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Increased insulin requirements during exercise at very high altitude in type 1 diabetes.

AbstractOBJECTIVE:
Safe, very high altitude trekking in subjects with type 1 diabetes requires understanding of glucose regulation at high altitude. We investigated insulin requirements, energy expenditure, and glucose levels at very high altitude in relation to acute mountain sickness (AMS) symptoms in individuals with type 1 diabetes.
RESEARCH DESIGN AND METHODS:
Eight individuals with complication-free type 1 diabetes took part in a 14-day expedition to Mount Meru (4,562 m) and Mount Kilimanjaro (5,895 m) in Tanzania. Daily insulin doses, glucose levels, energy expenditure, and AMS symptoms were determined. Also, energy expenditure and AMS symptoms were compared with a healthy control group.
RESULTS:
We found a positive relation between AMS symptoms and insulin requirements (r = 0.78; P = 0.041) and AMS symptoms and glucose levels (r = 0.86; P = 0.014) for Mount Kilimanjaro. Compared with sea level, insulin doses tended to decrease by 14.2% (19.7) (median [interquartile range]) (P = 0.41), whereas glucose levels remained stable up to 5,000 m altitude. However, at altitudes >5,000 m, insulin dose was unchanged (36.8 ± 17 vs. 37.6 ± 19.1 international units [mean ± SD] P = 0.75), but glucose levels (7.5 ± 0.6 vs. 9.5 ± 0.8 mmol/L [mean ± SD] P = 0.067) and AMS scores (1.3 ± 1.6 vs. 4.4 ± 4 points [mean ± SD] P = 0.091) tended to increase. Energy expenditure and AMS symptoms were comparable in both groups (P = 0.84).
CONCLUSIONS:
Our data indicate that in complication-free individuals with type 1 diabetes, insulin requirements tend to increase during altitudes above 5,000 m despite high energy expenditure. This change may be explained, at least partly, by AMS.
AuthorsPieter de Mol, Suzanna T de Vries, Eelco J P de Koning, Rijk O B Gans, Cees J Tack, Henk J G Bilo
JournalDiabetes care (Diabetes Care) Vol. 34 Issue 3 Pg. 591-5 (Mar 2011) ISSN: 1935-5548 [Electronic] United States
PMID21273491 (Publication Type: Controlled Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Blood Glucose
  • Insulin
Topics
  • Adult
  • Altitude
  • Blood Glucose (drug effects)
  • Diabetes Mellitus, Type 1 (drug therapy, physiopathology)
  • Energy Intake (physiology)
  • Energy Metabolism (physiology)
  • Exercise (physiology)
  • Female
  • Humans
  • Insulin (administration & dosage, therapeutic use)
  • Male

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