Table 3—

General recommendations for individuals with type 1 diabetes trekking at altitude

Pretravel preparation
During travel
GeneralDiabetes relatedGeneralDiabetes related
Get a general physical check-up, as well as a dental check-up, to prevent any unnecessary health problems whilst travelingGet a diabetes-specific check-up; if complications are present, discuss the advisability of travel at altitude with your physician, based on the severity of the complication and any contraindications for travel (depending on the nature of the complication; see text)Maintain a good level of hygieneMonitor blood glucose levels frequently (a minimum of 6–8 measurements/day is recommended, or more as appropriate) and adjust insulin doses appropriately
A good level of physical training is an assetEnsure that you are capable of self-management of your diabetes, including the ability to adjust insulin doses based on exercise, food intake, and/or the results of glucose monitoringMaintain adequate levels of hydration and nutritionMonitor ketone bodies, as appropriate, and adjust insulin doses appropriately
Pack appropriate clothing, as well as a suitably rated sleeping bag and other appropriate outdoor gear, as recommended by travel companiesConsult your physician regarding prevention and treatment of hypoglycemia, ketoacidosis, illness, and infectionTake all possible proactive measures to prevent illness and/or infectionInsulin doses may be need to be reduced by 50% or more if exercise intensity or duration is high
Pack appropriate supplies, as outlined in Tables 1 and 2Know how your body normally reacts to different types of stresses, particularly exerciseInsulin doses may need to be increased above normal levels at high or extreme altitudes, despite increased levels of exercise and/or decreased food intake
Obtain emergency evacuation and medical insuranceInsulin doses may need to be adjusted in the event of illness, particularly nausea
Be prepared for the unexpected!Insulin doses may need to be adjusted in the event of anorexia; do not inject preprandial insulin until food intake is assured
Use a new source of insulin if unexplained hyperglycemia cannot be corrected with the bottle currently in use, as both freezing and high temperatures can reduce activity