Monday 13th September 2010Day 3, Puivert – Espezel 9.72 miles climb 1783 ft descent :513 ft

(Garmin says 3102 calories)
Awoke to a blood glucose of 4.8mmol, again not too big a drop. OH went into the village for croissants and bread . We had some boiled eggs with bread for breakfast, I saved my croissant for elevenses.
At last we were on the Cathare trail proper. Puivert nestles at the very edge of the Pyrenees; the way forward was clear, round the lake, across the fields and upwards towards the higher ground.

The lake and castle at Puivert

Thats where we were going

The first 1.9 miles had only 121 ft of climb so was a gentle start. Then it got tougher. As we started to climb I became very conscious of the weight of the rucksack, it was one thing of the flatter ground but going uphill it slowed me quite a bit .The trouble is I’m not one of those people who can get by with the bare minimum of luggage. We took it steadily with frequent stops for tiny jellies and choc apricots, glucose levels were on the low side but not too low . I soon discovered that if my right shoulder was beginning to feel sore my levels needed topping up. It was almost as reliable as using the meter.

We spotted this newborn just before we started to climb up through the woods

The trail went gradually upwards though because it was through woodland it was more enclosed than I like with few long vistas. We saw more people today including some mountain bikers riding hell for leather down the hill.
The woodland trail eventually lead to the village of Escale, our lunchstop.

The village like so many others in the area helped provision the local Maquis. In August 1944 it was totally destroyed, set alight by Nazi troops .It wasn’t rebuilt until the mid fifities and there is a display showing the harsh temporary living condtions suffered by the locals during the early post war years.
After lunch we regained the trail which continues further upwards, past the PC du Masquisards, the stone hut which was the base of the Maquis. This was also set alight by the Germans but the resistants had already fled. It was restored in 1993.
The path eventually stopped climbing. We had started in Puivert at about 1550 ft and had climbed to about 3,200ft. We had started out walk amongst cultivated fields, it was really odd to have climbed so far and to be again in an area of very flat, cultivated fields. This was the Plateau du Sault and we were able to speed up for the last few miles to Espezel where we were going to camp.

In spite of the flatter terrain, we were quite shattered when we arrived, we eagerly anticipated putting up the tent and a shower .
The campsite was on our way into town, but our faces dropped when we saw it; long grass, a few ancient caravans, no sign of life. We went in, found a building and pushed the door open. It was the sanitation block, one door opened to show a loo au Turque, in the corner was a sink that didn’t look much more modern than the lavoir in our village, and much dirtier. We don’t mind camping, but this was more like slumming it.
We walked out and wandered into town We met a young French girl, she and her boyfriend were also doing the Cathare Trail, they had decided to bivouac outside the village. We felt we were too old for that so investigated other possibilities. We soon found the gite d’etape, actually an Auberge . Yes they had room and we were soon installed in a comfy double room complete with shower. We were going up in the world!

If you want a fun evening, stay at the Gite at Espezel. Its owner sporting a typical French beret is a fabulous mine host. The food is good and in available in huge quantities, no one would leave hungry. The wine flows very freely. There is no choice, but it was all good, charcuterie, duck, salad, sauté potatoes, cheeseboard, tarte aux myrtilles. Our fellow guests at the gite were a group from Denmark on a week’s organised trip (the type where your luggage goes from place to place, (I sometimes got a bit envious) They spoke good English and we all got along well. From them we learnt that there was an English/Australian group staying at the hotel. We also met an older French couple. The two groups and the 2 couples were to become our companions on the journey, overtaking them, being overtaken and meeting up in the evening. I really enjoy this aspect of long distance walking in France. Mine host decided to initiate our Scandinavian friends into the intricacies of drinking from a poron (none of them seemed to have spent youthful holidays in the Costa Brava). I ended up impressing him by joining in with the chorus of the Occitan anthem . We rather staggered to bed, my meter tells me I remembered to test, it was 4.9 thought fortunately had risen slightly when I tested during the night. Meals like that take a fair time to digest!

