Mt. Whitney Portal Store & Hostel Forums General Mt. Whitney Portal Store Message Board Hypoglycemia vs AMS

I have not found specifics on this so I wanted to ask.

How do you differentiate between the symptoms of hypoglycemia and AMS at altitude?

Specifically, I am thinking about this: Take 2 people (identical in physical shape / mass), one at sea level, and one at 14,000 ft. Assume they are both doing a certain amount of activity so that they have the same caloric expenditure. At the same caloric expenditure, will the person at 14,000 ft have a larger drop in blood sugar level?

Is there research showing that food intake affects AMS symptoms? I have not found specific literature but have seen this stated in general.

Overall, can we compare/contrast what variables cause these two conditions?

Can we compare/contrast the symptoms exhibited in these two conditions?

Thanks,

Zé

I haven't found literature either.

However, I am diabetic, and have been so on both my summits of Mt. Whitney.

The mechanism of the two problems are different:

AMS is caused by the lack of enough oxygen reaching the cells. One solution is to increase the number of red blood corpuscles (the haemoglobin in them combines with oxygen to form oxyhaemoglobin which it then transports to the cells via the bloodstream and releases oxygen for metabolizing sugar, at the cell level. So, when enough oxygen does not reach the cells one has to either (a)increase the number of trucks doing the delivery (more red blood cells. This is what hapens by acclimatization) or (b)increase the load per truck (force the haemoglobin to carry close to the normal amount by catalyzing the combination of oxyhaemoglobin. This is what happens when you take Diamox)

Hypogleicemia is when less (hypo) sugar (glucose) reaches the cells. This is caused by one of two reasons (a) there isn't enough carbs in the stomach to breakdown into glucose for transport to the cells (in which case the body will start to burn fat - a very slow process) or (b) there is enough carb, and hence breakdown glucose present, but either the body produces no insulin (type 1 diabetes) or produces not enough insulin (type 2 diabetes). Insulin is the enzyme necessary for the cells to absorb the glucose so it can be metabolized by the oxygen that the haemoglobin carried to it.

So, while both AMS and hypoglecimea work by depriving the cells of nutrition, there is no *apparent" cause for sugar metabolism to be affected by high altitude, while there *is" apparent cause for oxygen delivery to be disrupted by not enough pressure for oxygen to combine with haemoglobin efficiently.

Just calorific expenditure alone will not cause extremely unusual drops (it will cause some immediate drop) in blood sugar, certainly not enough to induce hypogleicemia in a normal person as long as there is carbs or even burnable fat available.

-N

I'm a medical layman, so take my comments accordingly. However - AMS is a collection of symptoms whereas hypoglycemia refers to a specific condition. If you don't eat regularly on a trip up Whitney, it's been my observation that most will experience some degree of hypoglycemia. If you also experience some effects of altitude, then you have additional reasons to feel cruddy.

I read your trip report, and IMHO a bagel isn't enough food for 20+ miles and 7K' elevation gain for most mortals (from what I read - Rick Kent excluded). Loss of appetite is rather common at altitude, especially above 12K, and because you don't feel like eating doesn't mean your body doesn't need the food.

I couldn't find any specific resource, but then, my access is limited for a week or so until I get back 'home'.

If glycemia sugar problems, just manage your eating (often and small) over your exercising duration. Understand that you will be getting physically (and chemically) stressed and the exertion will be affecting you. Probably not the altitude any more than anybody else. Just keep your sugar levels where they are supposed to be and what you are used to routinely doing exercise all day long. You may not feel like a lot of protein because of the altitude.

You can not afford NOT to snack if you have gollywobbles from the altitude. If you can't eat, you have a different problem than those with normal blood sugar controls walking around up there at the same altitude. If you have vision problems, severe malaise then those may be associated with your blood sugar. If you can't fix it (or change it) by eating, then you have AMS. If you can't eat...well, you might have a problem most up there don't. Time to call it a day.

