Time to rest? Diabetes mellitus and hot climate.

Diabetes- This complex disease, the course of which directly depends on many environmental factors. Heat and cold, precipitation, changes atmospheric pressure– all these everyday realities are very important for the patient to take into account. The weather brings surprises, primarily affecting blood glucose levels. It is this indicator that underlies the compensatory capabilities of a patient with diabetes mellitus. Fortunately, there are real and simple ways fight against negative influences external environment.

Diabetes and heat

In summer, the main role in the deterioration of a diabetic’s condition is played by the increased temperature background of the surrounding air. This leads to the following changes in the patient’s body:

blood thickens;
the risk of sunstroke increases;
sweating increases, which leads to fluid loss;
the body's energy reserves are intensively consumed, so the need for nutrition increases;
hyperglycemia occurs ( high level blood glucose), which is difficult to control.

The greatest danger occurs in people suffering from insulin-dependent diabetes. Syringe pens and regular vials with insulin must be protected from high temperatures. In hot conditions, the mobility of patients is reduced, as they are forced to depend on the refrigerator. Due to hyperglycemia, thirst and hunger increase, which leads to an even greater increase in blood sugar levels. As a result, the need for insulin and oral (taken by mouth) hypoglycemic agents increases.

However, the effect of heat on the body can be significantly reduced. There are simple recommendations for this:

Drink more – it’s better if you always have a bottle of water at hand;
have a cooler bag for insulin;
Monitor your sugar levels more often using a glucometer, which will optimize treatment;
try to shift physical activity to the morning hours, when the heat is still low;
use air conditioning or fan;
facilitate skin breathing - daily shower or bath and light colors in clothes;
Be sure to wear a hat.

It will not be possible to completely protect the patient from the effects of heat, but by easily adapting to it, you can significantly improve the quality of life in the summer.

Diabetes and cold

Chilly weather - no best period for anyone, even healthy person. People suffering from diabetes are especially susceptible to the effects of cold air masses. The following pathological processes occur in the body:

immunity decreases, which is especially dangerous if the background is initially low due to diabetes;
decreases physical activity, and this provokes a decrease in glucose utilization by tissues;
blood flow sharply worsens, especially in the lower extremities;
it is difficult to control sugar levels, as incorrect values are possible due to cold hands;
the risk of depression sharply increases, which is extremely dangerous for a patient with diabetes.

Due to reduced immunity, they easily join colds, which quickly leads to hyperglycemia. Low physical activity also contributes to this. Because blood glucose meters often give inaccurate readings, it is difficult to maintain an optimal insulin dose.

However, despite the complexity of the situation, there are remedies to help cope with the cold. For patients with diabetes mellitus we can recommend:

avoid crowds and take echinacea extract to prevent colds;
do not miss preventive vaccinations according to the national calendar;
daily dosed physical activity is required;
regularly monitor glucose levels medical institutions and compare with glucometer readings;
prevent insulin from freezing;
it is advisable to increase sexual activity– this will not only allow you to get pleasant emotions, but also improve glucose utilization;
walk in sunny days which will help fight depression;
Pay special attention to keeping your hands and feet warm - use gloves and shoes that are appropriate for the season.

The influence of atmospheric pressure and precipitation on diabetics

Changes in atmospheric pressure, rain, wind and snow are rather unpleasant companions at any time of the year. Precipitation leads to hypothermia, so there is a risk of an increase in sugar due to low activity. Therefore, even while at home, it is important not to stop physical training which will enhance metabolism. If the rain is light, then a half-hour walk under an umbrella and warm clothes It won't hurt at all. But the feet should always remain dry, since the blood vessels are a very vulnerable place in diabetes.

The situation is worse with changes in atmospheric pressure. Stagnant changes occur due to blood thickening in the vessels of the brain, so the risk of strokes increases. It is important to control blood pressure, which should be no higher than 140/90. You should definitely talk to your doctor about blood thinning medications in case of growth blood pressure. In case of any deviations in health status, you must immediately seek medical help.

Greetings to all! In touch Lebedeva Dilyara, endocrinologist, author of the blog Saxarvnorme.ru

It's summer on the calendar, although it's not visible on the street this year. And this fact motivates even more to apply for more warmer climes, closer to the sun, sea and snow-white sand.

However, the question arises about the possibility of such a sea holiday for people with type 1 diabetes. What to look for, what dangers lie in wait, what to take with you on the road and other questions.

I’ll say right away that such a vacation is not at all contraindicated for diabetes, you just need to be more attentive to yourself.

