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Insulin at altitude

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Insulin at altitude

 Poster: A snowHead
Poster: A snowHead
Got to Val d'Isere yesterday Blush , and the mrs is having problems with her sugar levels.

She's got an insulin pump and is normally well controlled. Even without doing anythying, her sugar level drops. She's been reducing the dose in her pump and isn't skiing today (wasn't planning to), starts lessons tomorrow.

So, any medics/diabetics know if altitude affects these things?

Ta.

Snow looks superb btw snowHead snowHead snowHead
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
martinm, my OH is diabetic, but without a pump. He doesn't have particular problems, but does find that either cold, or skiing - or both - reduce his blood sugars rapidly. And that isn't particularly energetic skiing. He tests more frequently (though the meter doesn't work if it gets cold - need to avoid outside pockets) and eats a lot of muesli bars. He also finds vin chaud effective. wink At high altitude I guess the body is working a bit harder to do everything.
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
martinm, Mrs M. is experiencing the normal effects of working harder.

Here are four sites, all roughly saying the same thing:

ifyouski.com Health Guide for Diabetes
diabetesdaily.com
diabetes-treatment.suite101
diabetic-lifestyle.com

The key advice is Never Ski Alone and Prepare for Hypoglycaemia.

P.S. I am surprised your wife didn't discuss going skiing with her doctor
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Hi, I'm a T1 diabetic and have just been skiing for the first time. I don't use a pump but do monitor and inject at least 4 times a day.

My experience is almost identical to Pam W's OH; eatl ittle and often; I ate on the lifts so as not to waste time at the top and Peanut M&M's were my food of choice; keep your meter warm - they do not work when cold; definate thumbs up for vin chaud as an apre ski tipple!! There is a small piece on skiing with diabetes on the Lifescan (makers of meters and other stuff) website, http://www.lifescan.co.uk/Segment/Type1Diabetes/Article/Fitness/CampsSkiiingTrips.aspx , but I suppose if you have any worries speak to a doctor.

My levels for the first couple of days were all over the show; I put this down to staying up all night before we flew at 6am in the morning, combined with not eating as well and as regulary as I would normally do under a 'normal day' circumstance. As a result my sugars were up for day 1 and I adjusted my insulin accordingly; by the end of the second day in resort I was back to normal levels. Perhaps her levels have been upset by the travelling and change of routine also?

Kind regards, Nick
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Anyway, snowHeads is much more fun if you do.
martinm, I took my mum to Cervinia a few years back and she made it up to the top no problems at all with the insulin (T1, 5 times a day) - but it was the exercise which affected hers and more than once I had to run over clutching a bar of chocolate. As N1ckster points out there was also the 4am start, bus transfer and temporary loss of luggage to worry about which probably didn't help the first few days!

We also explained to her ski instructor/others in the lesson that should she keel over they knew why... although tbh I'm not sure the instructor understood. Sad

Good luck for the rest of your holiday. Smile
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martinm, My daughter is T1 and skis ( she also goes to the gym every day) ... the advice from her doctors is all mirrored above ... she enjoys the opportunity to eat more sweet things rolling eyes She has gone 'hypo' just the once when skiing ... a result of not testing herself after she finished skiing for the day. Her belief is that altitude does have a small effect ( as outlined above) but insignificant compared to the amount of exercise she gets through when skiing.
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There's a particular brand of blood glucose meter that is recommended by others for use at low temps. I'll have to ask julesb if he remembers which one, but think it may have originally been a recommendation from another SnowHead. Echo the advice given by others above. Carry a bag of Jelly babies with you.
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 After all it is free Go on u know u want to!
After all it is free Go on u know u want to!
Helen Beaumont, My daughter had one in the US but not available in the UK, would be very interested to know what it is ... same problem with different makes & test strips between the UK & France/Switzerland as well .... Evil or Very Mad

n1ckster, My daughter has always been told (by the docs) that she might read higher at altitude ( the reasons were explained) but she hasnt noticed that at all even at the start of the holiday .. but then again may just be a case of insufficient readings rather than fact.
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Thanks all - this is without skiing so, she'll turn the wick down on her pump a lot, especially when having lessons!!

