Hypoglycemia episode

[JustOneGuy]

Yesterday with a couple of friends, my partner and I went for a long walk in the mountains of the island where we live: 22 km in total and 960 m of elevation gain uphill. Nice temperature (16-18 C). Everything went well, we had a great time despite some rain, until, arriving after about 6 hours in a small village where we thought we would get a “bocadillo” (sandwich) before catching a bus back, my wife sat down and started to feel sick. Shortly thereafter she fainted.

We immediately called an ambulance that arrived after about 20 minutes (we were in a small, isolated town) and transferred her to a medical center where they examined her: hypoglycemia. On the way she vomited, which looks typical.

All other values-pressure, heart rate, blood oxygen were perfectly normal. They gave her a glucose and anti-nausea drip and we took her home soon after. She has had periodic blood tests at the same center recently, but she is still waiting for the results.

I am mainly to blame : first, it was the first time my wife, who is a good walker in good physical shape for her age (62) anyway, covered such a distance in the mountains (and I insisted to convince her...). Second - I had prepared a good quality bag of various high-quality supplements and food, but.. it was left at home when I made changes in my backpack at the last moment. We just had some bread and Parmigiano Reggiano with us, plus 3 liters water, but she didn't eat and drink very much of them.

My question is whether you think it is appropriate to continue with these hikes, including - of course - trying to make more stops for drinking and eating? This is her first time but other times, looking back, she had felt almost faint, only we had underestimated it.

By the way, she totally recovered although we are staying at home just relaxing today.

I will end by saying that the staff at the bar was of absolute kindness, helping us, talking to the 112 instead of me (who speaks Spanish only as a second language), smiling and trying to comfort me with a courtesy that, thinking back, literally brings tears to my eyes. They also vacated one of the rooms in the bar for us. The ambulance and medical center staff were also of absolutely outstanding competence, professionalism, and kindness.

And all completely free of course: we are in Spain.

Thank you Europe, for existing and being the place where I live!

 

[SabsP]

Sorry to hear. Luckily help was quickly available.
Seeing I am not a doctor my advice is that your wife discusses it with her GP. As you say : medical care in Spain is of a very high quallity and almost free ( medical care in Europe is not free but we pay via our taxsystem ).

In general, while walking, it is never a bad idea to stop regularly and have enough water with you.

 

[MinaKamina]

My question is whether you think it is appropriate to continue with these hikes, including - of course - trying to make more stops for drinking and eating? This is her first time but other times, looking back, she had felt almost faint, only we had underestimated it.

the answer to your question should be given by your wife's doctors once they have diagnosed the cause of this hypoglycemia.

 

[dick bird]

I can only endorse what the previous two posts have said, only a medical professional can give you the right advice.

 

[J Willhaus]

I would check with my doctor before resuming this hiking routine.

 

[Pelegrin]

22 kms with 960 m elevation gain in 6 hours being more than sixty can make some problems. I think yoo should slow down and make more stops ( for your wife) on walks of this level of difficulty.

 

[JustOneGuy]

Thanks for the advice guys.

My wife is going to discuss this with her doctor on Monday. She already booked a full blood exam in a week as a regular check.

The potential problem is that, as the doctor is a GP and not an expert, he may give her advice that is not tailored to this type of activity. What I mean is that in the past I have spoken to a lot of doctors who said "stop doing that", where "that" may have been long distance running, or walking, etc, which in the end can be worse for the whole body because you lose enthusiasm, gain some weight (my wife is well within her normal BMI range, currently) and stop doing good physical activity.

That's why I asked here. Because I was hoping to get some advice from someone who has been through such an episode.

 

[SabsP]

Thanks for the advice guys.

My wife is going to discuss this with her doctor on Monday. She already booked a full blood exam in a week as a regular check.

The potential problem is that, as the doctor is a GP and not an expert, he may give her advice that is not tailored to this type of activity. What I mean is that in the past I have spoken to a lot of doctors who said "stop doing that", where "that" may have been long distance running, or walking, etc, which in the end can be worse for the whole body because you lose enthusiasm, gain some weight (my wife is well within her normal BMI range, currently) and stop doing good physical activity.

That's why I asked here. Because I was hoping to get some advice from someone who has been through such an episode.

