The document provides guidance for managing diabetes during the Hajj pilgrimage. It notes that over 20-30% of Hajj pilgrims have diabetes. While Hajj poses challenges for diabetic patients due to changes in environment, diet, and increased physical activity, it states that with proper planning, education, medication management, and care during potential illnesses, people with diabetes can perform Hajj safely. It emphasizes the importance of consulting doctors prior to travel regarding insulin/medication adjustments, hypoglycemia treatment, and sick day management to safely navigate the physical demands and potential health issues associated with the Hajj pilgrimage.

1. PRACTICAL MANAGEMENT OFPRACTICAL MANAGEMENT OF
DIABETES DURING HOLY HAJJDIABETES DURING HOLY HAJJ
Prof. M. FariduddinProf. M. Fariduddin
Founder Chairman & Course CoordinatorFounder Chairman & Course Coordinator
Department of EndocrinologyDepartment of Endocrinology
Bangabandhu Sheikh Mujib Medical UniversityBangabandhu Sheikh Mujib Medical University
Dhaka, BangladeshDhaka, Bangladesh
Email: dr.md.fariduddin@gmail.comEmail: dr.md.fariduddin@gmail.com

2. Diabetes & HajjDiabetes & Hajj
 Holy Hajj is one of the five pillars of IslamHoly Hajj is one of the five pillars of Islam
 Good physical and mental health is the most importantGood physical and mental health is the most important
prerequisiteprerequisite
 More than two million Muslims perform Hajj each year; amongMore than two million Muslims perform Hajj each year; among
them 20-30% are diabeticthem 20-30% are diabetic
 Hajj is a real challenge for diabetic patients & their attendantsHajj is a real challenge for diabetic patients & their attendants
 However by good planning & pre travel education andHowever by good planning & pre travel education and
consultation with medical teams & muallem Hajj can be performedconsultation with medical teams & muallem Hajj can be performed
safely without major health consequencessafely without major health consequences

3. Health hazards during HajjHealth hazards during Hajj
 People with diabetes may face difficulties as they travel throughPeople with diabetes may face difficulties as they travel through
places where geography, weather, diet, habits & language areplaces where geography, weather, diet, habits & language are
different.different.
 Specific risks during Hajj includes inter-current illnesses i.e upperSpecific risks during Hajj includes inter-current illnesses i.e upper
respiratory tract infections, urinary tract infections, dysentery &respiratory tract infections, urinary tract infections, dysentery &
diarrhea, heat stroke, dehydration , generalized body ache &diarrhea, heat stroke, dehydration , generalized body ache &
fluctuating blood sugar levels.fluctuating blood sugar levels.
 So not only acquiring conception about those common problemsSo not only acquiring conception about those common problems
but also having the preliminary knowledge of management bybut also having the preliminary knowledge of management by
consulting with concerned physician prior travel for holy Hajj is theconsulting with concerned physician prior travel for holy Hajj is the
basis to overcome such unpleasant circumstances.basis to overcome such unpleasant circumstances.

4. Preparation Before TravelPreparation Before Travel
Better to start preparation for Hajj prior to Ramadan by consultingBetter to start preparation for Hajj prior to Ramadan by consulting
with concerned physician as well as caravan manager (Muallem)with concerned physician as well as caravan manager (Muallem)
 Practice walking for at least half an hour a day.Practice walking for at least half an hour a day.
 Complete your recommended vaccinations.Complete your recommended vaccinations.
 Try to have a good control of diabetes & high blood pressure.Try to have a good control of diabetes & high blood pressure.
 Seek for other medical management if needed.Seek for other medical management if needed.
 Do an X-ray Chest & ECG consulting your doctors.Do an X-ray Chest & ECG consulting your doctors.
 It is obligatory to learn practical management of diabetes includingIt is obligatory to learn practical management of diabetes including
hypoglycemia , sick day management & blood pressure control inhypoglycemia , sick day management & blood pressure control in
different adverse situations by consulting with physicians prior todifferent adverse situations by consulting with physicians prior to
travel.travel.

