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From Cape Girardeau, Missouri, USA:

I am a 20 year old type 1 who was diagnosed several months ago. This December I am going to climb Mount Kilimanjaro. There is a seven hour difference in time and I was wondering what to do with my dosage. I am on three shots a day. Morning Humalog and NPH, Lunch Humalog, Nighttime Humalog and NPH. Also, do you know how the high altitude (roughly 19,000 feet) will affect my blood sugar levels, and what I should do with my insulin. Starting at about 14,000 ft. resting heart rate can be up to 120. This climb is more of a rigerous hike and lasts for 7 days with an average of 6 hours of hiking a day. How should I manage carbohydrate intake and insulin dosage for such activity? I have both anaerobic and aerobic work outs twice a day, each lasting about a half hour.


Crossing time zones can confuse an individual's insulin schedule. You may need to make a new plan for timing your insulin injections. You may also need to adjust your total daily insulin dose as well. Consult with your health-care team. They can help you schedule your medication.

In general, when it comes to trips that are longer and have a time change of more than a several hours (such as where you are going), you may be advised by your health care team to increase or decrease the amount of insulin in proportion to the time you will gain or lose. When traveling east, you get a shorter day and therefore you need less insulin. When traveling west, you get more hours in a day and therefore you need more insulin.

When an individual takes more than one injection (such as in your case), you have to think of your travel day as being lengthened or shortened at the end. While your first dose will probably go unchanged, the later ones will be either increased or decreased. Once you arrive at your destination, switch to the local time. When you wake up in the morning, resume your normal schedule of meals, exercise and medication.

With regard to self-management and mountain hiking (climbing): self-management is essential! If mountain climbing is performed during good conditions, it is considered an endurance sport. That means the exercise is aerobic (where you are using large muscle groups, it's continual and rhythmical in nature) and lasts for many hours to several days, as you have stated in your letter. With all of the circumstances you have mentioned, insulin needs usually decrease substantially and consumption of carbohydrates increases. Because of this, you really need to monitor your blood glucose levels and keep a record of the duration (amount of time) and quality of exercise in relation to your body's reactions.

Keep in mind: exercising at high altitudes stimulates the sympathetic nervous system which results in high heart rates and sweating. The ability to recognize hypoglycemia may be confused in these conditions. In addition, poor appetite and sometimes nausea can occur at high altitudes and this can compromise proper food and fluid intake, which can precipitate hypoglycemia. The individual who engages in mountain climbing needs to carefully plan drinking and eating schedules before getting started and monitor blood glucose frequently.

With regard to insulin. Insulin is altered by high temperatures, light, excess agitation and freezing. When walking in the sun, try to store your insulin in an insulated box in an unexposed place in your backpack. With cold weather or at night, placing insulin in a location close to your body (sleeping bag) can prevent it from freezing. Also check all insulins regularly for clumping or precipitation.

General Guidelines for Insulin Storage
Temperature Comments
<2 C
<36 F
Risk of freezing

Short-acting insulin (soluble): usually no damage. Nethertheless, change to a new vial as soon as possible.

Long or intermediate-acting insulin: probable loss of biological activity. Change to a new vial as soon as possible.

2 to 8 C
36 to 46 F
Ideal storage temperature
8 to 30 C
46 to 86 F
No significant effect on insulin activity for 1 month
30 to 45 C
86 to 113 F
Acceptable for very short periods (days); loss of biological activity possible.

There are many mountain climbers with diabetes, such as the well-known Italian Vittorio Casirahgi. Remember: this sport is very strenuous and you really need to take special care to monitor and manage your diabetes. I have to tell you, I am very excited for you. Enjoy, and please, let me know how everything works out. If you take a picture, please send us one for our web site, Children with Diabetes; we would be honored. You are an inspiration to others with and without diabetes.


Original posting 2 Dec 1998
Posted to Insulin and Exercise and Sports


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Last Updated: Tuesday April 06, 2010 15:09:02
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