Diabetes and body temperature


How Hot and Cold Weather Affects Your Blood Sugar

When temperatures start to get out of control, so can your blood sugar. Both hot and cold weather extremes can affect your testing equipment and your medications, and have a negative impact on your body’s ability to produce and use insulin.

Research shows that when it’s hot out, more people with diabetes end up in the ER and are hospitalized because of heat illness. The number of deaths in diabetes patients due to heat illness also increases in summer. Low temperatures can be an issue for people with diabetes as well.

But you don’t have to let the environment have the upper hand. Taking a few smart precautions can help you outsmart Mother Nature. Here are the adjustments to make depending on where you live and the weather forecast.

6 Tips to Survive the Summer Heat

Take these steps to keep your diabetes under control when the temperature soars:

Stay hydrated. Lori Roust, MD, an endocrinologist at the Mayo Clinic in Arizona, explains, “The problem is that in the heat, people tend to get dehydrated easily. When you’re dehydrated, you have higher concentrations of blood sugar because less blood flows through your kidneys. With less blood, your kidneys don’t work as efficiently to clear out any excess glucose (blood sugar) from your urine.” When it’s hot, be sure to drink plenty of water or sugar-free drinks. Don’t wait until you are thirsty to replenish fluids.

Store your medications properly. High summer temps can affect your diabetes medications, glucose meter, and diabetes test strips. “When it’s hot out, it’s easy for insulin and other drugs to become degraded,” Dr. Roust says. Be sure to store your medications properly — out of the extreme heat. Never leave them in your car on a sweltering summer day, for instance. “It could get up to 150 degrees inside your car,” warns Roust.

If you’re traveling, don’t forget to take your type 2 diabetes medicines with you. You may need to carry them in a cooler with an ice pack. Just be sure they’re not sitting directly on ice or the ice pack.

Stay out of the heat of the day. Exercise is an important part of diabetes management and blood sugar control. But you don’t want to be outside exercising during the hottest part of the day. “Get in your exercise first thing in the morning or once the sun goes down,” advises Angela Ginn, RD, a diabetes educator at the University of Maryland Center for Diabetes and Endocrinology and a spokeswoman for the Academy of Nutrition and Dietetics. Another option is to work out in an air-conditioned gym.

Know signs of low blood sugar. Some of the symptoms of heat exhaustion are similar to those of low blood sugar, or hypoglycemia. These include sweating, light-headedness, shakiness, and confusion. “You may think it’s the heat and not recognize that your blood sugar levels have fallen to dangerous lows,” Roust warns. Be aware of the warning signs of low blood sugar and keep some carbohydrates with you to eat if you need to raise your blood sugar. Have a plan for a medical emergency.

Test more often. You may need to test your blood sugar levels more frequently so that you can adjust your insulin and your diet as necessary. Talk with your diabetes educator about guidelines if you’re unsure of the best schedule, Ginn says.

Mind your feet. People with diabetes are susceptible to problems with their feet. In the summer you face the temptation to go barefoot or wear open sandals that expose your toes … to trouble. Always wear shoes that fit well — even in warmer months — and at the end of the day, check your feet for any cuts, scrapes, blisters, or bruises. Don’t ignore injuries to your feet. Get medical treatment right away.

6 Ways to Winter-Proof Your Diabetes Care Plan

Freezing temps and inclement weather can make it more challenging to stay on top of diabetes. Here’s what to watch for during the colder months:

Keep your supplies out of the cold. Just like extreme heat, extreme cold can affect your insulin and cause your glucose monitor to stop working. Don’t leave supplies in a car when temperatures outside are below freezing.

Do your best to avoid getting sick. Winter is cold and flu season. When you’re sick, you’re stressed, and being under stress can raise your blood sugar. Also, when you don’t feel good, you’re likely to not eat properly. Wash your hands with soap and water often so that you don’t spread germs. Ginn recommends “diabetes patients have a sick-day kit at home and fill it with soup, sugar-free cough drops, tea — things that will make you feel better and that you can access easily.” Also, be sure to get vaccinated against the flu.

