Although many people may never attempt the extremes of temperature, altitude, and physical exertion reported by Dr. Herter, the article brought to light some important and often overlooked management issues that can also be experienced in less extreme conditions. Dr. Herter's "five extra essentials" (extra insulin, extra supplies, back-up monitoring supplies, injectable glucagon, and willingness to communicate) should be taken on all trips, not just outdoor adventures.

Having dealt extensively with blood glucose monitoring at various altitudes, I would like to further comment on the effects of altitude. As altitude increases over 6,000 feet, all meters and strips can be affected by the decreased oxygen needed for the enzymatic reaction to occur. Cold temperatures further compromise this reaction.

I suggest that those traveling to higher altitudes carry control solution and compare the results at high altitude to those obtained at their home altitude. High altitudes affect even visual blood glucose test strips.

Individuals with type 1 diabetes who travel need to be aware of these deviance's and to adjust their therapy appropriately to avoid medical emergencies.