What You Need To Know About How High Altitude Affects Diabetes

Although regular physical activity is recommended for diabetics, exercising at high altitudes raises the risk of a number of potential problems.

High altitude and diabetes are associated in that they can cause either hypoglycemia or hyperglycemia in diabetic trekkers and climbers.

The absence of oxygen stresses the body and induces the production of hormones (adrenaline, noradrenaline, and cortisol). In the presence of these hormones, the liver produces more glucose (sugar), and insulin’s efficacy is reduced (insulin resistance).

High Altitude and Diabetes

Although insulin needs may increase due to changes in counter-regulatory hormones, diet and exercise have a higher effect on blood glucose levels than high altitude. Loss of appetite is frequent at high altitudes. Slowing food absorption at high altitudes has (in some circumstances) resulted in hypoglycemia after meals, followed by hyperglycemia.

Ascent to high altitude has varying effects on blood glucose levels, and insulin doses may need to be modified. Continuous glucose monitoring in real-time can help with insulin dose optimization.

Cold perception may be compromised in diabetics even when no indications of peripheral sensory neuropathy are present, this is one of the high altitude and diabetes risks. This can lead to serious cold injury under high conditions at altitude. Basic precautions for preventing cold-related injuries include a daily check of exposed extremities, proper diet and hydration, footwear (excellent fit, non-sweating socks with good insulation), handwear (mittens instead of gloves; try chemical hand warmers), and layered clothes. 

Fluid loss and a propensity toward hyperglycemia at altitude may raise the risk of dehydration and the development of diabetic ketoacidosis in persons with type 1 diabetes.

Some Tips for Maintaining Blood Sugar at High Altitude

Altitude and diabetes can be managed by following the tips mentioned below for maintaining blood sugar:

• Keep your blood sugar levels at 9 mmol/L to offer yourself some leeway while trekking.
• Consider changing your long-acting insulin boluses in the morning or evening. Use the first week to monitor blood sugar levels and make changes for the second week based on this information.
• Carry unused Dexcom Sensor packs with you to decrease the possibility of transmitter latches breaking off in transportation.
• Bring a variety of snacks with you to help you maintain your glucose levels.

Diabetes patients often wonder, does altitude affect diabetes but with proper measures taken they should not be discouraged from taking part in activities at altitude. Most likely, active and sensible subjects with well-controlled, uncomplicated diabetes will not experience major problems at high altitudes, or even very high altitudes, provided that they take sufficient time to acclimatize. However, factors including diabetes complications and comorbidities, and exposure to very high and extreme altitudes or extreme conditions (especially cold exposure) can complicate successful travel at altitude and demand careful preparation and planning of diabetes management.

It is critical for the treating physician to assess for contraindications to traveling at altitude, develop good self-management skills and understanding of diabetes regulation, and to create a personalized strategy that limits risks while also incorporating medication changes. Most persons with diabetes who exercise preferentially alter their insulin requirements to prevent hypoglycemia, resulting in hyperglycemia.

Variables that produce hypoglycemia (exercise, reduced nutritional intake) and factors that boost blood glucose levels (brief intense activity, stress, or acute mountain sickness (AMS) causing elevated counter-regulatory hormones) influence insulin requirements at high altitudes. Thus, maintaining stable blood glucose levels needs a significant degree of trial and error, and expertise, and will vary depending on altitude and exertion. Understanding carbohydrate counting will likely be useful when climbing and trekking at high altitudes. Furthermore, frequent monitoring of blood glucose levels will aid in the detection of unanticipated changes.

Sources:

1. https://pubmed.ncbi.nlm.nih.gov/25962798/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633730/
3. https://type1better.com/en/how-high-altitude-impacts-blood-sugar-levels/
4. https://diabetesjournals.org/care/article/37/8/2404/30003/Physical-Activity-at-Altitude-Challenges-for