Rising temperatures spell trouble for urban diabetes patients: Threat of heightened risk

Monjurul Islam is a 40-year-old private jobholder in Dhaka city suffering from type-2 diabetes. He takes insulin twice a day to regulate his blood sugar level. However, during the recent ongoing summer heat, which is the highest recorded in the past 58 years, Monjurul is feeling extremely fatigued and disoriented, and has high blood sugar often. Such incidents are not unique to Monjurul only, rather, entering the summer season, these have become a common cause of diabetes patients' visits to their physicians.

Over 160 million people in Bangladesh are experiencing the unpleasant reality of rising temperature and its effect on health, and the people living with diabetes are among the hardest hit. High blood glucose levels are a symptom of diabetes, a chronic condition in which the body's ability to generate or use insulin is impaired.

Recent data shows that Bangladesh has more than 10 million individuals living with diabetes, making it one of the top ten countries with the highest prevalence of the condition. Projections suggest that by 2045, the number of people with diabetes in the country could reach over 13 million.

The health of people with diabetes is particularly vulnerable to the effects of extreme heat, which can make it more challenging to control their condition and cause a variety of issues. Lack of fluid intake can cause blood sugar to rise, and high blood sugar can cause individuals to urinate more frequently, leading to dehydration.

When dehydrated, the body produces more glucose to make up for the lack of water. This is hazardous for diabetics because it can cause hyperglycemia, a condition in which blood sugar levels are too high. Fatigue, decreased urine, increased thirst, lightheadedness or dizziness, headache, dry lips, and dry eyes are symptoms of mild to moderate dehydration. Some people even observe a decrease in sweat production. Hyperosmolar hyperglycemic syndrome (HHS) or diabetic ketoacidosis (DKA) risk increases with dehydration.

Due to a reduced ability to dissipate heat, diabetes often puts people at higher risk for heat-related illnesses during heat waves. People's sweat glands may be impacted by some diabetic problems, such as damage to blood vessels and nerves, which makes it harder for the body to cool down. Diabetes patients have been shown to sweat less and have reduced cutaneous blood flow during heat exposure.

In addition to dehydration, heat exhaustion, heat stroke, and an increased risk of infection, increasing temperatures can have additional negative effects on the health of diabetic patients. For instance, excessive temperatures can cause blood vessels to dilate, resulting in a decrease in blood pressure. This can be especially hazardous for diabetic patients who are already susceptible to low blood pressure. In addition, elevated temperatures can lead to fatigue, making it more challenging for diabetics to manage their condition.

Managing diabetes is a hard endeavour in and of itself, and extreme heat can add to this stress, leading to anxiety and depression, both of which can have negative effects on the health of persons with diabetes. To manage the adverse effect of diabetes, it is recommended to consume an adequate amount of water, even in the absence of thirst, to prevent dehydration.

It is also advised to refrain from consuming alcoholic beverages and beverages containing caffeine such as coffee, energy drinks, and sports drinks. They may cause water loss and raise blood sugar levels. Before, during, and after engaging in physical activity, diabetic patients need to check their blood sugar levels. It may be necessary to adjust the dosage of insulin utilised.

Diabetes patients should consult with their doctor to receive assistance in modifying their medication dosage. Extreme heat can disrupt the efficacy of insulin and other diabetes medicine. Hence, they should keep medicines, supplies, and equipment out of the heat.

Furthermore, diabetic people should put on loose-fitting, lightweight, and light-coloured garments. It is advisable to utilise sunscreen and a hat as protective measures when spending time outdoors. Exposure to excessive sunlight resulting in sunburn has the potential to elevate an individual's blood glucose levels.