Type 1 and higher elevation issues

[tiffanyhope13]

Hi all,

I am new here and live in Arizona. I have been Type-1 for almost five years (late onset). I am 47. The last couple of years, I have noticed when I travel to 7000 feet elevation or more and go camping, my blood sugar fluctuates and goes low over and over and over to where I panic and rush off the mountain quickly. My endocrinologist said that higher elevations may cause issues. The thing is, I keep going back to try and figure it out, but I am not able to! She said to lessen my 24 hour, which I do, but when I eat, and take insulin, my blood sugar drops fast. Where I stay, there is no phone service, so it makes me so nervous, which is why I pack it up and leave. I just want to be able to do the outdoor things that I love, without constantly watching my CGM.

There isn't much information out there on higher elevations and Type-1 care. Has anyone experienced this at all?

Thank you!
Tiffany

 

[Robin]

Hi all,

I am new here and live in Arizona. I have been Type-1 for almost five years (late onset). I am 47. The last couple of years, I have noticed when I travel to 7000 feet elevation or more and go camping, my blood sugar fluctuates and goes low over and over and over to where I panic and rush off the mountain quickly. My endocrinologist said that higher elevations may cause issues. The thing is, I keep going back to try and figure it out, but I am not able to! She said to lessen my 24 hour, which I do, but when I eat, and take insulin, my blood sugar drops fast. Where I stay, there is no phone service, so it makes me so nervous, which is why I pack it up and leave. I just want to be able to do the outdoor things that I love, without constantly watching my CGM.

There isn't much information out there on higher elevations and Type-1 care. Has anyone experienced this at all?

Thank you!
Tiffany

Yes. We have holidays walking in the Alps, and my blood glucose always plummets the first few days, after which I usually acclimatise. We stay at 1500m but walk at altitudes up to 2500m. (5000-8000ft). Extra exercise and the heat don't help either). I’ve usually just lowered my basal (quite a lot, like, 20%, I don’t take much to begin with, but on put last hol I put my daytime down from 6 to 4 units in the day, and from 3to 2 overnight). I also find planned snacks while I’m exercising helps, ie, I bolus for and eat my lunchtime roll, but save the bit of cake for half way through the walk, and my fruit for later in the afternoon, and have them without extra bolus. The other alternative if eating a couple of jelly babies every hour, but I get fed up with them.
It’s definitely the altitude, I assume the body has to work harder. We go on other walking holidays in the U.K., and I don’t have such a problem.

 

[Inka]

As well as lowering your basal, do you reduce your mealtime insulin too @tiffanyhope13 ? That’s what I do, as well as eating snacks and glucose.

 

[SimonP]

That's really interesting, I wonder if people get an effect while flying in that case (aircraft cabins have a pressure altitude of ~8000ft), though probably quite hard to unpick the travel stress response from altitude effects (in my experience at least), plus lots of sitting and eating vs actually doing exercise!

 

[tiffanyhope13]

Yes. We have holidays walking in the Alps, and my blood glucose always plummets the first few days, after which I usually acclimatise. We stay at 1500m but walk at altitudes up to 2500m. (5000-8000ft). Extra exercise and the heat don't help either). I’ve usually just lowered my basal (quite a lot, like, 20%, I don’t take much to begin with, but on put last hol I put my daytime down from 6 to 4 units in the day, and from 3to 2 overnight). I also find planned snacks while I’m exercising helps, ie, I bolus for and eat my lunchtime roll, but save the bit of cake for half way through the walk, and my fruit for later in the afternoon, and have them without extra bolus. The other alternative if eating a couple of jelly babies every hour, but I get fed up with them.
It’s definitely the altitude, I assume the body has to work harder. We go on other walking holidays in the U.K., and I don’t have such a problem.

Robin,

Thank you so much! No one believes me when this happens! Thank you so much for the reply. I know everyone is different, so it's nice to know I am not alone. 🙂

For example, when I exercise at a normal altitude, like at the gym, my arrow goes up and my sugar skyrockets. Many people I know, their sugar gets low. It's definitely frustrating trying to figure out.

 

[tiffanyhope13]

As well as lowering your basal, do you reduce your mealtime insulin too @tiffanyhope13 ? That’s what I do, as well as eating snacks and glucose.

Hi Inka,

Thank you for the reply. I actually did lower my short acting and I still continued to go low. Then I started to not eat at all and/or I'd skip taking insulin all together. This made for a stressful, not enjoyable camping trip, which is supposed to be relaxing. As soon as I fled off the mountain and got home, I'd just cry in peace, knowing my sugar would go back to normal. But I don't want to have to miss out on fun things!

 

[tiffanyhope13]

That's really interesting, I wonder if people get an effect while flying in that case (aircraft cabins have a pressure altitude of ~8000ft), though probably quite hard to unpick the travel stress response from altitude effects (in my experience at least), plus lots of sitting and eating vs actually doing exercise!

Simon,

I thought about this also. There's NO way I'd get on a plane any time soon until I get this figured out! Maybe short flights would be okay, but I thought about a 6-hour flight, for example, or 8-hour flight, ugh! I wish there were more studies on altitude and Type-1 for sure.

Thank you for the reply!

