. The dose of insulin needed to control blood sugar varies hugely depending on the activities of the day, be it a lazy day recovering in basecamp or a long challenging climb. Add to that the effects of altitude, less familiar food eaten at unusual times and the adrenalin of a steep lead, then the chances of keeping one’s blood sugar level within the desired and elusive ‘zone’ (5-9mmol/l for me) are slim indeed. There is still plenty that can and does go wrong, but with trial and error, and thanks to the advances in technology now made available to the type 1 diabetic by the NHS, it is still possible to enjoy climbing in the world’s most remote areas. I’m excited to see where my next adventure will take me.

As the great climber and inspiration to type 1s, Jerry Gore, says, ‘Diabetes is NOT an excuse!’.

The Yawash Sar I-IV expedition is grateful for the support of AAC(UK), MEF, FRCC, MACCF, BMC, Expedition Foods and Black Diamond Equipment. Team members were Nicholas Hurndall Smith (leader), Nigel Bassam, Tom Bell, Paul Winder, Ross Bell and Karim Hayat.

Struggling with altitude high above the Ghidims Valley

The trek back to Shimshal

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