5. Preparation Before Travel… cont.Preparation Before Travel… cont.
 Pack your general & emergency medications, insulin, syringe,Pack your general & emergency medications, insulin, syringe,
glucometer, cotton, dipstick etc. in separate plastic container or inglucometer, cotton, dipstick etc. in separate plastic container or in
your hand luggage.your hand luggage.
 Carry on your physicians’ prescription always with you and a keepCarry on your physicians’ prescription always with you and a keep
a duplicate copy in luggage.a duplicate copy in luggage.
 You can keep your insulin in water for better storage in hot weatherYou can keep your insulin in water for better storage in hot weather
where facilities not available (i.e freezing) or can take suggestionswhere facilities not available (i.e freezing) or can take suggestions
from provider company.from provider company.
 Monitor blood sugar regularly by glucometer.Monitor blood sugar regularly by glucometer.

6. Diabetes care during HajjDiabetes care during Hajj
 Always carry some carbohydrates (i.e glucose, sugar, biscuit, datesAlways carry some carbohydrates (i.e glucose, sugar, biscuit, dates
etc.)etc.)
 As hypoglycemia is a medical emergency, it is obligatory to explainAs hypoglycemia is a medical emergency, it is obligatory to explain
its’ proper management to the caravan manager as well as to theits’ proper management to the caravan manager as well as to the
teammates in the very beginningteammates in the very beginning
 Drink plenty of normal Jamjam water dailyDrink plenty of normal Jamjam water daily
 If use insulin, before Ehram one can check blood glucose byIf use insulin, before Ehram one can check blood glucose by
glucometer & urine ketone by dipstick.glucometer & urine ketone by dipstick.
 If needed, use a small dose of insulin to cover hyperglycemia and orIf needed, use a small dose of insulin to cover hyperglycemia and or
some bread for hypoglycemia by measuring sugar with dipstick.some bread for hypoglycemia by measuring sugar with dipstick.
 Insulin can be stored in special cool wallets. Kept away insulin &Insulin can be stored in special cool wallets. Kept away insulin &
blood glucose test strips from direct sunlight.blood glucose test strips from direct sunlight.

7. Diabetes care during Hajj… cont.Diabetes care during Hajj… cont.
 Better to consume some extra carbohydrates before TawafBetter to consume some extra carbohydrates before Tawaf
(Circumambulation around Ka’abah), saaye (walking between Safa(Circumambulation around Ka’abah), saaye (walking between Safa
and Marwah) and whenever long walking & more activities areand Marwah) and whenever long walking & more activities are
needed.needed.
 It is recommended to decrease dose of insulin about 25% andIt is recommended to decrease dose of insulin about 25% and
same can also be applied to sulfonylurea drugs before and duringsame can also be applied to sulfonylurea drugs before and during
those days of long walking.those days of long walking.
 Try to protect your feet from damage by ground tiles or otherTry to protect your feet from damage by ground tiles or other
pilgrims during walking or from being stamped on while circling thepilgrims during walking or from being stamped on while circling the
Ka’abah barefoot.Ka’abah barefoot.
 Consult Hajj medical team promptly in case of fever, diarrhoea,Consult Hajj medical team promptly in case of fever, diarrhoea,
vomiting or any acute medical conditions.vomiting or any acute medical conditions.

8. Sick day management of DMSick day management of DM
 Insulin or diabetes medication should be continued.Insulin or diabetes medication should be continued.
 Blood glucose level should be monitored by glucometer moreBlood glucose level should be monitored by glucometer more
frequently (both fasting & after meal) and medications should befrequently (both fasting & after meal) and medications should be
adjusted accordingly.adjusted accordingly.
 With type 1 diabetes if blood glucose level more than 15 mmol/LWith type 1 diabetes if blood glucose level more than 15 mmol/L
blood or urine should be tested for ketones.blood or urine should be tested for ketones.
 If being sick, take carbohydrate containing drinks such as milk &If being sick, take carbohydrate containing drinks such as milk &
other milky drinks, fruit juice or sugary drinks.other milky drinks, fruit juice or sugary drinks.