Avoid packing on the pounds. Managing type 2 diabetes during the holidays can be tricky. Many seasonal treats are loaded with carbohydrates that cause your blood sugar to rise. Plan your meals and pace your special treats so that you don’t greet spring a few pounds heavier. Even a small weight gain makes it more difficult to control your diabetes and blood sugar levels.

Keep an eye on your feet. Diabetes can cause a loss of feeling in your toes and feet. Protect them with the right winter footwear, especially in snow. Apply moisturizer to your feet to keep your skin healthy. Inspect them regularly, and if you notice an injury that doesn’t heal, seek medical attention. Don’t wait.

Warm your hands. “If your hands are cold, you may have to warm them up to get a good blood sugar reading,” Roust says. Wash them in warm water before testing.

Your meter will work best when it’s kept in a room where the temperature is between 50 and 104 degrees Fahrenheit.

Don’t skip your workouts. It can be hard to get motivated to exercise in winter. But exercise is an important part of keeping blood sugar in check. It helps if you dress in layers when you’re exercising outdoors in the cold. Or join a gym where you can work out indoors. Another option: Work in exercise at home by taking the stairs, lifting weights, and exercising to videos.

Hypothermia is a symptom of severe hypoglycemia, which can of course be life-threatening.

Annette, a 47-year-old African-American female with Type 1 diabetes mellitus, was admitted to the hospital with a foot infection that was progressive despite therapy with intravenous vancomycin.

Annette had a long-standing history of type 1 diabetes. She had developed significant peripheral neuropathy and had previous diabetic foot infections, which had led to partial amputations of both feet. Her diabetes was controlled with insulin glargine (Lantus), as well as a prandial insulin aspart (NovoLog) sliding scale. Her medical history was also remarkable for a remote history of seizures, for which she took no medication.

Overnight Personality Change

Radiographs of Annette’s foot revealed osteomyelitis of the calcaneus. Her antibiotic regimen was expanded to include piperacillin-tazobactam, and she underwent surgical debridement on the fourth day of the admission.

The next morning, Annette was found to be noticeably less responsive relative to baseline. She also exhibited slurred speech and was very argumentative in her interactions with staff. In addition, she was diaphoretic and cool to touch.

Temperature Dropping Fast

Annette had received multiple doses of hydromorphone in the preceding 12 hours, and initially, a narcotic overdose was suspected. However, her vital signs revealed significant hypothermia of 93.5°F (axillary), with otherwise unremarkable vital signs (heart rate 90 beats/minute, blood pressure 140/66 mmHg, respirations 14/minute, with pulse oximetry of 94% on room air). Her temperature was also taken via rectal thermometer, which yielded a reading of 95.6°F.

Interestingly, just two hours earlier, her oral temperature had been recorded as 98.7°F.

One Missed Meal

This confusing clinical picture was quickly clarified when a point-of-care glucose reading registered at 47 mg/dl (reference range 70 – 110 mg/dl). A 50 ml bolus of 50% dextrose was given immediately, and over the next two hours her mental status returned to baseline and her core temperature (when taken orally) normalized to 97.6°F.

It was discovered later that she had received her morning dose of insulin aspart, but had not eaten her breakfast. The remainder of her hospital stay was uneventful, and she was discharged two days later in stable condition to complete her intravenous antibiotics at a skilled nursing facility.

Downside of Exogenous Insulin

The number of Americans living with diabetes has more than tripled over the past 30 years, and by 2014, 29.1 million Americans had been diagnosed with the disease.1,2 Patients with Type 1 diabetes are entirely insulin-deficient due to a loss of insulin-producing pancreatic beta cells, usually as a result of autoimmune destruction of these cells.

