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How to Manage Your Diabetes in Extreme Summer Heat  

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How weather can affect your blood sugar  

 

We often look forward to a change of seasons and warmer temperatures. But if you have diabetes, you may be especially sensitive to the hot weather of summer.

Extreme heat can affect your blood sugar control. If you use insulin or your blood sugars aren’t effectively controlled, you could be at higher risk during the summer months. Worsening blood sugar control is often the main concern, and depending on your level of activity, developing low blood sugars may also be a concern.

If you’ve had complications from diabetes that have damaged the nerves to sweat glands, you may be unable to sweat properly. This can become serious as outdoor temperatures rise, leading to heat exhaustion and heat stroke.

Extreme temperatures can also damage your medications and testing equipment, says Dr. Marwan Hamaty, endocrinologist at Cleveland Clinic, Ohio. “I always remind my patients to take precautions to protect themselves and their supplies during both winter and summer.”

He says it’s important to get a handle on your blood sugar control before you engage in summer fun. “If your blood sugars are mostly higher than 250 mg/dl, I recommend improving your blood sugar control before engaging in heavy physical activity — regardless of the climate and the temperature, as recommended by the American Diabetes Association.”

Dr. Hamaty also advises that the extreme heat of summer affects blood sugar levels. How the heat affects your levels depends on what you’ve eaten, whether you’re well-hydrated and your activity level.

If the heat and your activity make you sweat a lot, you may become dehydrated, leading to a rise in glucose levels. “If you become dehydrated, your blood glucose levels will rise. This can lead to frequent urination, which then leads to further dehydration and even higher blood sugar levels — a kind of vicious cycle,” he says.

Things can become even worse if the treatment includes insulin: “Dehydration reduces blood supply to your skin and, therefore, the ability of your body to absorb the insulin you’ve injected is reduced,” he says.

Most types of insulin can tolerate temperatures up to 93-95 degrees Fahrenheit. Exposing your supply to anything higher than this will make the medication quickly break down. Be careful and pay attention to any insulin you’re carrying with you in the heat.

While it’s fine to store insulin and glucagon in the refrigerator, hot temperatures (as well as freezing temperatures) will cause the medications to degrade, making them ineffective and unusable. High temperatures can have a negative effect on other medications and diabetes management supplies too. Don’t forget about the weather’s effect on things like test strips and monitoring devices. When the mercury begins to rise, these items can change in their effectiveness.

Physical activity usually causes blood sugar levels to decrease, reducing your need for insulin. The sudden addition of exercise may put you at an increased risk for low blood sugars.

Therefore, if you’re active in extreme heat, know that you’re at high risk for both low and high blood sugars. This means you should take extra precautions and monitor your sugar levels before exercising.

“I advise my patients to maintain warm skin and adjust insulin dosage prior to engaging in physical activity because insulin adjustment could vary significantly,” says Dr. Hamaty. “But don’t allow the heat to keep you indoors. It’s OK to participate in outdoor activities and enjoy all types of weather as long as you take a few precautions.”

Dr. Hamaty also suggests seeking input from your doctor regardless of the temperature before adding physical activity to your routine.

Follow these tips to help manage your diabetes while enjoying the outdoors:

  1. Drink plenty of water.Staying hydrated is important for everyone during physical activity, and it’s especially critical if you have diabetes.
  2. Avoid becoming dehydrated.Carry small bottles of water or low-calorie electrolyte-replenishing sports drinks in a backpack or on a belt while you’re hiking or playing sports.
  3. Adjust your insulin as needed.Ask your provider or diabetes educator how you should adjust your insulin (and sometimes eating extra carbohydrates) before exercising. Typically, your first few doctor’s visits focus on urgent issues, such as getting diabetes under control. Ask about how to adjust your insulin so you can prepare to be physically active.
  4. Test your blood sugar levels frequently.Since hot temperatures can cause blood sugar levels to fluctuate, it’s a good idea to test more often. That way, you can take appropriate and immediate action to keep your levels stable. You should continue frequent monitoring for several hours after you’re done with your workout or other activity. That’s because the effects of activities on blood sugars usually last for a longer period of time.
  5. Keep items to treat low blood sugar with you. This includes glucose tabs or glucose gel. If you’re at high risk for very low blood sugar (if you have frequent low blood sugar or had very low blood sugar previously), you should also have a glucagon kit available.
  6. Take some snacks with you.Some snacks can serve as a meal replacement while others help prevent low blood sugar. Discuss possible options with your dietitian.
  7. Protect your medication and supplies. Take proactive steps to protect your insulin, glucagon kit and other supplies before you head outdoors, regardless of the temperature. Consider a car cooler that plugs into a 12-volt car adapter to keep your supplies at the proper temperature. This will keep the temperature stable for some time. If you’re going away from your car for an extended period, you’ll need to take your supplies along with you. If you are on insulin pump, be sure to protect your insulin pump from high temperatures. Depending on the situation and how long your activity will be, you might simply need to monitor your glucose more often. In certain circumstances (if it’s extremely hot or you’re out for an extended amount of time) consider using a long-acting insulin temporarily along with meal insulin injection instead of an insulin pump.
  8. Avoid sunburn. You can get sunburned while skiing on the slopes or while hiking in the summer. Sunburn stresses your body and can raise blood sugar levels. Use a broad-spectrum sunscreen and wear protective eye gear.
  9. Finally, limit how much time you spend outside in extreme temperatures. “While I advise staying active during the peak winter or summer months, I also tell my patients to try to take advantage of outdoors activities when temperatures aren’t too extreme,” says Dr. Hamaty. By taking a few precautions, you can enjoy an active, healthy lifestyle in most any weather.

