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• Management of diabetes at high altitude
  Conxita Leal
  Published on: 9 May 2001

• Published on: 9 May 2001

  Management of diabetes at high altitude

  • Conxita Leal, General Practitioner

  Dear Editor,

  In response to the letter of Moore et al [1], we would like to report the results obtained in 8 type I diabetic mountaineers who ascended the Aconcagua (6950m) [2] without significant medical problems. The only climber unable to make the summit reached 6700m because of a problem not related to diabetes.

  None of the climbers took any drug to prevent Acute Mountain Sickness (AMS), because of...

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  Dear Editor,

  In response to the letter of Moore et al [1], we would like to report the results obtained in 8 type I diabetic mountaineers who ascended the Aconcagua (6950m) [2] without significant medical problems. The only climber unable to make the summit reached 6700m because of a problem not related to diabetes.

  None of the climbers took any drug to prevent Acute Mountain Sickness (AMS), because of the possible added risks. Instead, a steady acclimatization was made.

  Above 5000m some of the diabetic climbers experienced hypoglycemia after dinner with nocturnal hyperglycemias probably because of delayed absorption of carbohydrates at altitude and rapid absorption of Lispro Insulin used by the main part of the group. We recommended delaying the administration of insulin until the end of dinner.

  There were no problems with glucometers. The devices were protected with self-made bags and carried next to the skin.

  As expected all members of the team had hypo and hyperglycemias and managed successfully. Glycemia was monitored on average 7 times a day. The expedition doctor had to intervene only in one case of medium post- prandial hypoglycemia at 5000m.

  In a previous enquiry between type I diabetic climbers, 15 out of 24 had reached altitudes above 5000m (3 above 7000m). None of them have reported major complications at altitude nor taken any drugs to prevent AMS. In climbs under 3000m hyperglycemia related to dehydratation (2 cases) or extensive solar burns [1] have been reported, all of them self- managed and resolved before reaching hospital. One climber had already measured his glycemia as high as 8200m on Mount Everest. He tested the glucometer in the hypobaric chamber at 5000m without significant differences with sea level.

  An optimal management of the diabetes, together with progressive acclimatization were the key for success. All the team was good at self- monitoring in any conditions, had skills to calculate insulin and carbohydrates and the ability to handle early hyper and hypoglycemia.

  Climbing mountains at high altitude is a risky sport. Diabetic climbers should not avoid going to altitude provided that they are aware of increased risks, of the importance of frequent self-monitoring and acclimatize slowly to avoid AMS.

  Jordi Admetlla, GP. IEMM. IDEA2000 Expedition Doctor
  Conxita Leal, GP. IEMM.
  Antoni Ricart, Intensive Care Medicine. IEMM.

  (1) K. Moore, C. Thompson and R. Hayes. Diabetes and extreme altitude mountaineering. Br J Sports Med 2001; 35:83
  (2) www.idea200.org
  

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  Conflict of Interest:
  None declared.

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