Lyme disease is caused by a bacterium transmitted to humans through the bite of various types of infected ticks.
The smaller, immature tick nymphs usually spread the disease because they are so small and difficult to see.
In most cases, the tick must be attached for 36 to 48 hours or more before the Lyme disease bacterium can be transmitted.
If infected, a person can experience flulike symptoms, such as fever, headache, and fatigue, and in about 80 percent of the cases, a “bull’s-eye” skin rash can be seen around the bite area.
The typical treatment is a few weeks of antibiotics.
If the infection is not treated, it can eventually affect joints, the heart, and the nervous system.
According to the Centers for Disease Control and Prevention, it is estimated that children ages five to nine face the greatest risk of contracting Lyme disease, with about 75,000 children diagnosed annually.
It is also considered the most common tick-borne disease in the country, with about 300,000 new cases (all ages) per year.
But the numbers may be higher as many cases mimic other illnesses and are not diagnosed.
What happens if a person with diabetes contracts Lyme disease?
Few studies have been conducted on how a person with diabetes can cope with Lyme disease. In addition, if there is no telltale rash, the symptoms often mimic other diseases. Some of the symptoms, if the infection is not treated, seem as if they would exacerbate diabetic conditions, as the infection often involves inflammation (from the infection) and neuropathy-type symptoms, both of which are not only symptoms of diabetes but also conditions that worsen if a person has diabetes.
What is the West Nile virus?
According to the Centers for Disease Control and Prevention, the West Nile virus is a seasonal problem that is commonly transmitted by infected mosquitoes.
It is found widely on other continents, including Africa, Europe, and Asia, and was first detected in the United States in 1999.
The insects become infected with the virus when they feed on other contaminated animals, especially birds.
From there, the insects spread the virus to humans and other animals.
The virus has an incubation period of about three to 14 days (which means that the symptoms will not start until three to 14 days after a bite).
But most people, around 70 to 80 percent, do not develop any symptoms.
Others who are infected can develop a fever, along with a headache, body aches, joint pains, vomiting, diarrhea, or rash.
Most people recover completely.
It is estimated that less than 1 percent of people infected develop serious neurological illness, such as encephalitis (inflammation of the brain) or meningitis (inflammation of the lining of the brain and spinal cord).
As of this writing, there is no treatment or vaccine for the virus.
What happens if a person with diabetes contracts West Nile virus?
For people with diabetes, there is a known risk factor for contracting a severe case of West Nile virus.
In addition, it appears that people who also had high blood pressure were more likely to develop a serious case of West Nile virus in comparison with healthier individuals who contracted the virus.
It is estimated that people with diabetes were four times more likely to have serious complications from the virus, while people with high blood pressure were twice as likely to have serious complications.
This is why health care professionals suggest that people with diabetes use insect repellent while outdoors in the summer, especially in areas in which West Nile virus has been reported (or when traveling to mosquito-infested areas, including some overseas spots).
Because mosquitoes are most active at dusk and dawn, people should wear long sleeves and pants if they go outdoors during these times.
Finally, anyone with diabetes who experiences any hyperglycemia or symptoms noted above should seek medical attention.
Are people with diabetes sensitive to temperature?
Yes, a person with diabetes can be temperature-sensitive, especially when it is hot.
In fact, people with diabetes have to be extra cautious when the temperatures go up as extreme heat can affect their blood glucose levels, depending on what they have eaten, whether they are well-hydrated, and their level of physical activity.
For example, studies have shown that older people with type 2 diabetes have a more difficult time cooling down in hot temperatures.
One study also found that exercise and a subsequent rise in body temperature could be a difficult challenge to those with diabetes, indicating that people without diabetes were able to cool down twice as well as people with diabetes.
The researchers believe this is because diabetes damages blood vessels, including those involved in regulating body temperature. (For more about diabetes and exercise in hot and cold conditions, see the chapter “Diabetes and Exercise.”)
How can extremely high temperatures affect diabetes medications and equipment?
Not only do extreme temperatures affect a person with diabetes, but they can also cause a problem with a person’s medications and testing equipment.
Heat, especially combined with high humidity, can affect certain medications, especially long-term exposure to high temperatures.
For example, many types of insulin are fine in temperatures ranging from 93, 95° Fahrenheit (34, 35° Celsius), but any higher, and the medication rapidly degrades.
When temperatures are about 80° Fahrenheit (27° Celsius), with humidity higher than about 40 percent, not only are diabetes medications affected, but so also is diabetes-testing equipment, causing the equipment (including insulin pumps) to malfunction or batteries to stop functioning.
In addition, a disconnected pump or supplies should not be left in a hot car, by a pool, in direct sunlight, or on the beach.
According to the American Diabetes Association, it is best, in these conditions, or in any climate and temperature, to protect and take precautions to maintain medications, supplies, and equipment.
