Each year around two and a half million people complete the Haj pilgrimage to Mecca in Saudi Arabia. It is one of the founding pillars of Islam and is mandatory for Muslims in good health to make the journey at least once in their lifetime.
Having diabetes need not exclude those wishing to attend Haj, as long as it’s well managed.
Dr Farhana Bin Lootah, specialist, Internal Medicine at Imperial College London Diabetes Centre in Abu Dhabi, says that diabetes management depends on an established stable routine, which can be affected during Haj. This is due to changes in physical activity levels, diet and meal times, which could result in fluctuations in blood sugar levels and dehydration.
Here are her tips for staying healthy and managing diabetes during the pilgrimage.
- Ensure you are up to date with your influenza and meningococcal vaccines two weeks before you travel. Infectious diseases such as flu and chest infections are common during Haj as a large number of people are gathering in a confined space during a short time. Try to avoid close contact with people wherever possible, and wear a face mask if you are particularly prone to infections.
- Prepare the correct amount of medications as advised by your doctor and place them in separate, well-labelled containers. Make sure to carry a cool pack to store insulin.
- Pack your medications in carry-on luggage, rather than in checked baggage. This will help to avoid not only bags going missing, but possibly altering the efficiency of the insulin as a result of extreme temperature differences on the airplane.
- Prepare glucose and ketone dipsticks (to know the state of diabetes control during Ihram).
- Inform the organiser of your Haj trip of your medical conditions as they may have a doctor accompanying the group. If this is not possible, it is still important to tell people you are travelling with that you have diabetes and teach them the signs of low sugar levels and how to treat it.
- Avoid walking barefoot and always protect your feet with comfortable shoes and clean cotton socks, and make sure to wash and dry your feet every day. Foot care is extra important for diabetics. Damage to your peripheral nerves can cause weakness, pain and numbness in your feet — this in particular could lead to cuts, blisters and sores going untreated, resulting in possible ulcers and infections, known as diabetic foot. Be aware of 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 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 glycemic index and plenty of fibre such as pears, apples and strawberries
- Prepare your snacks, such as a handful of nuts and seeds, low-fat yogurt, or soup to avoid sudden dips in glucose levels. Make sure you have access to simple sugars at all times in the event of a hypoglycaemic episode. This happens when blood sugars drop to less than 70mg/dl and you experience symptoms of dizziness, sweating and palpitations. Eat three dates or one tablespoon of honey, or drink half a glass of fruit juice and recheck your blood glucose levels after 15 minutes. You should also inform the medical team on site
- Drink plenty of water during the day and with every meal — minimum of two litres daily, and preferably more as you may be losing water through sweating 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, increasing 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