Journeys to High Altitude—Risks and Recommendations for Travelers with Preexisting Medical Conditions

Mieske, Kelly; Flaherty, Gerard; O’Brien, Timothy

doi:10.1111/j.1708-8305.2009.00369.x

Cited by 84 publications

(40 citation statements)

References 124 publications

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“…Glucose needs change with changes in physical activity, delays in meals, changes in diet (e.g., unknown carbohydrate values in unfamiliar foods), and physiologic stress which may ultimately lead to needing changes in insulin dose [23][24][25][26]. Additional travel-related issues that need to be considered are co-morbidity control, travelrelated infections, problems carrying injection material through travel security checkpoints, and unanticipated problems with their glucose meters, insulin pumps, or continuous glucose monitors.…”

Section: Discussionmentioning

confidence: 99%

How do you get there with Diabetes? Results of a Survey of Diabetic Travelers

Elkins¹,

True²

2014

J Tourism Hospit

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Section: Discussionmentioning

confidence: 99%

How do you get there with Diabetes? Results of a Survey of Diabetic Travelers

Elkins¹,

True²

2014

J Tourism Hospit

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“…Pilgrims with pre-existing problems such as diabetes, peptic ulcer disease, and coronary artery disease need to see a knowledgeable physician and obtain as much advice as possible regarding their illness and travel to high altitude, including the medical advisability of going on the high altitude pilgrimage (Mieske et al, 2010;Basnyat and Tabin, 2011) in their present condition. But at the same time, simply turning away the pilgrims (who often have a strong desire to make the pilgrimage) with these illnesses without proper assessment and optimal medical therapy is inadvisable.…”

Section: Pre-travel Evaluationmentioning

confidence: 99%

High Altitude Pilgrimage Medicine

Basnyat

2014

High Altitude Medicine & Biology

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Religious pilgrims have been going to high altitude pilgrimages long before trekkers and climbers sojourned in high altitude regions, but the medical literature about high altitude pilgrimage is sparse. Gosainkunda Lake (4300 m) near Kathmandu, Nepal, and Shri Amarnath Yatra (3800 m) in Sri Nagar, Kashmir, India, are the two sites in the Himalayas from where the majority of published reports of high altitude pilgrimage have originated. Almost all travels to high altitude pilgrimages are characterized by very rapid ascents by large congregations, leading to high rates of acute mountain sickness (AMS). In addition, epidemiological studies of pilgrims from Gosainkunda Lake show that some of the important risk factors for AMS in pilgrims are female sex and older age group. Studies based on the Shri Amarnath Yatra pilgrims show that coronary artery disease, complications of diabetes, and peptic ulcer disease are some of the common, important reasons for admission to hospital during the trip. In this review, the studies that have reported these and other relevant findings will be discussed and appropriate suggestions made to improve pilgrims' safety at high altitude.

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“…Poorly controlled diabetics are at increased risk of dehydration (due to hyperglycemic osmotic diuresis), heat illness (Kenny et al, 2010;Yardley et al, 2013), or hypothermia (impaired thermogenesis in hypoglycemia), and any peripheral vascular or peripheral neuropathic complications that increase the risk of cold injury or frostbite. Other comorbidities such as renal, coronary artery, or ocular disease add further hazard to altitude travel (Bartsch and Gibbs, 2007;Burtscher, 2007;Luks et al, 2008;Mader and Tabin, 2003;Mieske et al, 2010;Milledge and Kupper, 2008;Wu et al, 2007). 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.…”

Section: Introductionmentioning

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.

show abstract

Journeys to High Altitude—Risks and Recommendations for Travelers with Preexisting Medical Conditions

Cited by 84 publications

References 124 publications

How do you get there with Diabetes? Results of a Survey of Diabetic Travelers

How do you get there with Diabetes? Results of a Survey of Diabetic Travelers

High Altitude Pilgrimage Medicine

The Practical Aspects of Insulin at High Altitude

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