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Diabetes at Altitude - Broad Peak 2004 What is diabetes? Type 1 diabetes - is an autoimmune condition, resulting in the complete deficiency of insulin Type 2 diabetes - caused either by a shortage of insulin, or by the body being resistant to insulin. For more information as produced by Diabetes UK, please check out their website via the link at the foot of this page. How long have I had diabetes, and what type do I have? How do I manage my diabetes? My basal (background) insulin requirements are administered by the pump in very small discrete doses every 3 minutes or so and has been programmed to carefully match my body's requirements. If I am ill or stressed - I increase my basal dose of insulin. If I am exercising - I generally reduce my basal insulin because the exercise generally has an effect of increasing the body's sensitivity to what insulin there is around, as well as enabling small amounts of glucose to enter from the bloodstream into the cells passively i.e. without the need for insulin. How will I manage my condition in such extreme environments
such as on Broad Peak? I will ensure that I have sufficient batteries for my
equipment, and that I have sufficient insulin and glucose test strips
for the duration of the trip x100% (in case of unforeseen circumstances
etc). Some test strips are very sensitive to temperature, and some are
very sensitive to hypoxic conditions - so this is being carefully planned
for which meter to take. I will be ensuring that my infusion sites and
finger tips are kept as clean as possible to prevent any infection occurring. What about the effects of exercise on diabetes? As mentioned above, aerobic exercise tends to increase your sensitivity to insulin, as well as enabling some glucose to enter passively into cells for use - thus overall in general, a decrease of insulin is required unless this is counteracted by consumption of sufficient carbohydrates. If I am out walking on the mountain all day, I tend to find that my insulin requirements are reduced by 50%. This does vary depending on lots of factors - this is where the trial and error comes in - to see what works best for you to keep your blood sugar levels at a good level. I never exercise if my blood sugars are very high, or if there are ketones present - as this makes the body go into a feed-forward mechanism where blood sugars can then be further elevated. Many athletes, if they have fairly high blood sugar (but no ketones present) - will often use exercise TOGETHER with a small bolus of rapid acting insulin to bring their blood sugar levels down. There are pros and cons of doing this, especially if you inject more insulin than you need as this will lead to hypoglycaemia. It is interesting to note that some exercise e.g. rock climbing and weightlifting - can require no reduction in insulin as these sports tend to have a hormonal effect which causes an increase in blood sugar levels. What about the effects of altitude on diabetes? It is also worth registering on the discussion group located at http://uk.groups.yahoo.com/group/madidea/ as there is a wealth of practical advise and information out there. What diabetes management equipment will I be taking
with me? What about the rest of the Expedition Team? What diabetes problems am I likely to encounter? It is easy to confuse symptoms of exhaustion and AMS and
other conditions - with low or high blood sugars. I know exactly what
my own signs are symptoms of becoming "low" and "high"
- and if in doubt, I always check my blood glucose level. Equipment not working properly due to extreme temperatures - hopefully our preparations and planning for this will prevent this happening. Luckily my glucose test strips also have a visual gauge on the reverse, so if my meter is no functioning for whatever reason, I will use this. (Of course, in a coloured tent with headtorches on - the colour may well be completely different!) Possibly retinal haemorrhages (due to the altitude) - I have had my optician check my eyes for any pre-existing damage which could cause problems, and this is advisable for anyone (with or without diabetes). Infection - caused by untreated water or contaminated
food supplies. This can cause nasty sicknesses, resulting in weakness
and more importantly dehydration. When you are ill - the last thing
you want to think about is self management for diabetes - but this is
a must to prevent hyperglycaemia and ketoacidosis occurring. |
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