The graph shows reasonable control during the walk, so far but I was still skirting the lows a bit, its difficult to realise just how much you need to reduce the insulin when you are using so many calories each day. The mountain at the beginning, well it was certainly odd, perhaps something on my fingers from packing, or perhaps raised adrenalin levels as I started the walk. Who knows?

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Sunday 12th September 2010 Day 2 Ste Columbe sur L’Hers- Puivert 9.14 miles

Great morning, reading, it dropped just a bit and was 5.3mmol.
After a breakfast of boiled eggs and bread we took down the tent. We had arranged to buy some croissants from the little shop but neither of us felt like venturing into the village before breakfast.. We picked them up on the way and they made a very satisfactory 2nd breakfast later in the morning.
Unlike the the first day we had to rely on out map reading skills, the route followed footpaths but not any official route. We met no other walkers all day so it felt a bit remote and off the beaten track. The path started on the green way

but soon turned into the woods to climb through the woods

Then sharply down into the valley to out lunchtime stop of Rives, a sleepy place with a tiny village square to have our lunch in. During the morning, my pump had been firmly down at 20% , every now and then we stopped checked levels and I ate a few chocolate apricot bits ( OH put them in at the last moment and they were excellent fairly low gi carb nibbles. Lunchtime though glucose was just below 4mmol so very much time to refuel. We ate what was to be a typical lunch of bread soft cheese, tomatoes and peaches washed down with water.

After lunch, having gone down we went up again. The path was at times even more difficult to follow than in the morning. At one time it had been ploughed up and moved to the other side of a field. Fortunately OH map reading skills came to the fore and we worked out where we were.

It wasn’t the most scenic route since for a lot of the time we were enclosed by trees but occasionally we got glimpses of the mountains ahead.

Puivert castle came into sight, to our left. It was a little strange realising that this was one of the Cathar castles but we wouldn’t be getting any nearer.

Puivert itself was a busy little village . The municipal campsite was beside the lake and for once we weren’t the only people on site. We were given a large pitch for our tiny tent but had the luxury of our own electricity to recharge the garmin and mobile phone. (on other campsites we used the plugs in the sanitary blocks)
Tent up we collapsed for a while, unused muscles were beginning to protest but not for long as we had to find food. Glucose levels with the reduced basals, extra breakfast and the odd handful of chocolate apricots had been reasonable all day but a good dinner was a welcome prospect....Tonight it was at an Afghan restaurans , a rather odd thing to find in this part of France. Sadly we were a bit conscious of expenses so didn’t go for the specialities and I went for the menu fixe of salade with lardons (OK but not as good as the night before) and steak frites. OH went for a curry which was much better than they usually are in France. It was just light when we got back to the tent but it wasn’t long before darkness fell One thing about this walking is to remember to cut the bolus insulin with evening meals, the first night was a bit low considering the large meal and it had been a less hilly day. So I reduced the bolus by a couple of units. It didn’t make much difference as when I checked at bedtime, only about an hour after the meal but it was almost dark so it had to be bedtime it was 6.3mmol. Hoping that it wouldn't drop to far during the night I slept.

Day 1 Lavelanet to Ste Colombe sur L'Hers (8.29 miles.)

When we picked it as base we knew nothing about Lavelanet It was simply central and on some major footpaths.
We found it’s not a particularly beautiful town but seems like a good place to live with lots of things going on , some good shops and what seems to be a lot of communal/regional investment. We noticed two sports stadiums, a little theatre, a gym, outdoor pool, even the judo club had dedicated premises. The municipal campsite had a really good new, clean sanitation block, absolutely vital for making camping a reasonable experience. The site was managed by a very helpful lady who agreed that we could leave our car inside the site for the week.
The town used to be a centre of the textile industry. It grew up alongside a fast river. In early times the water was important for washing and dyeing the fabrics; later the water was used to power the looms. Many of the old factory buildings still exist and when we peered through the windows of one near to the textile museum we realised that it was still equipped (or reequipped for display?) with looms.

