Keys to Staying Healthy This Summer
With a little planning, staying healthy this summer should be a breeze
Sure, summer is a welcome reprieve from the dark days of winter, but sweltering temperatures, damaging UV rays, and days at the beach can make it harder for you to manage your diabetes. “You can still have fun, be active, and do all the things you want to do—you just have to plan a bit more carefully,” says Nirali Shah, MD, assistant professor of medicine, endocrinology, diabetes, and bone disease at the Icahn School of Medicine at Mount Sinai in New York City. Read on to find out how.
Fight the urge to walk around barefoot once the weather gets warm. Doing so could lead to cuts and scrapes, and wounds tend to heal more slowly for people with diabetes. Going without shoes is especially dangerous if you have nerve damage (neuropathy) and have lost sensation in your feet. You may not notice that you have a sore or cut on your foot, opening the door for an infection that could easily get out of hand.
“I can’t tell you the number of near disasters I see in my office every summer from people who say, ‘Well, I just slid my shoes off for a few minutes so I could play beach volleyball with my kids,’ ” says Harvey Strauss, DPM, a podiatrist at the Hospital for Special Surgery in New York. At the shore, wear a closed-toe beach shoe, ideally one that you can also wear into the water.
Cover open wounds with bandages, which will block UV rays as well as prevent harmful bacteria from entering your skin and causing infection. If you have more extensive wounds or ulcers, you may need to wear a protective boot or even use crutches, especially if the ulcer is on the bottom of your foot. “Both help reduce pressure and irritation to the area, which allows it to heal faster,” explains Strauss. Until your doctor clears you, stay out of the pool or ocean, both of which harbor germs that can cause a sore to get infected.
Get Sock Smart
In addition to closed-toe shoes, wear sensible socks. “One of the biggest errors I see is patients wearing cotton socks in the summer,” says Strauss. “They assume they’re light and breathable, but [cotton] doesn’t wick moisture away.” Sweat can collect between your toes, causing the skin to break down and increasing your chances of getting a fungal infection, to which people with diabetes are more susceptible. Sprinkle a powder such as cornstarch in your shoes and socks every day, and wear moisture-wicking socks, such as those with high-bulk acrylic, advises Strauss.
Do Foot Checks
Every night, examine your feet for cuts, blisters, redness, swelling, or calluses. Use a mirror to inspect hard-to-see areas, such as the bottoms of your feet. If you find any injuries, call your doctor.
Irritants such as salt water and chlorine may dry out your skin, especially on your feet. “If your skin gets very dry, it can cause cracking that in turn can lead to infection,” says Strauss. Moisturize your feet every day with a light cream, but avoid putting it between your toes, which can cause dampness and lead to a fungal infection. If you’ve started to develop cracked skin, your doctor may prescribe a cortisone cream to use until the situation is under control.
Stop Adhesive Slips
In the summer, the adhesive patches that help keep your insulin pump infusion set and continuous glucose monitor (CGM) sensor secure may not be enough. “When you sweat, the adhesives can slip or peel off,” says Dawn Noe, CDE, RD, a certified diabetes educator at the Cleveland Clinic. You can help prevent this by taking a few proactive measures. Before applying your infusion set or CGM sensor, clean your skin or wipe the area with an alcohol pad to get rid of dirt or sweat that can prevent the device from sticking. From there, you can use a skin prep wipe, liquid barrier—Noe suggests Skin-Tac Liquid Adhesive Barrier or Mastisol Liquid Adhesive—or tapes and adhesives that sit on the skin and under your device adhesive. Note: Don’t use a wipe or liquid adhesive where you plan to insert your CGM sensor, and don’t insert a sensor through adhesive; doing so may affect the accuracy.
In addition to—or instead of—adding a barrier, you can tape over your infusion set or sensor adhesive pad (but not the device itself) with products such as Polyskin and IV3000.
If these three steps don’t work, consider moving your insertion site. The most secure areas are the sides of the abdomen, hips, buttocks, or outer thighs. Try a few different spots to see if one works best for you. Still dealing with adhesive slips? Noe suggests switching from a pump to insulin injections when you’re on, say, a two-week beach vacation.
