Diabetics beware: ORSL contains ten times more sugar than ORS — are you reading the label?

Mislabeled energy drinks are often mistaken for ORS. Endocrinologists warn that this poses a severe threat to diabetics, leading to dehydration and even kidney damage.

ByChetana Belagere

Published Jun 13, 2024 | 7:00 AM Updated Jun 13, 2024 | 2:19 PM

ORS vs ORSL. (Wikimedia Commons)

Oral Rehydration Solutions (ORS) are frequently given to both children and adults to combat dehydration. However, doctors find seemingly similar drinks, often available in various flavors and named ORSL, which can have vastly different impacts on blood sugar levels.

While pediatricians have been raising awareness about the differences between actual ORS and the similarly named ORSL products, and the dangers of consuming the latter, endocrinologists are now emphasising that ORSL contains 10 times more sugar than the original ORS.

This elevated sugar content can be extremely dangerous for diabetic patients and adults who have undiagnosed diabetes.

Doctors agree that many purchasing these mislabelled energy drinks from pharmacies has resulted in diabetics landing in the emergency room with severe complaints of dehydration and also diabetic ketoacidosis (DKA).

Dr G Shanmugasundar, Consultant Endocrinologist at Magna Centres for Obesity Diabetes and Endocrinology in Chennai, acknowledged the confusion between ORS and ORSL.

Speaking to South First, he said that due to the similarity in the names of these rehydration solutions, there are chances of diabetic patients going into diabetic ketoacidosis, which can be dangerous.

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Composition, risks of high-sugar rehydration solutions

Dr Sri Nagesh, renowned consultant Endocrinologist from Hyderabad explained the formulation of rehydration solutions.

“The sugar in these solutions acts as a bridge for sodium to enter the body,” he noted. “If the sugar content is low, glucose can effectively aid in hydration. However, when the sugar content is high, it paradoxically draws water out of the cells, worsening dehydration.”

According to Dr Nagesh, the ideal glucose content in rehydration solutions should be around 1.35 grams per 100 millilitres of water. This balance ensures effective hydration without the negative effects of high sugar levels, he said.

Recounting his experiences from his early career in paediatrics, where Dr Nagesh pointed out the challenges in getting children to consume the standard ORS. “Children often reject the traditional WHO-recommended ORS because it isn’t very palatable,” he explained.

“To make these solutions more appealing, manufacturers have added flavours like apple, orange or lemon, along with additional glucose. Unfortunately, this defeats the purpose of ORS, as the high sugar content can lead to further dehydration, ” he continued.

Dr Nagesh highlighted a significant issue with some commercially available rehydration drinks.

“These drinks often have high sugar content, turning them into nothing more than flavoured beverages. They can be particularly dangerous for individuals with undiagnosed diabetes” he further said.

“When these individuals consume high-sugar drinks, their blood glucose levels can spike, leading to severe complications such as diabetic ketoacidosis, ” Dr Nagesh said.

“A WHO-recommended ORS formula should have 5.4 kilo calories per 100 millimetres based on the recommended 1.35 grams of glucose. However, some commercially available solutions like ORSL have almost 10 times the kilo calories due to added sugars,” he added.

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Impact of rehydration liquids on diabetics

Summer heat naturally increases the risk of dehydration, which can further complicate diabetes management. When the body is dehydrated, the concentration of glucose in the bloodstream rises, making it harder for diabetics to keep their sugar levels under control.

“Patients with poorly controlled diabetes already have high blood glucose levels, which can cause dehydration,” Dr Sundar explained. “Consuming high-glucose liquids like ORSL can exacerbate this condition, leading to intracellular dehydration and further aggravating dehydration symptoms.”

Agreeing to this, Dr Nagesh pointed out that ORSL’s high sugar content could spike blood glucose levels, similar to consuming sugary drinks or fruit juices.

