Hot climates are not the most forgiving, especially when it comes to outdoor activities. During the peak of summer, high temperatures can be difficult for anyone to deal with. For those with diabetes, the heat can be even more troubling. Dr. Harshit Shah, an endocrinologist with Dignity Health Medical Group – Bakersfield, answers important questions related to managing diabetes in the heat. [Skip to video]
- What are some reasons that a person with diabetes may feel the heat more than someone without diabetes?
Nerve damage, or autonomic neuropathy, as well as blood vessel damage caused by diabetes can affect sweat glands and prevent the body from cooling immediately. This will result in higher body temperatures. The heat can also feel more severe for someone with diabetes in humid climates where sweat evaporates slowly, slowing the body’s process for cooling itself.
- Does this mean someone with diabetes is more likely to experience heat exhaustion?
“Yes, especially when the person is not drinking enough water,” says Dr. Shah. Heat exhaustion is caused by the loss of water and salts from the body. A lack of water in the body produces an increase in blood sugar, causing more frequent urination, leading to further dehydration.
The symptoms of heat exhaustion are similar to those of hypoglycemia (low blood sugar)—confusion, dizziness, fainting. “A common misconception in my diabetic patients is that these symptoms arise due to hypoglycemia. One may think its low blood sugar, when it’s really heat exhaustion, and take sugar tablets, further worsening the problem,” states Dr. Shah. Conversely, potential hypoglycemia symptoms are occasionally regarded as heat exhaustion. “Always check sugar levels to see if symptoms are hypoglycemia-based.”
- If a diabetic person has a higher body temperature, can that lead to more complications? If so, what kind?
Further complications, such as high blood sugar, low blood sugar, and increased perspiration, can arise as a result of a higher body temperature. Remember, high blood sugar can cause frequent urination, worsening dehydration and body temperature regulation. Complications from high blood sugar are more severe when using SGLT2 inhibitors, which cause glucose excretion in urine but also worsen dehydration.
Low blood sugar also poses a problem, especially when combined with exercise. Heat warms the skin and causes blood vessel dilation and faster insulin absorption as a result. “I recommended my diabetic patients try to get their exercise in during the early hours of the day,” suggests Dr. Shah. Blood sugar should be tested frequently, especially when taking part in a physical activity in hot weather, to prevent hypoglycemia.
Perspiration can also cause problems by loosening adhesives on continuous glucose monitors and insulin pumps. This can affect insulin delivery and result in high sugar levels. “Be careful! Store insulin at room temperature to avoid damage. Otherwise, insulin pumps and continuous glucose monitors function adequately if not directly exposed to sunlight for long periods of time.”
- How do things associated with high body temperature affect diabetes?
Certain byproducts of high body temperatures, such as sweating and dehydration, can be problematic for someone with diabetes. Dehydration due to profuse sweating leads to a rise in glucose, producing more urination. This reduces blood supply to the skin, which results in decreased absorption of injected insulin dosage. “You can see how this cycle can be detrimental for those with diabetes,” says Dr. Shah.
An additional complication is that those with diabetic peripheral neuropathy may be unaware that their feet are burning if they are standing on a hot surface or are outside, exposed to direct sunlight. If you have diabetes, make sure you’re protecting your feet from the sun and heat, as you may not be able to feel them becoming uncomfortable.
- What are some tips to help someone with diabetes manage heat?
It is always best to stay hydrated and drink water, even when one is not thirsty. “Water is the best option for hydration,” states Dr. Shah. “Drinks that have caffeine or sodium content will actually cause more dehydration.” Avoid alcohol, soda, energy drinks, and coffee. You can also stay cooler by wearing loose-fitting, light colored clothing. Remember sunscreen should be worn to avoid burning and shoes should always be worn.
When you can, stay in the air conditioning. Because insulin can be damaged by heat, storing it in a hot car or keeping it exposed to direct sunlight should be avoided. Glucose meters and test strips can also be damaged by the heat. Make sure to read the instructions and store these items at room temperature.
Dr. Harshit Shah is an endocrinologist with Dignity Health Medical Group – Bakersfield, and specializes in diabetes and metabolism disorders. Dr. Shah is currently accepting new patients and his office is located at 9500 Stockdale Hwy, in suite 201. To learn more or make an appointment, visit DHMF.org/Bakersfield, or call 661.327.1431.