The Environment, Heat and Diabetes

Type 2 diabetes dates all the way back to the Egyptian period. There were an estimated 536 million people with diabetes in 2021 and there are 783 million people with diabetes expected by 2045. According to a 2020 article published in the Journal of Community Hospital Internal Medicine Perspectives, “Climate change, and in particular global temperatures are expected to impact the health of people living with diabetes and lead to worse outcomes.”

Heat waves, air pollution, dust storms, droughts, floods, electrical storms, wildfires, heavy rains, hurricanes, tornadoes, earthquakes and any other types of severe weather occurrences, hold negative consequences for people who have diabetes. The three most dangerous environmental hazards for people living with diabetes are: “extreme temperatures, natural disasters and air pollution.”

A review of “42 studies looked at by researchers” found higher hospitalization risk and worse glycemic control during temperature extremes compared with normal temperatures. Very high temperatures cause blood vessels to dilate and push blood to the skin’s surface. This enhances insulin absorption and may lead to hypoglycemia or low blood sugars.

Elderly people with diabetes suffer more due to an impaired ability to regulate their body temperature. This causes a bigger problem with hydration and dehydration. Natural disasters and extreme weather conditions lead to trouble getting diabetes supplies , diabetes medications and food and water. Smoke from wildfires leads to elevated glucose levels, body inflammation and oxidative stress.

People with diabetes are more sensitive to extreme temperatures because of their impaired thermal regulatory control. Heat and humidity affect the way your body uses insulin, and it can increase insulin resistance or your ability to use insulin. Both heat and humidity, as well as extreme cold weather, puts extra stress on your body which leads to blood sugar fluctuations.

Hot days make you breathe faster, which also leads to dehydration and deeply breathing in more air pollution. Sweating makes the heartbeat faster and work harder leading to even more dehydration. Dehydration drives up blood sugar since the blood becomes more concentrated. The increase in blood sugar then makes you urinate more, causing more dehydration.

If you have a higher BMI (being overweight), you also have greater fluid needs. People with diabetes do not perspire as they should due to changes in sweat glands and impaired blood flow. This creates fluid loss, dehydration and electrolyte imbalances.

Risk Factors for Dehydration:

Older adults – they have a lower volume of water in their body and less sense of thirst. They can forget to drink fluids.
Vomiting.
Sweating.
Diarrhea.
Bladder infections.
Out of control diabetes.
Medications – water pills, blood pressure pills, diabetes pills.
Not drinking enough.
Fever.
Hot, humid weather.
Having dementia.
Being in high altitudes.
Flying in planes with low humidity in the cabins.
Taking chemotherapy.
Drinking caffeine.
Drinking alcohol.

Dehydration causes your liver to produce more sugar and promotes insulin resistance. Dehydration also increases the risk of atrial fibrillation (heart arrythmia) and blood clots, vessel blockage, strokes and heart attacks.

Symptoms of Dehydration:

Dry mouth.
Dry tongue; little saliva production.
Dry lips.
Thirst.
Fatigue/exhaustion.
Dry skin.
You stop perspiring.
Sunken eyes and cheeks.
Muscle weakness.
Dizziness.
Cardiac issues.
Respiratory issues.
Dark and concentrated gold or brown urine.
Heat exhaustion.
Heat stroke.

If dehydration is not treated early, it can morph into heat exhaustion and possibly heat stroke, which can be life threatening.

Who are at highest risk of problems?

Chronic illness – diabetes, heart disease and kidney disease.
Overweight and obese individuals.
Elderly – over 65.
Outdoor workers – especially roofers and gardeners.
Infants and children.
Women.
Those on medications for high blood pressure such as diuretics and diabetes medications.

Your body is made up of 78% water. Your brain is 73% water. Water cushions your organs and bones, delivers oxygen to your body, balances your brain chemicals or neurotransmitters, regulates your body temperature, makes saliva and aids in your digestion. Dehydration is dangerous.

Involvement of local non-profit organizations

To help with extreme weather and heat conditions in our daily lives, we need better community preparation and involvement.

Cooling locations and air-conditioned shelters, schools, hospitals, auditoriums, city/community centers and libraries.
Insulin, meter, and other diabetes supplies when emergency weather situations occur.
More education for patients to handle daily living under adverse conditions.
Involvement of hospital systems.
Campaigns through the city/county about climate awareness.
Institute national advocacy boards, as well as state, regional and local advocacy boards.
Hydration/snack stations.
Sunscreen samples given out at local events.
Coolers for drinks and food.

What should concern you on a hot day? Remember, these can all cause first and second-degree contact burns

Hot seatbelts.
Hot steering wheels.
Hot doorknobs.
All metal surfaces.
Falls on asphalt, concrete.
Being outdoors from 10AM-3PM should be avoided.
Ability to cool your home with fans or air conditioning.
Hottest states include – Arizona, New Mexico, Texas, Oklahoma, Florida, Alabama, Georgia, Mississippi, Hawaii, Arkansas and Louisiana.

The quickest way for your body to cool down is by sweating because evaporation of the perspiration causes natural cooling. You must replace that fluid.

What else can you do to protect yourself from extreme heat?

