For people with Diabetes, the heat and humidity of summer can be particularly hazardous if adequate measures are not taken to ensure lifestyle changes. Even when it doesn’t seem very hot outside, the combination of heat and humidity can be dangerous. When sweat evaporates on your skin, it removes heat and cools you. It’s harder to stay cool in high humidity because sweat can’t evaporate as well. A major concern in this weather for those living with diabetes are at the risk of rising or fall in the Blood Glucose level (Hyperglycemia or Hypoglycemia) along with water imbalance and electrolyte imbalance leading to dehydration, and other diabetes-related emergencies. As it affects the elderly and children very easily, understanding the signs of heat exhaustion and taking timely measures can prevent complications.
Diabetes is India’s fastest growing disease with 72 million cases recorded in 2017. The prevalence of diabetes in adult Indians is 10.4%. It is estimated that by 2035, there will be a staggering 109 million Diabetics in India. Diabetes is a chronic medical metabolic disease and it can be ideally controlled at the initial level by introducing lifestyle changes and medication; and later on with Insulin added on, with the progression of Diabetes in advanced stages.
One of the complications of Diabetes, both Type 1 and Type 2, is an impaired ability to adjust to rises in temperature, which can cause dangerous increases in body temperature during the summer. Nerve damage (Neuropathy), an associated complication of Diabetes, can affect nearly every organ in the body, including sweat glands thereby making it difficult for the body to cool down as the temperature outside rises. Diabetes can cause the body to lose water quickly. In the absence of sufficient hydration, this can raise Blood Glucose levels, causing frequent urination which further adds to water loss from the body – all of which can be detrimental. In higher temperatures, the body’s insulin requirements can also vary making it even more necessary to test Blood Glucose more often and adjust the insulin dose accordingly.
Heat and Humidity: Physical activity is key to managing diabetes, but don’t get active outdoors during the hottest part of the day or when the heat index is high. Get out early in the morning or in the evening when temperatures are lower, or go to an air-conditioned environment to get active.
Blood sugar level: The summer season can throw off your routine, and possibly your Diabetes Management Plan. Check your blood sugar more often to make sure it’s in your target range no matter what the summer brings. Check your blood sugar before, during, and after you’re active. You may need to change how much insulin you use.
Eating and Drinking: Avoid alcohol, soft drinks and drinks with caffeine, like coffee and energy or sports drinks. They can lead to water loss and spike your blood sugar levels. Drink plenty of water even if you’re not thirsty, so you don’t get dehydrated stay adequately well hydrated. If you do eat some of the summer staples that aren’t as good for you when you have diabetes, adjust your insulin accordingly
Diabetes Supplies (Medicines, Insulin Injections, Insulin pens, Glucometer and strips): Diabetes supplies can be sensitive to heat, so they require extra care in the summer. For example, insulin should be refrigerated until it is open. Once open, it should stay at room temperature. If you leave your insulin in your car’s glove compartment on a hot day, you could ruin it as the insulin gets denatured and may be less effective or not work at all.
Thermo-regulatory Capacity: Another factor to consider which increases risk in high temperatures among people with diabetes is possible abnormalities of the thermo-regulatory capacity caused by autonomic neuropathy. Autonomic neuropathy affects several organ systems, with undesirable outcomes such as Hypoglycemia unawareness and cardiovascular dysfunction.
Protect yourself from the sun: The heat index can be up to 15 F (9 C) higher in full sunlight. Stay in the shade as much as possible when you’re outside. Wear a hat/cap/scarf and use sunscreen too. If needed, consider using an umbrella to cover yourself from direct sunlight.
Wear light, loose-fitting clothes: When humidity is high, your sweat can’t evaporate as well. Wear clothing that allows sweat to evaporate easily, preferably thin cotton loose fitting clothes.
Plan outdoor activities to avoid the heat: As far as possible avoid outdoor activities or work during extreme heat. If necessary, schedule outdoor activities during the cooler hours of the day, such as an early morning or late evening.
Vehicle parking: Always try to park your vehicle under the shade or in covered parking, because the temperature inside your car gets higher by 3 to 5 C than outside. Also, avoid sitting inside if you have to stay for a few minutes and get out of the car and don’t leave elder people or children inside the car and find a proper shade for everyone.
Family Education and Awareness: All family members of Diabetic patients must be educated and made aware that if they observe the slightest change in alertness, movement, behavior from what it used to be, it should raise a red flag in their mind to seek emergency attention and expert medical care.
It’s important to pay attention to how you’re feeling when temperatures climb and to have a good plan in place to keep your blood sugar and hydration of body at a good level. If you don’t feel well, don’t hesitate to contact your doctor.
The writer, Dr. Joozer Rangwala, is a Senior Consultant – Internal Medicine and Diabetologist at Narayana Multispeciality Hospital, Ahmedabad
