High-Altitude Medical
HANDBOOK
DIABETES
According to the American Diabetes Association (ADA), people with type 1 diabetes who maintain proper blood glucose control and have no diabetes-related complications can participate in all forms of physical activity (American Diabetes Association Position Statement – Diabetes Mellitus and Exercise, 2004). Between 1995 and 2005, around 50 climbers with type 1 diabetes took part in expeditions above 5,500 m (18,000 ft) above sea level.
PLANNING AND PREPARATION
In remote locations, access to professional medical care is limited, so a person with diabetes is more dependent on their own knowledge and the preparation of their team.
➤ Traveling east shortens the day, so insulin doses should be reduced on the day of travel.
➤ Traveling west lengthens the day, so insulin doses should be increased.
➤ During long flights, frequent blood glucose monitoring is essential.
Type 1 diabetics acclimatize well and are not more prone to altitude-related illnesses. Individuals with well-controlled blood glucose and no vascular complications can undertake significant physical effort, but blood sugar levels must be monitored carefully.
Diabetics without neuropathy or vascular complications are not at higher risk of frostbite or hypothermia, but should protect themselves thoroughly from cold exposure.
SELF-MONITORING AND EXPERIENCE
A diabetic planning a mountain expedition should be able to:
➤ Manage their own insulin doses,
➤ Maintain proper blood glucose levels in the months preceding the trip,
➤ Have experience in blood glucose control during exercise at lower altitudes,
➤ Handle hypoglycemia and hyperglycemia effectively.
Multiple insulin injections or insulin pumps facilitate glucose control. Not every diabetic is suitable for high-altitude expeditions – individuals with poorly controlled blood sugar should avoid such trips.
Studies show that physically fit diabetics have better glucose control than less active individuals. At high altitude, more frequent blood glucose monitoring is recommended, as even brief fluctuations can cause additional fatigue.
ALTITUDE AND GLUCOSE CONTROL
At high altitudes, several factors complicate blood sugar management:
➤ Increased glucose demand due to elevated stress hormones (cortisol, growth hormone),
➤ Unpredictable physical effort, depending on weather and climbing challenges,
➤ Reduced aerobic capacity – maximum oxygen performance decreases by ~1% per 100 m above 1,500 m,
➤ Inadequate carbohydrate intake – irregular meals and slower carbohydrate absorption,
➤ Cold exposure – increases energy expenditure, minimally affects glucose,
➤ Decreased insulin sensitivity, stress, fatigue, and symptoms of acute mountain sickness (AMS) may contribute to hypoglycemia.
Flexible adjustment of insulin doses according to exertion and carbohydrate intake is advised, and insulin can be safely injected through clothing to avoid poor absorption from cold skin.
GLUCOMETERS AND INSULIN PUMPS
➤ Some glucometers may malfunction at high altitudes due to low pressure, cold, heat, or low humidity.
➤ Increased blood viscosity may underestimate glucose readings.
➤ Insulin pumps are recommended for use up to 2,300 m, although climbers on Aconcagua have successfully used pumps at higher altitudes.
KETOACIDOSIS
Ketoacidosis may result from:
➤ Incorrectly reducing or stopping insulin,
➤ Insufficient food intake,
➤ Malabsorption, infections, or severe altitude illness,
➤ Dehydration or faulty glucometer readings,
➤ Exposure of insulin to excessive heat,
➤ Continuing physical exertion despite ketonuria – ketonuria is an absolute contraindication to exercise.
KEY RECOMMENDATIONS BEFORE THE EXPEDITION
➤ Choose climbs according to your skills.
➤ Bring extra insulin, glucagon, glucometers, and fast-absorbing carbohydrates.
➤ Consider alternative methods for glucose monitoring (color-changing strips, glucometer, insulin syringes).
➤ Bring a ketone meter and strips to measure ketone bodies.
➤ Plan your diet according to available food on the expedition.
➤ Test glucose control during training under different conditions.
➤ Visit an ophthalmologist – diabetic retinopathy is a relative contraindication for high-altitude travel.
➤ Perform a retinal angiogram if ischemic or proliferative changes are suspected.
KEY RECOMMENDATIONS DURING THE EXPEDITION
➤ Train partners on hypoglycemia management and glucagon administration.
➤ Climb with individuals aware of your diabetes and first aid principles.
➤ Carry instructions for assistance in case of unconsciousness (in Polish, English, and the language of the country).
➤ Always carry glucose, glucagon, and a glucometer.
➤ Carry fast-absorbing carbohydrates (bars, dextrose tablets).
➤ Protect insulin from freezing and excessive heat.
➤ Frequently monitor blood glucose and adjust therapy accordingly.
➤ Carefully calculate insulin, carbohydrate intake, and exertion.
➤ Maintain blood glucose between 100–200 mg/dL.
➤ Remember that exercise reduces, while rest increases insulin requirements.
➤ Recognize early signs of hypo- and hyperglycemia.
➤ Never interrupt insulin therapy.
➤ Carry out used strips and syringes.
➤ Avoid infections.
➤ Acclimatize slowly.
➤ Be aware of cognitive changes and assess your condition at altitude.
➤ Avoid acetazolamide – it can lead to ketoacidosis.
➤ Be aware that HAPE and HACE may complicate glucose control.
REFERENCES
• Travel at High Altitude – www.medex.org.uk
• K. Mieske et al., Journeys to High Altitude—Risks and Recommendations for Travelers with Preexisting Medical Conditions, Journal of Travel Medicine, 2010; 17(1): 48–62
• Conxita Leal, Going High with Type 1 Diabetes, High Altitude Medicine & Biology, 2005; 6(1): 14–21
• Pieter de Mol et al., Physical activity at altitude: challenges for people with diabetes: a review, Diabetes Care, 2014; 37: 2404–2413
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WANT TO LEARN MORE?
If you want to better prepare your health for trekking or a high-altitude expeditions, check out the expanded guide in the ebook "High-Altitude Medicine for Trekkers and Climbers" >>
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Gain practical skills for handling emergencies in the mountains through our online training "High-Altitude First Aid" >> - prepared for those planning trips to high altitudes.
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For a detailed list of what to include in your expedition medical kit and step-by-step instructions for assembling your personal first aid set, see the ebook "High-Altitude Expedition Medical Kit Guide" >>
PLANNING A TREK OR A HIGH-ALTITUDE EXPEDITION?
If you would like to check whether your health condition allows you to safely participate in a trek or high-altitude expedition, consider booking a medical consultation >> or using a telemedical expedition package >>
This allows you to assess potential health risks in advance, prepare properly fot altitude, and increase your safety during the expedition.
The company was established in 2004. The goal of MedEverest is education in the field of mountain medicine and the dangers of high altitudes. I deal with all medical aspects of staying at high altitude. I organize medical support for trekking and high-altitude expeditions.
Specialist Medical Practice Medeverest Robert Szymczak based in Gdańsk (80-360), at ul. Bolesława Krzywoustego 19F, NIP: 5841943576, REGON: 220148318.
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