As temperatures climb, so do risk factors for patients with diabetes

Managing diabetes in the summertime calls for more education about heat-related dangers.

Summer has arrived. Before patients with diabetes can fully enjoy their vacations, barbeques and sunny skies, preparation for soaring temperatures is vital.

Everyone is at risk for heat-related health problems, but these issues are amplified for patients with diabetes, according to Curtiss B. Cook, MD, a professor and endocrinologist at the Mayo Clinic Arizona.

“We know that the heat can have a definite impact on the health and death rate of patients with diabetes. During heat waves, patients with diabetes are more prone to ED visits, hospital stays and mortality,” Cook told Endocrine Today.

Changing care

Because the season presents challenges for patients with diabetes, health care providers must be ready to field questions and offer advice about how patients can protect themselves during extreme heat. With this in mind, Cook and colleagues at the Mayo Clinic Arizona developed guidelines to help health care providers address these issues.

Curtiss B. Cook

Hydration is of great concern for patients with diabetes. Excessive heat can have an effect on blood glucose levels, disrupt cardiovascular stability and change the absorption of some insulin. High blood sugars combined with the heat may increase a patient’s risk for dehydration; yet, many patients with diabetes wait until they are thirsty before increasing their fluid intake, Cook said. Physicians should encourage prophylactic drinking or drinking on a schedule to help prevent dehydration. Additionally, patients should be educated about the symptoms of heat stress and heat exhaustion.

Patients with diabetes are encouraged to change their exercise regimens during the warmer months. According to the recommendations, patients should exercise in an air-conditioned facility or exercise outdoors during the early morning or evening when it is cooler. Regular monitoring of blood glucose is important when outdoors for long periods in the heat. During physical activity or other prolonged heat exposure, patients should consistently and frequently check their blood glucose levels.

Light clothing, hats or visors and regular sunblock application are suggested to protect skin from the sun. Patients should never go barefoot, and wearing sunglasses with ultraviolet protection is recommended.

Extreme temperatures may also affect various diabetes medications and equipment, such as insulin and glucometers. Heat-related damage can render treatments ineffective or lead to inaccurate glucose readings. To guard devices and medication from heat damage, patients and providers should carefully read about a product’s temperature intolerances in package inserts. According to the recommendations, equipment and medication should never be left in the car, and heat-sensitive medications such as insulin should always be transported using gel packs or refrigerated coolers. Cook said packages designed for this purpose are commercially available.

Taking protective measures

Unfortunately, many patients with diabetes remain unaware of or neglect to take precautions necessary to protect themselves when the heat hits, Cook and Adrienne Nassar, MD, internal medicine resident at Mayo Clinic Arizona, found in a study they published in the Journal of Diabetes Science and Technology in 2010.

“The respondents’ awareness was actually quite low,” Cook said in an interview. “A lot of these patients didn’t know what to do.”

Protective practices varied widely among the 152 patients with diabetes who were included in the survey. Most reported staying indoors and avoiding the heat, and drinking additional fluids, applying sunscreen and wearing protective clothing were also popular precautions.

In terms of protecting diabetes medications, supplies and equipment, most respondents (73%) reported receiving information on insulin, but only 39% received information about the heat’s effects on oral medications; 41% received information about the effects on glucose meters; and 38% received information about the effects on glucose test strips.

It is recommended that protective measures start at temperatures of 80·F with 40% humidity; however, 20% of respondents said they do not institute these practices until temperatures reach triple digits.

“Patients should not wait for three-digit temps before taking precautions,” Nassar said in a press release.

Further, although many respondents (66%) check the weather forecast daily, only 38% said predicted temperatures affected their care of diabetes medications and supplies. In addition, understanding of the terms used during weather forecasts appeared to be limited, as only 55% of respondents knew the correct definition of the heat index.

When polled about preventing heat damage to their medications and equipment, although some patients reported using refrigerated coolers and other protective measures, more than one-third reported simply leaving them at home. This practice would result in many patients not having diabetes equipment and medications with them at times of need, Cook said.

Increasing awareness

“There really has to be a multi-tiered effort to increase education about diabetes management during the hot weather,” Cook said. “Physicians’ offices — particularly offices that deal with diabetes patients — ought to have written materials to provide their patients.” He also said caring for diabetes during heat waves should be a part of standard diabetes education programs.

However, education regarding this issue should not stop there. Cook said public health agencies should become involved via public service announcements through TV, radio and the Internet. Local weather agencies can also send updated weather alerts through text messages to patients.

“The bottom line is that people with diabetes need to be more aware of how heat affects management of their disease,” Cook said. – by Melissa Foster

For more information:

• CDC. Managing summer heat, travel with diabetes. Available at: www.cdc.gov/features/diabetesandtravel/.
• Nassar AA. J Diabetes Sci Technol. 2010;4:1156-1163.
• Westphal SA. (May/June 2011). Diabetes self-management in the heat. Practical Diabetology, 21-24.

Disclosure: Drs. Cook and Nassar report no relevant financial disclosures.