Unopened insulin should be stored in a refrigerator kept at 36 to 46 degrees. In-use insulin vials and pens must be kept from freezing or from temperatures above 86 degrees. Keep insulin in a cooler when traveling in the car for long periods of time or for trips to the park or beach. But don’t place the insulin directly on ice, because freezing it will make it ineffective. At the beach, store your meter and test strips in a sealable bag to keep out sand, then wrap them in a towel and place in a cooler to prevent extreme heat, which can lead to inaccurate meter readings.
Insulin pumps typically aren’t affected by heat, though they may malfunction if the temperature rises high enough. More problematic, though, is the insulin in the pump. It can warm up, making it less effective. “One of the drawbacks to insulin is that it’s temperature-sensitive,” says Indianapolis-based diabetes educator Christy Parkin, MSN, RN, CDE. “In order to protect your investment, it’s important to follow the manufacturer’s guidelines for extremes of temperature.” The smartest solution: Plan ahead. Parkin suggests using a product such as Frio’s cooling pump wallet, which protects the pump and your insulin from heat.
Most insulin pumps and CGMs are water resistant, not waterproof, so be careful around pools and the beach. Check your device’s manual to determine if it can be worn in water. If you decide to disconnect your pump for a swim, be sure to reconnect within an hour. Another alternative is to take a break—use an insulin pen or syringe and vial for your day at the pool or beach.
People with diabetes may get dehydrated more quickly, particularly during the summer. “In diabetes, dehydration can become cyclical,” says Avantika Waring, MD, an endocrinologist and medical director of the diabetes program at Kaiser Permanente in Seattle. “Dehydration can raise your blood glucose, and high blood glucose can then make you urinate more, which worsens dehydration.” In addition, some medications, such as diuretics that are used to treat high blood pressure, cause more-frequent urination, raising the chances you’ll become dehydrated.
Heat exhaustion is more common in people with autonomic neuropathy, a diabetes-related complication in which the nerves that control involuntary bodily functions—including the ability to sweat—are damaged. Because sweating is the body’s way of cooling itself down, people with autonomic neuropathy can find themselves overheating in the summertime.
You can help stave off both conditions by drinking plenty of caffeine-free fluids, such as water. “Anything that’s sugar-free is fine,” says Noe. Avoid alcohol and caffeinated coffee, tea, or soft drinks, all of which can be dehydrating. If it’s really hot, or you’re outside for a long time, check your blood glucose more often. “Four times a day, or every four hours, is a great goal,” says Noe. If your level is higher than normal, that may be a sign that you need to guzzle more H2O.
Pack Healthy Snacks
Summer is prime time for water-rich fruits and veggies such as cherries, peaches, cucumbers, and tomatoes, making it easier to pass on the boardwalk fries. There are plenty of easy grab-and-go snacks that you can throw into a cooler if you’re going to be outdoors. Noe recommends an apple and piece of low-fat string cheese, a hard-boiled egg, a half cup of low-fat plain yogurt sweetened with a half cup of fruit, or even celery sticks dipped into a tablespoon of peanut butter.
Sun protection is especially important for people with diabetes because a sunburn can trigger inflammation throughout your body, raising blood glucose levels. “A sunburn is a form of physical stress on your skin, and any stress releases hormones such as cortisol and adrenaline, which can drive up blood sugar levels,” explains Shah. Pick a broad-spectrum sunscreen, which will protect against both UVA and UVB rays. (While UVB rays lead to sunburn, UVA rays can cause skin cancer.) Opt for the highest SPF possible—SPF 50 is a good place to start. “The average person doesn’t put on enough sunscreen to begin with and also doesn’t always reapply, so in these situations extra protection is beneficial,” says Jenny Murase, MD, associate clinical professor of dermatology at the University of California–San Francisco. Also look for the words “water resistant,” which tells you that the sunscreen will stay on wet or sweaty skin for either 40 or 80 minutes.
When slathering on sunscreen, the American Academy of Dermatology recommends using an ounce (enough to fill a shot glass) for your entire body. But if you have an open foot wound, don’t put sunscreen on it.
If despite all your efforts you’ve ended up as red as a boiled lobster, there are things you can do to minimize the inflammation that may affect your glucose levels. Hop into a cool bath or shower, then use a moisturizer or cream that has aloe vera to help soothe skin, suggests Shah.
Monitor your levels closely for the next couple of days, and if they go up, call your doctor. “You may temporarily need to raise your basal insulin levels by 10 or 20 percent for a day or two, similar to what you’d do if you were sick,” explains Shah. If you develop blisters, watch them closely for signs of infection, and resist popping them—it can introduce bacteria.