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Background
Pilgrimage is one of the main pillars of Islam and is mandatory for all adult Muslims who can afford the trip and who are in good health. The pilgrimage is to visit the holy cities of Saudi Arabia in Mecca and Medina and the surrounding area for a short specified period. Hajj, among other things, consists of traveling long distances and camping in deserted tents. This also includes the presence of pilgrims in the desert plain of Arafat from noon to noon where they spend most of their time standing and praying. Performing simple rites will take a long time because of the large number of people.
Health Consequences During Hajj
Hajj is very demanding on the body in terms of physical and mental exertion. A significant proportion of people performing Hajj are elderly and suffer from chronic diseases such as diabetes, high blood pressure, kidney and heart disease that can worsen. The usual temperature during Hajj varies from 37 to 45 degrees Celsius. This with overcrowding may be badociated with some health risks. During the Hajj, a person's routine changes during his trip to a place where geography, temperature, diet and habits are different from those of his place of origin. People performing Hajj are concerned about religious rituals and self-management is a low priority, complicated by the language barrier that affects medical services. Common problems during Hajj include chest infections, diarrhea, dehydration, heart disease and some communicable diseases.
Diabetes and Hajj
The management of diabetic patients is closely dependent on a stable routine. The following health risks are particularly observed in people with diabetes:
1. Hypoglycaemia
2. Hyperglycemia
3. Dehydration
4. [19659009] Exhaustion by heat and heat stroke
5. Chest Infections, Diarrhea, Middle Eastern Respiratory Syndrome
6. Infections and foot ulcers
7. Heart Problems
[19659004] Hypoglycemia
Hypoglycemia is always a risk during Hajj. This is because of abnormally excessive physical activity, smaller meals, different normal meal times, preference for prayer in sacred shrines (which may be quite far from the residence) may delay meals. Excessive heat during the summer season can increase the absorption of insulin. Difference of insulin preparations between Saudi Arabia (available in vials of 100 units) and India (available in vials of 40 units) resulting in overdose if 100 insulin units are administered with a syringe of 40 units.
Prevention and management:
1. Before going for a long walk, it is advisable to decrease the insulin dose by 20% and the oral drug dose by half.
2. Before Ihram, check your blood glucose, if it is high (> 250), administer a small dose of insulin to cover high blood sugar or take bread if the blood sugar is low (less than 100)
3. Before Tawaf and Saay, eat extra carbohydrates like bread.
4. Always take a mid-morning snack such as bread or fruit such as apple, pear, orange or strawberry or nuts and yogurt fat seeds or a bowl of soup to prevent a sudden drop in blood sugar between breakfast and lunch.
5. In case of symptoms of hypoglycemia (such as exhaustion, headache, palpitations, tremors, sweating, the person should be treated with any of the following ingredients: honey (a spoon at soup), dates (2-3), fruit juice (half a glbad), sports drink (100 ml), glucose tablets, jelly candies or 2-3 glucose cookies with water, Si If the person is unconscious and his blood glucose level is suspected, he should be rubbing the honey on the gums or the carbohydrate injection given agon. 39; hypoglycemia corrected, one should take a snack such as a slice of toast or a sandwich or bowl of cereals
Hyperglycemia
Insulin deficiency or intercurrent illnesses can increase blood sugar. To avoid this, keep taking insulin or anti-cancer drugs. iabetes, test your blood sugar regularly, if it is> 250 (especially in type 1 diabetes), test for urine or blood ketones. If someone feels sick, he / she should take a drink containing carbohydrates as suggested above. If you still feel bad, contact the health care team
Dehydration
Take plenty of water (at least 8 gases) during the day and carry bottles of water with you all the time. Avoid caffeine or sugary drinks. If possible, carry an umbrella and use water frequently to keep one cool. In case of diarrhea, consult the medical team for rapid management of dehydration.
Foot Infections and Ulcers
In summer, soil temperature can exceed 50 to 60 degrees Celsius; the temperature can be even higher on hot marble. Walking barefoot at high temperatures can cause burns. In addition, cracks may develop in the soles due to dry weather and high temperature. Minor toenail injuries can also develop during Tawaf. The following measures will prevent foot problems:
1. Make sure the shoes, the sandals you wear are of the correct size, the shoes should be "worn out" before being used to prevent excessive friction. The shoes must have a good support of the ankle and a sufficiently wide front part (to avoid extra pressure on the feet and toes during walking). Walking in the mosque is allowed to wear leather socks, which will provide some protection. In order to avoid dryness, use a moisturizer 3 to 4 times a day, especially after Wudhu.
Kidney and Heart Disease
Patients with diabetes and kidney disease should avoid dehydration and avoid self-medication. An electrocardiogram before the trip is recommended and in case of symptoms such as chest pain, palpitations, shortness of breath, you should report to the health center as soon as possible.
SUMMARY AND RECOMMENDATIONS
Before the Journey
1. Try to have a good control of diabetes mellitus
2. Let the caravan manager know about your illness and your medications.
3. Complete the recommended vaccines, including influenza and pneumococcal vaccines.
4. Prepare Appropriate Medicines and Place in Separate Containers
5. If possible, prepare a refrigerated bag to keep insulin
6. Choose shoes, sandals and flip-flops of appropriate shape and size.
7. Pack your medications in carry-on baggage rather than checked baggage.
During the voyage
1. Always carry sugar containing food for use in case of hypoglycemia (honey, jam, etc.)
2. Use as vegetables and two units of fresh fruit daily and avoid fruit juice.
3. Drink at least eight glbades of water a day and carry enough bottles of water with yourself.
4. If you use insulin; Before Ihram, check your blood glucose meter. If necessary, use a small dose of insulin (if glucose is greater than 250 mg / dl) or bread (if glucose is less than 70 mg / dl).
5. Before and during a long walk, decrease the dose of insulin short and intermediate by about 20% and the oral drug by 50%
6. Before Tawaf and Sa & # 39; ay, consume a little carbohydrates (bread is preferred).
7. slowly during Tawaf and Sa & # 39; ay, and try to protect your feet from damage caused by ground tiles or other pilgrims. Avoid walking barefoot as much as possible, generously use a moisturizer.
8. In case of fever, diarrhea, vomiting or any other acute medical problem, consult your medical team instead of waiting at your home.
Abstract:
Although difficult for diabetic patients, with good planning and good knowledge, this spiritual pilgrimage can pbad safely.
Bashir Ahmad Laway is Professor and Head, Endocrinology, SKIMS
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