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Type 2 Diabetes And High Altitude

Managing Diabetes At High Altitude: Personal Experience With Support From A Multidisciplinary Physical Activity And Diabetes Clinic

Managing Diabetes At High Altitude: Personal Experience With Support From A Multidisciplinary Physical Activity And Diabetes Clinic

Managing diabetes at high altitude: personal experience with support from a Multidisciplinary Physical Activity and Diabetes Clinic Find articles by Sivasujan Sivasubramaniyam 2 Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, St. Mary's Campus, London, UK, 1 Department Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK, 3 Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK, 1 Department Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK, 2 Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, St. Mary's Campus, London, UK, 3 Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK, Correspondence to Dr Neil E Hill; [email protected] *GM contributed to this article but is not affiliated with an academic institution. Author information Article notes Copyright and License information Disclaimer Copyright Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: Physical activity is important for well-being but can be challenging for people with diabetes. Data informing support of specialist activities such as climbing and high-altitude trekking are limited. A 42-year-old man with t Continue reading >>

Diabetes And High Altitude: Your Complete Travel Guide

Diabetes And High Altitude: Your Complete Travel Guide

Does altitude affect your diabetes? Some people say yes, some say no. As with many aspects of diabetic care, it depends largely on the individual. What is altitude sickness? Altitude sickness...as defined by Google is... “Illness caused by ascent to high altitude, characterised by hyperventilation, nausea, and exhaustion resulting from shortage of oxygen.” So basically if you are going higher in the world than what you are used to...Then you are likely to experience altitude sickness. It affects everyone differently- I have had people tell me they couldn’t leave their hotel rooms, to people who managed it easily. Everyone is brilliantly unique! Diabetes and altitude sickness is then a whole other ball game. Blood glucose and altitude Does altitude affects blood sugars? Altitude can impact your blood sugars in a variety of ways... 1) Hypoglycemia and altitude The symptoms of altitude sickness are quite similar to those of low blood sugar (hypoglycemia), such as, sickness, feeling light headed & dizzy, actual headaches & out of breath; so it can make it difficult to actually work out whether you are in a hypo or suffering from attitude sickness- this happened quite frequently with myself in Bolivia & Peru, and I would recommend testing your blood sugars even more frequently to make sure you know the difference. 2) Hyperglycemia and altitude Altitude can potentially cause your blood sugars to go high- now I have seen articles argue for and against this, but I will tell you that in my own experience, this is completely true. At high altitude my blood sugars took a turn for the worst and were a lot harder to control. I frequently had high blood sugars for no other logical reason- and when you have the continual symptoms of a high blood sugar, and the symptoms of altitu Continue reading >>

How Many Factors Actually Affect Blood Glucose?

How Many Factors Actually Affect Blood Glucose?

A printable, colorful PDF version of this article can be found here. twitter summary: Adam identifies at least 22 things that affect blood glucose, including food, medication, activity, biological, & environmental factors. short summary: As patients, we tend to blame ourselves for out of range blood sugars – after all, the equation to “good diabetes management” is supposedly simple (eating, exercise, medication). But have you ever done everything right and still had a glucose that was too high or too low? In this article, I look into the wide variety of things that can actually affect blood glucose - at least 22! – including food, medication, activity, and both biological and environmental factors. The bottom line is that diabetes is very complicated, and for even the most educated and diligent patients, it’s nearly impossible to keep track of everything that affects blood glucose. So when you see an out-of-range glucose value, don’t judge yourself – use it as information to make better decisions. As a patient, I always fall into the trap of thinking I’m at fault for out of range blood sugars. By taking my medication, monitoring my blood glucose, watching what I eat, and exercising, I would like to have perfect in-range values all the time. But after 13 years of type 1 diabetes, I’ve learned it’s just not that simple. There are all kinds of factors that affect blood glucose, many of which are impossible to control, remember, or even account for. Based on personal experience, conversations with experts, and scientific research, here’s a non-exhaustive list of 22 factors that can affect blood glucose. They are separated into five areas – Food, Medication, Activity, Biological factors, and Environmental factors. I’ve provided arrows to show the ge Continue reading >>