Like a healthy person, a person with diabetes on vacation is subject to: thermal and solar overheating, skin burns, dangers on the water. Security tactics work the same for everyone.

Much more actual question about insulins, doses and other issues directly related to diabetes.

Insulin

Insulin is a protein substance that denatures (collapses) when exposed to high temperatures.

Therefore, while on vacation you need to take care that essential medicine in the life of a sweet person it was reliably hidden from excess heat and direct sun.

The solution would be to purchase special covers and thermal bags that will support optimal temperature inside, cooling the handle with the hormone.

But even if you are in such a bag or case, you still need to protect it from direct sun rays. We put the case with the syringe pens on the bottom of the beach bag and cover it with clothes or a towel on top. An additional buffer is created.

All insulin supplies should be stored in the refrigerator door. Make sure there is no contact with the freezing elements. Both heat and frost are detrimental to insulin.

Always take a month's supply of insulin when traveling. When flying, place your supplies between your clothes in the thickness of your suitcase or take them in your hand luggage.

Insulin therapy

Due to movement closer to the equator, dose requirements may decrease. Therefore, do not forget to take a decent number of test strips; you will have to measure very often.

Those who have glucose monitoring are lucky. This will require fewer strips, but don’t forget to take a supply of sensors.

Hypoglycemia

Based on the first point, you need to be prepared for episodes of hypoglycemia, and therefore keep tablets or gels with glucose with you, or juices for extreme case. It is advisable to find packaged juices at the hotel, because supposedly freshly squeezed juices are ungodly diluted with water, and you will not know how many carbohydrates you drink.

I do not recommend going to sea while using bolus insulin. Water procedures are quite a heavy load and can bring down the sugar at the most inopportune moment, when you are far from the shore, and there is only salt in sea water)))

In this case, it is better to wait for the insulin to peak or eat additional carbohydrates. It’s better to save the excess than to wait for rescuers when you start to drown on low sugar.

Be careful with alcohol! Remember that the risk of hypoglycemia increases at night.

List of diabetic accessories

thermal cover or thermal bag to protect insulin from heat

room thermometer to measure the temperature in the room refrigerator and inside the thermal cover

spare syringe pen

spare glucometer with lancing device

a supply of needles for syringe pens and a lancet for a piercer

batteries for glucometer and scales

culinary scales

urine test strips for sugar and acetone (in case of decompensation and ketoacidosis)

Medicines for frequent illnesses on vacation (underline as appropriate):

antipyretics (Nurofen and/or paracetamol)

antiviral (Kagocel, Anaferon, etc.)

sachets of sea salt for rinsing the nose (Dolphin)

means for treating the oral cavity (Malavit)

intestinal sorbents (Polysorb or Smecta)

antidiarrheals (Loperamide or Imodium)

antiemetics (Motilium)

enzymatic preparations(Creon)

bacterial preparations(Maxilac or Primadofilus)

antiallergic (Zyrtec, Advantan cream)

antihypertensive drugs

heart medications (validol, nitroglycerin, etc.)

medications if available chronic diseases

Will there be problems at customs control?

For your peace of mind, get a certificate from your endocrinologist that you have been diagnosed with diabetes and need insulin injections. Let this certificate be certified by all the official seals that the clinic has.

Monitoring sensors on the human body pass safely through a metal detector at the airport. It is better not to carry receivers and readers through them, but to put them in a separate tray, although we put them through an x-ray and everything was fine.

How does diabetes behave on an airplane?

No one can tell you how sugars will behave on an airplane several kilometers from the ground. Every body is unique and everyone has their own diabetes.

If you have to fly for a long time, 8-10 hours, then be prepared that while stationary, the need for insulin doses will be higher.

Have a good rest and bright impressions!

With warmth and care, endocrinologist Lebedeva Dilyara

Diabetes is one of the most common chronic diseases worldwide. Yes, this is an illness for life, but this does not mean at all that people who have once encountered this illness should limit themselves to the simple daily joys of life for the rest of their days. You just need to do everything thoughtfully, planning your actions in advance down to the smallest detail.

Aina Suleymanova

Endocrinologist

So how should a future traveler with diabetes prepare and plan their vacation to a distant country? Let's try to figure it out together...

Preparing to Travel with Diabetes

When it comes to preparing for a vacation, the first thing that comes to mind is creating a list of necessary things that you may need in a place far from your home. You may have to worry a lot about purchasing them abroad if you are careless or forgetful, and some devices/medicines are completely impossible to buy in a foreign country without the necessary documents.

