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Hillebrandt D, Gurtoo A, Kupper T, Richards P, Schöffl V, Shah P, van der Spek R, Wallis N, Milledge J. UIAA Medical Commission Recommendations for Mountaineers, Hillwalkers, Trekkers, and Rock and Ice Climbers with Diabetes. High Alt Med Biol 2023; 24:110-126. [PMID: 30335516 PMCID: PMC10282971 DOI: 10.1089/ham.2018.0043] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/20/2018] [Indexed: 01/01/2023] Open
Abstract
Hillebrandt, David, Anil Gurtoo, Thomas Kupper, Paul Richards, Volker Schöffl, Pankaj Shah, Rianne van der Spek, Nikki Wallis, and Jim Milledge. UIAA Medical Commission recommendations for mountaineers, hillwalkers, trekkers, and rock and ice climbers with diabetes. High Alt Med Biol. 24: 110-126.-The object of this advice article is not only to give the diabetic mountaineer general guidance but also to inform his or her medical team of practical aspects of care that may not be standard for nonmountaineers. The guidelines are produced in seven sections. The first is an introduction to the guidelines, and the second is an introduction to this medical problem and is designed to be read and understood by diabetic patients and their companions. The third section is for use in an emergency in mountains. The fourth is for rock, ice, and competition climbers operating in a less remote environment. These initial sections are deliberately written in simple language. The fifth and sixth sections are written for clinicians and those with skills to read more technical information, and the seventh looks at modern technology and its pros and cons in diabetes management in a remote area. Sections One and Two could be laminated and carried when in the mountains, giving practical advice.
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Affiliation(s)
- David Hillebrandt
- Union Internationale des Associations d'Alpinisme Medical Commission (UIAA MedCom), Bern, Switzerland
- Derriton House, Holsworthy, England
| | - Anil Gurtoo
- Union Internationale des Associations d'Alpinisme Medical Commission (UIAA MedCom), Bern, Switzerland
- Department of Medicine, Lady Hardinge Medical College and Associated SSK Hospital, New Delhi, India
| | - Thomas Kupper
- Union Internationale des Associations d'Alpinisme Medical Commission (UIAA MedCom), Bern, Switzerland
- Institute of Occupational and Social Medicine, RWTH Aachen University, Aachen, Germany
| | - Paul Richards
- Faculty of PreHospital Care, Basildon and Brentwood CCG, Essex, England
| | - Volker Schöffl
- Union Internationale des Associations d'Alpinisme Medical Commission (UIAA MedCom), Bern, Switzerland
- Section Sportsmedicine, Department of Trauma and Orthopedic Surgery, Klinikum Bamberg, Bamberg, Germany
- Department of Trauma Surgery, University of Erlangen-Nuermebrg, Germany
- Section of Wilderness Medicine, Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado
| | - Pankaj Shah
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Rianne van der Spek
- Union Internationale des Associations d'Alpinisme Medical Commission (UIAA MedCom), Bern, Switzerland
- Department of Endocrinology and Metabolism, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Nikki Wallis
- Emergency Department, Ysbyty Gwynedd, Bangor, Wales
| | - Jim Milledge
- Union Internationale des Associations d'Alpinisme Medical Commission (UIAA MedCom), Bern, Switzerland
- Northwick Park Hospital, Harrow, United Kingdom
- Department of Medicine, Medical Research Council, United Kingdom
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Adolfsson P, Taplin CE, Zaharieva DP, Pemberton J, Davis EA, Riddell MC, McGavock J, Moser O, Szadkowska A, Lopez P, Santiprabhob J, Frattolin E, Griffiths G, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1341-1372. [PMID: 36537529 PMCID: PMC10107219 DOI: 10.1111/pedi.13452] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Peter Adolfsson
- Department of Pediatrics, Kungsbacka Hospital, Kungsbacka, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Craig E Taplin
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Dessi P Zaharieva
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA
| | - John Pemberton
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Elizabeth A Davis
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Michael C Riddell
- Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Jonathan McGavock
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.,Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Diabetes Action Canada SPOR Network, Toronto, Ontario, Canada
| | - Othmar Moser
- Division Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany.,Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology & Nephrology, Medical University of Lodz, Lodz, Poland
| | - Prudence Lopez
- Department of Paediatrics, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia
| | - Jeerunda Santiprabhob
- Siriraj Diabetes Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Linda A DiMeglio
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA
