General recommendations for individuals with type 1 diabetes trekking at altitude
| Pretravel preparation | During travel | ||||
|---|---|---|---|---|---|
| General | Diabetes related | General | Diabetes related | ||
| Get a general physical check-up, as well as a dental check-up, to prevent any unnecessary health problems whilst traveling | Get 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 hygiene | Monitor 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 asset | Ensure 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 monitoring | Maintain adequate levels of hydration and nutrition | Monitor 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 companies | Consult your physician regarding prevention and treatment of hypoglycemia, ketoacidosis, illness, and infection | Take all possible proactive measures to prevent illness and/or infection | Insulin 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 2 | Know how your body normally reacts to different types of stresses, particularly exercise | Insulin 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 insurance | Insulin 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 | |||||