Altitude |

Altitude |

Aside from the in-flight experience, you may need to deal with the effects of high altitude if you are traveling to one of various popular destination spots renowned for their high altitude sports such as cross country skiing, snowboarding, or mountain climbing. Having an awareness of how altitude may affect your blood glucose readings in these situations is a must for anyone with diabetes. Most blood glucose meters are dependent on oxygen to work properly. At altitude, the amount of oxygen in the air decreases and can negatively affect the performance of a meter, leading to errors in working out dosages. Most people only pause to wonder about altitude once they are boarding a plane for a long-haul flight, but what about people who live at altitude? There are numerous cities across the globe that are situated in high altitude settings. Individuals with diabetes who live in these cities may regularly administer erroneous insulin dosages. Cities such as these include Colorado Springs, USA (1840 meters, 6040 feet), Mexico City, Mexico (2200 meters, 7220 feet), and La Paz, Bolivia (3640 meters, 11940 feet). For many blood glucose meters, there is about a 1-2% underestimation of blood glucose levels for every 300 meters (1,000 feet) of elevation. This could mean nearly 25% error in the daily meter readings if you live in La Paz! No wonder many individuals have a hard time establishing strong control of their levels while traveling. Even if they are able to hit their target numbers, their meters may not be reading accurately. How frustrating! Further research needs to be conducted to check the performance of glucometers as various altitudes in order to better understand the relationship between altitude and glucometer performance. Until then, speak with your team of medical Continue reading >>

Blood Glucose Monitoring At High Altitudes

Blood Glucose Monitoring At High Altitudes

Blood Glucose Monitoring at High Altitudes I would like to comment on Dr. Christian D. Herter's article in the "Clinical Decision Making" section of Diabetes Spectrum ("DKA on Mt. Rainier: A Case Report," Vol. 12, No. 4, p. 198-200, 1999). Although many people may never attempt the extremes of temperature, altitude, and physical exertion reported by Dr. Herter, the article brought to light some important and often overlooked management issues that can also be experienced in less extreme conditions. Dr. Herter's "five extra essentials" (extra insulin, extra supplies, back-up monitoring supplies, injectable glucagon, and willingness to communicate) should be taken on all trips, not just outdoor adventures. Having dealt extensively with blood glucose monitoring at various altitudes, I would like to further comment on the effects of altitude. As altitude increases over 6,000 feet, all meters and strips can be affected by the decreased oxygen needed for the enzymatic reaction to occur. Cold temperatures further compromise this reaction. I suggest that those traveling to higher altitudes carry control solution and compare the results at high altitude to those obtained at their home altitude. High altitudes affect even visual blood glucose test strips. Individuals with type 1 diabetes who travel need to be aware of these deviance's and to adjust their therapy appropriately to avoid medical emergencies. Continue reading >>

Blood Glucose And Altitude

Blood Glucose And Altitude

I am 72 years old and have had diabetes for 15 years. At sea level in Southern California, with a moderate activity level and normal eating habits, I need between 140 and 150 units of Humalog each day. When I exercise, my blood sugars rise, and I need insulin to come back down. I keep my blood glucose in check by measuring 4 to 6 times per day, and I use both a needle and a pump. I control to between 70 and 110 and have an A1C of 6.2.I currently live in Aspen/Snowmass, Colo., at an altitude of 8,200 feet. Although I do exercise more, my insulin requirement is between 40 and 50 units each day. In addition, when I exercise, my blood sugars drop, so I can only ski or bike starting at an elevated blood sugar level. Quite the opposite from sea level.The dawn phenomenon that I experience requires me to take an additional 15 units of insulin at sea level, but only an additional 6 units when I am at a higher altitude.I have not found an explanation yet for this phenomenon. William McArthur, Aspen/Snowmass, Colorado Continue reading >>

Does Altitude Affect Blood Sugar Readings?

Does Altitude Affect Blood Sugar Readings?

Does altitude affect blood sugar readings? Registration is fast, simple and absolutely free so please,join our community todayto contribute and support the site. This topic is now archived and is closed to further replies. Does altitude affect blood sugar readings? A friend called me today to see if I might help find an answer for him. He is 70, diagnosed type II 2 years, fairly well controlled by diet and exercise alone. Normal bgs. fasting 110-125, dropping to 100 before lunch. 2 hr PP normally in the 130's. He watches his carbs carefully. Around 15-25 grams carb at lunch and 10-15 at other meals -- less than 75 day. Problem is he is vacationing in New Mexico at 8700' above sea level -- he lives at 700' in Texas. His blood sugar has gone up very high with little or no change in his diet. Fasting is now 170's and doesn't drop as it usually does. PP after lunch (his largest meal) is also 170's. Lowest he's been since being in NM is 145+/-. His question is does altitude affect bgs, and if so, what can he do to help bring numbers down without meds? (He's not close to medical help where he's vacationing.) I've searched this forum and found nothing. Did find a a 2 year old thread on another forum that indicated bgs in Type 1s can be affected either way by altitudes above 6500', and meters tend to lose accuracy above that elevation also. Does anyone have any other information or personal experience that I can pass along to him as how he can bring his bgs down? I've been vacationing in Utah for the past week, at 9200 feet, and I find that my BGs are running higher than usual, but not hugely. Average for the last 7 days is running 94; 5% higher than the week before. Fastings all in the 90s (and one 101), after a week in the high 80s. My highs are not necessarily higher (only Continue reading >>

