Women at altitude: Changes in carbohydrate metabolism at 4,300-m elevation and across the menstrual cycle

We hypothesized that, in women, the blood glucose response to a meal (BGR) would be lower after exposure to 4,300 m compared with sea level (SL) and that BGR would be reduced in the presence of estrogen plus progesterone (E+P) relative to estrogen alone (E). Sixteen women were studied in both the E and E+P conditions at SL and in either the E or E+P condition at 4,300 m. On day 9 in each condition, blood was sampled before, and every 30 min for 2 h after, the subjects ate a high-carbohydrate meal. At 4,300 m, BGR peaked at a lower value (5.73 ± 0.94 mM) than at SL (6.44 ± 1.45 mM) and returned to baseline more slowly (P < 0.05). Plasma insulin values were the same but C peptide was slightly higher at 4;300 m (P < 0.05). At SL, BGR returned to baseline more slowly in E+P condition (5.13 ± 0.89 and 5.21 ± 0.91 mM at 60 and 90 min, respectively) relative to E condition (4.51 ± 0.52 and 4.69 ± 0.88 mM, respectively) (P < 0.05). Insulin and C peptide were not different between E and E +P conditions. The data indicate that BGR is lower in women at high altitude compared with the SL, possibly due to greater suppression of hepatic glucose production or stimulation of peripheral glucose uptake by insulin. BGR was lower in E condition relative to E+P condition at SL and possibly at 4,300 m, but the relative concentrations of ovarian hormones do not appear to alter the magnitude of the change in BGR when women are exposed to high altitude.