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Furian M, Tannheimer M, Burtscher M. Effects of Acute Exposure and Acclimatization to High-Altitude on Oxygen Saturation and Related Cardiorespiratory Fitness in Health and Disease. J Clin Med 2022; 11:jcm11226699. [PMID: 36431176 PMCID: PMC9697047 DOI: 10.3390/jcm11226699] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Maximal values of aerobic power (VO2max) and peripheral oxygen saturation (SpO2max) decline in parallel with gain in altitude. Whereas this relationship has been well investigated when acutely exposed to high altitude, potential benefits of acclimatization on SpO2 and related VO2max in healthy and diseased individuals have been much less considered. Therefore, this narrative review was primarily aimed to identify relevant literature reporting altitude-dependent changes in determinants, in particular SpO2, of VO2max and effects of acclimatization in athletes, healthy non-athletes, and patients suffering from cardiovascular, respiratory and/or metabolic diseases. Moreover, focus was set on potential differences with regard to baseline exercise performance, age and sex. Main findings of this review emphasize the close association between individual SpO2 and VO2max, and demonstrate similar altitude effects (acute and during acclimatization) in healthy people and those suffering from cardiovascular and metabolic diseases. However, in patients with ventilatory constrains, i.e., chronic obstructive pulmonary disease, steep decline in SpO2 and V̇O2max and reduced potential to acclimatize stress the already low exercise performance. Finally, implications for prevention and therapy are briefly discussed.
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Affiliation(s)
- Michael Furian
- Pulmonary Division, University Hospital Zurich, 8092 Zurich, Switzerland
- Research Department, Swiss University of Traditional Chinese Medicine, 5330 Bad Zurzach, Switzerland
| | - Markus Tannheimer
- Department of Sport and Rehabilitation Medicine, University of Ulm, 89075 Ulm, Germany
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
- Correspondence:
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Schubert-Olesen O, Kröger J, Siegmund T, Thurm U, Halle M. Continuous Glucose Monitoring and Physical Activity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12296. [PMID: 36231598 PMCID: PMC9564842 DOI: 10.3390/ijerph191912296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 06/16/2023]
Abstract
Continuous glucose monitoring (CGM) use has several potential positive effects on diabetes management. These benefits are, e.g., increased time in range (TIR), optimized therapy, and developed documentation. Physical activity is a recommended intervention tool in diabetes management, especially for people with type 2 diabetes (T2D). The benefits of physical activity for people with diabetes can be seen as an improvement of glycemic control, glycemic variability, and the reduction of insulin resistance. In relation to the physical activity of people with T2D, the benefits of CGM use can even be increased, and CGM can be a helpful tool to prevent adverse events due to physical activity of people with diabetes, such as hypoglycemic events and nocturnal hypoglycemia after sports. This narrative review aims to provide solid recommendations for the use of CGM in everyday life physical activities based on the noted benefits and to give a general overview of the guidelines on physical activity and CGM use for people with diabetes.
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Affiliation(s)
| | - Jens Kröger
- Center of Digital Diabetology Hamburg, 21029 Hamburg, Germany
| | - Thorsten Siegmund
- Diabetes, Hormones and Metabolism Center, Private Practice at the Isar Clinic, 80331 Munich, Germany
| | - Ulrike Thurm
- IDAA, Diabetic Athletes Association, 12621 Berlin, Germany
| | - Martin Halle
- Department of Preventive Sports Medicine and Sports Cardiology, University Hospital Klinikum Rechts der Isar, Technical University of Munich, 80992 Munich, Germany
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Dugan CW, Maloney SK, Abramoff KJ, Panag SS, Davis EA, Jones TW, Fournier PA. Effects of Simulated High Altitude on Blood Glucose Levels During Exercise in Individuals With Type 1 Diabetes. J Clin Endocrinol Metab 2022; 107:1375-1382. [PMID: 34935935 DOI: 10.1210/clinem/dgab881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Current exercise guidelines for individuals with type 1 diabetes (T1D) do not consider the impact that high altitude may have on blood glucose levels (BGL) during exercise. OBJECTIVE To investigate the effect of acute hypoxia (simulated high altitude) on BGL and carbohydrate oxidation rates during moderate intensity exercise in individuals with T1D. METHODS Using a counterbalanced, repeated measures study design, 7 individuals with T1D completed 2 exercise sessions; normoxia and hypoxia (~4200 m simulated altitude). Participants cycled for 60 min on an ergometer at 45% of their sea-level V̇O2peak, and then recovered for 60 min. Before, during, and after exercise, blood samples were taken to measure glucose, lactate, and insulin levels. Respiratory gases were collected to measure carbohydrate oxidation rates. RESULTS Early during exercise (<30 min), there was no fall in BGL in either condition. After 1 h of exercise and during recovery, BGL were significantly lower under the hypoxic condition compared to both pre-exercise levels (P = 0.008) and the normoxic condition (P = 0.027). Exercise in both conditions resulted in a significant rise in carbohydrate oxidation rates, which returned to baseline levels postexercise. Before, during, and after exercise, carbohydrate oxidation rates were higher under the hypoxic compared with the normoxic condition (P < 0.001). CONCLUSIONS The greater decline in BGL during and after exercise performed under acute hypoxia suggests that exercise during acute exposure to high altitude may increase the risk of hypoglycemia in individuals with T1D. Future guidelines may have to consider the impact altitude has on exercise-mediated hypoglycemia.
