SINGAPORE – For many Muslims, the pilgrimage of haj or umrah is the spiritual journey of a lifetime. For those with diabetes, however, these sacred trips can pose serious health challenges.

In 2021, Ms Mariana Mahadi, an advanced practice nurse and nurse clinician at Khoo Teck Puat Hospital’s (KTPH) Advanced Practice Nurses & Specialty Nurses Department, noticed a worrying trend.

“I observed an increasing number of patients being hospitalised or developing diabetes complications after going on umrah and haj,” she says, without giving specific figures.

She reviewed medical research and confirmed that this issue was not unique to Singapore, but was happening worldwide. Many pilgrims faced difficulties managing diabetes while juggling the physical and spiritual demands of haj and umrah.

Umrah and haj are Islamic pilgrimages to the holy city of Mecca in Saudi Arabia. They are sometimes held during periods of intense heat, with temperatures that can exceed 50 deg C, making it a physically demanding experience.

The main difference is that the haj takes place only once a year, during a specific period in the Islamic calendar. The umrah can be done at any time of the year, except during the haj period.

One of the key issues Ms Mariana identified among patients was a lack of knowledge in diabetes self-care during travel. This is particularly true for pilgrims, who often face significant changes to their daily routines due to differences in geography, climate, diet and lifestyle.

Some of the common challenges they face include hypoglycaemia (low blood sugar), hyperglycaemia (high blood sugar), infections, foot complications and dehydration.

One case, Ms Mariana recalls, particularly highlighted the need for tailored guidance. A 48-year-old woman, whose diabetes was poorly controlled, sustained a foot injury just before an umrah in 2023. She initially sought treatment from a general practitioner in Singapore and was prescribed oral antibiotics.

During the umrah, the cond...