Trip to Kilimanjaro
Hello everybody,
I'm new to this website and I found it as I was searching the web for answers. I'm a Type I diabetic who is planning on doing a 2 month tour of Africa. Part of this tour involves hiking up Mt. Kilimanjaro and I have a few concerns (most of which I have been able to alleviate by reading of others' experiences). If anyone has experience or can help in answering any of the following questions, that would be really appreciated. Thanks in advance to all.
1. What is the best method to prevent insulin from freezing on the way up Kilimanjaro? I've read "keep the insulin close to your body", but does that mean put the bottles in some sort of thermal protection (if so, please specify a good brand) and then put it in your pocket?
2. I use an insulin pump (Medtronic). Will the pump work at high altitudes and low (-30 Celcious) temperatures? I've read pumps do work up at the summit, but I wanted to double check with anyone who has been to such conditions as I'm afraid the pump won't work or won't deliver insulin as the insulin has frozen.
3. I've read meter readings can be off (both low and high). No question here, just wondering if anyone has any tips.
Thanks so much. I'm sorry if I've placed these questions in the wrong spot on the website - if you would kindly re-direct me to a better place, that would be great. I had earlier posted this same text in the "recent posts" section, but panofsmith was kind enough to suggest that I post here instead. Thanks for that, panofsmith.
Hello Sanga,
I am a Type 1 diabetic who uses a Medtronic insulin pump and I summited Kilimanjaro in August, 2009. Like you, I searched the web prior to my trip, trying to find as much information as I could. Perhaps my experience will help you prepare.
I protected my insulin at night by putting it and my meter(s) at the bottom of my sleeping bag. While this may have kept it warmer than is ideal, I believe that option was better than the possibility of it freezing. During the day, the temperature was above freezing so I protected my insulin by wrapping it in other 'thermal' clothing, etc. and keeping it in the middle of the pack. I think this will give better protection than simply keeping it close to your body because my experience in the mountains has been that cold air, etc. coming from 'outside' has affected my meter, despite it being inside my jacket and against my body.
When we summitted Kili, the temperature was -19C with a wind chill. We did not stay at the summit for long. My pump was under a few layers of clothing, and I did not experience any problems with my pump at the summit or at all during the climb. I did, however, obtain a 'travel pump' from Medtronic. They will, for $50.00, supply you with a 'back-up' pump that you return when you are home again. I have utilized this option from Medtronic a number of times and although I have never had to use it, I would recommend this option for when you are travelling to 'out of the way' places. As well, though, I did pack sringes and Humulin N, in addition to my Nova-Rapid. Fortunately, I brought it all home unused, but I knew that I had supplies for all possible eventualities.
In regard to BG readings, I, too was aware that they could be off due to cold weather. My BG readings were surprisingly very good throughout the climb - which made me question my meter! However, when I returned home, my HbA1C results were the same as the previous A1C, so that would indicate that my blood sugars weren't all that bad. Of course, I kept 'snacks' and dextrose tablets with me throughout the climb and made sure that I was consistent in snacking. However, the food supplied by the trekking 'company' was certainly ample for me.
In my research prior to departure, I read an article that indicated a possible relationship between acedazolamide (diamox) and ketoacidosis so this made me wary of taking diamox to prevent altitude sickness (AMS). Although the travel clinic doctor did perscribe diamox, he also said there is anecdotal evidence that indicates that ibuprofen can prevent altitude sickness. Due to this, although I had diamox with me, and would have taken it if I developed symptoms of AMS, I chose instead to take 1200 mg of Ibuprofen daily, (2 X 600 mg) beginning on the second day when we reached 3847 meters (12,621 ft). I was fortunate not to experience any problems with acclimatization.
I hope my experience can be of some help to you, but more, I hope you have a great hike up Kilimanjaro and a wonderful time in Africa!
All the best!
Louise
Hello Sandesh. Welcome to the site.
I've personally never been on Kili but know of many, many type 1 diabetics who have been on its summit. Likely dozens (hundreds?) have been there and some with not so great experiences. Some with pumps, others not. But, then again, I know of non-diabetic folks who have had quite a rough time on Kili. It's sort of the nature of that kind of place....Nobody is very well acclimatized and it's a big, dusty hill with lots of people!
I know of at least one insulin pump being used up to 7500 meters or so on Cho Oyu (Nepal/Tibet) a few years ago. In 2005, Marco Peruffo reached the summit of Pik Lenin (7134 meters) using a MiniMed Medtronic pump. I had serious technical difficulties with my Animas pump which coincided with my Pik Lenin summit day. I don't believe altitude had anything to do with my pump "issues." I have no idea about all models of insulin pumps at extreme altitudes and know there are precautions to take for all systems. I now am using a Medtronic pump and haven't yet been above 2000 m!
Although, I'm unclear how hypoxia (low barometric pressure associated with higher altitudes) affects a pump body, reservoir, tubing, etc.., I do know that it gets cold up high and ALL device needs to be protected from the cold and kept as close to recommended operating conditions as possible. Also, air bubbles may need to be purged from tubing/reservoirs (same for pen needles or syringes), particularly for unsealed/non-waterproof pumps . Many ways to accomplish all this. On Kili, you'll need to be concerned about insulin also getting fried from the heat and for this a FRIO pouch will be the ticket. Where it's cold, you'll need to keep things from getting too cold.
In short, YES, you do need to take special precautions when skiing, trekking, or climbing with a pump. That said, I find it much more convenient to use for extreme cold weather activities such as winter camping or climbing. No more drawing up a syringe of NPH (or lantus) in my sleeping bag or showing skin in very exposed situations to give myself an injection. But pumps are fallible (like many of the tools we use) and you need to plan for backups.
Blood glucose monitoring is another beast. Just because a manufacture won't "certify" results above a given elevation doesn't mean that automatically the meter won't give decent results. For many meters on the market, it's not very likely that hypoxia is the biggest issue for "accurate and precise" monitoring. The cold is a much bigger factor and meters on the market vary considerably in their operating range. Keep those meters warm!
You can read more at www.idea2000.org and www.mountain-mad.org Also, you can communicate via another forum (many of the people whocontribute here) with other active diabetics at this user group -- http://uk.groups.yahoo.com/group/madidea
A few more references you should probably consider include journal articles by Dr. Conxita Leal and Patricia Brubaker. Both of the articles may be helpful and you should be able to locate them by just doing a google search.
Best wishes and have fun,
David Panofsky