6.7 Hajj and Travel

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6.7 Hajj and Travel14,15

Risk stratification, medication adjustments, proper clinical assessment, and education before doing the Hajj are crucial.

 

6.7.1 Health risks

  • Hypoglycemia
  • Dehydration
  • Foot injuries and infection
  • Hyperglycemia
  • Heat stroke and heat exhaustion
  • Infection
  • Cardiac problems

6.7.2 General recommendations

Before travel

  • To consult physician 1-2 months before the Hajj.
  • To complete recommended vaccinations.
  • It is preferable to pack diabetes medications in carry-on bags, not in the checked luggage.
  • This will protect the medicines from temperature changes in luggage stored in cargoes, which may affect the potency of insulin and other medications.
  • To choose shoes, sandals, and flip-flops with appropriate shapes and sizes (wide-front shoe to avoid extra pressure on the feet and the toes during long walking). Use socks while barefoot walking is required.

During travel and Hajj

  • Some carbohydrates to be carried for use during hypoglycemia. Meals should not be skipped.
  • Should drink plenty of water.
  • If using insulin, before Ihram should check blood glucose using glucometer and urine ketone using dipstick (for T1DM). If needed, a small dose of insulin to cover for hyperglycemia and/or small meal to avoid hypoglycemia should be kept always.
  • If using insulin before and during long walking, decrease the dose of short and intermediate insulin about 20% or more depending on the distance and effort. For those on sulfonylurea drugs, this adjustment of daily dose (up to 50% decrease in the corresponding drug dose of previous dose) can be applied.
  • Before tawaf (circumambulation around Ka’bah) and saee (walking between Safa and Marwah), should consume some additional carbohydrates (Complex carbohydrate is preferred) if the blood sugar within target.
  • Should check feet daily before going to bed.

6.7.3 Medication adjustment

  • Metformin, alpha-glucosidase inhibitors, thiazolidinediones, dipeptidyl peptidase-4 (DPP4) inhibitors, glucagon-like peptide-1 (GLP1) receptor agonists and SGLT2 inhibitors require no dose adjustment.
  • Sulfonylureas should be used with caution. The dose may be adjusted before doing the Hajj physical activity, and newer generations are preferred.
  • Insulin treatment is usually linked to increased risk of hypoglycemia, especially during the Hajj and its prolonged walking.