She's a beginner, so the 3 hr lesson will be enough for her.
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martinm, yes, 3 hours is quite long for a beginner, let alone a diabetic one. One warning sign with my OH is that he tends to fall if his blood sugars get a bit low (they don't have to be that low for this to happen - can happen above 4 sometimes. He's best kept above 6. He always tells anyone he's skiing with. often in lessons there's a nurse or doctor - who can keep an eye. He's never had a bad hypo on the slopes - just wobbly moments - though he has had some at night, possibly hangover from exercise during the day. You do need to make sure instructor have understood - and know what to do. I find two minutes down the bra warms the blood sugar monitor up a treat. wink
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snowHeads are a friendly bunch.
pam w, What if Martin's not wearing a bra? snowHead
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 And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
The Y fronts might do.
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 So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
Alexandra, beat me to it! I was going to say: I've heard of man boobs, but does your OH really have to wear a bra, pam w? Laughing
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 You know it makes sense.
You know it makes sense.
pam w, I'm imagining a scenario where martin's poor wife is laying prone on the piste and martin rushes over fiddling with his fly exclaiming "don't worry, I've got just what she needs". Shocked Laughing
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 Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
Quote:

does your OH really have to wear a bra, pam w?

it goes down my bra. rolling eyes
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 Poster: A snowHead
Poster: A snowHead
phone/logon to your pump and/or insulin manufacturer (and your smbg/test strip manufacturer for that matter), part of their product claims and subsequent clearence-to-sell by the various authorities will likely include altitude testing to allow for the obvious (haematocrit levels). they will be able to advise - part of the advice may well be that the product is only "rated" to a certain altitude but that's a little arbitrary (testing is usually simulated - and there is more we dont know than know about diabetes management i'm afraid), but they should be able to put your mind at ease, give you some general advice, certainly if they're worth their salt! If you get no joy, pm me and i'll dig out some links for you to browse around.

does she feel like she's low or just trusting your meter?
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
I've had T1 for a year now, and didn't have any problems when I skied last year (apart from the meter not working occasionally because of the cold). I swear by a regime of regular testing and jelly babies...half a dozen or so before the first run of the day and I was fine until lunch!
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
I think the SnowHead with the meter that is good in the cold weather is on the birthday bash. I was hoping he would drop in and remind us.
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I'm certainly no expert on this, but a friend who uses a pump says that they are affected by altitude - somewhere around the 3000-5000m mark she thinks!!!
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Anyway, snowHeads is much more fun if you do.
Helen Beaumont, is that scarpa?
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pam w, I thought he would have been online by now, but I think he is at the s6bb. He'd researched it quite thoroughly.
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 Then you can post your own questions or snow reports...
Then you can post your own questions or snow reports...
After much forum searching, the blood testing meter that he recommended was the Freestyle Mini.
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 After all it is free Go on u know u want to!
After all it is free Go on u know u want to!
I think it has now been replaced by the Freestyle Lite, which doesn't need a coding chip.
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Helen Beaumont, that looks good - I wonder if the strips are any more expensive? My OH could ask his GP to prescribe the right strips, but obviously if they are more expensive that's a problem, as they're a very expensive item (the meters are very cheap - like printers, they make their money from the consumables). Having a new meter might save me having to grope around putting a very cold item down my bra....
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10,000 feet is generally the altitude most meters/strips are certified to. differing haematocrit performance between differing brands may be worth looking into to potentially identify "the best" at "altitude"
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 snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
pam w, phone them up and ask for a starter kit, they SHOULD throw in a pot of strips in an effort to hook you in
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 And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
pam w, strips are reasonably priced as far as I know. I can check, what meter is your husband using now?
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 So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
I admit I haven't come across anyone being refused test strips from their GP before.
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 You know it makes sense.
You know it makes sense.
Helen Beaumont, thanks very much. His current meter uses One Touch Ultra test strips. I don't expect the GP would refuse - but my OH is very conscious of the amount he costs the NHS and he wouldn't want to change if it was going to be a lot more expensive.
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 Otherwise you'll just go on seeing the one name:
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pam w, a few pounds difference at most I would have thought. Off the top of my head, most are a similar cost price, which is what it will cost the NHS.
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 Poster: A snowHead
Poster: A snowHead
'but a friend who uses a pump says that they are affected by altitude '

Interesting - be handy to know in what way, and if it's the pump or the insulin.

However, we've just notice a large air bubble in the 'syringe' - presumably has expanded from being a small one in the UK at sea level. It's quite possible that when it expanded it pushed more insulin through the tube.

She's doen a lot of walking/using lifts today and has been OK, so fingers crossed for tomorrows lesson!!

And I'm skiing to Tignes snowHead
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
martinm, fingers crossed for her too.
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
I've been T1 for the past 35 years, and skiing for 30 of them. I find it's the excercise.

