By: Dr. Salah Tigany

Head of Internal Medicine Department, UDH

Modification of life style is the basis for control of blood sugar in diabetes, without it drug therapy may not be effective.

It implies that the patient should control his timing hours of sleep, times of meals, quantity, quality and content of meals, carry out regular physical exercise appropriate for his age and general health.

However this system may be disturbed during the season of Hajj due to many factors like:

• Disturbance of sleeping pattern.
• Timing and in particular food content.
• Unaccustomed physical effort.

All this takes place in a hard environment ,crowded , limited space which results in an easy spread of communicable diseases like Influenza , cerebrospinal meningitis and viral infections, add to all these is the probability of physical trauma.

Other points to be considered in this context are:

• A high percentage of pilgrims are elderly, week and suffer from multiple disorders concurrently like diabetes , hypertension , cardiac disorders , renal insufficiency , bronchial asthma and obstructive airway disease…this suffering is further complicated by extremely hard environment, frequent long travel , exposure to infections, heat stroke, dehydration , salt and mineral imbalance, improper diet and exposure to dust.
• Many pilgrims forget to bring adequate amount of medications or fail to preserve it well, hence loses its efficacy.
• Pilgrims may find it difficult to find the location of nearest health centers at the time when needed.
• Some may not wear proper shoes or may lose them in the grounds or after prayer and may need to walk bare footed on hot roads suffering severe feet burns especially those with loss of sensation in the feet due to diabetes, hence it is wise and mandatory for diabetics to be prepared well ahead before the season…here are some advices :

1. 1. Consult your doctor to adjust proper doses especially insulin , like reducing the dose before an intended heavy physical exercises, reducing the dose of long acting insulin and oral hypoglycemic tablets or may need to switch to short acting ones before having meals , taking snakes after heavy exercise…etc.
   2. Consult the cardiologist and the nephrologist before your trip as silent heart or kidney involvement by diabetes may be detected & proper action taken as such diseases may be aggravated by improper diet, drinks, exercise and hot weather.
   3. Wear a medical wrist band with diagnosis written and carry your medical report issued by your treating doctor.
   4. Inform the group leader about your medical condition.
   5. Take the pre- Hajj vaccinations 2-3 weeks earlier.
   6. Take enough quantity of medicines, keep them properly e.g. ice bag for insulin.
   7. Keep a reliable glucometer for regular sugar level check up and when needed.
   8. Wear proper shoes.
   9. Keep some candies and sweats in your hand bag for immediate use in case of hypoglycemia, for which you must know the symptoms and signs.
   10. Keep bottles of mineral water to use in enough amounts especially in hot weather especially in case of evident kidney problems.
   11. Pay an effort to know the nearest medical center or hospital to your camp, do not hesitate to go quickly for consultation ASAP in case of feeling any health disturbance.

May Allah protects and blesses you and all pilgrims.