Dealing with Diabetes in the Summer Heat
On June 29, there was an article in the New York Times called "Really? The Claim: Diabetes makes you sensitive to heat." It was written by Anahad O'Connor. You can read the full article here.
Both type 1 and type 2 diabetics may develop diabetic neuropathy (nerve damage) which makes it difficult to cope with the summer heat. A large number of people with diabetes have neuropathy (between 60% and 70%), which may affect the ability to sweat and therefore cool the body.
The article included the results of 2 research projects. One done by Mayo Clinic in Phoenix found that diabetics have more hospitalizations, dehydration, and death in the heat, but they were not aware of this heat problem or how to remain healthy in this situation.
Another research measured skin and body core temperatures, as well as sweat rates. For diabetics, sweat rates plateaued despite the temperature so that the body could not cool itself as well as the control group.
If you have neuropathy, please take care of yourself. Go out after dark or early in the morning. Drink water to stay hydrated and cut down on drinks with caffeine, such as coffee or tea, sodas with caffeine, and alcohol. Exercise in an air conditioned gym and when outside, cover your head and skin with light breathable fabric clothing.
Do ask your health care team about the affect of heat on your insulin. You may want to place less insulin in your insulin pump reservoir during the summer if you spend time in the heat as its potency may be affected by temperature. Also ask if you can change to insulin that is formulated to protect potency.
JDRF Artificial Pancreas Project Update
We have reported on two trials of a closed loop system which marries an insulin pump a continuous glucose monitor. The American Diabetes Association and the JDRF presented results from the trials at the ADA Scientific Sessions held June 25-29.
Medtronic, which makes insulin pumps and a continuous glucose monitor, followed 485 people aged 7 to 70. Half of those people used the closed-loop system and the others used multiple injections of insulin per day.
At the end of the study, A1c fell from 8.3 to 7.5 for those in the closed-loop system. As important was the fact that hypoglycemic events remained very similar for both groups.
Read more about this project on the JDRF website.
More on Avandia for Type 2 Diabetes
Also at the ADA meetings this year, 3 different "experts" presented 3 different studies on the medication Avandia.
Since 2007 when Dr. Nissan of the Cleveland Clinic Foundation presented information that questioned the effects of the medication on cardiovascular events, Avandia has been under attack. It is, however, still available for the treatment of type 2 diabetes.
At the ADA meeting, the 3 papers connected the use of Avandia with cardiovascular harm, another linked the medication with cardiovascular benefits, and a third suggested the use of Actos, another medication in the same family.
The American Heart Association, the American College of Cardiology, and the American Diabetes Association all have made no statements as to whether they are for or against the use of Avandia.
Some doctors challenge whether either Avandia or Actos should be used as n add-on third or fourth level of medication for type 2 diabetes. Others see a benefit in a subgroup of obese diabetics who develop the disease at an early age and who, because their diabetes is very difficult to control, develop liver disease or even liver failure. We continue to await what the FDA will do about Avandia and will let you know as soon as we do.