Diabetes does not preclude gorilla trekking. Many people with both Type 1 and Type 2 diabetes complete gorilla treks successfully every year, and with appropriate preparation and management the additional complexity of managing blood sugar during sustained physical activity in a remote environment is entirely manageable. The key is specific preparation — not the general advice that applies to all trekkers, but the additional planning that diabetes management on a challenging hike requires.
The physiological challenge: exercise and blood sugar
Sustained aerobic exercise — the type that a several-hour gorilla trek produces — lowers blood glucose levels through two mechanisms: direct glucose utilisation by working muscles, and increased insulin sensitivity that persists for hours after exercise ends. For people managing diabetes, this means that a blood sugar level that is appropriate before the trek begins may fall significantly during and after the hike, and hypoglycaemia (low blood sugar) is the primary acute risk on trek day rather than hyperglycaemia.
The duration and intensity of a gorilla trek vary more than many activities, which complicates pre-trek planning. A 90-minute moderate hike on a morning when the gorilla family is close to the park gate creates a very different metabolic demand than a five-hour strenuous hike when the family has moved deep into the forest overnight. This variability means that flexible blood sugar management — being able to respond to glucose levels as they change during the hike rather than applying a fixed protocol — is more important than a pre-planned, fixed approach.
Pre-trek preparation for insulin-dependent diabetes
For people using insulin pumps or multiple daily injection regimens, the standard pre-exercise protocol of reducing basal insulin and having rapid-acting carbohydrate available during the hike should be adapted for the longer duration and variable intensity of a gorilla trek. Discussing specific adjustments with your endocrinologist before travelling — using the scenario of a hike of three to six hours with variable intensity at altitude — allows you to arrive with a customised protocol rather than a generic one.
Starting blood glucose slightly higher than target — typically around 8–10 mmol/L (144–180 mg/dL) rather than the tighter targets appropriate for sedentary periods — provides a buffer against the glucose-lowering effect of the hike. This is a strategy that exercise physiologists and diabetes specialists recommend for prolonged physical activity and is appropriate for a trek of this duration. Your endocrinologist can advise on the specific starting level appropriate for your management approach and typical glucose response to exercise.
Carry significantly more rapid-acting carbohydrate than you think you will need: glucose tablets, gels, or small packets of juice. The forest environment means that if you run out, there is no pharmacy or shop available, and managing hypoglycaemia with whatever the ranger or porter happens to have in their bag is not an appealing prospect. Pack at least three times your expected carbohydrate requirement for the anticipated duration, stored accessibly in an outer pocket of your daypack rather than at the bottom of the bag.
Blood glucose monitoring during the trek
Continuous glucose monitoring (CGM) devices — if you use one — are genuinely valuable on a gorilla trek, providing real-time glucose data without requiring you to stop and prick your finger at intervals. The receiver or smartphone display should be accessible during the hike rather than packed away. If you do not use CGM, plan to check capillary blood glucose at the start of the hike, approximately 45–60 minutes into the hike (at a natural rest point), and before and after the gorilla hour itself. More frequent checks are appropriate if you are experiencing any symptoms or if the hike is proving significantly longer than anticipated.
Tell your guide and at least one other member of your trekking group about your diabetes before the hike begins. Describe the symptoms of hypoglycaemia clearly — pallor, trembling, confusion, sweating — and explain what they should do if you show these symptoms (stop the hike, give you glucose, wait for recovery). This is not a disclosure that should cause concern to well-trained guides; it is a practical safety communication that allows others to help effectively if needed. Experienced Bwindi guides have encountered diabetic trekkers before and handle the information matter-of-factly.
Equipment and medication storage
Insulin storage in the humid, temperature-variable conditions of a forest trek requires specific attention. Insulin that has been heated above 37°C or frozen loses efficacy and should be discarded. In Bwindi’s highland climate, temperatures during the hike are typically comfortable — 18–22°C — and freezing is not a risk. The main concern is the thermal transfer from your body or backpack straps, which can create localised heating of items in contact with these surfaces.
An insulated insulin carry case — the small, soft pouches designed to maintain insulin at stable temperatures during travel — provides adequate protection for trek day conditions. Keep insulin in the main body of your pack rather than in an outer pocket exposed to direct sun, and avoid leaving it in a bag on the forest floor in direct sunlight during the gorilla hour. The FRIO insulin cooling wallets — which use water-activated crystalline material to maintain cool temperatures without refrigeration — are well-suited to this environment and are worth carrying for any multi-day expedition.
Glucagon emergency kit or equivalent — if you carry one as part of your standard diabetes management — should travel with you on the trek day, not left at the lodge. In the event of severe hypoglycaemia that you cannot self-treat with oral glucose, having the emergency injection option available means that the ranger or another group member can administer it rather than waiting for evacuation. Ensure that at least one person in your group has been briefed on its use.