Wear sunglasses and a hat and closed-toe shoes with socks.
Rest in the shade. Find and sit under a big tree.
Carry an umbrella to block the sun.
Use SPF sunscreen. Re-apply frequently.
Place ice cubes under your tongue. Place ice cubes on your neck or wrist.
Put ice packs under your arms or in the groin area. Any area with blood vessels close to the skin’s surface exposed to ice, will help you cool down quickly.
Splash yourself with cold water. Pour water over your head.
Drink ice water. “Drinking cold water does not narrow your blood vessels or harm you.”
Jump into a pool, lake, stream or ocean.
Take a cool bath or shower.
Wrap a wet scarf or wet towel around your neck.
Carry a misting spray bottle.
Carry a small electric hand-held fan.
Wear light colored clothing. Wear clothing with UPF (ultraviolet protection factor). This blocks your skin from the sun.
You lose electrolytes in the heat. Carry a sports drink low in sugar. The electrolytes added to these drinks are: sodium, potassium, magnesium and chloride. Electrolytes regulate PH, muscle contractions, nerve signaling and help maintain hydration.
Keep prepared electrolyte tablets available. They are easy, portable, inexpensive, taste good and are just added to plain water. You can also add your own cut up fruit or muddled fruit.
Pedialyte used to be recommended only for children but is now considered a good supplement for dehydration in adults. “It has a precise balance of electrolytes and glucose to rehydrate cells to help you feel better fast.” There are on the go powder packets which can be added to water.
Eat foods with a higher water content. Melons, bell peppers, strawberries, peaches, pineapple, celery, lettuce and cucumbers are great choices.
Freeze berries and snack on them.
Place berries into ice cubes, freeze and place under tongue.
Consider a small salty snack such as popcorn, peanuts or pretzels to have handy if you do not have high blood pressure for sodium content.
You can make your own smoothie from fresh fruit, green veggies, herbs, nuts and dairy milk or plant-based milk. You can add protein powder if you want to support muscle growth. Blend with ice and drink cold.
Wear sunscreen and try mineral sunscreen over chemical sunscreen. When you get sunburned, your body diverts fluid from the rest of your body toward the burn to help repair damaged skin. There is less circulating fluid for cooling the body by sweating and body temperature increases.
Always be prepared with a 3-day supply of food, water, supplies and medication in case of a natural disaster or emergency.
Sign up for phone alerts for the heat and humidity index. Watch weather Apps for weather extreme updates. Check AirNow.gov for air quality and pollution levels. Request videos and pamphlets on the risks of extreme local heat and air pollution.
Look for education resources and classes in your area and community.
Talk to your physician about reducing your diuretics during heat waves. Never do this on your own.
Understand insulin stability and absorption may change during heat waves and extreme cold. In the heat, insulin will be absorbed more quickly and may cause more hypoglycemia or low blood sugar. Insulin can freeze in extreme cold. Never store insulin in the freezer. Keep at room temperature once opened.
Women should drink approximately 11.5 cups of fluid per day and men should drink 15.5 cups of fluid per day. Coffee, tea, herbal tea, diet drinks and water all count.

Continue to stay safe by:

Treat allergies when high pollen levels exist. Try to stay indoors.
Use your air conditioner and consider purchasing a good quality air purifier. Base it on the size of your room. Air purifiers trap pollutants such as dust, pollen, bacteria and disperse clean air back into the room.
Plan on being outdoors early in the morning and during dusk or after. Make sure to wear bug spray.
Do not walk or jog on busy streets or highways due to air pollution from cars and trucks.
Avoid drinking alcohol or too much caffeine.
Carry glucose tablets and a small snack of protein and high quality of carbohydrate.
Pre-hydrate before you go out for the day. Keep hydrating throughout the day.
Check blood sugars more frequently by using your glucose meter if you do not wear a CGM (continuous glucose monitor).
Keep meters, supplies and medications out of the sun or in the heat or cold of a car.
Do not place sunscreen near insulin pump insertion site or sensor.
Cover insulin pump with a small towel or cover when out in the sun.
Carry and store insulin in a cool bag, pouch or wallet.

As we continue to embrace and understand climate change around the world, we must focus on “environmentally friendly diabetes management.” There is no one quick fix or solution, but change will happen. Heat, cold and air pollution are topics that should be discussed with each patient with diabetes and an individualized plan should be set up for natural disasters.

Diabetes is due to genetics, urbanization, sedentary lifestyle, poor diet plans, obesity and now, climate change. Climate change can lead to food insecurity due to less agricultural production and higher prices for fruits and vegetables. This encourages eating more processed and bagged foods leading to more diabetes and chronic disease.

Stay informed and know what is best for you and your daily care with diabetes.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9067932/
https://www.health.com/avoid-heat-illness-injury-7567017
https://www.everydayhealth.com/type-2-diabetes/symptoms/surprising-causes-of-blood-sugar-swings/
https://www.healthline.com/health-news/cardiovascular-deaths-extreme-heat-projected-increase
https://www.pedialyte.com
https://www.healthline.com/nutrition/electrolytes-drinks
https://www.ncei.noaa.gov/news/global-climate-202307
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-023-02980-x
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10039694/
https://www.verywellhealth.com/environmental-risk-factors-for-type-2-diabetes-6537605
https://www.piedmont.org/living-real-change/change-in-temperature-can-affect-blood-sugar-levels
https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/hot-weather
https://www.sciencedirect.com/science/article/abs/pii/S0378378220307040
https://journals.viamedica.pl/clinical_diabetology/article/view/94568
https://edition.cnn.com/2017/03/20/health/climate-change-type-2-diabetes-study/index.html
https://diabetesed.net/what-is-the-link-between-diabetes-and-a-changing-climate/
https://www.healio.com/news/endocrinology/20230801/qa-climate-change-presents-special-concerns-for-people-with-diabetes
https://www.mayoclinic.org/diseases-conditions/dehydration/symptoms-causes/syc-20354086