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Affiliation(s)
- Cory W Dugan
- Department of Sport Science, Exercise and Health, School of Human Sciences, The University of Western Australia, Crawley, Australia
| | - Shane K Maloney
- Department of Sport Science, Exercise and Health, School of Human Sciences, The University of Western Australia, Crawley, Australia
| | - Kristina J Abramoff
- Department of Sport Science, Exercise and Health, School of Human Sciences, The University of Western Australia, Crawley, Australia
| | - Sohan S Panag
- Department of Sport Science, Exercise and Health, School of Human Sciences, The University of Western Australia, Crawley, Australia
| | - Elizabeth A Davis
- Childrens Diabetes Centre, Telethon Kids Institute, Nedlands, Australia
| | - Timothy W Jones
- Childrens Diabetes Centre, Telethon Kids Institute, Nedlands, Australia
| | - Paul A Fournier
- Department of Sport Science, Exercise and Health, School of Human Sciences, The University of Western Australia, Crawley, Australia
- Childrens Diabetes Centre, Telethon Kids Institute, Nedlands, Australia
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Trojian T, Colberg S, Harris G, Oh R, Dixit S, Gibson M, Corcoran M, Ramey L, Berg PV. American Medical Society for Sports Medicine Position Statement on the Care of the Athlete and Athletic Person With Diabetes. Clin J Sport Med 2022; 32:8-20. [PMID: 34930869 DOI: 10.1097/jsm.0000000000000906] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/06/2020] [Indexed: 02/02/2023]
Abstract
ABSTRACT The American Medical Society for Sports Medicine (AMSSM) developed this position statement to assist physicians and other health professionals in managing athletes and active people with diabetes. The AMSSM selected the author panel through an application process to identify members with clinical and academic expertise in the care of active patients with diabetes. This article reviews the current knowledge and gaps regarding the benefits and risks of various types of exercise and management issues for athletes and physically active people with diabetes, including nutrition and rehabilitation issues. Resistance exercises seem to be beneficial for patients with type 1 diabetes, and the new medications for patients with type 2 diabetes generally do not need adjustment with exercise. In preparing this statement, the authors conducted an evidence review and received open comment from the AMSSM Board of Directors before finalizing the recommendations.
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High-altitude illnesses: Old stories and new insights into the pathophysiology, treatment and prevention. SPORTS MEDICINE AND HEALTH SCIENCE 2021; 3:59-69. [PMID: 35782163 PMCID: PMC9219347 DOI: 10.1016/j.smhs.2021.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/11/2021] [Accepted: 04/11/2021] [Indexed: 01/19/2023] Open
Abstract
Areas at high-altitude, annually attract millions of tourists, skiers, trekkers, and climbers. If not adequately prepared and not considering certain ascent rules, a considerable proportion of those people will suffer from acute mountain sickness (AMS) or even from life-threatening high-altitude cerebral (HACE) or/and pulmonary edema (HAPE). Reduced inspired oxygen partial pressure with gain in altitude and consequently reduced oxygen availability is primarily responsible for getting sick in this setting. Appropriate acclimatization by slowly raising the hypoxic stimulus (e.g., slow ascent to high altitude) and/or repeated exposures to altitude or artificial, normobaric hypoxia will largely prevent those illnesses. Understanding physiological mechanisms of acclimatization and pathophysiological mechanisms of high-altitude diseases, knowledge of symptoms and signs, treatment and prevention strategies will largely contribute to the risk reduction and increased safety, success and enjoyment at high altitude. Thus, this review is intended to provide a sound basis for both physicians counseling high-altitude visitors and high-altitude visitors themselves.
