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Management of diabetes at high altitude
  1. J Admetlla,
  2. C Leal,
  3. A Ricart
  1. Institut d'Estudis de Medicina de Muntanya Barcelona, Spain cleal{at}

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

    None of the climbers took any drugs to prevent acute mountain sickness (AMS) because of the possible risks. Instead, they acclimatised gradually.

    Above 5000 m some of the diabetic climbers experienced hypoglycaemia after dinner with nocturnal hyperglycaemia probably because of delayed absorption of carbohydrates at altitude and rapid absorption of the Lispro Insulin used by most 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 home made bags and carried next to the skin.

    As expected, all members of the team suffered bouts of hypoglycaemia and hyperglycaemia but were managed successfully. Glycaemia was monitored on average seven times a day. The expedition doctor had to intervene in only one case of medium postprandial hypoglycaemia at 5000 m.

    In a previous investigation of type I diabetic climbers, 15 out of 24 of the climbers reached altitudes above 5000 m (three above 7000 m). None reported major complications at altitude nor taking any drugs to prevent AMS. In climbs under 3000 m, hyperglycaemia caused by dehydration (two cases) or extensive sunburn (one case) were reported; all were self managed and resolved before the climbers reached hospital. One climber had previously measured his glycaemia at a height of 8200 m on Mount Everest. He tested the glucometer in the hypobaric chamber at 5000 m without any significant differences from sea level.

    Optimal management of the diabetes, together with progressive acclimatisation, was the key to success. All the team were good at self monitoring under any conditions and had the skill to calculate insulin and carbohydrates and the ability to handle early hyperglycaemia and hypoglycaemia.

    Climbing mountains at high altitude is a risky sport. Diabetic climbers should not be deterred from going to altitude provided that they are aware of the increased risks and the importance of frequent self monitoring and gradual acclimatisation to avoid AMS.


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