In that case the GP will have the professional attitude to send her for more detailed advice to an endocrinologist ( = the expert ) if he/she feels the need.

 

[ShoshTrvls]

Agreed that this forum is not a place to get your question answered.

That being said, I think you’ve identified the main issue here - not having appropriate supplies with you. I always keep in my packs (different ones for different types/lenths of walks) several electrolyte gel packs, like GU or similar. So it doesn’t matter if I decided to change up which pack I’m taking or decided to walk a more difficult or longer path than planned; I know there’s always a few tucked away. And at the first hint of lightheadedness, I pull one out and am usually good to go after that.

 

[Pelegrin]

In my opinion if you did 22 kms and 960 m elevation gain in 6 hours, probably you went up with a speed of more than 300 mts of elevation gain per hour that is the " normal".

 

[JustOneGuy]

In my opinion if you did 22 kms and 960 m elevation gain in 6 hours, probably you went up with a speed of more than 300 mts of elevation gain per hour that is the " normal".

Just to clarify, it was more an up-and-down. There were only 2 really steep sections, lasting about 300 m each, one at the start and one at km 13. The profile follows:


Let me say again that I am fully aware that the diagnosis must be made by doctors (I am a scientist after all), but I would like to understand if this has happened to any other person in similar circumstances: no pre-existing medical problems, good health, low carbo/water consumed on the walk, etc.

I would like to understand whether this may be hiding something else. And, if not, whether it is still possible to plan a Camino together with my wife, taking proper precautions, of course.

 

[SabsP]

Just to clarify, it was more an up-and-down. There were only 2 really steep sections, lasting about 300 m each. The profile follows:
View attachment 180898

Let me say again that I am fully aware that the diagnosis must be made by doctors (I am a scientist after all), but I would like to understand if this has happened to any other person in similar circumstances: no pre-existing medical problems, good health, low carbo/walk on the walk, etc.

Of course it happens. Happened with me a while ago ( though not to the point of fainting) on a long hot walk. Two days later I had a minor viral stomach infection and most probably my body was already fighting it while on my walk.

Viral, bacterial, hormonal issues are always factors to take into consideration while we walk or do other sports.

 

[JustOneGuy]

Thank you, @SabsP.

What really worries me is that she looked fine until we sat down at the end of the walk, and then she collapsed in less than 30 seconds.

This has never happened to her before, although she did complain a couple of times in the past about feeling a bit dizzy while hiking long distances (which I didn't take seriously... ).

 

[dfox]

... first, it was the first time my wife, who is a good walker in good physical shape for her age (62) ...

I'm not a medical doctor! As already mentioned by some forum members, it is important to work with a medical doctor to find out the underlying cause(s) of your wife's hypoglycemia.

If your wife, in good physical shape, was not overly exerting herself on the trail, "sudden" drop of blood sugar level and could not recover by brief rest or/and injest sugary stuff, e.g., candy, while on the trail, it is desirable to find out the underlying cause(s).

 

[Peterexpatkiwi]

I would like to understand if this has happened to any other person in similar circumstances

I think we all appreciate that, your anxiety about your wife's condition, and your desire to understand it better.

But even if we had experienced a similar situation, as you are well aware it does not automatically follow that whilst your wife's symptoms match mine for example that the cause and/or the treatment is the same.

I would like to understand whether this may be hiding something else

Of course it could be but how on earth are we to know? Let alone ascertain what that may be or the risks pertaining to that.

Imagine if I reassure you online here, you go out walking again this time (with or without your snacks) but your wife died?

As stated by everybody above your first point of call is of course the doctor, if you feel the information forthcoming insufficient or even simply unhelpful then as you well know you can seek an appropriate specialist.

Hopefully it will be identified as something very minor and easily rectified and you can continue on with your plans.
Best of luck for the next couple of weeks.

 

[raincitygal]

I'm a nurse, walked my first Camino in 2022 at age 65, and found that I needed some kind of fuel about every 2 hours to be able to keep chugging along, so carried snacks with protein, sugar and fat like nuts and dried or fresh fruit, cheese, bread, granola bars etc. I can tell when I'm getting low blood sugar- ish and also have low BP to begin with so must stay hydrated. Your wife's mileage may vary and her GP's assessment will be key. Buen Camino!

 

[JustOneGuy]

I think we all appreciate that, your anxiety about your wife's condition, and your desire to understand it better.

