Hot weather and diabetes

Today's near perfect beach weather (at least in this part of the country) reminds me that it's time to put out some reminders of the precautions that diabetics should take as the temperature rises and summer approaches.

In parts of the country that have 4 seasons, it is important that we remind our patients of hot weather concerns that can adversely impact their glycemic control. I will mention a few significant points here, and I hope you will all add anything that I miss...or share how you approach this topic.

• Avoid exercising in the heat, choosing instead to do so in an air-conditioned place.
• Wear light colored clothing made of fabrics that can "breathe."
• Protect your feet — never walk barefoot on hot surfaces.
• Watch for signs of possible heat exhaustion, such as dizziness, fainting or excessive sweating. Seek medical attention if you experience symptoms.
• Maintain adequate hydration, avoiding caffeinated or alcoholic beverages that can be dehydrating.
• Check sugar levels frequently throughout the day, especially during exercise, since blood sugars may fluctuate.
• On the road? Transport diabetes supplies and medications in an insulated bag protected by a cold pack. (Avoid freezing.)
• Dehydration:

Hyperglycemia itself can cause dehydration in addition to the dehydrating effect of sweating in the heat. Increased non-caloric fluid intake (preferably water) is a must even if blood glucose is within target range. If patients are taking metformin, they need to be reminded that adequate hydration is essential to prevent the buildup of lactic acid if the kidneys do not have enough fluid function properly.

• Blood Glucose Monitoring:

**Dehydration can cause blood glucose monitoring tests to be inaccurate in reflecting the person's actual blood glucose level.

**Exposure to extreme heat can permanently destroy the accuracy of blood glucose test strips

**Blood glucose monitors can give inaccurate readings if they get too hot (see specifics for each meter). Waiting until the meters cool down is usually OK for blood glucose testing as long as the test strips are accurate. Control solution should be used to test accuracy of test strips , and control solution itself should be replaced every 3 months and used before its expiration date. Control testing of test strips is especially necessary when blood testing supplies are delivered by mail order as they may have been exposed to hot temperatures in transit or when delivered on a hot day.

**Advise patients not to leave blood glucose meters or test strips in their cars or by a window that gets a lot of hot sun. Carrying cases with gel packs or the Frio packs are helpful for that purpose.

Insulin Pumps:

The pump itself will tolerate higher temperatures than the insulin in the tubing and reservoir. DKA can result if the insulin containing parts of the pump system are exposed to direct sunlight and heat. Keeping the pump and tubing protected from the heat is essential with a Frio pack or some other type of gel pack. The option to disconnect from the pump and switch to subcutaneous injections for prolonged sun or heat exposure can be discussed.

• Protect all medications:

*** Generally speaking insulin, insulin pens, exenatide, pramlintide pens and most oral agents should not be exposed to temperatures higher than 86degrees F (30 degrees C). Acarbose,repaglinide and nateglinide should be stored at temperatures less than 77 degrees F (25 degrees C)