After my trek in the Atlas mountains in September, I blogged about the issues I faced managing diabetes on a mountain. Following my Kilimanjaro trek, here's a little update on what worked for me this time. Amazingly, things went remarkably well and the only real problems I had were following my failed summit attempt, no doubt due to the stress on the body.
Everyone is different, but here's what worked, and didn't work, for me. During the trek, I reduced my basal insulin from 7am - 10pm from 0.9 units per hour to 0.7 units per hour. I then set a temporary basal rate of approximately 60% (from 0.9 down to 0.5) from breakfast (about 30 minutes before we started walking) until about an hour before we finished walking (if I could predict when that would be). At night, I experimented more, but mostly a basal reduction of about 10% (from 0.7 to 0.6 units per hour) worked well for me. Bear in mind that 0.7 is my overnight setting for active days anyway (most days) - for non-active days it's more like 0.9 units per hour. This turned out to be a bit more hit and miss, though I mostly woke up with good results and had very few major highs or lows.
My biggest problem was the dreaded dawn phenomenona and the hour after breakfast, when my levels would often spike up to about 13, and it was hard to know whether to let it drop naturally with the exercise or to take a small correction bolus. Mostly I went with the latter, which was quite successful. Amazingly, I had no almost no hypos on trek at all. of the 6 packs of glucose tablets and 2 bags of jelly babies I took with me, I only used about 1 1/2 bags of jelly babies and no glucose tablets, and many of these were to stave off an impending hypo rather than fight a real one. I also had cereal bars which occasionally I'd use for a minor hypo.
Interestingly, the increasing altitude seemed to have no real effect on me at all, even up to base camp at 4900m, although the lack of hypos and a few high levels in the evening suggest that I was probably reducing my insulin a little bit too much (based on a normal trekking day, which actually involves a lot more mileage than we were covering, due to the difficulties of altitude). I should probably take this into consideration in future, although frequent testing and correcting meant I had little problem. Summit night started off well and after the first hour, at 1am, my blood sugar was still at a perfect 7. Due to the intense difficulties I faced after that on the summit, and the severe cold and lack of time at any stop, I didn't test again, which was probably a mistake, as when I reached base camp at around 7am my blood sugar had spiked right up to 33. I felt desperately sick and dehydrated, but whether that was a result of the high blood sugar, or more likely, the cause of it, is hard to tell. It responded very quickly to a large dose of insulin (7 units) and lots of water, so I suspect again that the high blood sugar was reactionary to my condition caused by altitude sickness, rather than vice versa.
I also had no problems with infusion sets or filling reservoirs with insulin at altitude, unlike when I was in Peru. I had to gradually remove a little air from the insulin vial as we got higher, to prevent the bottle exploding, but just sticking the needle into the vial and allowing the air to escape was sufficient.
All in all, it was a valuable experience and I was very relieved to find that I was able to manage things so well. Of course, it would have been very easy for it all to have gone horribly wrong, so I shall definitely not be complacent next time. But it's nice to see that lots of practice and experimentation seem to be paying off.
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