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From Camarillo, California, USA:

I am seeking information on strenuous hiking (overnight backpacking) and diabetic meal planning and precautions (especially at high altitudes, over 10,000 feet). I am Type 2, white male, age 52, diagnosed five weeks ago and don't intend to give up backpacking (well, unless it's going to kill me or worse). I'm sure there are other backpackers and major hikers who are also diabetic. Many additional details will require attention during backpacking, specifically the increased importance of diet and glucose monitoring. I'd sure like to find some information - some of us must be backpackers!


There are two areas of concern with my answering your question. First: The management of your diabetes is unclear. You stated you have Type 2 diabetes; however, you did not mention if you were taking oral glycemic medication, insulin, or if you manage your diabetes through diet and exercise. Second: You mentioned backpacking/hiking in an altitude over 10,000 feet.

Exercise at High Altitude

In general, one needs to be able to regulate exercise according to the environment. In your case, it is the effect of high altitude on physical performance. Maximal oxygen consumption begins to deteriorate at an altitude of approximately 5,000 feet with pulmonary diffusion being the major limiting factor. As the partial pressure of oxygen decreases with altitude, the driving force of oxygen from the environment to the pulmonary circulation is impaired. In simple terms: The force of gravity is reduced as one goes away from the surface of the earth, and consequently less oxygen is brought into the lungs with each breath. This reduces the amount of oxygen carried in the blood. The decreasing availability of oxygen to the tissues would be expected to hamper physical performance, and indeed it does. So if you are accustomed to a certain exercise pace at home where you may be at sea level or even 400 feet in elevation, and you went to the mountains (such as the Colorado Rockies) where the altitude exceeds 5,000 feet, exercise at the same pace would produce a higher exercise heart rate. You would need to slow down your pace due to the lack of oxygen available to the tissues.

Ability to adjust to higher environments over a period of time is called acclimatization. The higher up you go the longer the time it will take to acclimatize yourself. Altitudes below 3,000 feet probably require no acclimatization. The problem is slight up to 5,000 feet. The problem of acclimatization is only academic above 10,000 feet.

Exercise or competitive sports at altitudes higher by 3,000 feet or more than the home environment will be noticeably impaired by hypoxia if the activity depends highly upon aerobic energy (of one minute or greater duration).

The critical height for the appearance of acute mountain sickness (AMS) is about 11,000 feet, but it may occur as low as 6,000 feet. Symptoms include headache, insomnia, irritability, weakness, vomiting, rapid heart rate, and disturbances of breathing.

Glycogen depletion is often a problem of these climbs due to extremely heavy exercise loads and inadequate caloric intake. Prolonged exposure to high altitudes can lead to deterioration with symptoms such as weight loss, increasing lethargy and weakness. Lack of oxygen at high altitude can result in blunting emotional response, lack of insight and mental inertia, and the slowing of thought process.

Before you continue backpacking/hiking you need to know the "ins and outs" of your diabetes and how to make adjustments.

Tips to help you Backpacking/Hiking in High Altitude

  1. Make sure you carry bottled water and snacks (especially if you have Type 1 diabetes or if you have Type 2 diabetes and you are taking an oral glycemic agent or insulin).
  2. Be sure to carry a source of fast acting carbohydrate with you if you are taking oral glycemic agents or insulin.
  3. Check blood glucose before backpacking/hiking, during and after.
  4. Always backpack/hike with a partner and educate them as to the signs and symptoms of hypoglycemia and how to treat. Hypoglycemia can be confused with AMS.
  5. Use caution if you have a cardiovascular and/or respiratory condition.
  6. Foot care is essential - Check for blisters, abrasions, cuts, etc. Always keep feet clean and dry.
  7. Even if you are in tip-top shape, allow time to become adjusted to the altitude. The higher up you go, the longer the time it will take you to acclimate yourself.
  8. Check with your physician, endocrinologist, or diabetes team before you continue to engage in backpacking/hiking.



[Editor's comment: I'd also suggest you contact the International Diabetic Athletes Association (1647-B West Bethany Home Road, Phoenix, AZ 85015, (800) 898-IDAA or (602) 433-2113; fax (602) 433-9331). Additional information about the IDAA can be found at their website. WWQ]

Original posting 29 Jul 97


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Last Updated: Tuesday April 06, 2010 15:08:54
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