Ain't No Mountain High Enough: Managing Diabetes In High Altitudes (part Ii) | Speaking Of Diabetes | From Joslin Diabetes Center

Ain't No Mountain High Enough: Managing Diabetes In High Altitudes (part Ii) | Speaking Of Diabetes | From Joslin Diabetes Center

Zack McCune snowboarding in Squaw Valley, California While there are many people who enjoy snowboarding, skiing, and hiking in the mountains, there are others who like push the limits even further. Some consider climbing into the clouds to reach mountaintop summits to be the ultimate test of mind and body. For people managing diabetes, mountain climbing can present even more challenges. In the second installment of our two part series, we take a look at what you need to know when your winter activities involve extreme altitudes. In the U.S., some of the highest ski resort summits are Beaver Creek at 11,440 ft, Vail at 11,570 ft, and Breckenridge at 12,998 ft. But what if youre planning on going even higher? Mount Whitney in California has a 14,505 foot summit, Kilimanjaro is 19,308 feet above Tanzania, and Ojos del Salado is a whopping 22,608ft in the air. Theres a lot more to think about than the cold . At those altitudes its pretty complex in that there are a lot of physiological changes that impact the diabetes, says Jacqueline Shahar , M.Ed., RCEP, CDE, a Certified Diabetes Educator and Manager of Exercise Physiology at Joslin Diabetes Center. Although it hasnt been studied extensively, there have been a few studies monitoring climbers with type 1 diabetes as they ascended steep peaks. Besides being attentive to problems experienced at lower mountain altitudes like decreased temperatures, exacerbated diabetic neuropathy from the cold, and increased risk of low blood sugar from low oxygen and increased physical activity, you also have to be aware of worsening diabetic retinopathy . The increased altitude can worsen the affect diabetes has on your eyes and even cause retinal hemorrhages, so make sure to have a thorough eye exam and an okay from your doctor before emb Continue reading >>

Diabetes In The Altitude

Diabetes In The Altitude

I spent the last week in Crested Butte, Colorado, for what has now become an annual family ski trip. The place we were staying was at an elevation of 7,000-something feet. Of course, my mom told us to drink plenty of water and take saltwater nose drops to flush the system out. All of this is fine and dandy, but I wondered what, if any, effect does altitude have on diabetes ? I know that my lungs were working a bit harder to adapt to the drier air. I was out of breath after climbing two sets of stairs. I also found that I needed a snack every couple of hours on the slopes, but this makes sense, as snow skiing is a workout. I would leave the condo every morning with my glucometer, NovoLog FlexPen, needles, and about four granola bars to eat on the lifts in between runs in case I felt a little low. The tricky part here was that it was more of a guessing game, because my glucometer could easily get too cold at the top of the mountain to check my blood glucose. Anyone have any tips on checking your blood glucose outside in really cold weather? This year had exceptionally good weather for spring skiing and we celebrated my niece Sara Reevess fifth birthday. I really enjoy spending time with her and watching her grow up. We skied together and she followed right in my tracks. There is nothing cuter than a five-year-old with pigtails on skis. After a long day on the slopes, we got in the hot tub with everyone for a few minutes and she felt like a big girl. One morning, before breakfast, I was in the kitchen drawing up my insulin , and she was at the bar having cereal. I asked her if she wanted to give me a shot, and she said no. Then she said something that surprised me. She said one of her best friends, Molly, has diabetes. Maybe its just that it was coming from an adorable fi Continue reading >>