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Combined Team of Ministry of Health and TCI Hospital personnel attend United Kingdom Health Security Agency (UKHSA) Antimicrobial Stewardship (AMS) Workshop in Anguilla.   

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#TurksandCaicos, December 10, 2023 – A combined team of Ministry of Health and Human Services (MoHHS) and TCI Hospital personnel recently represented the Turks and Caicos Islands at a three-day UKHSA AMS Workshop, which was held in Anguilla between November 29th and December 1st, 2023. The team included Mrs. Winsome Hayles-Parker – Lead Medical Technologist in Microbiology, TCI Hospital, Mr. Andre Morgan – National Pharmacist, MoHHS and Ms. Arlene Siebs – Director of the National Public Health Laboratory, MoHHS. The workshop was well attended by physicians, pharmacists and laboratory personnel who hailed from the United Kingdom, St. Helena, Anguilla, Bermuda, British Virgin Islands, Cayman and Montserrat.

The workshop involved both laboratory and non-laboratory sessions. The laboratory sessions were practical sessions that were geared toward the diagnostic technologies used by the various UKOTs in the detection of antimicrobial-resistant (AMR) pathogens and the use of BioFire in diagnostics. Most territories are now equipped with the BioFire Assay Technology, which forms part of the laboratory setup for molecular resistance markers.

The non-laboratory sessions included parallel professional development sessions on topics including AMS, the use of the MicroGuide antibiotic prescribing App, antibiotic surveillance, situational analysis of AMS in the UKOTs and AMS accreditation. Importantly, the attendees were able to discuss case presentations on clinical management and infection prevention and control.

In providing comments, Ms. Siebs stated, “Medical Laboratory Scientists must continue to improve their skills and competency as we work together in combatting AMR through laboratory services. I was thrilled at having the opportunity to compare disc susceptibility testing with automated analysers for the detection of antimicrobial resistance in microorganisms.”  

Mrs. Hayles-Parker believes that “the information gathered will be of value in helping us in the TCI to uphold the standards on AMS and in the long term with the fight against AMR. As we move forward as change agents, we are better able to assist with safeguarding the health and wellbeing of the people of the TCI.”

Mr. Morgan concluded that “the three-day workshop was a major success and I am excited to utilise the information acquired in strengthening the TCI’s National Action Plan for Antimicrobial Resistance, which will, in turn, develop and strengthen antimicrobial stewardship in the Turks and Caicos Islands. I hope that these advances will continue to safeguard against this emerging AMR global threat by implementing strategies that will ensure sustainable pharmaceutical care for the present and future.

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90% of strokes are avoidable with a few lifestyle changes!

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Cleveland Clinic Expert Shares Six Simple Steps to Prevent Vast Majority of Strokes

  

December 5, 2023 – According to the World Stroke Organization (WSO), stroke is the leading cause of disability worldwide. The WSO says one in four people will have a stroke in their lifetimes, and each year over 12 million people worldwide have strokes. However, it adds that 90% of strokes are preventable by addressing a small number of risk factors that are responsible for most strokes. In The Bahamas, on average 224 people (or 9.56%) die annually from strokes. 

Here, Andrew Russman, DO, Medical Director of Cleveland Clinic’s Comprehensive Stroke Center and a vascular neurology specialist, offers advice on how to reduce stroke risk by better managing existing health conditions and also through implementing lifestyle changes. “These tips are interrelated as most of the lifestyle changes mentioned also play a role in improving management of hypertension, high cholesterol and diabetes, which all increase stroke risk,” Dr. Russman points out.

  1. Reduce hypertension

Uncontrolled hypertension – that is, blood pressure that is consistently above 130/80 – is the single most important modifiable risk factor in stroke worldwide, says Dr. Russman.

Aside from medication, an important step in reducing blood pressure is to reduce salt intake, which Dr. Russman says is good advice even if you don’t have high blood pressure. “We recommend consuming no more than 2g of salt per day. I advise my patients to check food labels and nutritional websites for sodium levels as their intake is usually far higher than they realize,” he adds.

