Managing Chronic Disease in Trying Times

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•  Heat may change insulin requirements, patients may need to be increase blood glucose monitoring during heat events.
• Establish plans for insulin dosing adjustments during heat events during routine care visits, ideally before the onset of the warm season.
• Heat can damage glucometers, insulin pumps, test strips, and other diabetes equipment and supplies; they should not be left in a hot car, by a pool, in direct sunlight, or on the beach.
•  Caution patients against going barefoot during heat events due to increased risk of burns.

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•  Heat can increase ground level ozone formation, which can trigger asthma and chronic obstructive pulmonary disease (COPD) flares.
•  Exposure to hot air increases bronchoconstriction, meaning these patients should limit time outdoors during heat events.
•  During hot weather, advise individuals with COPD and asthma to check the local air quality index (AQI), and to develop a plan to access cleaner air if AQI is above 50.

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• Persons with dementia or other cognitive impairment may need assistance with assessing temperatures, staying hydrated, and accessing cooling resources.

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•  Help pregnant women develop cooling plans, as higher ambient temperatures are associated with:

- Low birth weight

- Stillbirths

- Preterm birth

- Congenital anomalies, including congenital cataracts, hypospadias, and certain types of cardiac and neural tube defects.

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• Help patients with cardiovascular disease develop a cooling plan as heat exposure has been associated with:

-  Elevated risk of morbidity and mortality from myocardial infarction

- Stroke and heart failure 

- May promote atrial and ventricular arrhythmias

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Encourage patients to work with their Nephrologist to manage their kidney health, as kidney disease is one of the most commonly identified contributors to excess morbidity and mortality during heat events

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