High Altitude And Diabetes

High Altitude And Diabetes

As I noted in my previous post, I recently took my diabetes with me on a trip to Tibet. (I offered to let it stay home, but it refused.) In addition to the whole altitude sickness/swollen-brain thing, which seemed likely to occur, given that we were going to be at altitudes up to 5100 meters above sea level, I was worried about how my diabetes equipment was going to function. What if my glucose meter stopped working? What if I was setting myself up for a week and a half of inaccurate readings and altitude-induced insulin resistance? Well, Im back at relatively normal heights now (1700 meters or so above sea level) and I have good and bad news. First, the good: my meter (an Abbott Freestyle and an Abbott Freestyle Navigator CGM) appeared to stand up admirably to my 16,000-foot ascent. I busted open my little bottle of control solution (am I the only diabetic out there who never usually uses the stuff?) and every time I checked, the result came back within the control solutions range. A big relief, even though the change in altitude made the bottle squirt red liquid all over my pants. Why the blood-colored control solution? Why? What the accuracy of my meter made clear, though, was that my second fear altitude-induced insulin resistance was indeed happening. Or, at least something was causing my blood sugar to refuse to budge after correction boluses. It could have been because I got food poisoning on our second day on the road, and spent several mornings vomiting on the toilet (Im all for multitasking, but thats taking it a step too far). But even once I felt better, my blood sugar remained so stubborn that I switched insertion sites to see if something had gone wrong. The tubing was fine; the insulin just wasnt working. I need to do more research on the causes behind a Continue reading >>

Travelling In High Altitudes For People With Diabetes

Travelling In High Altitudes For People With Diabetes

Home Living Well With Diabetes -Articles Management Travelling in high altitudes for people with diabetes Travelling in high altitudes for people with diabetes Two elderly alpine skiers climb on skis and sealskins If you are planning an adventurous trip that involves high altitude, such as mountain climbing, there are some things you should know about high altitude and diabetes management before you travel. Altitude sickness is common in people with and without diabetes after being exposed to high altitudes, although there is no difference in the rates or incidence between the two populations. However, for people with diabetes, being exposed to high altitudes for lengthy periods of time can have an effect on their disease. A handful of studies have been conducted regarding mountain climbing in people with diabetes. These studies all showed that low blood sugar (hypoglycemia) can occur at high altitudes; this if often due to low oxygen levels and increased physical activity. In rare cases, high altitudes can cause high blood sugar (hyperglycemia). Its not known exactly why this happens, but some researchers have suggested that high altitudes may cause insulin resistance because carbohydrates are not metabolized as effectively. Increased altitudes have also been shown to cause diabetic retinopathy to worsen, due to low oxygen levels at greater heights. In fact, high altitudes can actually cause hemorrhaging (profuse bleeding) of the retina. Thats why its important to have an eye examination if youre planning a high-altitude vacation. Another complication that can arise in people with diabetes who travel at high altitudes is ketoacidosis, a serious diabetes complication that happens when the body cannot use sugar (glucose) as a fuel source because there is no insulin or n Continue reading >>

Living At High Altitude Could Reduce Type 2 Diabetes Risk

Living At High Altitude Could Reduce Type 2 Diabetes Risk

Living at high altitude could reduce type 2 diabetes risk Living at high altitude could reduce type 2 diabetes risk Sitting less and walking more could reduce fasting insulin levels by 11 per cent 27 January 2017 People living at higher altitudes have a reduced risk of type 2 diabetes , heart disease and stroke , according to Spanish researchers. Scientists at the University of Navarra suggest that the geographic area in which you live to contribute to the risk of metabolic syndrome. This is the medical term for the combination of high blood sugar , blood pressure and cholesterol , which contributes to a higher risk of type 2 diabetes , heart disease and stroke. "We found that those people living between 457 to 2,297 metres had a lower risk of developing metabolic syndrome than those living at sea level (zero to 121 metres)," said co-senior author and PhD candidate Amaya Lopez-Pascual. Obesity, smoking and sedentary behaviours are among the leading risk factors for metabolic syndrome, but not a lot is known about how our environment could affect this risk. The researchers analysed data from a Spanish project that asked participants to submit their health information twice-yearly since 1999. This data was then used to track the development of metabolic syndrome in relation to the altitude of where participants lived, of whom were initially health at the beginning of the study. It was shown that the higher the altitude where a person lived, the less likely they were to develop metabolic syndrome. This association existed even after analysis of family history. "Living or training at high altitudes or under a simulated hypoxic [oxygen deficient] environment seems to help with heart and lung function, losing weight , and improves insulin sensitivity ," said co-senior author Continue reading >>

