Physical Activity at Altitude: Challenges for People With Diabetes

Abstract

A growing number of subjects with diabetes take part in physical activities at altitude such as skiing, climbing, and trekking. Exercise under conditions of hypobaric hypoxia poses some unique challenges on subjects with diabetes, and the presence of diabetes can complicate safe and successful participation in mountain activities. Among others, altitude can alter glucoregulation. Furthermore, cold temperatures and altitude can complicate accurate reading of glucose monitoring equipment and storage of insulin. These factors potentially lead to dangerous hyperglycemia or hypoglycemia. Over the last years, more information has become available on this subject. PURPOSETo provide an up-to-date overview of the pathophysiological changes during physical activity at altitude and the potential problems related to diabetes, including the use of (continuous) blood glucose monitors and insulin pumps. To propose practical recommendations for preparations and travel to altitude for subjects with diabetes. DATA SOURCES AND SYNTHESISWe researched PubMed, medical textbooks, and related Internet sites, and extracted human studies and data based on relevance for diabetes, exercise, and altitude. LIMITATIONSGiven the paucity of controlled trials regarding diabetes and altitude, we composed a narrative review and filled in areas lacking diabetes-specific studies with data obtained from nondiabetic subjects. CONCLUSIONSSubjects with diabetes can take part in activities at high, and even extreme, altitude. However, careful assessment of diabetes-related complications, optimal preparation, and adequate knowledge of glycemic regulation at altitude and altitude-related complications is needed.An increasing number of subjects with diabetes reside at high altitude for short periods of time, partly for work, but mainly for recreational purposes such as skiing, trekking, and climbing. Exercise under conditions of hypobaric hypoxia poses some unique challenges for subjects with diabetes and could potentially lead to dangerous situations such as unexpected hypoglycemia and hyperglycemia, inaccurate

The Role of Diabetes Care and Its Contributions to the Field of Diabetes: A Profile in Progress

“…In 2011, a report from the Look AHEAD (Action for Health in Diabetes) study provided strong evidence of significant improvement in cardiovascular disease risk factors from modest weight loss (67). And in 2014, an interesting review article summarized available evidence on the challenges faced by people with diabetes who want to participate in physical activities at high altitude (68).…”

The association between the level of baseline daily physical activity and selected clinical and biochemical parameters during mountain trekking in patients with type 1 diabetes

“…However, day-long mountain trekking may be a challenge for T1DM patients, as it requires many hours of intense aerobic and interval exercise. Crucial factors for optimal insulin management during such types of exercise have not yet been established [4,5]. It is known that blood lactate level is useful marker of physical fitness, muscle fatigue, and adaptation to endurance training, such as mountain trekking [6,7].…”

N-Terminal Pro-Brain Natriuretic Peptide, Cardiac and Vascular Function in Patients with Type 1 Diabetes Mellitus during the Ascent of Mt. Kilimanjaro

“…Among others, altitude can alter glucoregulation, cold temperatures and altitude can complicate accurate reading of the glucose monitoring equipment and storage of insulin. This can lead to either hyperglycemia or hypoglycemia [10]. Exercise, dietary change, stress and illness, increased sympathetic output at altitude can lead to conflicting accounts of insulin requirement [11].…”