Quite a lot of info on Google for the following:

diabetes high altitude

Check with your diabetician who might chat with you about 'leaky veins'.

But if you are managing glucose well, you should be fine. The problem is keeping the insulin (if dependent) cool enough for the trip. There are some good insulating bags for that and you will have plenty of cool spring water as well.

Well I would start with that I have been fine hiking 7000 ft and 16 miles on a bagel. In fact, there is no loss of performance for me. Am I underfed? Sure. As a non-diabetic, however, I do not get so hypoglycemic that I would feel fatigued and dizzy. This previous experience is evidence #1.

Evidence #2 comes from the whitney hike. When I hiked up to high altitude, I got dizzy and slow- but then I got better when I hiked back down a bit. Correct me if I'm wrong, but to me that doesn't indicate hypoglycemia. That indicates AMS.

These pieces of evidence are personal feedback that I would rely on to make future decisions. Neither indicates to me that I need to force-feed myself on a hike at altitude. Now, I certainly could be wrong. But it would be great to get an explanation why.

Hi Neel,

Came across this link, don't know if it is useful for you.

Link

Hypogycemia is low blood sugar period.It has nothing to do with how much sugar gets into the cells. Only insulin and insulin resistence influence cellular transport of glucose from the blood into the cell. It is not caused by type I or Type 2 diabetes. Low blood sugar(hypogycemia) can be caused from not consuming enough food or from having your insulin remove glucose from the blood and into the cells. This causes low blood sugar and resulting blood sugar symptoms.This can be remedied immediately by consuming simple cabohydrates like sugary foods and slower with other food such as complex carbs,protein or fats.

getting way too complicated here. Let's go back to simple question:


Answer:
In a non-insulin-using person, eat carbs...hypoglycemia responds in 5-30 minutes..AMS does not. Harvey

Well, no shit.

I'm actually looking for rationale for why people are saying you need to eat more carbs when at hiking at altitude than at sea level to maintain blood sugar level...

The query is about symptoms. I'm an insulin-dependent diabeticx53 years, a hiker/climberx36 years, have experienced both. Caveat: different people can experience different symotoms with the same physiological state. But here goes--AMS usually involves lethargy, a feeling of depletion, often nausea. Hypoglycemia elicits a more panicky state--because your body is having an adrenal response to dying (or so your brain cells, which metabolize only glucose, think). In fact, my quandry is to distinguish hypoglycemia from fear, especially when climbing. Also, my hypoglycemia elicits a ravenous hunger (makes semse)--hand me a piece of bread, and I'll stuff it in my mouth and start chewing. Panic and hunger--think hypoglycemia.

I am not sure anyone can distinguish between AMS and hypoglycemia in the moment because both cause foggy headed poor decision making thinking. One should know that if they have a hypogycemic tendency they should consume carbs immediately upon feeling symptoms. To put it simply if anyone is feeling weak exhausted,light headed etc., they should consume candy,goo,cliff shots and see if they feel better quickly. If not then decend and see if that makes them feel better.That probably is the best way to distinguish between the two.There are way too many overlapping symptoms. It helps if you have experience with either and to be able to know your body.

Actually, this is a very different question than the highly complex question that you started this thread with.

I don't remember seeing that assertion, above. Could you provide links or references? I actually don't think it is true.

Carbs give a quick blood sugar boost.Simple carbs like sugary foods break down almost immediately and give a quick energy boost. Problem is that it also triggers an insulin response which removes blood sugar from the blood and the brain demands more glucose immediately.The only quick solution is more simple carbs or sugar.That is why one needs to keep consuming carbs continously. I perform better with a balance of protein, fats and less carbs. When hiking I only go to the candy or goo shots when I am boinking and need a quick pick up.Otherwise I prefer to eat more protein,and fats/oils which breaks down slower and gives a steady blood sugar release rather than that quick carb blast. I graze on protein bars, and nuts like almonds and macadamias.At altitude it depends on what you appetite will allow you to eat.