But even if we had experienced a similar situation, as you are well aware it does not automatically follow that whilst your wife's symptoms match mine for example that the cause and/or the treatment is the same.

Of course it could be but how on earth are we to know? Let alone ascertain what that may be or the risks pertaining to that.

Imagine if I reassure you online here, you go out walking again this time (with or without your snacks) but your wife died?

As stated by everybody above your first point of call is of course the doctor, if you feel the information forthcoming insufficient or even simply unhelpful then as you well know you can seek an appropriate specialist.

Hopefully it will be identified as something very minor and easily rectified and you can continue on with your plans.
Best of luck for the next couple of weeks.

Hi Peter, I completely understand what you and so many others wrote. I may not be able to explain myself. Let me try again:

If 5 people said "yes, I'm generally fine, but it happened to me one day because I didn't have enough food/water/sugar/sleep" or "it also happened to my husband to suddenly faint after a long walk because he didn't slept enough", I would think - as I suspect - that it was a set of circumstances rather than an underlying health problem.

The fact that no one has reported such episodes on a forum like this, where most people are used to very long walks worries me a little.

Anyway, thanks again to everyone for the tips and suggestions. As I said several times, my wife is fine now and going to see a doctor tomorrow (we can just walk to the Centro de Salud, wait 20 minutes or so and spend half an hour or more with a nice, excellent GP here). She booked a full blood test a week ago and has already had an ECG. Maybe he will send her to a specialist.

Let me conclude by saying that yesterday I found so many kind people around me, known and unknown, who were eager to help (a gentleman who happened to be there, for example, went to fetch a fan at home to wave at my wife's face) that my opinion of humanity, at least the one living around me, has improved somewhat in a period of black pessimism.

 

[SabsP]

The fact that no one has reported such episodes on a forum like this, where most people are used to very long walks worries me a little.

Maybe because people prefer to deal with health issues in the privacy of their home or at the consultation room of the doctor?

I had some health issues on some Caminos and I only discussed them in very general and superficial terms on this public forum.

 

[stevelm1]

Sorry to hear your wife's troubles. I am a diabetic and very susceptible to hypoglycemic episodes. I have walked three Caminos and I always carry a fast acting glucose item with me. There are many on the market, but a few sugar cubes will work as well. Of course, this is reactive, the best plan is to keep you glucose up during your walks. This is easy to do as well, at least when you remember to bring your snacks along.

 

[dreaming]

I walked with a pilgrim last year who was wobbling across the track. It was hot. He had only drunk one cup of coffee no water. When rehydrated he was fine.

 

[artsschmidt]

I haven't read all posts but....I have hypoglycemia. I have walked 4 Caminos. Take something sweet for raising blood sugar fast. There ae products you can buy but just a bit of candy or orange juice works. Don't eat a lot of sugar before hiking. Blood sugar drops fast and one will end up as your wife did on this hike.

 

[JerryStroebele]

I fainted twice on the Camino. The first time was abut 20 km east of Bilbao. I had l planned to walk 30 km to an albergue but it was completo. I had to walk another 6 km to find a bed. I had had food poisoning about two weeks before starting the Camino and still had a queasy stomach, so I wasn't eating much. I was 73 and in fairly good shape for walking. It was my fourth Camino. At dinner at 8pm I was very hungry and ate my first course, delicious green beans. I drank a beer. I felt funny and my Camino amigo across the table asked me if I was all right. Next thing I knew I was laying on the floor of the restaurant and an ambulance crew was lifting me onto a gurney. I was in the hospital ER for 4 hours. I had 4 blood draws, 2 EKGs, and a drip in my arm. A neurologist asked me questions for what seemed an hour. There were several nurses in attendance at all times. Two doctors examined me. The last doctor said to me, you can go now, you had low blood sugar. He prescribed "eat more, walk less." When I checked out the bill was 280 euros. I have been in a lot of ERs with my 4 children. This was one of the nicest, cleanest, most professional I had every seen. The bill at that time here in Alaska would have been more than $6000. The restaurant owner refused payment for my dinner.