So I advise you to study this list very carefully and write down for yourself all the most important things for your rest days:

Drugs insulin short-acting and daily-acting, or mixed insulins, depending on what you use. Take twice the amount of insulin approximately calculated for the days of vacation. This will help avoid problems with finding the medicine if it is lost or damaged.

- Syringe pens or regular insulin syringes in sufficient quantity.

- glucometer(preferably two) with test strips; lancet (+ supply of lancers and batteries just in case).

A thermal bag or thermal case for storing insulin. An almost indispensable item for patients with insulin-dependent diabetes, helping to protect the drug from exposure to excessive heat.

Sugar-lowering tablets, if you use them.

Test strips for urine analysis for acetone and glucose.

Room thermometer - in order to clarify the temperature inside the minibar (in a hotel) or refrigerator abroad.

Culinary scales - for calculating bread units.

An insulin pump and/or continuous monitoring system (if used).

Help or medical card, which contains information that you have diabetes, as well as a form with a clear algorithm of actions for providing first aid in the event of the development of hypo- or hyperglycemic conditions.

Refined sugar, boxes of fruit juices, pure glucose, glucagon in case of hypoglycemia.

Waterproof bag (if available).

Comfortable shoes.

Scissors, file for foot care; special cream for moisturizing the skin of the feet.

In addition to this basic list, patients with diabetes may need:

Antihypertensive drugs ( long acting and to eliminate crises).

Antihyperlipidemic agents (statins, fibrates, etc.).

Tonometer - to determine the level of systolic and diastolic blood pressure at home.

Eye drops.

And, of course, it won’t be superfluous to take with you in the first aid kit antiallergic (Zyrtec, Suprastin), antiemetic (Cerucal, Motilium), antidiarrheal (Imodium), antipyretic (Paracetamol) and antiviral (Arbidol, Kagocel) drugs, as well as a bandage, iodine, hydrogen peroxide, plasters and alcohol just in case of emergency.

Information for diabetic travelers

When traveling to a foreign country with an unusual climate, do not forget that high humidity and temperature are factors that you should be wary of and avoid if possible.

In hot weather, dehydration occurs very quickly and unnoticed, so try to drink more clean water in a situation like this.

It is extremely important to monitor the glycemic profile more frequently during periods of possible dehydration, since it is exposure to bright sunlight that in some patients causes sugar readings on the glucometer monitor to go off scale.

I would also like to touch a little on the topic of active classes. physical labor diabetic patients while traveling. I advise you not to overload your body sports games, and increase the load gradually. For example, on the first day it could be walking at a fast pace in the hotel park, on the second - cycling, on the third - tennis, volleyball, etc.

Try to move any excursions and hikes, as well as all kinds of sports, to a less hot time of the day. Ideally, this is the period after 17:30 pm and before 11:00 am.

Unfortunately, in hot weather, a diabetic patient is at equally high risk of developing hyperglycemia and hypoglycemia. So keep in mind that self-monitoring with a glucometer should be performed as often as the ambient temperature is higher.

Swimming at sea or in a pool can also be one of the reasons for a sharp drop in blood sugar. Therefore, before diving into the water, try to eat one apple or a piece of bread.

Periods of stay in water should not exceed 15 minutes. If you use an insulin pump, then temporarily water procedures it will need to be disconnected.

A separate issue is storing insulin when traveling to another country. Before your flight, be sure to place your entire supply of insulin in your hand luggage, as it may freeze in the luggage compartment of the plane and thus become completely unusable.

In the list above, I indicated that you must take a regular room thermometer with you on your trip. Now I'll explain to you why... Since the conditions of stay in each hotel vary, no one can tell you for sure what the air temperature is inside the minibar in the room where you will most likely store all your unused insulin supply.

Just leave the thermometer inside the minibar for a couple of hours, and after that you will clearly know the answer to this extremely important question patients with insulin-dependent diabetes mellitus.

I think all readers already know that under no circumstances should insulin be stored in direct sunlight or in extreme cold (freeze). Also do not forget that if you injected an insulin drug and immediately after that visited the sauna or did active physical exercise, you must be extremely careful because muscle work and the influence of hot air increase the rate of absorption of the drug. As a result, signs of hypoglycemia may occur ( cold sweat, feeling of fear, tachycardia, tremor, feeling of hunger, etc.).

Regarding the dosage of administered insulin preparations: during flights to countries with hotter climates, a decrease in the overall need for insulin (basal and bolus) is most often observed. The dose should be reduced gradually: start reducing with the evening dose long-acting insulin(while focusing on morning sugars), and then move on to correcting bolus insulins.

