General Guidelines for Diabetic People Who Intend to Perform Hajj Pilgrimage

General Guidelines for Diabetic People who intend to Perform Hajj Pilgrimage

Introduction The Saudi Diabetes and Endocrine Association is pleased to present these guidelines to diabetic people who intend to perform Hajj, aiming to help them to have safe and blessed Hajj without health complications. Diabetes is widespread in the community due to many factors; such as genetics, unhealthy lifestyle, lack of exercise and obesity. Diabetic pilgrims are advised to consult their doctors and to follow the below guidelines to avoid health complications prior and during Hajj. Hajj period is limited to a few days in which diabetic pilgrims have to perform many rites which require extra effort and exercise, accordingly; they have to prepare themselves .for additional activities than normal days during the Hajj period

The government of Saudi Arabia has made a lot of effort to ensure the safety and security of the pilgrims and issued educational guidelines for them to follow. In addition, the government has assigned thousands of security and health care personnel for the sake of pilgrims’ safety and established hundreds of Emergency Centers all over the area. In addition, the government has installed fire resistant tints and compounds, safe accommodations, ensured safe and adequate transportation, ensured adequate safe food and water supply, planted thousands of trees for shading, installed cold water sprinklers to control high temperature, constructed safe highways and bridges and made all the needed facilities and utilities according to the International standards, of health, safety and .environment In order to avoid high or low blood sugar, pilgrims are advised to  :observe the following

Hot weather is one of the primary causes of • Dehydration and sunstroke, if the pilgrim is under direct sun too .long .Acute kidney failure, resulting from dehydration and sunstroke Increase in blood viscosity, which many cause stroke/heart .attack .Dizziness .Exhaustion To avoid these complications, the pilgrim is advised to avoid staying in the sun unnecessarily and to use an umbrella or to stay in the shade as much as possible. Wetting the head and body with water .many times during the day is another way to keep the body cool Diabetics should drink a lot of fluids, especially water, during the day and night, to replace sweat and urine loss. Less urine output .and dark color of the urine indicate the need for more water Medications •

Insulin must be kept in a refrigerator at the residence or in the coolest area of the room or in an iced thermos or in insulated bags, during transfer from one place to another. Otherwise the insulin will .not be effective .Oral medication should be kept in a cool place Medication should be placed in safe and secured places and not to be placed in the gloves cabinets of the vehicles or within the air .traveling luggage or under direct sun or in heated areas Diet •

Diabetic pilgrims should follow their diet plans during the Hajj period and to eat their meals and snacks as advised by their doctors and dietitians. Food exchange lists are to be used to select food items that are available on the road and at Mecca & Madina in order to meet their diet requirements and to keep their blood sugar at normal levels. They should avoid foods that are prepared under unhygienic conditions and avoid consuming unhealthy foods to avoid food poisoning. They should always check the foods’ expiry dates, read food labels, and consume pasteurized or long life food .items

Diabetic pilgrims are advised to eat their healthy meals and snacks based on the time schedule set for them by their doctors and dietitians. The meals should be low fat, moderate in salt, rich in fiber and well-balanced. The meals schedule should be integrated .with the pilgrims’ activities and medication regimen Diabetic pilgrims, if they wish to fill Zamzam water, should ensure .the hygienic condition of their bottles and containers Blood Sugar Monitoring •

Diabetics, especially those using insulin and oral medications, are advised to check their blood sugar levels twice a day, minimum, to ensure that their blood sugar is within normal level. The results should be recorded before taking medication. In case of frequent low blood sugar, the patients are advised go to the nearest Emergency Center to adjust their medication doses, as the activity .level of pilgrims during Hajj reduces the required dosages Helpful Tips

:The general guidelines are divided into three stages •

Prior to traveling to Mecca in order to prepare diabetic pilgrims .1 .for healthy and safe Hajj .On the way to Mecca, either by air or land or sea .2 .At Mecca during performance of Hajj rites .3

Diabetic pilgrims are advised to take all the necessary vaccinations • prior to commencing their Hajj, as require by the government of Saudi Arabia, and to do all the required tests to ensure about their physical and healthy abilities to perform .Hajj safely and healthfully If diabetic pilgrims have been cleared by their doctors to perform • Hajj, they should inform their companions at the vehicles and residences that they have diabetes. The pilgrims’ organizers have to be informed that diabetic people are included within their .pilgrims so that help can be provided should the need arise

If diabetic pilgrims choose to travel via air, they are advised to • contact their airlines and inform them about their food needs and other requirements. They should not keep their medications with .the luggage, as these should be hand carried with them

Diabetic pilgrims should carry their diabetic ID cards and cubes of • sugar, candy or juices, in order to be prepared for a possible episode of low blood sugar. Low blood sugar symptoms: are hunger, trembling, weakness, sweating, confusion, .irritability, and tingling of mouth and fingers

Diabetic pilgrims are advised to take with them an • adequate supply of medication, in addition to Glucagon Kit if they are on insulin. This kit will be used in case of low blood sugar coma. Family members or companions should be trained to administer Glucagon injection once needed. Diabetic pilgrims are advised to take First Aid Kit with them, along with their personal items; such as seizers, eye glasses, alcohol swaps, tooth .paste and brush, towels, etc

Diabetic pilgrims are advised to perform their Hajj away from • crowded areas and to take deep breaths in order to inhale more oxygen, as less oxygen is available in crowded areas. They should .take care of their feet in crowded areas to avoid injury

Diabetic pilgrims are advised not to share their personal items • with others, and are advised to practice safety and hygiene, wash their hands more often with water and antiseptic soap. They also are advised to stay away from sick people and cover their mouths .and noses when coughing or sneezing

Foot care is very important for diabetic pilgrims; therefore, they • are advised to keep their feet clean, dry, and use proper footwear to protect their feet. They also are advised not to walk barefoot on hot surfaces or sharp objects, to check their feet regularly, and use the transportation available in order to avoid walking .long distances

To prevent the consequences of low blood sugar event • during the journey, diabetic pilgrims are advised to ask .a member of their families, or companions, to drive

Diabetic pilgrims they also are advised to report to the nearest • Emergency Center in case of sudden sickness, chest pain, .infection, severe diarrhea, vomiting, foot injury or falls The Saudi Diabetes & Endocrine Association hopes that the above guidelines will be helpful for pilgrims to perform safe, healthy and holy Hajj