The second time was this March when I walked from Malaga to Cordoba with my daughter. Our last day was 24 km and then another 4 km across town to our hotel. Now I was just shy of 80 and had had a heart attack a couple of years earlier. I thought I had carried enough water and food. It was a hot day but I used my umbrella for shade. I had a nice hot shower, felt great, went to dinner and had a few sips of wine. Then that familiar feeling started creeping over me again. I told my daughter to come hold me, I think I'm going to faint. I did. Off to the hospital I went. An EKG showed no heart problems but low blood sugar. "Eat more, walk less." This time I was in a public hospital. When I asked for my bill they said there was none.

On returning to the US I asked my doctor if I really did need to go to the ER. He said yes, always get an EKG after fainting. I assume because of my heart history. It is also reassuring for the people you are with at the time. Last month I walked 460 km on the Camino Frances, my 13th Camino. I walked less every day except a couple of 29 km days that were unavoidable and I ate A LOT MORE! I still lost 8 lbs. If I need a beer during the hot day, it is 0.0. Wine and water with dinner. I carried my 19 lb backpack. Lesson learned. Eat more, walk less, but keep walking. Buen Camino

 

[AllisonMarie]

Thanks for the advice guys.

My wife is going to discuss this with her doctor on Monday. She already booked a full blood exam in a week as a regular check.

The potential problem is that, as the doctor is a GP and not an expert, he may give her advice that is not tailored to this type of activity. What I mean is that in the past I have spoken to a lot of doctors who said "stop doing that", where "that" may have been long distance running, or walking, etc, which in the end can be worse for the whole body because you lose enthusiasm, gain some weight (my wife is well within her normal BMI range, currently) and stop doing good physical activity.

That's why I asked here. Because I was hoping to get some advice from someone who has been through such an episode.

But also, what does your wife want? You do mention bringing some pressure to bear on her. What is her thought on this. That, in combination with her doctor’s input seems most relevant.

 

[JustOneGuy]

I fainted twice on the Camino. The first time was abut 20 km east of Bilbao. I had l planned to walk 30 km to an albergue but it was completo. I had to walk another 6 km to find a bed. I had had food poisoning about two weeks before starting the Camino and still had a queasy stomach, so I wasn't eating much. I was 73 and in fairly good shape for walking. It was my fourth Camino. At dinner at 8pm I was very hungry and ate my first course, delicious green beans. I drank a beer. I felt funny and my Camino amigo across the table asked me if I was all right. Next thing I knew I was laying on the floor of the restaurant and an ambulance crew was lifting me onto a gurney. I was in the hospital ER for 4 hours. I had 4 blood draws, 2 EKGs, and a drip in my arm. A neurologist asked me questions for what seemed an hour. There were several nurses in attendance at all times. Two doctors examined me. The last doctor said to me, you can go now, you had low blood sugar. He prescribed "eat more, walk less." When I checked out the bill was 280 euros. I have been in a lot of ERs with my 4 children. This was one of the nicest, cleanest, most professional I had every seen. The bill at that time here in Alaska would have been more than $6000. The restaurant owner refused payment for my dinner.

The second time was this March when I walked from Malaga to Cordoba with my daughter. Our last day was 24 km and then another 4 km across town to our hotel. Now I was just shy of 80 and had had a heart attack a couple of years earlier. I thought I had carried enough water and food. It was a hot day but I used my umbrella for shade. I had a nice hot shower, felt great, went to dinner and had a few sips of wine. Then that familiar feeling started creeping over me again. I told my daughter to come hold me, I think I'm going to faint. I did. Off to the hospital I went. An EKG showed no heart problems but low blood sugar. "Eat more, walk less." This time I was in a public hospital. When I asked for my bill they said there was none.

On returning to the US I asked my doctor if I really did need to go to the ER. He said yes, always get an EKG after fainting. I assume because of my heart history. It is also reassuring for the people you are with at the time. Last month I walked 460 km on the Camino Frances, my 13th Camino. I walked less every day except a couple of 29 km days that were unavoidable and I ate A LOT MORE! I still lost 8 lbs. If I need a beer during the hot day, it is 0.0. Wine and water with dinner. I carried my 19 lb backpack. Lesson learned. Eat more, walk less, but keep walking. Buen Camino

Thank you!

You are one of the few here - together with @raincitygal - who understood what I was looking for and responded accordingly: direct experience.