 

[rebrascora]

Which basal (long acting/24 hour) insulin do you use? If you use one of the very long acting ones, like Tresiba or Toujeo, you might need to reduce it a few days before your trip for the reduction to work. Or you might find a more flexible basal insulin like split dose Levemir helps you to manage it better, which is what @Robin uses. I imagine it is hot in Arizona so that might also be an increased factor in the mountains as Robin mentions as oppose to a gym where there will likely be A/C.

The change in BG levels due to exercise varies with the type of exercise. Anything which stresses your body like a high intensity workout will make your levels go up during the activity, but should come down later and particularly overnight afterwards as the muscles replenish their stores and repair/build. More prolonged steady exercise like hiking will drop them steadily whilst you are exercising as well as afterwards, so you do have to be prepared for that and consecutive days of steady prolonged hiking will have a greater effect. So for instance, if I do a long brisk walk one day, I usually need to drop my evening basal by 2 units. If I do another one the next day, I will need to drop it again another 1 or 2 units as well as reducing my meal time doses a bit. If I get to 3 consecutive days of hiking, I don't take any evening basal and start reducing my morning dose..... and this is at normal altitude not in the mountains although it does involve quite a bit of steep hill climbing. As I mentioned above, this is not possible with all basal insulins because they do not respond very rapidly to change in dose, but Levemir does allow consecutive daily changes. You would not be able to do that with most other long acting insulins and get

Do you have Libre or other CGM to warn you of levels getting low? If not, that might be something to invest in for your next trip.... although I would recommend using one for a few weeks before your trip to learn how to interpret the info it gives you and find safe levels to set the alarms at. If you already have CGM then setting your low alarm higher should give you peace of mind.

Another thought is .... Do these hiking trips involve any alcohol as I imagine alcohol, altitude and exercise could be particularly challenging even if it is just a single beer which might not have any impact at normal altitude.

As regards flying, please be assured that I have never seen anyone report issues from flying and as mentioned it is likely because of the inactivity of sitting still that there is no issue. There is a big difference between hiking and making camp and doing physical stuff all day in the hot sun in the mountains and sitting on your backside unable to move with the stress of travel pushing your BG up in a temperature controlled cabin. I think you will be safe to fly so please don't worry about that.

 

[Inka]

Hi Inka,

Thank you for the reply. I actually did lower my short acting and I still continued to go low. Then I started to not eat at all and/or I'd skip taking insulin all together. This made for a stressful, not enjoyable camping trip, which is supposed to be relaxing. As soon as I fled off the mountain and got home, I'd just cry in peace, knowing my sugar would go back to normal. But I don't want to have to miss out on fun things!

I’m sorry to hear that @tiffanyhope13 How much did you lower your bolus (meal/fast) insulin by? And where did you inject? From what you’ve described, it sounds like you’re reasonably ok until you inject your bolus? If so, further reductions should help.

On a related note, when flying I go high. This is largely due to sitting down, the strange times of flights, and stress. If you want to fly, you could try a short flight first?

 

[SimonP]

I wouldn't worry about flying either, I was just curious as it's a quite significant and quite rapid change in altitude (effective pressure altitude at least, full exposure to cruising altitude might cause some stress response!)

I tend to go low when "flying" (i.e. getting there to and through the airport, flying, getting wherever I'm going on the other side), which I think is due to all of the activity rushing around counter-acting the stress of needing to rush around, everyone's different!

 

[SimonP]

 

[tiffanyhope13]

View attachment 27084

Thank you, Simon! I have this book and have never read it! I will take a look at it! 🙂

 

[tiffanyhope13]

I’m sorry to hear that @tiffanyhope13 How much did you lower your bolus (meal/fast) insulin by? And where did you inject? From what you’ve described, it sounds like you’re reasonably ok until you inject your bolus? If so, further reductions should help.

On a related note, when flying I go high. This is largely due to sitting down, the strange times of flights, and stress. If you want to fly, you could try a short flight first?

Thank you for the reply, Inka. My doctor told me to lower my insulin by two units a WEEK before a trip. So much for spontaneous trips in the mountains! 😛 I usually inject in the stomach. Sometimes the thighs or butt, but mainly stomach.

I'll have to try a short zip over to San Diego, CA. It's only a 45 minute flight! I will let you know if I do, haha.

 

[Bubbleblower]

No one believes me when this happens!

 

[SimonP]

Is there a DOI for the paper that came from?

I assume most of this is a transient effect until the body gets round to producing more red blood cells and therefore reduces workload, I wonder if heart rate is also elevated and could be used as a proxy?

I guess there may be a residual/long term effect if it's simply harder to live at altitude and the body is not able to adapt completely, would be interesting (though not for any particular reason) to know.

 

[tiffanyhope13]

View attachment 29317

Is there a DOI for the paper that came from?

I assume most of this is a transient effect until the body gets round to producing more red blood cells and therefore reduces workload, I wonder if heart rate is also elevated and could be used as a proxy?

I guess there may be a residual/long term effect if it's simply harder to live at altitude and the body is not able to adapt completely, would be interesting (though not for any particular reason) to know.

Yes, I agree. This is very interesting. I would like to know also. Thank you!

 

[Bubbleblower]

It comes from: Residents at high altitude show a lower glucose profile than sea-level residents throughout 12-hour blood continuous monitoring but at the time they weren't sure yet what caused this;
acute hypoxia increases glucose metabolism in skeletal muscle using the same pathway as muscle contraction.

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