Climbers with diabetes do well on Mount Kilimanjaro

Abstract

More than 30 000 climbers attempt to reach the summit of Mount Kilimanjaro every year; it is likely that a significant proportion have diabetes [1]. Summit success rates in climbers with diabetes appear to be similar to those without diabetes [2,3], with the exception of a study carried out on Mount Kilimanjaro in 2001, in which all 15 climbers with Type 1 diabetes failed to reach the summit [4]. One explanation suggested for this discrepancy is the short time of 5 days allowed for climbers to reach the summit of Kilimanjaro at 5895 m.Whilst investigating altitude physiology and acute mountain sickness (AMS) on tourist trekkers attempting Kilimanjaro, we compared a group of 11 climbers with Type 1 diabetes [six males, five females, age 20 ± 7.6 years (mean ± SD ), body mass index (BMI) 22.0 ± 2.3 kg/m 2 ] with 275 subjects without diabetes (180 males, 95 females, age 33 ± 12.1 years, BMI 23.0 ± 2.8 kg/m 2 ). All subjects gave written informed consent and ethical approval was obtained from the Tanzanian Commission for Science and Technology (COSTECH reference 2005-261-NA-2005. Eight of the eleven diabetic climbers (73%) took regular acetazolamide as AMS prophylaxis, compared with 66 (24%) of subjects without diabetes. The climbers with diabetes attempted the mountain over 7 days, with two acclimatization nights at 3700 m during ascent. Seven of the eleven climbers (64%) reached the summit, a success rate comparable with that of the rest of the hiking population (61%); three reached 5600 m, and one reached 4700 m. Reasons for turning back were AMS symptoms of dizziness, fatigue and nausea.AMS scores (Lake Louise questionnaire) were not different between those with or without diabetes (median = 6, range 1-15 versus median = 6, range 1-21 respectively on the summit day, P = 0.389). The physiological response to high altitude in the diabetic group was not different to that in nondiabetic climbers (SaO 2 , respiratory rate, heart rate and lung function). Although we did not have access to capillary blood glucose measurements, members of the group monitored their own measurements regularly whilst on the mountain.Mount Kilimanjaro is an extremely popular tourist mountain, and the risk of AMS is high for everyone. Climbers with Type 1 diabetes should not have a higher rate of AMS and should not have a reduced chance of success if they are well prepared and acclimatize, and we suggest the two extra acclimatization nights and the high rate of acetazolamide use were critical factors in this group's success. References1 Brubaker PL. Adventure travel and type 1 diabetes: the complicating effects of high altitude. Diabetes Care 2005; 28 : 2563 -2572. 2 Pavan P, Sarto P, Merlo L, Casara D, Ponchia A, Biasin R et al . Extreme altitude mountaineering and type 1 diabetes: the Cho Oyu alpinisti in Alta Quota expedition. Diabetes Care 2003; 26 : 3196-3197. 3 Admetlla J, Leal C, Ricart A. Management of diabetes at high altitude. Br J Sports Med 2001; 35 : 282-283.

Physical Activity at Altitude: Challenges for People With Diabetes

“…The incidence of AMS in subjects with type 1 diabetes does not differ from that of nondiabetic subjects, and, in reported studies, the use of acetazolamide was similar in both groups (47,50,61). Acetazolamide should be used with caution as it may lead to increased diuresis and acidosis (62).…”

Bronchial asthma on Mount Kilimanjaro is not a disadvantage

“…This is similar to trekkers with other chronic diseases 5. However, we recognise that these individuals have self-selected; only those with well controlled disease participate in such physical exertion and we are relying on unverified diagnoses.…”

The Practical Aspects of Insulin at High Altitude

“…During the Diabetes Federation of Ireland Kilimanjaro Expedition 1999, the two sickest diabetics had been taking acetazolamide and one remained acidotic, even after achieving euglycemia and resolution of ketonuria (Moore et al, 2001b). Overzealous insulin dose reduction above, continued exertion whilst ketonuric and dehydration were likely contributory as a later study, again on Kilimanjaro with a similar ascent profile where 8 of 11 Type 1 diabetics took acetazolamide, did not have these problems (Kalson et al, 2007). Nevertheless, with the potential to worsen acidosis, some caution in the use of acetazolamide is advised.…”

“…Nevertheless, as the prevalence of diabetes is now 4.4% in the United Kingdom (HM Government UK 2009), 8.3% in the USA (American Diabetes Association 2011), and anticipated to affect 366 million worldwide by 2030 (Wild et al, 2004), diabetics inevitably travel to high destinations for business, or as tourists, skiers, trekkers, or mountaineers, and appear to cope reasonably well. Acute Mountain Sickness (AMS) rates of Type 1 diabetic mountaineers at high altitude appear to be no different to nondiabetics l 2001;Kalson et al;l 2007;l 2001b;l 2003).…”