The situation with them, of course, is somewhat more complicated, since the dose is directly related to the food consumed, which many travelers manage to become familiar with only in the last 2-3 days of their stay at the hotel J The best way out is to take a culinary scale with you and use it, trying to give preference for dishes with a simple composition, for which the number of bread units can be determined.

Due to the accumulation of intermediate metabolic products in tissues and the insufficiency of the glutathione enzymatic system, increased need in oxygen, and therefore the use of aerotherapy, the main task of which is the full use of air oxygen by the body, is very advisable. The therapeutic effect of aerotherapy for diabetes mellitus conditioned and favorable changes functional state nervous system, disorders of which often underlie diabetes or occur secondaryly.

Aerotherapy is indicated for all patients with diabetes mellitus, primarily for severe functional disorders of the nervous system, concomitant chronic respiratory diseases, lesions of the cardiovascular system, as well as for significant metabolic disorders (the presence of acidosis, severe glycosuria and hyperglycemia), accompanied by a violation oxidative processes in organism.

The effect of heliotherapy on the course of diabetes mellitus depends on the intensity of insolation. Exposure of patients with mild forms of diabetes to moderate doses of sunlight either has a beneficial effect on carbohydrate metabolism, or have no effect on diabetes mellitus; intense solar radiation, especially in uncompensated forms of moderate and severe diabetes, can worsen the condition of patients.

Heliotherapy is used for those patients with diabetes mellitus who have certain indications for this, such as: phenomena of light starvation, skin diseases (pyoderma, eczema, scaly lichen), some lesions of the musculoskeletal system (arthritis, myositis, tendovaginitis), lesions of the peripheral nervous system (neuritis, polyneuritis). Sun treatment can only be carried out by patients with prediabetes, mild diabetes, and medium degree, with stable compensation of the disease.

The most common climatic treatment methods for diabetes mellitus are: in winter - nap in sleeping bags on open verandas, in summer - air and sunbathing.

Daytime sleep in the air in sleeping bags (on an open veranda or in an aerarium) is indicated for patients with diabetes mellitus after a short period of acclimatization (3-4 days). The duration of the first procedures is 30-45 minutes, then, if well tolerated, they are gradually increased to 1.5-2 hours; for a course of treatment from 12 to 20 procedures. Since during sleep fresh air in diabetic patients, especially those receiving moderate and large doses insulin, a state of hypoglycemia may occur; appropriate control is necessary.

Air baths in the open air with the patient's body completely exposed can be started at an equivalent effective temperature (EET) of 18-22°, i.e. in the zone of comfortable thermal sensation. At the beginning of the course of treatment, the duration of the procedure should not exceed 20 minutes, then with each subsequent procedure it is increased by 10-15 minutes and brought to 1-1.5 hours or more. Hardening effect air baths manifests itself not only with an increase in their duration, but also with a change in the time of their administration: first they are taken at midday and then in the morning; They also change the microclimatic conditions in the aerosolarium (with the help of wind shields, awnings, etc.).

In case of uncompensated forms of diabetes mellitus, especially severe, the presence of diseases for which significant climatic “load” is not indifferent (angina pectoris, disorders heart rate etc.), as well as for patients with diabetes who are not sufficiently adapted to the action climatic factors, air baths are best used using a gentle method. Depending on the initial state the patient, his reaction to the influence of climatic factors can first be prescribed dosed stay in the fresh air 1-2 times a day in clothes for 1-2 hours, and after that - air baths; the latter are carried out only under conditions of a comfortable heat sensation zone (EET 18-22°) or gradual decline EET, but not lower than 14°; however, the duration of the procedure should not exceed 10-15 minutes.

Sunbathing (local or general) is carried out by patients with diabetes mellitus at a radiation effective temperature (RET) of 18-21°, which is calculated taking into account solar radiation and factors air environment. The acclimatization period before heliotherapy is usually 3-5 days. Sun baths, like air baths, are used with a gradually increasing load, i.e., with an increase in the radiation dose (first irradiation with scattered and then direct solar radiation, increasing the duration of irradiation and the irradiated body surface). Heliotherapy for diabetes mellitus is best started with irradiation of individual parts of the body (legs, back, abdomen, chest) and only if they are well tolerated, proceed to general sunbathing.

Partial irradiation is carried out in a dose of approximately 10 cal, general irradiation starts with 3-5 cal and, increasing the dose with each subsequent procedure by 3-5 cal, reaches 30-35 cal, for a course of treatment 10-12 general or local sunbathing; with good tolerance to sunbathing and a small load of balneotherapeutic procedures, the number of sunbathing can be increased to 15. If signs of impaired diabetes compensation, especially hyperketonemia and ketonuria, appear, sunbathing is canceled.