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.