High Altitude Diabetes, Part II

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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, I’m 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 solution’s 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 (I’m all for multitasking, but that’s 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 wasn’t working.

I need to do more research on the causes behind altitude-induced insulin resistance, but from what I’ve read so far, it has something to do with the stress your body is under when you take away its oxygen. The process of acclimatization causes cortisol levels to rise, and as a result, your blood sugar digs in its heels and refuses to respond. And, of course, it doesn’t help when the main foods on offer are mixtures of noodle and rice and bread. My downfall, actually, was a plate of stir-fried tomato and egg — usually a great diabetic choice — served in a restaurant that turned out not to have running water. Goddamn dirty tomato.

Despite the stress — and the stubbornness — the trip was definitely worth it.  We visited the Dalai Lama’s palace, wandered the streets of Lhasa, watched prayer-wheel toting pilgrims prostrate themselves in front of temples, gazed down on the turquoise blue waters of Tibet’s most holy lakes, and spent a night sleeping in a yak hair tent near the foot of Mt. Everest (see photo).  It was one of the most memorable experiences of our nearly five months on the road — and I’d recommend it to anyone, despite the diabetic challenges.

Me, my pump, and Mt. Everest.

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Valerie
Valerie

You’ve penned your experience quite well, thanks for the fun read! My diabetes and I just returned from vacation in the mountains of Costa Rica, and I thought increased eating was maybe likely why I had to substantially increase my basal rate the whole time, but it wasn’t significantly more food… Anyway, your post is the only one in a quick Google search that can suggest the link if altitude and higher insulin needs. I told my massage therapist I take insulin before our session and even for a black coffee and a warm shower, and she pointed out that… Read more »

Chad
Chad

Helpful couple of posts. Thanks!  Will be using this info in 12hrs for my breif 4 day trip to Huaraz, Peru and 3,000-5,000meter altitudes.  Note taken: Insulin not going to be too effective, meter probably ok.

Steve Richert

I am really psyched to have found this article!!! I am preparing for my 365 day climbing challenge which will take me up Mt Ranier and a few other mountains–I have done some sport climbing at higher altitudes and some hiking but never for extended periods (greater than 5 days at a clip). I found my sugar tends to go LOW but that may be as a result of the additional exercise…or it may vary between those who pump vs using Lantus or the like. I was backing my Lantus down to half the normal dose just to keep from… Read more »

Atul
Atul

Great story, Catherine.  I went to Everest Base Camp last summer and had the same issue.  At Namche Bazar (about 13,500 feet) my blood sugar seemed totally out of whack, and my One-touch meter was showing morning readings of 180 to 200.  Seemed strange to me, after my workout reaching there, and food I had been eating, mostly protein bars, lentils (no rice) and eggs.  More importantly, I felt just fine.  I called my wife in US from Namche Bazar and she called One-touch rep who told her that the meter had to be recalibrated above 10,000 feet and so… Read more »

kaitlynn
kaitlynn

sounds great! I am going to be traveling to machu picchu and was wondering how you stored your insulin for your pump?

David Turkel
David Turkel

I hope to make the same trip some day.  It sounds fantastic, and worth a slight bump in BGL.  Oh – And I never use the control solution, until I see a reading I don’t like.

erica

Wow what an amazing feat—with diabetes or without! Very cool pic!

Bridget McNulty
Bridget McNulty

Well done, you brave diabetic!
I’ve never used control solution either… Sounds like this was a good time for you to start, though!

Karmel Allison

Awesome. Was the Dalai Lama there? Did your pump match the holy lakes as well as it does the beautiful Everest sky?
And, altitude-based insulin resistance! That makes so much sense! I used to visit Tahoe when I lived in Berkeley, and often my blood sugar would be high throughout the trip, until about halfway down the hill, somewhere around Auburn. I always thought the insulin itself was going bad with the pressure change, but in retrospect, insulin resistance/hormonal change seems more likely.
 

Jessica Apple

The trip sounds amazing, but sorry to hear about the insulin resistance.  I suppose it doesn’t matter now that you’re back, but could the vomiting have been altitude sickness, and not food poisoning?  I’m not trying to get behind the dirty tomato or anything, just that I had a similar vomiting experience in the Andes.  Anyway, great post… thank you for sharing it!

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