“Even in well-controlled diabetic patients, an acute increase in blood glucose levels from such solutions can lead to cellular dehydration, affecting electrolyte balance, especially sodium levels, which is very detrimental,” he noted.

Meanwhile, Dr KVS Hari Kumar, Secretary for the Endocrine Society of India told South First, “When a diabetic consumes sugary drinks, their blood glucose levels can spike dramatically. This sudden increase is something their bodies can’t handle effectively, leading to a condition known as diabetic ketoacidosis”

DKA occurs when the body, unable to use sugar for energy due to a lack of insulin, starts breaking down fat for fuel. This process produces ketones, which can build up to dangerous levels in the bloodstream, turning the blood acidic.

“In the summer, dehydration can exacerbate this condition,” Dr Hari Kumar said, adding “We’ve seen at least 34 admissions related to high blood sugar and DKA triggered by sugary drinks.”

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Serious health risks, mistaking ORSL for ORS

Diabetic patients often have compromised kidney function and are on multiple medications, including those for hypertension. Dr Sundar stressed that these factors can complicate the situation when high-glucose solutions are consumed.

“The combination of high blood sugar, dehydration, and compromised kidney function can lead to serious health complications,” he said.

In his clinical practice, Dr Sundar said he observed that patients often self-medicate by purchasing ORSL directly from medical shops, mistaking it for ORS due to the similar naming.

“Many patients come to us with ongoing diarrhoea, and upon taking a detailed history, we find they have been using ORSL. Once they stop these high-glucose solutions, their clinical condition, blood glucose control, and dehydration symptoms improve,” he shared.

Endocrinologists also noted that even healthcare professionals, not just laypersons, often mistake ORSL for ORS and administer it to their family members. “When we inform them of the differences, they are usually surprised and then take corrective actions,” he added.

Doctors also stressed that it might be a challenge if these ORSL liquids enter the rural areas. The awareness among the people regarding the difference between ORS and ORSL is limited even in urban areas and people in rural areas, may be even more unaware, they said.

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Need for scrutiny

Doctors stressed that the governments must do a careful scrutiny of rehydration solutions, particularly for vulnerable populations such as children, the elderly, and diabetics.

Mislabeling these drinks with high sugar content can lead to severe health risks, defeating their intended purpose of rehydration.

Dr Hari said, “Education and accurate labelling are key. Patients need to be aware of what they’re consuming to avoid potentially life-threatening complications.”

He added: “Proper rehydration solutions should be low in sugar and designed to genuinely aid in hydration, not worsen it.”

What diabetics can drink to hydrate themselves 

To combat these risks, the Endocrinologist Association emphasises the importance of proper hydration with suitable beverages.

In cases where diabetics are experiencing severe dehydration or gastrointestinal issues, such as continuous loose stools, immediate action is required.

“Along with standard ORS, simple salt solutions can be effective. It’s also important to ensure they are consuming enough fluids and monitoring their blood pressure,” Dr Hari recommended.

“We encourage diabetics to opt for buttermilk or lime water, which provide hydration without the added sugars,” said Dr Hari. “These options are not only refreshing but also widely available and easy to prepare at home,” he added.

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Don’t forget to monitor BP, blood sugar

For those experiencing symptoms of dehydration, such as persistent thirst or dizziness upon standing, it’s crucial to monitor blood pressure and blood sugar levels closely.

“Frequent monitoring can help catch spikes early and prevent complications,” advised Dr Hari. He said, elderly individuals, in particular, may suffer from undiagnosed diabetes.

Dr Hari stressed the importance of recognising the signs. “If an elderly person feels excessively thirsty or dehydrated without a clear environmental cause, it might be time to check for underlying diabetes,” he said.

Doctors insist that it is crucial for healthcare professionals and patients alike to be educated on the detrimental effects of inappropriate rehydration solutions.

“Spreading awareness and educating both the public and healthcare providers about these differences is essential to safeguard the health of diabetic patients,” Dr Sundar emphasised.

(Edited by Shauqueen Mizaj)