We slept the night in the ‘monstrosity’ , a tent that gives us loads of space but offends my artistic sensibilities , tents should be nice quiet colours not loud orange and reds. Unfortunately neither of us had a good night as we both felt a bit cold.

It took us forever to pack up the tent, pack and repack rucksacks trying to make sure we didn’t leave anything behind and then get going. It was 11.20am by the time we walked out of the campsite. As soon as I was out of the gate I realised I hadn’t checked glucose level, stop take off backpack; check. ...11.4mmol. I’ve no idea where that came from but decided not to correct Because it was so late we decide to stop for a coffee when we got into town but on arrival the cafe is shut with a , notice on the door ‘en greve’ .(.on strike), momentary panic...what if we get to our first stop and everywhere is shut because of the strike, will we get anything to eat? A quick look around reassures us as the cafe is the only business closed. About 20min later we find an open cafe (Lavelanet is a long town) and check glucose level which had descended to a more reasonable 7.4mmol. In fact at this point I lower my basal rate on the pump to 50%.
Restored (we’d done less than 2 miles!) we shouldered our packs and found our way out of Lavelanet onto the Voie Vert; an old railway track.

We were sensible to choose this route for day 1. It was a fairly easy, flat walk but with a backpack it took us far longer than it would do normally.

We went through a number of small towns once industrially important, now merely sleepy. It astounded me to learn that one industry horn working was big enough to necessitate the importation of horns all the way from New Zealand. I was a bit nervous as we approached a long tunnel, but I had no need to be,it contained movement activated lighting!

By lunchtime I knew that exercise was working it's magic on the glucose levels and I was in the high 3s by the time we sat down on the grass to eat. I cut the insulin for lunch in half and reduced the basal to 20% (0.1unit per hour). Even so I was sub 4 later and needed to stop for a snack before we got to our days campsite.
The site, just next to the track was basic but that didn't matter, we had it to ourselves. We set up camp and went out in search of food. First we found a little shop and checked they would be open the next morning so no worries about picnic for the next day.

We found a very unassuming looking restaurant and booked a table, then back to the site to rest a bit.

The restaurant was a brilliant surprise, A la Bonne Table was a cafe at the front , but at the back, a huge dining room. Since there were no windows the room was dark but was heated by a huge open fire (rather incongrous after the hot day) Later on we noticed it was used to grill steaks.
The meal was fantastic value for money. The portions were generous and everything was beautifully presented. To start a salad with lardons , this was big enough for a main course on it's own, a mixture of leaves topped with a mountain of crisply cooked lardons. To follow I had trout. It came scattered with almonds and accompanied by mussels, prawns and a creamy sauce...with a large number of slightly spicy baked potatoes (sans skin)...my glucose levels were good and I knew I had no fears about the amount of carbs but I couldn't manage all of them. After that a local sheeps cheese and to finish a thin slice of 'Opera', a gateau filled with a chocolate mousse.
A brisk walk home and to bed in our lightweight tent. A structure altogether more tasteful than the monstrosity

and whether it was the food and wine, or the temperature both of us felt very much warmer than the night before. Glucose level was 5.9 mmol, just a little worried that it might be too low.

Hi Ho, Hi Ho, It's Off To Walk We Go.

All packed including the kitchen sink.

This is my first multi day walk since the pump, hopefully fewer hypos than last time on MDI. Being able to reduce background insulin is my main reason for having it.

And meanwhile, here is one of the ups on our journey.

Montségur *this photo was taken by User:Gerbil from de.Wikipedia in August 2006 Category:Montségur)

Kit list

Ok, this is what I've worked out so far. I've also got a second list of things that can go in the car for a more relaxed camp in week 2. I find it very difficult not to try to cover every possibility so I end up with far too much so this maybe more than we take....although I still might think of some essentials we can't leave behind!

