Seasons Change: But What About You?

I love the fall because of the colours it displays everywhere you go. Even though we may dread what comes a couple of months after this beauty of nature, we can still try to enjoy what time is left. I prefer the cooler air and like the rustle of leaves as I walk. I remember walking home from university in the fall which was between 3-4 km and seeing homes with lights on and wondering what they were doing, just as I was wondering what my parents might be doing. It made me a big homesick I admit.

I think most of us could think of something that we should change. It might be about yourself or a change in your home. Those of us with diabetes are constantly facing change (s). New technology, devices and medications are bombarding the market in an attempt to provide us with a good quality of life. I read the other day that a person with diabetes makes 180 decisions a day more than the individual without diabetes. No wonder we get frustrated and our brain tires out. Our brain might be compared to a battery and it does run low at times and we shouldn’t condemn ourselves when this happens.

Winter is approaching so today I want to discuss a few tips on how to prepare for winter and the cold weather. You may be driving somewhere or out for an activity, but no matter what, you diabetes still has to be managed.

It can be a challenge for anyone to have a healthy lifestyle in the cold winter months. The thought of cold, wind, ice and snow make us a bit timid of the fresh air. Staying healthy with diabetes can be more of a challenge as we have to tune in and be aware of what our body needs.

Staying Safe & Winter Tips

Stay healthy: keep up to date with vaccinations. The flu vaccine usually starts in mid-October and you might consider other vaccinations, depending on your age and history of other chronic diseases. Many people receive the vaccination against pneumonia and/or shingles vaccination. Discuss this with your health care team and keep up to date with Covid vaccinations. You might want to consider wearing a mask while out in the public and don’t forget to wash your hands often. Vaccinations don’t guarantee that you won’t get the flu or pneumonia but your chances of avoiding them is increased or at least you illness will be less severe.

HINT: vaccinations take a while to become effective so don’t leave them to the last minute.

Stay Active: most of us bundle up when we go in the cold so exercising with multiple layers can increase your energy expenditure. It’s possible that your winter activity requires more strength than what you are used to. Don’t overdo it the first few times you go out. Check your blood sugar often until you know how your body is responding to this exercise. If it is too cold, it is best to continue with indoor exercises when permissible. It’s possible you may not feel you are experiencing a low blood sugar in the cold weather.

HINT: it’s probably not wise to think you can snowshoe for five hours the first time you go out, so increase your duration of activity gradually and bring snacks.

Protect your diabetes supplies: protect your insulin at all costs. Don’t leave your insulin in the car, your pocket, your purse or waist band if doing outside activity. All injectable diabetes medications must be protected from freezing. This includes insulin vials, insulin pens and the newer agents used in the management of Type 2 diabetes such as the group referred to as GLP-1 agonists (ie.semaglutamide, dulaglutide, liragllutide). Insulin freezes, like water, at 0 degrees celsius (32 degrees F) but unlike water, certain insulin proteins drastically change and render it less effective ( or not at all). If for some reason, you do not have access to a new vial then increase the frequency of glucose monitoring and be vigilant about activity and meal preparation. Try to get a new vial as soon as possible.

Insulin pump users should keep the pump as close to their body as possible so the body heat can help keep it warm. Cover the pump up with another warm layer of clothing over it. When I ran a few years ago, I would put a wool sock over my pump, as well as tucking it inside the long leggings and the jacket over it for protection.

Diabetes supplies such a blood glucose monitor, sensors and strips are also sensitive to the cold so do your best to keep them warm. Again, I used to put my meter and strips in an inside jacket pocket and put a hand or foot warmer close by and I never had a problem. The biggest problem I would have is to draw blood from the fingertip when your hands are cold. Again the portable foot and hand warmers came in handy. If you are carrying a thermos with a hot drink in it, then put your hands around the hot thermos. Also you could store your insulin in a thermos.

If you keep juice in your car for emergency hypoglycaemic spells, remember it too will freeze and be useless when needed. Anything that can freeze should not be stored in the car or cold. I have kept Dextrose tablets in the car year round and have had good luck with them. There are probably many choices, just be aware of what you can and cannot do to be safe.

The Intranasal glucagon powder (Baqsimi by Eli Lilly) for severe hypoglycemia does not have to be refrigerated and is ready to use. It is a powder format product and if it did freeze I suggest you call Lilly's Canadian Customer Service Response Center at 1-888-545-5972. You can search for this by using google.

HINT: think ahead of what you will need to take with you and how you can store it safely.

Diabetes Management: we all know that spontaneity is difficult for those with diabetes, especially if using insulin. So do your best to plan ahead. You might need to consider changing your insulin dose, basal rates if wearing a pump or continuous glucose monitoring or eating extra carbohydrates before the activity. Discuss this with your health care team and again be careful and wise.

HINT: Be sure others know that you have diabetes and what to do in case of a hypoglycaemic episode. They should know where to find your snacks and supplies as well.