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Szadkowska A, Michalak A, Łosiewicz A, Kuśmierczyk H, Krawczyk-Rusiecka K, Chrzanowski J, Gawrecki A, Zozulińska-Ziółkiewicz D, Fendler W. Impact of factory-calibrated Freestyle Libre System with new glucose algorithm measurement accuracy and clinical performance in children with type 1 diabetes during summer camp. Pediatr Diabetes 2021; 22:261-270. [PMID: 33034075 DOI: 10.1111/pedi.13135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/08/2020] [Accepted: 09/24/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Factory-calibrated intermittently-scanned Continuous Glucose Monitoring (isCGM) device FreeStyle Libre (FSL) has recently received improvements in its glucose tracking algorithm and calibration procedures, which are claimed to have improved its accuracy. OBJECTIVE To compare the accuracy of two generations of 14-days FSL devices (A in 2016, B in 2019) to self-monitored blood glucose measurements (SMBG) in children with type 1 diabetes in real-life conditions during a summer camp. MATERIALS AND METHODS Two largely independent groups of youth with type 1 diabetes took part in summer camps. In 2016 they used FSL-A, in 2019 FSL-B. On scheduled days, participants performed supervised 8-point glucose profiles with FSL and SMBG. The accuracy vs SMBG was assessed with mean absolute relative difference (MARD) and clinical surveillance error grid (SEG). RESULTS We collected 1655 FSL-SMBG measurement pairs from 78 FSL-A patients (age 13 ± 2.3 years old; HbA1c: 7.6 ± 0.8%) and 1796 from 58 in FSL-B group (age 13.8 ± 2.3 years old, HbA1c: 7.5 ± 1.1%)-in total 3451 measurements. FSL-B displayed lower MARD than FSL-A (11.3 ± 3.1% vs 13.7 ± 4.6%, P = .0003), lower SD of errors (20.2 ± 6.7 mg/dL vs 24.1 ± 9.6 mg/dL, P = .0090) but similar bias (-7.6 ± 11.8 mg/dL vs -6.5 ± 8 mg/dL, P = .5240). Both FSL-A and FSL-B showed significantly higher MARD when glycaemia was decreasing >2 mg/dL/min (FSL-A:22.3 ± 18.5%; FSL-B:17.9 ± 15.8%, P < .0001) compared with stable conditions (FSL-A: 11.4 ± 10.4%, FSL-B:10.1 ± 9.1%) and when the system could not define the glycaemic trend (FSL-A:16.5 ± 16.3%; FSL-B:15.2 ± 14.9%, P < .0001). Both generations demonstrated high percentage of A-class and B-class results in SEG (FSL-A: 96.4%, FSL-B: 97.6%) with a significant shift from B (decrease by 3.7%) to A category (increase by 3.9%) between generations (FSL-A: 16/80.4%; FSL-B:12.3/85.3%, P = .0012). CONCLUSION FSL-B demonstrated higher accuracy when compared to FSL-A However, when glycemia is decreasing or its trend is uncertain, the verification with a glucose meter is still advisable.
