International Travel Medicine Center of Iran International Journal of Travel Medicine and Global Health 2322-1100 12 4 2024 12 01 Heat stroke and hyperosmolar hyperglycemia state: two faces of the same coin(dehydration) in the Hajj journey How to reduce deaths among pilgrims 225 228 207556 10.30491/ijtmgh.2024.472572.1424 EN Amr Ahmed saudia arabia , Riaydh , khalydia 0000-0003-3477-236X Maher Akl independent researcher , mansoura , Egypt 0000-0001-5480-1688 Mahmoud Elkazzaz independent researcher , Egypt Journal Article 2024 08 09 Heat stroke (HS) and hyperosmolar hyperglycemia state (HHS) are critical conditions frequently affecting pilgrims with co-morbidities like diabetes Mellitus during the Hajj, especially with temperatures exceeding 50°C (122°F). This brief commentary examines the interconnected risks of HS and HHS among Hajj pilgrims, focusing on the heightened vulnerability of those with diabetes. We discuss the mechanisms linking dehydration, hyperthermia, and hyperglycemia, emphasizing the need for early recognition and intervention. Preventive strategies such as heat acclimation, proper hydration, and probiotic-based oral rehydration solutions (ORSP) are highlighted. Additionally, using smart ID medical bracelets for diabetic patients can improve emergency response. Implementing these measures can reduce the incidence and severity of heat stroke and hyperosmolar hyperglycemia state, protecting the health of pilgrims. https://www.ijtmgh.com/article_207556_d538524a911bfa49c81b6e8cf9d20fec.pdf