Wednesday, 21 July 2010

Diabetes and Heat Related Problems

Diabetes and Heat Related Problems

Past research indicates that people with diabetes have an increased number of emergency room visits, hospitalizations and deaths due to heat illness during hot weather. Researchers point out several possible reasons for this trend.

Heat Related Problems for Diabetics

The presentation "Diabetes in the Desert: What Do Patients Know About the Heat?" was offered at The Endocrine Society's 92nd Annual Meeting in San Diego.

Researchers from Mayo Clinic in Arizona, collaborating with the National Ocean and Atmospheric Administration and the National Weather Service, analyzed 152 surveys from diabetic patients in Phoenix, Arizona. Researchers concluded that diabetics in hot climates need to be aware off how heat affects their disease, according to lead researcher Adrienne Nassar, MD, third-year medical resident at Mayo Clinic.

"People with diabetes have an impaired ability to sweat, which predisposes them to heat-related illness, as do uncontrolled, high blood sugars," Nassar said. "Many patients surveyed had suboptimal glycemic control during the summer, possibly increasing their risk of dehydration."

One in five survey respondents reported that they do not take precautions until temperatures exceed 100 degrees Fahrenheit. "Heat illness can take place at 80 to 90 degrees when you factor in the heat index," Nassar said.

About fifty percent of patients could define heat index, which is a combination of air temperature and humidity. The danger with high humidity is that it slows the evaporation of perspiration, interferring with the body's ability to cool itself.

Hot Weather and Diabetes Medications

While the body struggles to maintain balance, heat can also interfere with the performance of diabetes medications and supplies. "Oral medications as well as insulin have a therapeutic temperature range above which they lose efficacy," Nassar said. The drug insert provides information regarding proper storage temperatures.

While 73 percent of participants in the study acknowledged that they had received information about the harmful effects of heat on insulin, only 39 percent recalled information regarding the adverse effects of heat on oral diabetes medications, 41 percent knew about the effects of heat on glucose meters, and 38 percent recalled the effects on glucose test strips.

Among those who know that heat is harmful to their medications and glucose-testing supplies, 37 percent chose to leave them at home to avoid the risk of heat exposure. But that creates added risk.

"If they are unable to check their blood sugars while they are away from home, that's unsafe," Nassar said.

"Increasingly more people with diabetes are living in places characterized by hot weather. Patient education focusing on diabetes management in hot climates is needed," she said.

Diabetes, Hot Weather, and Age-Related Risks

According to a review in CMAJ (Canadian Medical Association Journal), describing the effect of heat on human physiology and factors for increased risk of heat stress, people over age 60 with chronic illnesses fall in the high-ris category.

Laboratory-based physiologic studies were reported, indicating that in older individuals, the ability to detect heat is reduced. Also the physiological response to heat allowing adequate blood distribution and sweating to cool the body is slower. Older individuals also demonstrate delayed response to thirst and they take longer to recover from dehydration.

Management of Diabetes and Heat Related Risks

Education for persons with diabetes is necessary so these individuals are aware of specific risks. Impaired ability to cool the body, along with adverse effects on medicine and supplies cause problems in hot climates. People over age 60 may be at the greatest risk.

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