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Affiliation(s)
- Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
| | - Arkadiusz Michalak
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland.,Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Aleksandra Łosiewicz
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
| | - Hanna Kuśmierczyk
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
| | - Kinga Krawczyk-Rusiecka
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
| | - Jędrzej Chrzanowski
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Andrzej Gawrecki
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
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Acute mountain sickness induced diabetic ketoacidosis managed with hemodialysis: A case report. Ann Med Surg (Lond) 2020; 56:165-168. [PMID: 32637094 PMCID: PMC7330143 DOI: 10.1016/j.amsu.2020.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction The risk of developing ketoacidosis in patients with type 1 diabetes at high altitude is high. Anorexia associated with acute mountain sickness, dehydration and additional exercise associated with climbing exacerbates the generation of ketones and the development of ketoacidosis. Case presentation A 33-year-old gentleman with known history of uncontrolled type 1 diabetes mellitus trekked to Everest Base Camp at an altitude of 3440 m and became unwell. He developed altered sensorium and shortness of breath. He ingested eight tablets of acetazolamide (250 mg each) to address these symptoms. Upon presentation to emergency, he was diagnosed with severe diabetes ketoacidosis (DKA) with shock. Resuscitation was started with fluid, insulin, vasopressors and mechanical ventilation. Despite adequate fluid resuscitation, insulin, bicarbonates and other supportive measures, his acidosis and shock persisted and then managed with hemodialysis. After the first session of hemodialysis, improvement in acidosis and shock was noted. He was successfully extubated and later discharged. Discussion In this case report, DKA due to acute mountain sickness was complicated by acetazolamide use and noncompliance to his regular insulin intake. There is no proper guideline regarding the role of renal replacement therapy in management of DKA. However, evidence of hemodialysis in DKA is limited to few case reports. Improvement seen in our patient after dialysis is related to dialyzable nature of acetazolamide. Conclusion We present a case of a severe DKA potentially precipitated by acute mountain sickness, use of acetazolamide, noncompliance to his regular insulin intake and managed with hemodialysis in addition to conventional treatment for DKA. Metabolic decompensation that occur with high altitude increases the generation of ketones and the development of ketoacidosis. Incorporating renal replacement therapy in severe refractory acidosis in DKA management will reduce the morbidity and mortality in patient with DKA. The timely intervention of dialysis in severe refractory acidosis has a good outcome.
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Matejko B, Gawrecki A, Wróbel M, Hohendorff J, Benbenek-Klupa T, Zozulińska-Ziółkiewicz D, Malecki MT, Klupa T. Physiological Characteristics of Type 1 Diabetes Patients during High Mountain Trekking. J Diabetes Res 2020; 2020:8068710. [PMID: 33015195 PMCID: PMC7519997 DOI: 10.1155/2020/8068710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/17/2020] [Accepted: 08/25/2020] [Indexed: 12/24/2022] Open
Abstract
In this study, the aim was to provide observational data from an ascent to the summit of Mount Damavand (5670 meters above sea level (m.a.s.l), Iran) by a group of people with type 1 diabetes (T1DM), with a focus on their physiological characteristics. After a 3-day expedition, 18 T1DM patients, all treated with personal insulin pumps, successfully climbed Mount Damavand. Information was collected on their physiological and dietary behaviors, as well as medical parameters, such as carbohydrate consumption, glucose patterns, insulin dosing, and the number of hypo- and hyperglycemic episodes during this time frame. The participants consumed significantly less carbohydrates on day 3 compared to day 1 (16.4 vs. 23.1 carbohydrate units; p = 0.037). Despite this, a gradual rise in the mean daily glucose concentration as measured with a glucometer was observed. Interestingly, the patients did not fully respond to higher insulin delivery as there was no significant difference in mean daily insulin dose during the expedition. There were more hyperglycemic episodes (≥180 mg/dL) per patient on day 3 vs. day 1 (p < 0.05) and more severe hyperglycemic episodes (>250 mg/dL) per patient on days 2 (p < 0.05) and 3 (p < 0.05) vs. day 1. In summary, high mountain trekking is feasible for T1DM patients with good glycemic control and no chronic complications. However, some changes in dietary preferences and an observable rise in glucose levels may occur. This requires an adequate therapeutic response.
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Affiliation(s)
- Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Andrzej Gawrecki
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marta Wróbel
- Department of Internal Medicine, Diabetology and Cardiometabolic Diseases, Silesian Center of Heart Diseases, Zabrze, Poland
| | - Jerzy Hohendorff
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | | | | | - Maciej T. Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
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VanBaak KD, Nally LM, Finigan RT, Jurkiewicz CL, Burnier AM, Conrad BP, Khodaee M, Lipman GS. Wilderness Medical Society Clinical Practice Guidelines for Diabetes Management. Wilderness Environ Med 2019; 30:S121-S140. [PMID: 31753543 DOI: 10.1016/j.wem.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 11/18/2022]
Abstract
The Wilderness Medical Society convened an expert panel in 2018 to develop a set of evidence-based guidelines for the treatment of type 1 and 2 diabetes, as well as the recognition, prevention, and treatment of complications of diabetes in wilderness athletes. We present a review of the classifications, pathophysiology, and evidence-based guidelines for planning and preventive measures, as well as best practice recommendations for both routine and urgent therapeutic management of diabetes and glycemic complications. These recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks or burdens for each recommendation.
