Managing diabetes at high altitude: personal experience with support from a Multidisciplinary Physical Activity and Diabetes Clinic

Objective: Physical activity is important for wellbeing but can be challenging for people with diabetes. Data informing support of specialist activities such as climbing and high altitude trekking is limited. A 42-year-old man with type 1 diabetes (duration 30 years) attended a multidisciplinary Physical Activity and Diabetes clinic planning to climb Mont Blanc during the summer and trek to Everest Base Camp in the autumn. His aims were to complete these adventures without his diabetes impacting on their success. Methods: We report the information provided that enabled him to help safely facilitate his objectives, in particular the requirement for frequent checking of blood glucose levels, the effects of altitude on insulin dose requirements, and recognition that Acute Mountain Sicknes may mimic the symptoms of hypoglycemia and vice versa. Real-time continuous glucose monitoring was made available for his treks. Results: The effects of high altitude on blood glucose results and glycaemic variability whilst treated on multiple daily injections of insulin are reported. In addition, we present a first-person account of his experience and lessons learned from managing diabetes at high altitude. Conclusions: A dedicated multidisciplinary Physical Activity & Diabetes clinic delivering individualized, evidence based, patient- focused advice on the effects of altitude on blood glucose levels, and provision of real-time continuous glucose monitoring enabled uneventful completion of a trek to Everest Base Camp in a person with type 1 diabetes