  1. Be wary of diabetes

It is important to be tested for diabetes, and if diagnosed, to manage the condition wells, says Dr. Russman. He explains that diabetes causes narrowing of small, medium and large blood vessels in the body, including vessels of the eyes, kidney, heart and brain. Owing to this, diabetes can contribute to a variety of vascular, cardiovascular and cerebrovascular problems including stroke. In addition, for patients who have survived a stroke, the risk of having a second is three times higher in those patients whose diabetes is not controlled.

Dr. Russman says that as part of their treatment plan, people with diabetes should have their condition monitored through HbA1C tests, which provide a three-month snapshot of their blood sugar control. “We                                      recommend that these individuals aim for an HbA1C result of 7.0 or less. Taking prescribed medication correctly, watching their diet, exercising regularly, and following their healthcare provider’s recommendations                          will help them achieve this.”

  1. Address atrial fibrillation

The WSO says atrial fibrillation is associated with one in four strokes, and Dr. Russman says these strokes tend to be more severe and disabling than strokes associated with other risk factors.

“Atrial fibrillation is a heart rhythm condition characterized by very rapid heartbeats that don’t allow the top left chamber of the heart – the left atrium – to contract normally. Instead, it fibrillates and flutters so blood                         is not ejected normally from the chamber,” he says. “Anytime blood is stagnant for too long, it can form a blood clot that can travel elsewhere in the body. This clot could cause a stroke by blocking a blood vessel in the brain, depriving that part of the brain of the oxygen and nutrients it needs.”

Dr. Russman says atrial fibrillation is the most common acquired heart rhythm disorder in older adults, and its associated risk is strongly related to age. “The older you are, the more at risk you are of acquiring the condition, but also the higher the risk of stroke associated  with the condition,” he says. “It is estimated that up to half of all patients with a heart rhythm condition are not aware of it. However, once diagnosed, atrial fibrillation can be treated with a blood-thinning medication. These do carry some risks, but the benefits far outweigh these in the vast majority of patients.”

  1. Manage cholesterol levels

In addition to reducing high levels of low-density lipoprotein (LDL) or ‘bad’ cholesterol through diet, for example, by avoiding saturated fat, individuals might be prescribed statin medications that reduce future risk of heart attacks and strokes. Dr. Russman says these medications, particularly rosuvastatin and atorvastatin, may benefit patients beyond simply reducing cholesterol levels in that they also appear to reduce inflammation and stabilize plaque build-up in blood vessels.

  1. Stop smoking

“Any type of smoking is associated with increased risk of cardiovascular disease and stroke, and is strongly associated with accelerated hardening of the arteries and narrowing of blood vessels in the brain, heart and   elsewhere,” says Dr. Russman. “We therefore strongly recommend everyone completely stop any form of nicotine ingestion to significantly reduce their long-term risk for a multitude of diseases.”

  1. Adopt a healthy lifestyle

Dr. Russman recommends following an eating plan that is low in saturated fats and sodium, and to avoid alcohol and excessive caffeine consumption. Regular physical activity is also important as it can reduce the risk of stroke directly, but also indirectly as it helps to lower high blood pressure and blood sugar levels. Exercise can also help to reduce stress, as can other activities such as meditation or deep breathing, which is important as stress causes the body to release chemicals that can increase blood pressure, affect hormones and raise blood sugar levels, says Dr. Russman.

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Deaths due to HIV/AIDS down 50 percent as World Aids Day marked Dec 1

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Dana Malcolm 

Staff Writer 

 

December 5, 2023 – Deaths due to HIV/AIDS have been cut dramatically by fifty percent in the past thirteen years and on December 1, which is the annual commemoration of World AIDS Day, the World Health Organization called on communities to stand up to reduce the risks even further.  The 2023 theme is “Let Communities Lead” as a testament to the notion, shared by the WHO, that “we can end AIDS with communities leading the way.”

In the past five decades, treatment surrounding AIDS has increased exponentially and stigma is decreasing. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), AIDS-related deaths have been reduced by 69% since the peak in 2004 and by 51% since 2010. In 2022, around 630,000 people died from AIDS-related illnesses worldwide, compared to 2.0 million people in 2004 and 1.3 million people in 2010.

“Much more than a celebration of the achievements of communities, it is a call to action to enable and support communities in their leadership role,”  the WHO encourages.

The WHO is now focused on spreading awareness about the status of the pandemic and encouraging progress in HIV/AIDS prevention, treatment, and care around the world.

Locally, among the events planned in the Turks and Caicos Islands is the annual Surf and Turf Horse Racing night on Friday 8th December at Opus Wine Bar and Grill, residents are invited for an evening of food, luck, and chances. All proceeds go towards the Turks and Caicos AIDS Awareness Foundation and Edward Gartland Youth Center.

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