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Affiliation(s)
- Karin D VanBaak
- Department of Family Medicine and Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO.
| | - Laura M Nally
- Department of Pediatric Endocrinology, Yale University School of Medicine, New Haven, CT
| | | | - Carrie L Jurkiewicz
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
| | | | - Barry P Conrad
- Division of Endocrinology, Stanford Children's Hospital, Stanford, CA
| | - Morteza Khodaee
- Department of Family Medicine and Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO
| | - Grant S Lipman
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
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12
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Adolfsson P, Riddell MC, Taplin CE, Davis EA, Fournier PA, Annan F, Scaramuzza AE, Hasnani D, Hofer SE. ISPAD Clinical Practice Consensus Guidelines 2018: Exercise in children and adolescents with diabetes. Pediatr Diabetes 2018; 19 Suppl 27:205-226. [PMID: 30133095 DOI: 10.1111/pedi.12755] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/16/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Peter Adolfsson
- Department of Pediatrics, Kungsbacka Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Craig E Taplin
- Division of Endocrinology and Diabetes, Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Elizabeth A Davis
- Department of Endocrinology and Diabetes, Princess Margaret Hospital; Telethon Kids Institute, University of Western Australia, Crawley, Australia
| | - Paul A Fournier
- School of Human Sciences, University of Western Australia, Perth, Australia
| | - Francesca Annan
- Children and Young People's Diabetes Service, University College London Hospitals NHS, Foundation Trust, London, UK
| | - Andrea E Scaramuzza
- Division of Pediatrics, ASST Cremona, "Ospedale Maggiore di Cremona", Cremona, Italy
| | - Dhruvi Hasnani
- Diacare-Diabetes Care and Hormone Clinic, Ahmedabad, India
| | - Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
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13
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Nabrdalik K, Kwiendacz H, Gubała M, Tyrała K, Seweryn M, Tomasik A, Sawczyn T, Kukla M, Grzeszczak W, Gumprecht J. Diabetes-Related Knowledge of Polish National Mountain Leaders. High Alt Med Biol 2018; 19:237-243. [PMID: 29924643 DOI: 10.1089/ham.2017.0168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Nabrdalik, Katarzyna, Hanna Kwiendacz, Monika Gubała, Kinga Tyrała, Mariusz Seweryn, Andrzej Tomasik, Tomasz Sawczyn, Michał Kukla, Władysław Grzeszczak, and Janusz Gumprecht. Diabetes-related knowledge of Polish national mountain leaders. High Alt Med Biol. 19:237-243, 2018.-Mountain trekking is a popular activity for patients with diabetes. In Poland, mountain leaders often accompany organized groups to ensure their safety during treks; we aimed to evaluate their competency in caring for diabetic clients by assessing their diabetes-related knowledge. This was a cross-sectional study among Polish, certified, active mountain leaders carried out by means of an anonymous, standardized 41-item questionnaire adapted from a study by Wee et al. It was distributed through e-mail to 500 leaders. A total of 106 (21.2%) mountain leaders completed the questionnaire (males 60.4%) with a mean (standard deviation [SD]) age of 38.6 (13.5) years. Their mean (SD) length of experience acting as a mountain leader was 11.9 (10.2) years. The average score was 72.4% of the maximum possible (29.7 of 41 points). Results varied significantly depending on gender (p = 0.006). The percentage of correct answers among questions in each section varied between 23.6% and 100%. The main sources of diabetes-related knowledge identified by respondents were members of their family and their friends who suffer from diabetes (33%). First aid courses were indicated as sources of information by only 12.6% of the informants. Results of the questionnaire revealed that respondents did have a reasonable level of diabetes-related knowledge. There were topics in which the respondents achieved lower than an average score, demonstrating a need for further education.
