07 August 2017
This article is written by Dr. Farhana Bin Lootah, Specialist, Internal Medicine at Imperial College London Diabetes Centre, Abu Dhabi
Every year, during the month of Dhu al-Hijjah, around two-and-a-half million pilgrims make their way to the holy city of Mecca for Haj. As one of the founding pillars of Islam, the Haj is mandatory for practicing Muslims in good health to make this journey at least once in their lives. However, there are thousands who will make this journey in spite of different health problems, including diabetes and related conditions such as eye disease, coronary heart disease and diabetic foot syndrome.
Diabetes management, which depends on an established stable routine, may be affected during Haj due to changes in your levels of physical activity (walking and standing for long periods), diet and meal times, and it’s important that you look after yourself, for these changes may leave you with dehydration and fluctuations in blood sugar levels.
Here are some tips and advice on how you can stay healthy and manage your diabetes during your pilgrimage:
- Speak to your doctor before travelling, as any changes to food, activity levels and meal timings need to be discussed before you start out. Your doctor will also give you advice on how to take your medicine or insulin, what and when to eat, and how to avoid any diabetes complications during the pilgrimage. This is particularly important if you have other health-related problems such as a heart or kidney condition or a known history of hypoglycaemic episodes.
- Ensure that you are up-to-date with your flu and meningococcal vaccines two weeks before you travel. Infectious diseases such as flu and chest infections are common during the Haj as a large number of people gather in a limited space for a short time. Try to avoid close contact with people wherever possible, and wear a face mask if you are particularly prone to infection.
- Prepare the correct amount of medication you need as advised by your doctor, and place each medicine in separate, well-labelled containers. Make sure to carry a cool pack to store insulin.
- Pack your medicines in carry-on rather than checked-in baggage to avoid lost luggage as well as the extreme temperature differences on the airplane that could alter the efficiency of the insulin.
- Prepare glucose and ketone dipsticks to determine the state of diabetes control during Ihram.
- Tell the organiser of your Haj trip about your medical condition as they may have a doctor accompanying the group. If there isn’t one, it’s important to tell the people you are travelling with that you have diabetes and to teach them the signs of low sugar levels and how this can be treated.
- Avoid walking barefoot, and always protect your feet with comfortable shoes and clean cotton socks, making sure to wash and dry your feet every day. Foot care is extra important for diabetics as damage to your peripheral nerves can cause weakness, numbness and pain in your feet, and you may not feel a cut, blister or sore, which can lead to ulcers and infections known as diabetic foot. Watch out for any blisters and cuts and seek medical advice on how to treat them.
- Be smart with your food choices to keep your blood sugar under control. For many pilgrims, meals will be served buffet-style, so chose your food carefully. Start your meal with a fresh, well-cleaned salad and some vegetables, and opt for lean meat and basmati rice dishes to keep blood sugar levels under control. Desserts should be avoided as they increase your blood sugar levels and cause dehydration; instead, stick to whole fruits that have a low glycaemic index and plenty of fibre, such as pears, apples and strawberries.
- Choose snacks like a handful of nuts and seeds, low-fat yogurt or soup to avoid sudden dips in glucose levels. Make sure that you have access to simple sugars at all times in the event of a hypoglycaemic episode, which happens when blood sugars drop to less than 70mg/dl, resulting in symptoms like dizziness, sweating and palpitations. Eat three dates or a tablespoon of honey, or drink half a glass of fruit juice and recheck your blood glucose levels after 15 minutes. Be sure to inform the medical team on site.
- Drink plenty of water during the day and with every meal (a minimum of two litres daily and preferably more, as you may lose water through perspiration or diarrhoea). The weather in Mecca and Medina is normally hot and dry, and it’s easy to forget to drink enough water when you’re busy with your rituals and walking long distances, which only increases the risk of dehydration. Avoid caffeine and sugary drinks such as fruit juices and fizzy soda. If you are allowed to carry an umbrella, use this as much as possible along with a water spray to keep cool.
© My Salaam 2017