Diabetes Forecast

Climber Steve Richert's Year of Testing Himself

By Tracey Neithercott ,

Steve Richert climbs at Red Rock Canyon near Las Vegas.

Steve Richert was anchored to the side of a red sandstone cliff in Utah's Zion National Park. It was April 2012, and by then Richert had been rock climbing every day for the past four months. Before that, he'd spent years perfecting his technique. But this was different. It was the first time he'd become hypoglycemic during a long climb. Low blood glucose wouldn't be cause for alarm, if it weren't for one detail: He was hundreds of feet up in the air.

Richert, 30, is no stranger to climbing with diabetes. The outdoor activity was barely a blip on his radar when he was diagnosed with type 1 in 1999. A climbing lesson at his upstate New York high school may have sparked the idea, but his diabetes diagnosis spurred him on. "What I took from it was that my life was going to be really limited," he says, referring to his health care providers' reaction to his diagnosis. "And I thought, if I'm going to do it—sort of live big, die young—I was going to prove them wrong."

He didn't get a chance to try until he graduated from Binghamton University, where he earned a double degree in English and philosophy. But Richert decided he was less of a 9-to-5 guy and more of an outdoor adventurer, so he stockpiled rock-climbing books and taught himself the ins and outs of the sport before meeting a seasoned climber who became his mentor. With his focus on climbing, Richert took part-time jobs—as a lifeguard, an adjunct professor of physical education (when he met his wife, Stefanie), and eventually as a climbing guide—that provided enough money and time off for outdoor activities.

Diabetes on the Rocks

It's hard to say whether having diabetes has made Richert a more skillful climber or if his attention to climbing details has benefited his blood glucose. Regardless, the two are intertwined, he says. Both require patience, determination, and the ability to keep your cool. Both pose challenges, risks, and unforeseen obstacles. And both can take a toll on a person mentally and physically. "[Diabetes management] really is a training ground because climbing is a very calculated game where you're playing with a whole bunch of factors," he says. "When you think about it, diabetes really affects you mentally, and that's where climbing really speaks to me."

1.That's a long way down!

2. At the top of the 5th pitch it was "lunch time" and my sugar was 170. I had to choose between risking a hypoglycemic attack if I shot up to eat or just not eating anything since my sugar was high and risking "bonking" or running out of energy as we headed into the 2nd half of the climb.

3. Clif bar and raw almonds for lunch. I drank a bunch of water because I was beginning to cramp up badly by this point.

4. Contemplating the fact that I just shot up fast-acting insulin on a climb, breaking my own cardinal rule. I gazed out at the canyon and repeatedly had to reel myself back in as I began to feel real panic welling up in my gut. We were too high to turn around now. We had to finish and I had to deal with my sugar being imperfect. I closed my eyes and visualized myself on the couch feeling totally relaxed. It was the hardest moment I have had yet in climbing and diabetes—really having to juggle both simultaneously.
From the April 23, 2012, entry in Steve Richert's blog at livingvertical.org.

Rock climbing is a perilous sport for anybody. But Richert is no dummy; he knows the possibility of danger increases with diabetes. "But my theory is that life is fraught with risk," he says. "We manage risk every time we get behind [the wheel of] a car. For me, [risk management] is really the name of the game when managing diabetes in the vertical world."

Richert lowers his chance of rock-climbing disasters in a couple of ways. For starters, he didn't learn to climb on difficult outcroppings. "I went incrementally, seeing how far I could push the limit," he says. Second, he gives top priority to diabetes management. Richert credits his low A1C (it's been under 6.7 percent for the past six years) to a diet that's low in starches, high in fruits, vegetables, nuts, seeds, and protein, and includes barely any processed foods. Because of his tendency to go low during and after a climb, Richert sticks to multiple small snacks—such as almond butter, beef jerky, nuts, and seeds—over the course of a day because they don't require a shot of fast-acting insulin.

Exactly how his blood glucose reacts to the food and exercise varies from one climb to the next, based on a host of factors, including the height of a rock formation and its difficulty. The red rocks of Zion National Park, for instance, soar to 2,000 feet and are fairly difficult, so a climb there takes longer than one up lower or easier cliffs.

Total feet climbed by Steve Richert in 2012

Day 2 • 2,215
Day 42 • 13,505
Day 254 • 64,369
Day 365 • 79,419

And then there's the trek to the base of a cliff. Before Richert could begin climbing the mountains in British Columbia's Bugaboo Provincial Park, he first had to hike 3 1/2 hours to a base camp and then cross a glacier. All of that exercise, combined with the climb, allowed Richert to scale back his background insulin dose and skip mealtime insulin completely—without changes to his diet.

He prepares for all climbing conditions by adjusting his insulin to prevent hypoglycemia. "There are a lot of times when I'm like, 'Well, if I screw up out here, I'm on the side of a cliff and nobody's going to be able to get to me,'" he says. It's why, on the day of a climb, Richert will use less mealtime insulin at breakfast and skip the fact-acting medication for the rest of the day. He'd rather run a little high—though not ideal, elevated blood glucose is manageable—than drop too low.

He had one scare during a long climb, last year at Zion. At the start, he had tested his blood glucose, which hovered at 300 mg/dl, and injected a unit of fast-acting insulin to bring it into a normal range. At lunch, Richert covered his still-high blood glucose and an energy bar with one more unit of insulin. And then he regretted it.

"I was 800 feet from the ground and 400 feet from the top, and I felt absolutely helpless," he says. "But I forced myself to think, 'OK, what would you do if you were back home on the couch?' You need to tell yourself [that] these rules you learned at your house, they apply here." He was farther up the cliff, nearing the summit, when his blood glucose plummeted. At the first sign of hypoglycemia, Richert anchored himself to the rock, tested his blood glucose (it was 65 mg/dl), and downed a couple of energy chews. Once he revived enough to climb, Richert continued up the cliff.

A New Day, Another Climb

As if managing diabetes while hanging from the side of a cliff wasn't difficult enough, Richert hatched a project that would challenge him in new ways. In May 2011, he and his wife thought up Project 365. The concept was simple: Richert would climb (indoors or outside) every day for a year—with his wife, friends, or strangers he met along the way—and videotape, photograph, and blog about the process.

 What began in January 2012 as a means of realizing personal goals soon transitioned into a way for Richert to inspire and empower people with diabetes. "I can't bring everyone climbing, but I can help them see their diabetes differently," he says.

Though Project 365 has tried him physically, Richert says the hardest part was giving up physical and emotional comforts for a year. As he traveled around North America, Richert lived in his beat-up red 1987 Toyota or stayed on friends' or relatives' couches. His social life took a nosedive, and at times he went months without seeing his wife. "I'm getting my crampons [a spiked metal plate that fastens to the shoe] ready to scale the side of a mountain, and I'd be lying if I didn't say I want to spend New Year's Eve with my wife," he says.

Yet despite the sacrifices he's made, Richert believes Project 365 will make a difference. "This is what I was meant to do. This is an extension of who I am. In a lot of ways, it's blown my mind as to how the project has affected other people," he says, referring to times when strangers have called him an inspiration.

The underlying message of Richert's Project 365 is not only that people with diabetes can do whatever they set their minds to, but that diabetes can be an advantage. "Diabetes can make you more aware and meticulous about [your health], and then you're able to push yourself even more," he says. "I would not be aware and doing what I'm doing to my body if it weren't for my diabetes. Yes, it's annoying and frustrating at times, but it doesn't have to be a negative thing."



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