For Type 1 diabetics, the standard method for lowering glucose is to inject exogenous insulin into the body. While Type 1 diabetics are a minority of the overall diabetic population, comprising only 5% of all diabetic patients, they are at the greatest risk of hypoglycemia because of their total dependence on exogenous insulin, which lowers the serum glucose regardless of its current level. In 2011, there were approximately 282,000 emergency room visits of adults ages 18 years or older with hypoglycemia as the primary diagnosis and diabetes as a secondary diagnosis.2

Dangers of Hypoglycemia

Hypoglycemia places any patient at risk for serious systemic complications. The lower limit of normal fasting glucose levels is generally regarded as 70 mg/dL (3.9 mmol/L). Symptoms of hypoglycemia will often appear at levels around 50 mg/dL to 55 mg/dL, although this is variable based on an individual’s physiologic profile.

Hypoglycemia can progress quickly if left untreated, and can include extremely varied, and often unpleasant, physical and psychological symptoms (see list below3):

  • Shakiness
  • Nervousness or anxiety
  • Sweating, chills and clamminess
  • Irritability or impatience
  • Confusion, including delirium
  • Rapid or fast heartbeat
  • Lightheadedness or dizziness
  • Hunger and nausea
  • Sleepiness
  • Blurred or impaired vision
  • Tingling or numbness in the lips or tongue
  • Headaches
  • Weakness or fatigue
  • Anger, stubbornness, or sadness
  • Lack of coordination
  • Nightmares or crying out during sleep
  • Seizures
  • Unconsciousness

It is important that diabetic patients learn to recognize these symptoms as signs of severe hypoglycemia, and to take action immediately if they begin experiencing them. If left uncorrected, severe hypoglycemia can lead to loss of consciousness, coma, and even death.

Enter Hypothermia

Hypothermia is a symptom of severe hypoglycemia believed to manifest in response to severely depressed levels of glucose in the central nervous system (neuroglycopenia). It serves as a mechanism by which the body preserves energy during times of extreme energy storage depletion.4 Decreased body temperature (i.e., hypothermia) reduces oxidative stress and decreases the body’s energy requirements. For this reason, therapeutic hypothermia is integrated into the care of some patients with ischemic heart disease or stroke.5,6

Hypoglycemia causes heat loss through peripheral vasodilation and sweating, a paradox of rapid heat loss occurring during a time of increased energy expenditure and heat production.7 Additionally, shivering is inhibited when serum glucose levels fall in the range of 30 mg/dL to 45 mg/dL. Core temperature remains constant while shivering, but drops significantly when shivering ceases.

In cases of hypoglycemic hypothermia, shivering re-appears within 40 seconds of the administration of intravenous glucose.7 This physiology may help support the lack of shivering during hypoglycemic hypothermia, as decreased glucose demand in peripheral tissues would leave more glucose available for use by the brain and other critical areas of the body.

Drugs that Add to the Problem

To varying degrees, all diabetes medications have the ability to induce hypoglycemia. They work by various mechanisms in order to reduce the serum glucose levels in the body, as lowering blood sugar is strongly linked to reducing microvascular complications such as diabetic nephropathy, neuropathy and retinopathy.8

Overzealous use of antidiabetic medications, most commonly insulin or its secretagogues (e.g., sulfonylureas), is the most common cause of hypoglycemia. Therefore, diabetic patients whose therapy is directed towards tightly-controlled glucose levels need to be closely monitored for hypoglycemia.

Other drugs that may contribute to hypoglycemia include fluoroquinolones, pentamine, quinine, beta blockers, ACE inhibitors, and IGF-1.9 It has been suggested that some types of medications, such as beta blockers, selective serotonin reuptake inhibitors, and even insulin itself, may prevent the patient from experiencing any of the warning signs of hypoglycemia.10 This problem is termed “hypoglycemia unawareness”.11

At-Risk Patients

Some diabetic patients are more prone to eventually experiencing hypoglycemia, particularly those with liver disease, alcoholism, malnutrition, renal insufficiency, sepsis, or other endocrine disorders. Because the liver is essential for gluconeogenesis and glycogenolysis, hepatic dysfunction can impair these processes. Exogenous insulin is renally metabolized, so individuals with renal failure are at risk of delayed clearance of insulin and resulting hypoglycemia.

In addition, certain medical conditions, such as sepsis and malignancy, can dramatically increase the metabolic demands on the body, which in turn can deplete glucose stores and precipitate hypoglycemic episodes.