Because of the circulation problems diabetics suffer, frostbite is of special concern.
Can cold weather affect a person with diabetes?
Yes. In particular, people with diabetes often have problems with slower blood flow (vascular problems), especially to the extremities. For a person with diabetes who already has “sluggish” blood flow, cold weather can cause major problems, especially with staying warm. Because the blood flow in their extremities is less, the cold may further cause problems with feet and hands. Thus, people with diabetes who attend outdoor events or enjoy cold-weather activities should be aware of frostbite.
The cold can also affect the monitoring of a person’s blood glucose levels.
For instance, if diabetes test strips are used to monitor glucose, the strips need a certain level of oxygen and blood flow to calculate the level accurately.
Thus, a person who is too cold may obtain an incorrect blood glucose reading.
And if the person attempts to get blood from his or her fingertip to test blood glucose levels, cold fingers make it more difficult to obtain a good blood sample.
In such cases, warming the hands, many suggest holding the hands under their armpits, becomes necessary for a good reading.
What is Raynaud’s phenomenon or syndrome?
Raynaud’s phenomenon or syndrome is an autoimmune condition that causes a person’s hands and feet to become extremely cold.
It is usually brought on by cold weather and/or stress, with symptoms ranging from extreme cold in the feet, toes, and/or hands to numbness.
It is mostly due to the constriction of blood vessels in the extremities.
If a person also has diabetes, the blood flow to the extremities is slower, thus creating an even colder (or numb) feeling in the hands and feet.
This can also cause problems with blood glucose readings.
Raynaud’s can cause a false reading if blood is taken from the hands or feet and will not represent the person’s blood glucose levels throughout the body.
Thus, efforts to “correct” a blood-sugar level may be in error.
How can extremely cold temperatures affect diabetes medications and equipment?
Like extremely hot temperatures, cold temperatures can affect the medications and testing equipment (such as glucose monitors and test strips) of a person with diabetes.
As in extreme heat, diabetes medications are affected by cold, especially liquids such as insulin.
Diabetes-testing equipment can also be damaged by extreme cold, causing it to malfunction (especially insulin pumps and glucose monitors) or batteries to stop functioning.
As with extreme heat, it is best to protect all diabetes medications and equipment from the cold if at all possible.
If possible, take the medicines and equipment inside, as even leaving them in a car could cause problems in freezing temperatures.
How are variations in temperature detected by the body?
T emperature sensations are detected by specialized free nerve endings called cold receptors and warm receptors.
Cold receptors respond to decreasing temperatures, and warm receptors respond to increasing temperatures.
Cold receptors are most sensitive to temperatures between 50°F (10°C) and 68°F (20°C).
Temperatures below 50°F (10°C) stimulate pain receptors, producing a freezing sensation.
Warm receptors are most sensitive to temperatures above 77°F (25°C) and become unresponsive at temperatures above 113°F (45°C).
Temperatures near and above 113°F (45°C) stimulate pain receptors, producing a burning sensation.
Both warm and cold receptors rapidly adapt.
Within about a minute of continuous stimulation, the sensation of warmth or cold begins to fade.
Is there any seasonal variation in diabetes?
It is truly unknown whether there is any seasonal variation in diabetes.
But there are some interesting observations.
For example, according to several studies, it appears that type 1 diabetes develops more often in the winter than in the summer.
In addition, it is thought that type 1 diabetes is more common in cold climates.
This fact is often thought to be why Northern Europeans have more type 1 diabetes than Southern Europeans.
But more research needs to be done.
After all, one of the warmest islands in the Mediterranean is Sardinia, where people have a high risk of developing diabetes.
DIABETES AND TRAVELING
What should a person with diabetes think about before driving a vehicle?
One of the major things a person with diabetes can do when driving is to make sure his or her blood glucose level is stable.
This means the driver’s glucose levels are in a safe target range, not too low, causing a possible hypoglycemic episode, or too high, possibly causing a hyperglycemic episode.
In addition, most people with diabetes carry certain items in their car, including snacks and supplies in case they are delayed in traffic.
Some also carry a blood glucose meter and/or a glucagon kit in case of an emergency. (For details about glucagon kits, see the chapter “Taking Charge of Diabetes.”)
How can a person let local law officials know he or she has diabetes?
People with diabetes often experience episodes of hypoglycemia or low blood glucose.
When that happens, the person seems to slur his or her words, may be irritable and pale, and may stagger and sweat, much like someone intoxicated or on drugs.
If the person with diabetes is stopped by police during such an episode, officers may not know the difference.
And although many communities have trained or are training first responders (police, firefighters, and emergency medical technicians) to spot and care for people with diabetes, there are things a person with diabetes can do to help.
It might be a good idea to have a snack available in the car in case you get stuck in traffic and need something edible to control your sugar levels.