Altitude And Type 1 Diabetes

Altitude And Type 1 Diabetes

As you may already know, travel in general can have a big impact on Type 1 diabetes management. This is typically due to elements such as stress hormones, time change and other shifts in routine that can cause blood sugar levels to behave differently. However, there are other things to consider when taking trips or exploring the outdoors that might not occur to us right away – such as changes in altitude. The most important thing to remember when planning to journey some place at a higher altitude is that nobody is affected the same way, so it is best to be prepared for multiple outcomes. Altitude sickness By far the most common side effect of being at high altitudes is altitude sickness, which can then lead to (or simulate) other symptoms that can affect T1D management. Common symptoms of altitude sickness include: shortness of breath rapid heartbeat nausea exhaustion All of this is due to the decrease in oxygen, but these symptoms are also common when suffering from hypoglycemia (low blood sugar!). So it is important to test blood sugar levels often to distinguish between the two. Blood sugar levels Hypoglycemia – There is no direct evidence that altitude causes low blood sugar, but as previously mentioned, altitude symptoms can feel quite similar. Also, increased exercise (if hiking or walking a lot while in high altitudes), can definitely lead to lows. Hyperglycemia – Traveling, exercising and managing T1D when out in the elements can cause a good deal of stress. Stress hormones lead to high blood sugar. Insulin resistance There have been studies that suggest that higher altitudes can cause insulin resistance due to carbohydrates not being metabolized as effectively. This can be another cause of high blood sugar and it can also lead to ketones/ketoacidosis in Continue reading >>

Metabolic Effects Of High Altitude Trekking In Patients With Type 2 Diabetes

Metabolic Effects Of High Altitude Trekking In Patients With Type 2 Diabetes

Metabolic Effects of High Altitude Trekking in Patients With Type 2 Diabetes 4Department of Endocrinology, University Medical Center, Leiden, the Netherlands 5Department of Nephrology, University Medical Center, Leiden, the Netherlands 6Department of Internal Medicine, University Medical Centre, Groningen, the Netherlands 7Department of Internal Medicine, Isala Clinics, Zwolle, the Netherlands 1Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands 2Department of Clinical Chemistry, Isala Clinics, Zwolle, the Netherlands 3Department of Cardiology, Tjongerschans Hospital, Heerenveen, the Netherlands 4Department of Endocrinology, University Medical Center, Leiden, the Netherlands 5Department of Nephrology, University Medical Center, Leiden, the Netherlands 6Department of Internal Medicine, University Medical Centre, Groningen, the Netherlands 7Department of Internal Medicine, Isala Clinics, Zwolle, the Netherlands Corresponding author: Pieter de Mol, [email protected] . Received 2012 Jan 31; Accepted 2012 Apr 26. Copyright 2012 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details. This article has been cited by other articles in PMC. Limited information is available regarding the metabolic effects of high altitude trekking in patients with type 2 diabetes. Thirteen individuals with type 2 diabetes took part in a 12-day expedition to the summit of Mount Toubkal (altitude, 4,167 m), Morocco, after 6 months of exercise training. Energy expenditure, body weight, blood glucose, fasting insulin, lipids, and HbA1c were assessed. Training reduced fasting glucose (0.7 0.9 mmol/L, P = 0.026) a Continue reading >>

Trekking With Diabetes | High Altitude | Metabolic Effects

Trekking With Diabetes | High Altitude | Metabolic Effects

Trekker to escape. Discover. Meet. Get rich. Going further, higher, longer. Why our diabetes it would prevent us from living our projects, and achieve some of our dreams even the craziest? Know is the key to success. To go step by step, to learn from each experience. Our bodies, our diabetes are "machines" complex. The characteristics of the trek (duration, intensity, altitude, weather conditions), the available supply, our moral and physical condition all have an influence on our blood sugar control. From an article "Sports & Diabetes: a history of hormone", article I wrote for the journal "Nutrition Endocrinology" - No special EASD September 2014 Increasingly diabetes type1 (T1D) is engage in high-altitude treks, sometimes at a key summit. But the specific conditions at high altitude (> 3000 m) make the mountain a hostile environment for humans. Extreme temperatures aloft, the wind amplifies, are associated with a reduced atmospheric pressure, responsible for the partial pressure of O2 drops of the inspired air. The altitude is thus linked to a decrease in blood pressure in O2. The 'high mountain acclimatization thus refers to the reaction to physiological processes that prolonged exposure to hypoxia (= less oxygen) mandatory adjustments to the human body. Hypoxia is accompanied by hyperventilation with hypocapnia and respiratory alkalosis associated with an increased urinary elimination of bicarbonates. The buffering capacity of the blood decreased, promotes faster decompensation to ketoacidosis in a diabetic subject which would be unbalanced. Hypoxia also affects the concentration of certain hormones. The release of catecholamines (adrenaline and noradrenaline) is accompanied by hepatic glucose production when cortisol is responsible for insulin resistance. The alt Continue reading >>

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