Obviously, this is not a doctor's answer, but tell me that hypoglycaemic crises can happen under certain conditions, very similar to what my wife experienced on Saturday. In particular, that one can faint at the end, rather than during a walk, at the very moment when one sits down and start recovering, that is quite surprising IMO.

I am sorry for what happened to you, but congratulations on your resilience and ability to react. I hope that I will be like you when I am your age. You have my full appreciation for your abilities, both physical and mental. What I see around me are mostly people much younger than you (and me!) who can't even find the motivation to walk 500 metres (1640 ft) a day.

Congratulations and thanks again for taking the time to reply.

She will see a doctor later this morning, and will ask for a full blood exam and maybe an ECG under stress.

 

[JustOneGuy]

But also, what does your wife want? You do mention bringing some pressure to bear on her. What is her thought on this. That, in combination with her doctor’s input seems most relevant.

You should ask her. Unfortunately, she doesn't like writing on or reading social media.

As I said I insisted too much to start from home rather than 4 km later (where we met our friends).
However, I think I am right in saying that she loves this kind of activity, but prefers more relaxing things.

As I reported in one of the first posts on this forum, during a visit to Galicia in April this year, it was she who told me ‘what if we do a Camino de Santiago?’ after seeing some pilgrims and talking briefly with one of them.

She walks a lot because she spends part of the year in the UK where she does not have a car (20,000+ steps a day). She likes to walk on level ground every day but doesn't like the climbs, where she says she feels her heart rate rise a lot. However, medical checks didn't find any real problem so far with her cardiovascular system.

Obviously to tackle a Camino next year we need to have some physical preparation, so we thought we would slowly increase the distances. But maybe this time we have gone too far.

 

[60LifeChange]

Just to clarify, it was more an up-and-down. There were only 2 really steep sections, lasting about 300 m each, one at the start and one at km 13. The profile follows:
View attachment 180898

Let me say again that I am fully aware that the diagnosis must be made by doctors (I am a scientist after all), but I would like to understand if this has happened to any other person in similar circumstances: no pre-existing medical problems, good health, low carbo/water consumed on the walk, etc.

I would like to understand whether this may be hiding something else. And, if not, whether it is still possible to plan a Camino together with my wife, taking proper precautions, of course.

yes. out walking in the mountains here in Colorado and same thing, very dizzy, lightheaded... jumped on my electrolytes, and gone... that quick... kicked myself for that, as I was hyper-aware of sodium loss when I ran marathons... wasn't doing that while on a "hike"... lesson learned.

 

[JustOneGuy]

yes. out walking in the mountains here in Colorado and same thing, very dizzy, lightheaded... jumped on my electrolytes, and gone... that quick... kicked myself for that, as I was hyper-aware of sodium loss when I ran marathons... wasn't doing that while on a "hike"... lesson learned.

Apparently she was out of fuel (glycol), not electrolytes. The temperature was fantastic and we didn't sweat much.

I guess some people have less of it than others. I can miss lunch and dinner and still experience no problems. She can't and she starts to get headache.

I also learnt a lesson on Saturday! And I really regret not being able to give her more suggestions at breakfast and on the way. I am the scientist at home and she is the humanist (we always joke together that we make a brain in two... ). But I completely failed to understand that she was going low on carbohydrates.

 

[C clearly]

I really regret not being able to give her more suggestions at breakfast and on the way. I am the scientist at home and she is the humanist

I'm glad you are feeling reassured after the consultation with her doctor.

Even humanists are able to learn the signals that only they can feel in their bodies, and learn to pick their own breakfasts and snacks!

 

[truenorthpilgrm]

You are one of the few here - together with @raincitygal - who understood what I was looking for and responded accordingly: direct experience.

Per your original post (quoted below) it wasn't at all clear you were asking for direct and anecdotal experiences. Responses suggesting you direct questions to a medical professional were very appropriate.

My question is whether you think it is appropriate to continue with these hikes, including - of course - trying to make more stops for drinking and eating? This is her first time but other times, looking back, she had felt almost faint, only we had underestimated it.

 

[JustOneGuy]

Per your original post (quoted below) it wasn't at all clear you were asking for direct and anecdotal experiences. Responses suggesting you direct questions to a medical professional were very appropriate.

You are right. I should have been more clear...

 

[Pelegrin]

I think that all routes of 22 kms in La Palma require a good shape.