Protect your skin, hands and feet: exposure to frequent episodes of cold weather can dry the skin anywhere on your body. This dry skin may crack and make you at increased risk of infection and soreness/redness. This is especially true for the feet and if you have any signs of sensation loss in that area or have poor circulation, then you are more likely to not feel frostbite or be aware of an infection. Check the feet every day and deal with any soreness or redness immediately. Symptoms of frostbite include whitish or bluish-grey skin, numbness and maybe even blisters.

Wear appropriate footwear that is waterproof and has a warm lining. I have a little story to tell you about my experience buying new boots. A couple of years ago I was looking for a pair of navy boots. Eventually I found a pair at a well known and respected footwear store in town and I bought them. I was so pleased. They were a brand name and I never thought to ask if they would be waterproof. I guess I thought every winter boot was waterproof. Well I was wrong. I wore them and walked across the parking lot at work one morning, and it had rained and snowed, and there was lots of slush. Yes, you guessed it, my feet were soaked when I got inside. I assumed they had to be leaking so I went back to the store on my way home that night only to find out that this company makes 3 different types of winter boots and depending on the leather used, some were waterproof and some were not waterproof. I bought a pair which were not waterproof and I was a bit annoyed that no salesperson even thought to tell me or ask me if I needed waterproof. I was a regular customer at that store for years and I was disappointed. I went back to wearing my 10 year old boots which were still waterproof on those wet slushy days.

HINT: apply a moisturizing cream to the skin and feet (not between the toes) to help prevent drying and cracks.

HINT: Ask if the boots are waterproof

Socks: sweat-wicking socks will help to keep your feet dry. I checked on google (sweat wicking socks) and many types are available and at various prices.

HINT: if you can find a couple of pairs that suit your needs which will dry fast then that should work. One pair can dry when you wear the other.

Altitude & Altitude Sickness: this is new to me but there is published information that altitude can affect blood glucose levels and the accuracy of your meters and strips. Common symptoms of altitude sickness include: shortness of breath, increase heart rate, nausea and onset of extreme fatigue and these are all due to the lack of oxygen at higher levels. But if you notice, the symptoms of altitude sickness are closely related to the symptoms of hypoglycaemia so always test at the onset of any of these symptoms. It stands to reason if you have been downhill skiing you could be low as it requires a lot of energy. No strong evidence supports the relationship between altitude and change in blood glucose management yet if you are interested I refer you to this article.

HINT: stick to your plan of activity and don't overdo it or be convinced you can do it especially if you know it would be too risky at that time. Hopefully there will always be a second chance.

Manage your mood & your weight: the lack of sunlight and the shorter days could lead to seasonal affective disorder (SAD). Symptoms such as feeling fatigued and losing interest in doing your usual activities, becoming irritable, difficulty in concentrating may be a sign that is happening. Depression can affect diabetes management and cause weight gain so be careful and seek help and guidance from your health-care team as soon as possible.

HINT: keep the scales handy and take a moment to reflect on how your are managing the winter blues. Many cities and towns have indoor walking areas in the winter months and this gives you a chance to meet new people/friends. It gives you something to look forward to as well.

Today I have brought you some new information about having winter fun and staying safe. I agree that is takes extra effort but we don't want to have any unwanted complications and destroy our fun. Please refer to my references for further information.

I hope some of you were able to tune into the T1D and T2D conferences held virtually by Diabetes Canada on October 15th and October 22nd respectively. There was so much practical information provided and I learned several tidbits that could help me deal with difficult situations when they occur. However, I have to tell you about the first presentation on the T1D day of events.

The speaker was Kaleb Dahlgren- he was diagnosed with type 1 diabetes at the age of 4. Hockey was his life long dream. He was also one of the survivors of the terrible crash that occurred in Saskatchewan between the hockey team's (ie Humboldt Broncos) bus and the trailer transport in April, 2018. He was one of the 13 who survived, yet 16 others were killed. He tells his story with clarity, courage and dedication to those friends he lost. He wrote the book called " Crossroads: My Story of Tragedy and Resilience As a Humboldt Bronco". He is dedicating some of the proceeds of his book to what is called STARS (Shock Trauma Air Rescue Service). It was a # 1 National Best-seller. I suggest you have a Kleenex or two handy just in case.

This blog is for information purposes only. Always check with your health care team before making any changes in your diabetes management.

References :

1) Type 1 Diabetes Emergency Kit: What Supplies Should I pack? accessed on line October 16th, 2022

2) 5 Ways People with Diabetes Can Keep a Healthy Lifestyle in the cold -accessed on October 16th, 2022

3) Cold and Diabetes- Antifreeze in the Blood- accessed on October 16th,2022

4) Winter and Type 1 Diabetes- accessed on October 16th, 2022

5) Diabetes Winter Tips- accessed on October 16th, 2022

6) Altitude and Type 1 Diabetes- accessed October 16th, 2022

NOVEMBER is Diabetes Awareness Month and November 14th is World Diabetes Day. Check out the Diabetes Canada website for more information on diabetes and learn how you can help put an end to this disease.

ForFor more

This TT

This