The heat being experienced in many parts of the nation these days is tough enough for the average healthy person, but for the estimated 21 million Americans with diabetes, special precautions may be required, according to experts at Joslin Diabetes Center in Boston.

“People with chronic diseases like diabetes as well as people taking certain medications, including heart disease medications and diuretics, which are often used to treat complications of diabetes, are at increased risk of experiencing difficulties in the heat, even though they may not be aware of it,” says Catherine Carver, M.S., A.N.P., C.D.E, Director of Educational Services at Joslin Clinic.

Carver and her colleagues at Joslin Clinic offer the following tips for people with diabetes during these steamy summer days:

* Keep hydrated. Dehydration, or the loss of body fluids, can happen on these very hot summer days whether you have diabetes or not. If you have diabetes, dehydration also can occur when blood glucose is not under control. When blood glucose is elevated, this can lead to an increase in the body’s excretion of urine. To prevent dehydration drink plently of caffeine-free fluids such as water, seltzer, sugar-free drinks like iced tea, and lemonade. Limit your intake of alcohol.

* Watch for signs of heat exhaustion, especially if you are working or exercising outdoors. People with diabetes and other chronic diseases like heart disease are more susceptible to overheating. Symptoms include: feeling dizzy or fainting; sweating excessively; muscle cramps; skin that is cold or clammy; headaches; rapid heartbeat; and/or nausea. If you experience any of these symptoms, move to a cooler environment, drink fluids like water, juice or sports drinks (based on your healthcare provider’s instructions) and seek medical attention.

* Exercise in a cool place such as an air-conditioned gym, or early in the morning or later in the evening.

* Check blood glucose levels at least four times a day, and more often if you are not feeling well. Remember that heat can cause blood glucose levels to fluctuate. Carry plenty of water and snacks.

* Store your blood glucose meter, strips and insulin in a cool, dry place. Do not store insulin in extreme temperatures. Never store insulin in the freezer, direct sunlight or in the car or in the glove compartment of the car. Examine your vial of insulin. Clear insulin (Regular, Humalog, Novolog, Apidra, Lantus, Levimir) should remain clear. NPH insulin should not have any clumping or “frosting” on the vials.

Additional Tips For Insulin Pump Users

* For insulin pump users, excessive perspiration can be a problem in hot weather or during strenuous activities. This can loosen the adhesive securing the infusion set, the part of the device that attaches to your body. If perspiration is a problem, try using a spray of antiperspirant on the insertion site after your usual skin-preparation routine. Others have success with skin-barrier preparations such as Mastisol, Skin-Tac H or a compound tincture of benzoin applied to the skin.

* The pump housing provides some insulation from the heat. If you are concerned about heat, you can use a protective pouch with a small, cold gel pack placed inside the pouch as a way to protect your insulin from the effects of heat. If you are spending an extended amount of time in the sun, cover the pump with a towel to protect it from prolonged direct sunlight. Disconnecting your pump for up to an hour is another option, but if it is disconnected for a longer time, you will need to adjust your insulin infusion rate accordingly to allow for the missed doses.
If you have diabetes and have any questions about coping the heat and other extreme weather conditions, consult with your medical team.

Joslin Diabetes Center