Type of publication:
Conference abstract
Author(s):
*Basavaraju N.; *Jones A.; *Wilkes V.; *Singh P.; *Moulik P.
Citation:
Diabetic Medicine. Conference: Diabetes UK Professional Conference 2025. Glasgow . 42(Supplement 1) (no pagination), 2025. Date of Publication: 01 Feb 2025.
Abstract:
Background: Hypobaric hypoxia and low temperatures at high altitude can cause hyperglycaemia or hypoglycaemia in people with diabetes, inaccuracy with capillary blood glucose monitoring and insulin freezing. At altitude, even mild neuroglycopaenia could have serious effects. Case: A 65-year-old lady with post-pancreatitis diabetes, treated with only basal insulin Glargine travelled on a skiing holiday 3000 feet above sea level. Continuous glucose monitoring (CGM) data 2 weeks before, 1 week during and 2 weeks after travel and ambulatory glucose profile (AGP) data were analysed. Mean glucose readings increased from 9.7 to 10.7 mmol/L with activity, level 2 time above range and level 1 time above range increased from 9% and 30% to 15% and 37%, respectively, time in range reduced from 61% to 48% post-high altitude travel. There was pronounced dawn phenomenon and postprandial glucose rise particularly after breakfast during high altitude travel. Glargine dose remained unchanged. These changes reverted back to baseline after descent. Discussion(s): Acute mountain sickness and hypoxia stimulates sympathoadrenergic activity and production of epinephrine, norepinephrine and cortisol. This inhibits skeletal muscle glucose uptake, stimulates muscle glycogenolysis and increases lactate production resulting in increased glucose production by liver. Increased insulin sensitivity at high altitude may be due to exercise induced upregulation of skeletal muscle GLUT4 receptor translocation. One study demonstrated high resting level of norepinephrine, glucose, c-peptide and cortisol levels on sudden ascent which normalised after acclimatisation. Cold temperature is more detrimental in accuracy of glucose measurement than hypoxia. One CGM study has shown similar increase in nocturnal glucose at high altitude. Literature on management of insulin-treated diabetes at high altitude is sparse and warrants further studies.
DOI: 10.1111/dme.15498