Proposed Personal Kit
(until I weigh it and
decide what I don't really need)
Walking poles ***********************Rucksac 50 litre
Sleeping bag ultralite**sleeping mat****Silk sheet sleeping bag
Survival blanket*********************1.5 litre water bottle
Lightweight towel********************Toothbrush/flannel etc
Pants 5***************************** Bras 3
Pyjama top and shorts*************** 3 pairs walking socks, 2pairs ordinary socks
1 pair shorts*************************1 pair convertible shorts/trousers
3 breathable t shirts***************** 1 smarter blouse + 1 t shirt
1 lightweight zipped fleece*************Waterproof Poncho
Sandals ****************Walking boots *********** hat
Camping spoon/knife/forkPlate/cup
Book to read/pen/notebook************ Medical alert bracelet

Diabetes Supplies
Frio ; 1.5 vials insulin; 3 reservoirs; 4 infusion sets; 4 vials chlorehexidine;4 pkts gauze squares ; 2 spare batteries; Meter with new battery ; 3 tubs strips;
3 packets dextrose Small plastic bottle for sharps lancets
In case of pump problem emergency telephone number
Pump failure kit needles ; 2 apidra pens; 2 novorapid pens

And these things have to be divided between OH and I.

Tent Mckinley moonlight 3.2 kg************* Campin Gaz 206 stove with bottle
2 person cook set *************************Wooden spoon/spatula
Plastic egg cups ***************************Egg container with 6 eggs
Tiny salt pepper **************************Small bags with spices/herbs
Dehydrated curry for emergency ***********350g packet wholemeal wraps(If we can't get bread)
Teabags,coffee sachets, sweetner ************100g Dried milk in ziplock
50g Choc drink powder in ziplock************ 200g Muesli in ziplock
200g wholemeal pasta *********************Packet parmesan
Cereal barres ***************************** Matches/lighter
In small plastic bottles, cooking oil, washing up liquid, clothes washing liquid, tiny pegs
Shampoo/shower gel. toothpaste Small tube sunscreen Loo paper
Small first aid kit/ibuprofen/immodium/blister plasters
Camera Spare xd card ; Garmin fore runner and charger; Mobile phone and charger;
Swiss army knife; pan scourer
Maps : 1:25 2247 OT Lavelanet Montsegur 2147 ET Foix

Books: Le Sentier Cathare Barthes ; The Cathar Way Mattingly
Compass/whistle ; Bank cards ; Cash ; Carte vitales./prescription

Oh last but not least a portable, foldable kitchen sink!

More ups and Downs

I'm back, to blog some more ups and downs.

This time not glucose levels, but I'm sure that will come into it. We're off on Friday for a long walk in the Pyrenees . We're doing seven days inclding part of the Sentier des Cathares and then we'll stay at a campsite and do some day walks to some of the other Cathare Castles. We had intended to walk the whole Cathare way but after looking at the logistics found that it would cost far more than we would afford so this is our compromise.


We will drive to Lavelanet on Friday . Next morning is quite a gentle start following the Voie Vert, an old railway now converted to a footpath to Ste Columbe sur L'Hers . Next day we walk to Puivert where we join the Sentier des Cathares walking to Espezel, Comus, Monsegur and Roquefixade. The last stage of our walk will take us back to Lavelanet. Some nights we are camping, others staying in gites d'etape (bit like a youth hostel). We've tried to plan quite carefully as some places are miles from the nearest shop or restaurant. We need to make sure that we can get the ingredients for each meal.(and not have to carry too much).


The map shows an aproximate route, and isn't actually that far at about 75 milesbut I think there are some wiggles missing. I hope to use the garmin I use for running to get an accurate trace of each days stage

The elevation profile shows why daily distances are relatively short. According to Mapmywalk there is one HC climb (the hardest) and 1 Cat 1, 2 cat 2, 1 cat 3, 3 cat 4 and 5 cat 5 climbs on the route but as I put the route in fairly roughly it might be very inaccurate, we shall see.

