Diabetes Forecast

Cold-Weather Diabetes Management Tips

By Barbara Brody , ,

Rohappy/Getty Images; Haleigh Eason/Mittera (typography)

When it’s cold outside, some things—such as fuzzy sweaters, extra blankets, and a hankering for homemade soup—are pretty much a given. What’s not so obvious: the impact winter weather can have on your ability to manage your diabetes. Here’s how to sidestep some of the most common pitfalls so you can stay healthy all season long.

Seasonal Snafu: Your insulin or other injectable medication freezes.

If you use insulin or other injectable medications, such as liraglutide (Victoza), you know that these drugs are supposed to be stored in the refrigerator until they’re opened, then kept at room temperature. But if your mail-order medication arrives while you’re away, there’s a chance it could freeze. Same goes for pens or vials that get left in your car. Freezing affects insulin’s potency, which makes it less effective at lowering your blood glucose levels.

The Fix: If you see ice crystals, clumps, or other changes in the color or clarity of liquid medication, toss it, says Kim Kramer, RD, LDN, CDE, a certified diabetes educator at The University of Chicago Medicine. “You can’t just warm it up, because the damage is already done,” she says. So even if your medication appears normal, it may have frozen earlier in the day and thawed. That’s why it’s best to avoid the situation in the first place.

To prevent meds from freezing, Kramer suggests keeping injectable medications close to your body—in an inside jacket pocket, for instance—when you’re on the go. If you use a mail-order service and are concerned about the box sitting outside for days (or even hours), call the company and ask if the delivery can be made at a time when you know you’ll be home or delivered to a pharmacy or neighbor who will be home.

Be aware that the tubing connected to an insulin pump can freeze, too. If that happens, the insulin won’t be able to flow through it properly. Keep the tubing as close to your body as possible (not dangling) to make use of your body heat.

Seasonal Snafu: Your devices go haywire.

Diabetes devices are a little like Goldilocks: They don’t respond well to temps that are too hot or too cold. If it’s too cold out, your meter might not turn on at all, or it might provide an inaccurate reading, warns Carla Cox, PhD, RD, CDE, a spokesperson for the American Association of Diabetes Educators. “I love the cold weather—I recently moved to Utah from Montana and previously worked in Alaska—but meters don’t do well when it’s cool.”

The Fix: As with injectable medications, you’ll want to keep your blood glucose meter close to your body when you’re out and about. “Buy clothes with a lot of inside pockets,” suggests Cox.

If you use a continuous glucose monitor (CGM), you should similarly take care to make sure it stays warm and functions properly. Keep the receiver in a pocket close to your body or clipped to your pants instead of in your bag or an exterior jacket pocket.

Seasonal Snafu: Your fingertips are too cold. 

Drawing a drop of blood from a finger stick is trickier when you’re dealing with frozen digits. “It’s hard to get a reading on very cold fingers because when it’s cold out your blood shifts toward your core,” says Cox.

Cold fingers are also a problem for people with neuropathy. It’s common to lose a little sensation in your hands after being outside for a while, but if you have neuropathy, it can be dangerous because you could end up getting frostbite before you realize just how numb your extremities have become.

The Fix: When you expect to be outside for an extended period, wear warm gloves and socks to help shield you from the cold. If your hands are cold and you need to check your glucose, warm them up first. If possible, head indoors and run your hands under warm water. Planning to be outside for a while? Stash hand warmers in your pockets so you can use them before doing a check. 

If you have neuropathy-related numbness in your hands or feet, be careful when warming your extremities. Avoid sitting too close to a fire or space heater; you could get burned without realizing it.

Seasonal Snafu: Your go-to glucose remedy is frozen.

Juice boxes, glucose drinks, and glucose gels work well to treat lows most times of the year, but if you take these on an outdoor excursion or leave them in a parked car in the winter, they could freeze. That can leave you without fast-acting glucose should you develop hypoglycemia (low blood glucose).

The Fix: Glucose tablets or powders are a safer bet because they don’t freeze. Pay attention to your glucagon injection kit, too. It should be stored at 68 to 77 degrees. Liquid in a glucagon injection can freeze if you store your kit in your car or take it outside in cold temps. Keep it close to your body, or opt for Eli Lilly’s recently approved nasal glucagon powder, Baqsimi.

Seasonal Snafu: Your skin is parched.

Many people complain about dry, itchy skin this time of year, but if you have diabetes you may be especially prone to this problem because your body loses fluid when your blood glucose gets too high. Neuropathy may also be to blame. Nerve damage can hinder your ability to sweat, leading to extra-dry skin on your legs and feet.

The Fix: “You need to stay hydrated, even in the cold,” says Cox, who notes that a lack of fluids can both dry out your skin and raise your blood glucose. Whether you’re indoors or outdoors, stay hydrated and drink when thirsty. Water is always a good choice, or reach for some herbal tea if you need to warm up.

To keep winter from having its way with your skin, the American Academy of Dermatology advises taking short, warm (not hot) showers; slathering a thick moisturizer over your body, except between your toes; and running a humidifier in your home to keep the air moist. Don’t forget to thoroughly wash your lotioned hands before doing a blood glucose check. Moisturizers with fragrance may affect blood glucose readings.

Seasonal Snafu: You’re not well prepared for outdoor activities.

Whenever you do an activity that’s new to you or that you haven’t participated in since last winter—whether it’s skiing, ice skating, or shoveling snow—you’re going to use up extra energy, which could set the stage for low blood glucose. Equally problematic is the tendency to avoid usual outdoor exercise, such as after-dinner walks around the neighborhood, because it’s too cold. The result: a more sedentary season.

(Safety Note: Talk to your doctor before making big changes to your exercise plan or engaging in new, strenuous activities.)

The Fix: First off, don’t stop exercising just because it’s winter. If you’re not keen on moving your workout indoors, be sure to dress appropriately by wearing several layers (including an inner moisture-wicking one) and shoes with good traction.

Before heading outside, it’s a good idea to do a five- to 10-minute warm-up consisting of low-intensity exercise. Remember to check your blood glucose before you get moving. Recheck it every 30 minutes during exercise, or whenever you feel symptoms that suggest you might be going low.

When it comes to shoveling, keep in mind that this chore can be especially dangerous for anyone prone to heart disease (which includes people with diabetes) because it raises the risk of having a heart attack. Such heavy exertion, combined with the cold air (which constricts the arteries), can be a deadly combo. If you can’t outsource the task, remember to take frequent breaks, lift or push small amounts of snow, and stop if you feel any discomfort. 



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