9. Sick day management of DM… cont.Sick day management of DM… cont.
 If able to eat but no appetite, eat little & often, takingIf able to eat but no appetite, eat little & often, taking
carbohydrate containing drinks, as above, and snacks such ascarbohydrate containing drinks, as above, and snacks such as
toast, biscuits & cerealtoast, biscuits & cereal
 Must contact with health care team if any of the followingsMust contact with health care team if any of the followings
i. Blood glucose levels are continuously highi. Blood glucose levels are continuously high
ii. Ketones present in blood or urineii. Ketones present in blood or urine
iii. No improvement of vomiting or diarrhoeaiii. No improvement of vomiting or diarrhoea
iv. If unsure what to doiv. If unsure what to do

10. HypoglycemiaHypoglycemia
What is meant by hypoglycemiaWhat is meant by hypoglycemia ::
 When blood glucose level <3.5 mmol/L, it is termed as hypoglycemia.When blood glucose level <3.5 mmol/L, it is termed as hypoglycemia.
 It is a medical emergency.It is a medical emergency.
Why diabetic people are more prone to hypoglycemia during HajjWhy diabetic people are more prone to hypoglycemia during Hajj ::
 Hajj is demanding in terms of physical activities & mental effort.Hajj is demanding in terms of physical activities & mental effort.
 Insulin dose which shows effective & adequate during sedentary life at homeInsulin dose which shows effective & adequate during sedentary life at home
proves excessive during Hajj due to imbalance of dietary adjustment andproves excessive during Hajj due to imbalance of dietary adjustment and
strenuous exercise during the different formalities of Hajj.strenuous exercise during the different formalities of Hajj.
 Similarly performing prayers in the holy shrines, distance of residence etc.Similarly performing prayers in the holy shrines, distance of residence etc.
may delay meal times which may contribute to hypoglycemia particularly inmay delay meal times which may contribute to hypoglycemia particularly in
patients who are on insulin or sulphonylurea like drugs.patients who are on insulin or sulphonylurea like drugs.

11. Hypoglycemia… cont.Hypoglycemia… cont.
How to recognize hypoglycemiaHow to recognize hypoglycemia ::
Common manifestations of hypoglycemia are sweating, hunger,Common manifestations of hypoglycemia are sweating, hunger,
confusion, drowsiness, inability to concentrate, irritability, nausea,confusion, drowsiness, inability to concentrate, irritability, nausea,
headache, tiredness etc.headache, tiredness etc.
How to prevent hypoglycemiaHow to prevent hypoglycemia ::
All well controlled diabetic patients should reduce the oral dose ofAll well controlled diabetic patients should reduce the oral dose of
oral hypoglycemic agent or insulin as they are likely to beoral hypoglycemic agent or insulin as they are likely to be
exercising the equivalent of two hours or more every day.exercising the equivalent of two hours or more every day.
Insistence on regular meals & taking mid morning snacks is alsoInsistence on regular meals & taking mid morning snacks is also
important. People on twice daily mixture insulin may need toimportant. People on twice daily mixture insulin may need to
consider changing to basal bolus regime to allow flexibility.consider changing to basal bolus regime to allow flexibility.

12. Hypoglycemia… cont.Hypoglycemia… cont.
How to manage hypoglycemiaHow to manage hypoglycemia ::
 All diabetic people along with their mates & Muallem should knowAll diabetic people along with their mates & Muallem should know
how to manage hypoglycemia promptly as mentioned earlier it is ahow to manage hypoglycemia promptly as mentioned earlier it is a
medical emergency.medical emergency.
 In such case, if able to swallow, oral carbohydrate i.e glucose,In such case, if able to swallow, oral carbohydrate i.e glucose,
biscuits, honey, Jamjam water etc. should be given on urgent basis.biscuits, honey, Jamjam water etc. should be given on urgent basis.
 If unable to swallow, patient should be taken to the nearestIf unable to swallow, patient should be taken to the nearest
health care team.health care team.

13. Thank You AllThank You All