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Affiliation(s)
- Katarzyna Nabrdalik
- 1 Department of Internal Medicine, Diabetology and Nephrology in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia , Katowice, Poland
| | - Hanna Kwiendacz
- 1 Department of Internal Medicine, Diabetology and Nephrology in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia , Katowice, Poland
| | - Monika Gubała
- 2 Student's Scientific Association by the Department of Internal Medicine, Diabetology and Nephrology in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia , Katowice, Poland
| | - Kinga Tyrała
- 2 Student's Scientific Association by the Department of Internal Medicine, Diabetology and Nephrology in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia , Katowice, Poland
| | - Mariusz Seweryn
- 3 Department of Epidemiology, Medical University of Silesia , Katowice, Poland
| | - Andrzej Tomasik
- 4 Second Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia , Katowice, Poland
| | - Tomasz Sawczyn
- 5 Department of Physiology in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia , Katowice, Poland
| | - Michał Kukla
- 6 Department of Gastroenterology and Hepatology in Katowice, Medical University of Silesia , Katowice, Poland
| | - Władysław Grzeszczak
- 1 Department of Internal Medicine, Diabetology and Nephrology in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia , Katowice, Poland
| | - Janusz Gumprecht
- 1 Department of Internal Medicine, Diabetology and Nephrology in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia , Katowice, Poland
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14
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Malcolm G, Rilstone S, Sivasubramaniyam S, Jairam C, Chew S, Oliver N, Hill NE. Managing diabetes at high altitude: personal experience with support from a Multidisciplinary Physical Activity and Diabetes Clinic. BMJ Open Sport Exerc Med 2017; 3:e000238. [PMID: 29021909 PMCID: PMC5633730 DOI: 10.1136/bmjsem-2017-000238] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2017] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Physical activity is important for well-being but can be challenging for people with diabetes. Data informing support of specialist activities such as climbing and high-altitude trekking are limited. A 42-year-old man with type 1 diabetes (duration 30 years) attended a Multidisciplinary Physical Activity and Diabetes Clinic planning to climb Mont Blanc during the summer and trek to Everest Base Camp in the autumn. His aims were to complete these adventures without his diabetes impacting on their success. METHODS We report the information provided that enabled him to safely facilitate his objectives, in particular, the requirement for frequent checking of blood glucose levels, the effects of altitude on insulin dose requirements, and recognition that acute mountain sickness may mimic the symptoms of hypoglycaemia and vice versa. Real-time continuous glucose monitoring was made available for his treks. RESULTS The effects of high altitude on blood glucose results and glycaemic variability while treated on multiple daily injections of insulin are reported. In addition, we present a first-person account of his experience and lessons learnt from managing diabetes at high altitude. CONCLUSIONS A dedicated Multidisciplinary Physical Activity and Diabetes Clinic delivering individualised, evidence-based, patient-focused advice on the effects of altitude on blood glucose levels, and provision of real-time continuous glucose monitoring enabled uneventful completion of a trek to Everest Base Camp in a person with type 1 diabetes.
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Affiliation(s)
- Gary Malcolm
- Department Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Sian Rilstone
- Department Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Carol Jairam
- Department Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Stephen Chew
- Department Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Nick Oliver
- Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, St. Mary's Campus, London, UK
| | - Neil E Hill
- Department Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK.,Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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15
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Out of air: Is going to high altitude safe for your patient? JAAPA 2017; 30:10-15. [PMID: 28696953 DOI: 10.1097/01.jaa.0000521132.92796.a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
As more people travel to high altitudes for recreation or work, more travelers with underlying medical conditions will need advice before traveling or treatment for altitude illness. This article focuses on the two main issues for travelers: whether travel to a high altitude will have a negative effect on their underlying medical condition and whether the medical condition increases the patient's risk of developing altitude illness. Although patients with severe pulmonary or cardiac conditions are most at risk in the hypoxic environment, other conditions such as diabetes and pregnancy warrant attention as well.
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16
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Matejko B, Benbenek-Klupa T, Malecki MT, Klupa T. Personal Insulin Pump With Predictive Low Glucose Management Technology at High Altitude. J Diabetes Sci Technol 2017; 11:176-177. [PMID: 27170635 PMCID: PMC5375058 DOI: 10.1177/1932296816649973] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
- University Hospital, Kraków, Poland
| | | | - Maciej T. Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
- University Hospital, Kraków, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
- University Hospital, Kraków, Poland
- Tomasz Klupa, MD, PhD, Department of Metabolic Diseases, Jagiellonian University, 15 Kopernika St, 31-501 Kraków, Poland.
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