Hajj can be challenging in terms of physical activities, mental effort, and travel-related changes – including climate and diet – particularly for those with diabetes, who should be well prepared for them. Research has shown that 77% of diabetics admitted to a hospital in Mecca during Hajj had poor diabetes control, and only 22% of them were aware that frequent self-monitoring of their blood glucose was necessary during this period.
Hajj is one of the five cardinal components of Islam commonly known as the ‘five pillars of Islam’. Every year, during the month of Dhu Al Hujjah, around two-and-a-half million pilgrims make their way to Mecca in Saudi Arabia to perform Hajj. It is estimated that more than 220,000 of them have diabetes and a large proportion is over the age of 60.
“Whilst Hajj is an extremely important and spiritual time, pilgrims who have diabetes must be well-prepared for what they may experience to ensure their pilgrimage runs as smoothly as possible. There’s no reason for their condition to get in the way,” says Dr Farhana Bin Lootah, Consultant, Internal Medicine at Imperial College London Diabetes Centre (ICLDC).
“Diabetes management depends on an established stable routine, and this may be affected during Hajj due to physical exertion associated with walking and standing for long periods, inadequate nutrition, poor access to drinking water, an increased risk of infections and of heatstroke due to the hot weather,” explains Dr Bin Lootah.
“This is why it is essential for diabetics to consult their doctor or medical team prior to travelling to perform the pilgrimage duty and to regularly self-monitor their blood sugar throughout Hajj to make sure they avoid any problems related to their condition, including hypoglycaemia, foot injuries and infections,” advises Dr Bin Lootah.
With diligent preparation and doctor’s advice, it is more than possible to manage the health risks pilgrims who have diabetes might be subjected to. Self-monitoring of glucose levels is an essential precaution to take and is approved both in religious and medical contexts.
Dr Bin Lootah adds: “In addition to continuously checking their blood glucose levels, diabetics should be sure to drink plenty of water to avoid the increased risk of dehydration.
“They should also be smart with their food choices and prepare their snacks beforehand to avoid sudden dips of their blood glucose, in addition to taking care of their feet and inspect them daily for any blisters or bleeding.”
Pilgrims may walk up to 20km per day increasing the risk of foot injuries, cuts and burns. Since people with diabetes are at an increased risk of foot damage due to nerve injury and a loss of feeling in feet associated with diabetic neuropathy, Dr Bin Lootah urges careful foot inspection by a specialist before travelling. Additionally, wearing appropriate footwear throughout the Hajj and checking feet daily for anything unusual such as changes in appearance, sore, aches and pains, is a must.
Dr Bin Lootah’s recommendations for diabetics before travelling to observe Hajj this year:
- Consult a doctor and request a travel letter confirming your medical history and your need for carrying needles and syringes in hand luggage. Also, it is advisable to make and bring a copy of your latest list of medications list ideally with generic names.
- Make sufficient supply of medications including, if necessary, insulin needles, insulin pens, and blood glucose monitoring equipment.
- Ensure you are up to date with your influenza and meningococcal vaccines two weeks before the trip. Try to avoid crowded areas wherever possible, and wear a face mask (when not in Ihram), if you are particularly prone to infections.
- Carry a diabetes emergency kit in hand luggage, including a glucagon injection kit. Make sure you also have cool bags to store insulin and most other injectable diabetes treatments whilst moving around in hot places, once in Saudi Arabia.
- Bring a hand sanitiser, a medical wristband, an umbrella, a water spray, and a mask to prevent airborne infections. Make sure you wear protective and comfortable shoes and cotton socks.
Dr Bin Lootah’s recommendations for diabetics whilst in Saudi Arabia throughout the Hajj:
- Keep insulin in the fridge (not in a freezer section) or in cool bags, and ensure it is kept away from direct sunlight at all times. Adjust insulin doses before activities, if required
- Regularly monitor your glucose level. Check glucose before any activity especially before Tawaf. Make sure to also prepare glucose and ketone dipsticks to know the state of diabetes control during Ihram.
- Carry rapid-acting carbs (CHO) at all times – such as dates, honey, fruit juice – and make sure you have access to simple sugars in the event of a hypoglycaemic episode and you experience symptoms of dizziness, sweating and palpitations.
- Avoid caffeine and sugary drinks such as fruit juices and fizzy soda and make sure you drink plenty of water (minimum 2 litres daily or even more due to sweating or high humidity).
- Perform regular, daily foot care and inspection and avoid walking barefoot at all times.
“For many, Hajj is a once-in-a-lifetime experience. With appropriate planning ahead, you will be far better equipped to handle the unique challenges diabetics face when performing this duty and there will be no reason for your condition to get in the way,” Dr Bin Lootah advises.