When doing a half marathon a couple of years ago, I worked closely with my diabetoligist (sp?) , who was keen to find out what happened - there was a theory going around that exercise stimulated some sort of natural insulin substitute, and therefore by exercising hard and continuously, actually you would need less insulin rather than more He wanted to find out if this was true (I rather liked being a guinea pig).

It all seemed counter-intuitive at the time, but I found to be the case. Never was quite sure what the final investigative outcome was though from a science perspective. All I know is, it works. But it was certainly continuous exercise related - a short sharp burst - such as when I was rowing for the school, (many, many years ago) - 6 - 8 mins of high intensity - did not have that same effect.

But now, when I go the gym at lunchtime for a 30 min cardio session, I was advised to, and do, take less insulin (say 6 units rather than 10) than a non gym day. All works out OK for me. It seems to have become mainstream.

So either:
1) keep the insulin levels the same, but enjoy all the snacks you can stuff in (and watch the pounds pile on...)
2) run it low, keep on testing, eat normally, and work dem thighs.


Actually, I guess as with most things in a diabetic's life, it's all down to the testing...

Meanwhile,
As per thread on 3V, doing the jab on the Lac de Loup Itineaire last week whilst stopping for a picnic lunch, a million miles from anywhere was a highlight... fiorget the ironing, extreme injecting is the new kick-ass, just-do-it 'thing'.
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martinm, hi i have a son on the pump and a daughter on injections and have done loads of ski holidays inc Val D,isere with them. I have never found altitude to make any difference and I would guess the bubble is a more likely explanation, My daughter has to reduce her lantus from 14 units to 10 while on holiday to cope with with the increase in activity, However my son on the pump doesnt have to reduce his basal rate, as he plays lots of tennis and football at home so his activity rate is not greatly increased The general advice we have received has been to set a temp basal rate of about 15 % less and then take the same boluses but as we discovered it is horses for courses , and as everyone else has said lots of testing and a glucose source close to hand will soon let you know if you have got it right. one other thing worth watching is to make sure the tubing on the set stays warm as insulin is knackered if it freezes (found that out the hard way). have a great time!
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 Anyway, snowHeads is much more fun if you do.
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I have type 1 too.
I was told to reduce my "slow" working insulin to combat the natural sugar usage of skiing.
But I found that keeping my normal level was OK and that I just had to snack a bit more.
A chocolate croissant before skiing and no "fast"working during the day helps.

It depends on your fast to slow working insulin ratio too.

G
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Hi,

I haven't really written on here much before, but I thought I should say something... I'm TI with an insulin pump and have found with ski-ing/ altitude/ temperature in particular; I need to first turn my insulin levels up... then gradually I need to turn the level down as the week goes on... but not by much... I think it must be my body inital reaction to the altitude/temperature, then getting used to it...

martinm Insulin is affected by temperature- in the winter or when its really cold I find i need more Basal level, but in the summer or warm weather my body seems to process it faster: therefore less... Ski-ing can be an odd one; wrapped up warmly exercising, then getting cooler and it's very much EYO? and what DaveMcski said about tubing is very true!!

Remember Pumps are really adaptable,you can make alteration as you go along it's not like your stuck with too much long acting insulin for 24hrs- turning up or down can make a change in a couple of hrs.

My top tips would be to test loads- I use a disposible heat pad to keep my meter alive... Sorry Pam W no room in my bra which is already occupied by my pump!
Blood testing meters are affected by altitude more than pump I think- so they recommend you test at the bottom of a slope not the top- more acurate reading... and if you've been keeping a regular check you should know which direction your sugars are heading if you calculate how much Insulin you onboard. And as suggested above eat on the lift if necesessary... kendal mint cake!! some how seems more appropriate than gluco tabs in the alps Very Happy

Helen Beaumont I'm afraid there are some doctors out there who have been heard of to try and restrict the type of test meter patients use (deals with pharmacutial companys, specific to their practice). Some have also been heard of questioning the number of test strips they prescribe... a bit sad and short sighted when stats generally prove the more people test the better their control and therefore less risk of long term complications !!

Anyway lot of TI could rant for hours about the process they had to go through to even get a pump.. so I'm not going there...

martinm Enjoy the holiday and learn from the experience for next time; each time can only get better and simpler Very Happy Have a great time!
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Liberatespace, I do know of some restrictions on supply for T2 diabetics, but not for T1.
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 After all it is free Go on u know u want to!
After all it is free Go on u know u want to!
Well, very bad lesson experience, no more skiing for her ever, and I'm about to visit the Ski schoolwith 2 resort reps...... More to follow depending on the outcome.
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martinm, Shocked Sad
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martinm, yikes, hope all is ok?
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