Going High with Type 1 Diabetes

Leal, Conxita

doi:10.1089/ham.2005.6.14

Cited by 17 publications

(11 citation statements)

References 22 publications

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“…We have found a total of eight reported or cited cases of diabetic ketoacidosis at altitude, three of which were lethal (65), and one occurred in a subject with undiagnosed type 2 diabetes and HAPE (66). One fatal case of HACE in a subject with type 1 diabetes was reported (67), and one case of AMS in a subject with metabolic syndrome was reported (68). Type 2 diabetes is associated with obesity and a lower ventilatory response to hypoxia (6), both of which are risk factors for the development of AMS (69,70).…”

Section: Acute Mountain Illnesses In Subjects With Diabetesmentioning

confidence: 99%

Physical Activity at Altitude: Challenges for People With Diabetes

Mol

Vries²,

Koning

et al. 2014

Diabetes Care

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A growing number of subjects with diabetes take part in physical activities at altitude such as skiing, climbing, and trekking. Exercise under conditions of hypobaric hypoxia poses some unique challenges on subjects with diabetes, and the presence of diabetes can complicate safe and successful participation in mountain activities. Among others, altitude can alter glucoregulation. Furthermore, cold temperatures and altitude can complicate accurate reading of glucose monitoring equipment and storage of insulin. These factors potentially lead to dangerous hyperglycemia or hypoglycemia. Over the last years, more information has become available on this subject. PURPOSETo provide an up-to-date overview of the pathophysiological changes during physical activity at altitude and the potential problems related to diabetes, including the use of (continuous) blood glucose monitors and insulin pumps. To propose practical recommendations for preparations and travel to altitude for subjects with diabetes. DATA SOURCES AND SYNTHESISWe researched PubMed, medical textbooks, and related Internet sites, and extracted human studies and data based on relevance for diabetes, exercise, and altitude. LIMITATIONSGiven the paucity of controlled trials regarding diabetes and altitude, we composed a narrative review and filled in areas lacking diabetes-specific studies with data obtained from nondiabetic subjects. CONCLUSIONSSubjects with diabetes can take part in activities at high, and even extreme, altitude. However, careful assessment of diabetes-related complications, optimal preparation, and adequate knowledge of glycemic regulation at altitude and altitude-related complications is needed.An increasing number of subjects with diabetes reside at high altitude for short periods of time, partly for work, but mainly for recreational purposes such as skiing, trekking, and climbing. Exercise under conditions of hypobaric hypoxia poses some unique challenges for subjects with diabetes and could potentially lead to dangerous situations such as unexpected hypoglycemia and hyperglycemia, inaccurate

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Section: Acute Mountain Illnesses In Subjects With Diabetesmentioning

confidence: 99%

Physical Activity at Altitude: Challenges for People With Diabetes

Mol

Vries²,

Koning

et al. 2014

Diabetes Care

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“…On the other hand, the current study has clearly shown that HbA1c levels significantly increased in diabetic subjects living in moderate altitude compared to diabetic individuals living at sea level. It has been demonstrated that diabetic mountaineers report a reduction in metabolic control (Pavan et al, 2003;Leal, 2005), as demonstrated by elevated HbA1c, insulin requirements, and capillary blood glucose (Moore et al, 2001;Pavan et al, 2004). Reduced insulin sensitivity is thought to be the major factor contributing to these effects (Brubaker 2005;Leal 2005).…”

Section: Discussionmentioning

confidence: 99%

“…It has been demonstrated that diabetic mountaineers report a reduction in metabolic control (Pavan et al, 2003;Leal, 2005), as demonstrated by elevated HbA1c, insulin requirements, and capillary blood glucose (Moore et al, 2001;Pavan et al, 2004). Reduced insulin sensitivity is thought to be the major factor contributing to these effects (Brubaker 2005;Leal 2005). It was recently suggested that the influence of hypoxia is associated with high glucose (Kanafi et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

“…After short-term exposure to altitude, men and women appear to be less sensitive to insulin than at sea level (Braun et al, 2001;Jakobsson and Jorfeldt, 2006). With increasing altitude, diabetic mountaineers report a reduction in metabolic control (Pavan et al, 2003;Leal, 2005) as demonstrated by elevated HbA1c, insulin requirements, and capillary blood glucose (Moore et al, 2001;Pavan et al, 2004). After further altitude acclimatization, fasting glucose concentration is the same (Sawhney et al, 1991;Young et al, 1992) or below sea level value (Brooks et al, 1991).…”

Section: Introductionmentioning

confidence: 99%

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Changes in the Levels of Cytokines in Both Diabetic/Non-Diabetic Type I Children Living in a Moderate Altitude Area in Saudi Arabia

Allam

Alsulaimani

Alghamdi³

et al. 2014

High Altitude Medicine & Biology

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“…In a wilderness setting, ketoacidosis carries a high risk of mortality (Basnyat,1995;Shlim and Gallie, 1992). It would appear that it is a relative lack of insulin (reduced or no dosing, reduced efficacy from environmental/heat damage, misdosing due to meter error) in conjunction with other factors such as dehydration, infection, AMS, or continuing to exercise with ketonuria that particularly raises risk (Leal, 2005;Moore et al, 2001b).…”

Section: Hyperglycemia and Ketoacidosismentioning

confidence: 99%

The Practical Aspects of Insulin at High Altitude

Richards

Hillebrandt

2013

High Altitude Medicine & Biology

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With the increasing prevalence of diabetes and current social philosophy of enablement, many more diabetics are travelling to high altitude where the rate of AMS in Type 1 diabetic mountaineers is no different than nondiabetics. Numerous effects of exercise, both degree and duration, dietary change, illness, stress, mountain sickness, counter-regulatory hormones, and altitude increased sympathetic output, and catecholamines have led to conflicting accounts of insulin requirement increasing or decreasing at altitude. Overall, it would appear that the effects of diet and exercise outweigh those of altitude. Good control requires continual insulin dose adjustment with frequent feedback from blood sugar testing, but glucometers can over- or under-read at altitude. Additionally, heat or cold exposure can degrade insulin efficacy; strategies for storing insulin are described.

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Going High with Type 1 Diabetes

Cited by 17 publications

References 22 publications

Physical Activity at Altitude: Challenges for People With Diabetes

Physical Activity at Altitude: Challenges for People With Diabetes

Changes in the Levels of Cytokines in Both Diabetic/Non-Diabetic Type I Children Living in a Moderate Altitude Area in Saudi Arabia

The Practical Aspects of Insulin at High Altitude

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