Diabetic on the Camino

Just because your β-cells refuse to, doesn't mean you can't go and have fun.

Disclaimer: this is about Type 1 and 1.5 diabetes. If you’re suffering from Type 2, see your physician ahead of time, bring enough medication and your BG meter and you should be fine. Also: I am not your physician, and nothing on this page constitutes a medical consultation or advice, it’s a personal experience report.

Going on the Camino as a T1D sounds terrifying. What if I run out of humalog? What if I push a hypo at four AM and can’t find food? What if…

But the truth is, you’ll probably be fine. I am writing this way too much for comfort, but the myth deserves dispelling: in its core, most of the Ways of St. James, and definitely the Camino Frances are comfy afternoons and nights, linked together by easy day hikes. You’ll rarely be far from a pharmacy, and every ten days or so you’ll pass a huge city with more than that.

Spanish pharmacists are allowed to prescribe non-schedule drugs, so bring a paper from your physician (ideally translated into Spanish, but everyone speaks English) that states that you are a T1D, which Insulin you need, and they can hook you up. You’ll probably pay less out-of-pocket than you would in the US, but definitely more than you’d shell out if you’re from a country with better health care coverage.

1. Bring a USB powered cooler.

Those things are amazing. Between cooler and a 14000mAh external battery, you’ll keep your Insulin fresh and tasty, even trough the Meseta. Most albergues will allow you to store your stash in their personal fridge as well, so just ask.

2. MiaoMiao and Freestyle Libre might be your friends.

Instead of bringing a DexCom, with the added risk of site infections, many diabetics I spoke to brought a MiaoMiao with their Freestyle Libre. The Freestyle runs for ten or fourteen days, so bring accordingly (plus one extra for accidental pulls), the MiaoMiao can be charged off the USB battery you brought for your cooler.

Personally, I am not a big fan of Abbot’s app, so I am running with Tomato and Tidepool. Tomato connects to the MiaoMiao and writes (optionally, $24/year subscription) into Apple Health (Android works about the same). Tidepool’s app fetches the data from Apple HealthKit and uploads them to their servers, which means my loved ones can monitor me from remote and I get to see where my threshold in terms of distances walked lies, before I have to feed.

3. Contour Next is the most common brand in Spain

… and Accu-Check Fast Clix are rare. This is usually my setup: Fast Clix to poke myself with, and a Contour Next One because I am lazy and the Bluetooth functionality saves me one step. No one I spoke to had issues getting strips for the Contour Next (just show them the drum), but I had a hell of a time finding lancet drums. After running out, I switched to one-use that seem to be the status quo around the Camino.

4. Calibrate early, calibrate often

As much as the Camino changes, so do your interstitial fluids. Between exsiccosis from walking, the cold of some of the peaks, and the heat of the Meseta, you won’t have the luxury of slowly changing factors you enjoy at home. Your CGM/Pump don’t know that you’re out and about, so do yourself a favor and calibrate at least daily.

5. Clinics

You can hit any of the hundreds of medicos along the Camino, but if you have time, consider the following places:

  • Pamplona (4th day)
  • Logroño (~9th day)
  • Burgos (end of 2nd week)
  • León (3rd week)
  • Ponferrada (3rd/4th week)
  • Astorga (3rd/4th week)
  • Sarria
  • Santiago de Compostella

After Santiago, down to Muxia/Finisterre you’ll have a hard time finding a clinic. Muxia does not have one, you’ll have to take a cab to Cee. You’ll pass Cee on your way to Finisterre.

6. Bracelets

Spanish paramedics are not, like most EU medical services, officially permitted to check your wallet for a diabetic ID card. Even fewer are checking Apple/Android Emergency/Medical information on your phone. Bracelets, on the other hand, are common and well used. If you are carrying an ID or have your information on your phone’s SOS Page, it might be a good idea to get a T1D bracelet and wear it, just in case.

7. Conclusion

It’s definitely not impossible or dangerous to walk the Camino as a T1D. Food choices, access to power, cooling, clinics, and pharmacies is comparable to most all civilized urban areas. I’ve met dozens of diabetics on the Camino, the Freestyle Libre (and in two cases the telltale sign of a DexCom) serving as our unofficial badge…

I know you know this. After all, we’ve dealt with this for a while. But if you were wondering, no, there’s no risk from an infrastructure perspective. And, at least for me, walking 900km did only do good things to my health.

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