 

[JustOneGuy]

I think that all routes of 22 kms in La Palma require a good shape.

Actually I do not know by first experience about all the caminos, but it's someway true that is a very steep island. Someone says that is the "steepest" inhabited island in the world (this claim is highly questionable though...).

 

[SharkT]

Yesterday with a couple of friends, my partner and I went for a long walk in the mountains of the island where we live: 22 km in total and 960 m of elevation gain uphill. Nice temperature (16-18 C). Everything went well, we had a great time despite some rain, until, arriving after about 6 hours in a small village where we thought we would get a “bocadillo” (sandwich) before catching a bus back, my wife sat down and started to feel sick. Shortly thereafter she fainted.

We immediately called an ambulance that arrived after about 20 minutes (we were in a small, isolated town) and transferred her to a medical center where they examined her: hypoglycemia. On the way she vomited, which looks typical.

All other values-pressure, heart rate, blood oxygen were perfectly normal. They gave her a glucose and anti-nausea drip and we took her home soon after. She has had periodic blood tests at the same center recently, but she is still waiting for the results.

I am mainly to blame : first, it was the first time my wife, who is a good walker in good physical shape for her age (62) anyway, covered such a distance in the mountains (and I insisted to convince her...). Second - I had prepared a good quality bag of various high-quality supplements and food, but.. it was left at home when I made changes in my backpack at the last moment. We just had some bread and Parmigiano Reggiano with us, plus 3 liters water, but she didn't eat and drink very much of them.

My question is whether you think it is appropriate to continue with these hikes, including - of course - trying to make more stops for drinking and eating? This is her first time but other times, looking back, she had felt almost faint, only we had underestimated it.

By the way, she totally recovered although we are staying at home just relaxing today.

I will end by saying that the staff at the bar was of absolute kindness, helping us, talking to the 112 instead of me (who speaks Spanish only as a second language), smiling and trying to comfort me with a courtesy that, thinking back, literally brings tears to my eyes. They also vacated one of the rooms in the bar for us. The ambulance and medical center staff were also of absolutely outstanding competence, professionalism, and kindness.

And all completely free of course: we are in Spain.

Thank you Europe, for existing and being the place where I live!

I experienced something similar years ago while snorkeling and fighting a tide. I had skipped breakfast, and my energy levels dropped - I made it back to shore but everything in my vision was turning red. What I have learned is that I need protein snacks available, such as nuts, beef jerky, or ham & crackers, instead of anything sweet. Sweets will make me sick.

 

[JabbaPapa]

My question is whether you think it is appropriate to continue with these hikes, including - of course - trying to make more stops for drinking and eating? This is her first time but other times, looking back, she had felt almost faint, only we had underestimated it.

I'd personally say that's up to your wife -- and also, now that you are aware of this potential problem, then you should have no problem devising some strategies for preventing it in future. I think the most efficient glucose fast-delivery systems, or among them anyway, are normal Coke (not zero) and orange juice (freshly pressed if possible, otherwise bottled). There's beer too, though that may not be to your wife's taste, but carrying some coke in her pack might be a good idea. Some pilgrims swear by Aquarius for these sorts of purposes.

And whilst for some people setting off on an empty belly can be good practice, that's clearly not so for your wife. Animal fats are the most efficient way to maintain good base glucose levels, and BTW that can be via eggs, yoghurt, cheese and not just fatty meats or fish. Fruits are good too. Careful with veg, especially greens, as they can require more energy to metabolise than what they provide.

 

[JabbaPapa]

The fact that no one has reported such episodes on a forum like this, where most people are used to very long walks worries me a little.

I have seen a few mentions of it here and there on the forum -- though I think that "most people are used to very long walks" is germane here, in that whatever recurrent problems of this sort that we have had to face individually tend to have been resolved in our pasts during prep or during those walks.

Maintaining proper energy levels on these walks is a problem that varies from one individual to the next, with no one-size-fits-all magic solution.

I hope you both had good advice from the doctors !!

 

[dreaming]

I did a Park run last week in Australia in 28 degree heat. I felt like I needed water and a cold shower at the end. I had a can of Fanta lemonade and felt instantly fine. Another runner had heat stroke and lost his vision. I gave him water, lay him on his back and elevated his legs. I have no idea how hydrated he was before the race.