More on heat therapy
More on heat therapy
By Ralph Hall, MD,
Consulting Editor, Diabetes Management
Emeritus Professor of Medicine
University of Missouri, Kansas City
The recent review of a letter to the editor of the Journal of the American Medical Association written by Phillip L. Hooper, MD, an endocrinologist affiliated with the University of Colorado Health Sciences Center in Loveland, points out the potential benefits of hot tub therapy for Type 2 diabetics. (See Diabetes Management, December 1999, p. 142.) Prolonged exposure to high levels of heat, however, may have adverse effects on Type 1 patients who use insulin pumps.
A recent article in Diabetes Care (1999; 22:1,584) reported an episode of diabetic acidosis in a 32-year-old Type 1 diabetic using continuous subcutaneous insulin infusion following her first experi- ence using a sauna. She was testing herself regularly and in excellent control prior to using the sauna. After using the sauna, her blood glucose began to rise. The next morning, urine analysis revealed 4+ ketonuria. She decided to change the infusion set and use a new vial of insulin.
"Her condition improved dramatically within the following hours: Normoglycemia resumed in 6 hours, and ketonuria disappeared within 18 hours," the authors wrote. They note "a combination of circumstances" lead to the rapid occurrence diabetic acidosis. The exposure to insulin to high temperatures leads to a formation of insoluble fibils and aggregates of insoluble insulin, which resulted in insulin lack and the occurrence of diabetic acidosis.
In addition, plasma concentrations of counterregulatory hormones, including growth hormone and glucagon, are increased by exposure to hypothermia (Int J Hyperthermia 1997; 13:413-421).
The authors say that patient should be warned not to stay in a sauna bath while wearing an insulin infusion device. Patients who are using subcutaneous insulin injections should also be aware of potential alterations in their blood glucose.
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