Whole Blood or Plasma?

Mary, Mary quite contrary
How does your meter read?
With millimoles ,
Or milligrams
And clinical accuracy?

Mary Mary quite contrary
What does you meter mean?
Glucose in blood whole?
Or from the plasma sole
It's average your A1c?
With Apologies to Northerner: imitation is the sincerest form of flattery! (I don’t think it scans as well as your poems)

Any PWD on the internet soon realises that different parts of the world use different measurements for blood glucose readings. In the US, some parts of Europe and the Middle East they use milligrams per decilitre. In the UK , some parts of Europe and many places that are English speaking (Canada, Australia etc) they use millilmole per litre. To be awkward in France they use grams per litre.
It’s easy to change between the two, there are many convertors on the web but all you have to do to convert mmol to mg/dl is to multiply by 18, if you want to convert mg/dl to mmol/l you divide by 18. After a while you become bilingual.


But there is another difference that isn’t so obvious. When we measure our glucose we use whole blood from a capilliary. When a laboratory measures blood they measure the levels in the plasma.
For many years all the blood glucose meters reported the glucose level as in whole blood but this was not the same as a laboratory measurement would be. A laboratory plasma measurement would be about 12% higher than a whole blood one. In recent years some manufacturers have included a calculation (done automatically) that works out what the plasma reading would be and displays that as its reading.

Imagine you have 2 meters, both perfectly accurate (of that later) one whole blood, one plasma calibrated. You do a test with same spot of blood.
If it were plasma calibrated and it read 72mg/dl, the whole blood meter would read 64.3mg/dl.
So what constitutes a hypo depends upon what meter you are using.

When people in different countries are writing about their levels, they may not be using meters calibrated in the same way.It is important to know what type of meter you have because some blood glucose targets are written to reflect whole blood readings whilst others are written for plasma, if you are reading targets written for whole blood, they may be too low for people using plasma calibrated meters.

In the US all modern meters give plasma readings but in Europe some give plasma and some whole blood, and it’s not always easy to find out which does what. If you want to find out you may have to search.The place I found mine was not with the meter instructions but in very tiny print in the leaflet that comes with the testing strips.

In the UK, the manufacturers have been changing over the years and now according to DUK they all use plasma except for for those made by of of the largest manufacturers Roche ie Accu chek meters. DUK says that ‘ Roche is in the process of adjusting their meters to give results as plasma values, which they hope will be completed before the end of 2009.’ So if you have an Accu chek in the UK read the strips leaflet carefully.

I think that France may well be in the exactly same postion as the UK but I haven’t been able to find out about all makers. My old Meter, an Accu chek go used whole blood measurements, this is no longer made and I don’t know what the newer ones use. (in France they market the Nano and the Nano-performa). The newer Lifescan meters are plasma calibrated (one touch ultra meters). I couldn’t find a definitive answer for the Abbott meters (Optimum plus and Freestyle Papillon). In the UK all Abbott meters are plasma calibrated and I found this statement on the Swiss site ‘ont déjà programmé leurs systèmes de mesure de glycémie pour indiquer des valeurs plasmatiques comme celles relevées sur les lecteurs de laboratoire.’

This chart shows equivalents in mg/dl and mmol for both whole blood and plasma calibrated meters.

Of course even when you know what the meter reads, it’s not necessarily very accurate. They are allowed to be up to 20% out,. There is a convertor on the Lifescan website which demonstrates this clearly.So with that reading (4mmol) you could either be quite hypo and need some glucose quickly , just at a ‘safe’ level or have a very normal blood glucose reading!
And if you find that your HbA1c doesn’t really reflect what your meter has been telling you, perhaps this built in inaccuracy is a possible reason.

This post isn't really applicable to the UK anymore as all new meters are plasma calibrated