Other rare causes of hypoglycemia include neuroendocrine tumors or insulin autoimmunity.12 Patients with impaired cognitive function, dementia or psychiatric conditions can be susceptible if they are unaware of their symptoms or unable to express themselves.

Also important to note is that alcohol may also cause hypoglycemia by inhibiting gluconeogenesis, so patients presenting after an extended alcohol binge with little to no ingestion of food may display symptoms of hypoglycemia.13,14

In any of these scenarios, a simple finger stick or serum glucose test can confirm the diagnosis. Furthermore, it should be noted that the risks and potential consequences of hypoglycemia are very significant for patients who are trying to operate heavy machinery, work at a construction job, and or drive an automobile.4

What About Type 2 Diabetics?

Type 2 diabetes is far more common in America than Type 1, comprising 90% to 95% of cases. In Type 2 diabetes, the patient’s own body tissue slowly becomes resistant to the effects of insulin. Eventually, the pancreas stops producing insulin because it cannot continually meet the great demand for it caused by the tissue-resistance to insulin. Although most Type 2 diabetics do not need insulin early in their disease course, many of these patients will eventually require insulin as part of their therapeutic regimen.

Advanced Type 2 diabetics who are using insulin, taking multiple medications for reducing serum glucose, are elderly, or who have a co-existing critical illness are at high-risk for developing hypoglycemia.15,16

Implications for Practice

When faced with a lethargic or unresponsive patient, every bit of information might be useful in arriving at the correct diagnosis—which is crucial to guide timely and effective treatment. As we see with Annette’s case, the differential diagnosis for altered mental status can be broad. An awareness of the variable signs and symptoms of hypoglycemia allowed for prompt recognition of symptoms and quick initiation of treatment. Given the frequency and potentially life-threatening nature of hypoglycemia, it is essential that clinicians understand the manifestations of this disorder and maintain an index of suspicion when managing diabetic patients who are exhibiting strange symptoms.

2. Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014.

5. Arrich J, Holtzer M, Havel C, et al. Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Cochrane Database Syst Rev. 2012;9:CD004128.

6. Freinkel N, Boyd ME, Harris E, et al. The hypothermia of hypoglycemia. N Engl J Med. 1972; 287: 841-845.

7. Gale EM, Bennett T, Green HJ, et al. Hypoglycaemia, hypothermia, and shivering in man. Clinical Science. 1981;61:463-469.

8. Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321:405-412.

10. White, JR. The contribution of medications to hypoglycemia unawareness. Diabetes Spectr. 2007;20(2):77-80.

11. Ma RC, Kong AP. Drug-induced endocrine and metabolic disorders. Drug Saf. 2014;30(3): 215-245.

12. Iglesias P, Diez J. A clinical update on tumor-induced hypoglycemia. Eur J Endocrinol. 2014;170:R147-R157.

13. Marks V, Teale, JD. Drug-induced hypoglycemia. Endocrinol Metab Clin North Am. 1999;28(3):555-577.

14. Fitzgerald FT. Hypoglycemia and accidental hypothermia in an alcoholic population. West J Med. 1980;133(2):105-107.

15. Chelliah A, Burge MR. Hypoglycaemia in elderly patients with diabetes mellitus: causes and strategies for prevention. Drugs Aging. 2004;21(8):511-530.

Does Diabetes Affect Body Temperature?

Diabetes is a complex disease, affecting virtually every part of the body. The damage it does, to nerve endings, blood vessels, organs, and the brain, is the subject of many, many scientific research studies.

Several such studies have investigated the relationship between pancreatic secretions and core temperature changes. Findings from one study, conducted by the Scripps Research Institute and published in the January 2010 issue of the journal Diabetes, show that increases in pancreatic secretions cause a corresponding rise in core body temperatures.

Core Body Temperatures

Core body temperatures are those maintained within the trunk of the body and the head, which encompass all vital organs. Temperatures within the core generally remain fairly steady, with only slight variations, facilitating various enzymatic reactions. When core body temperatures go outside this narrow range for extended periods or to extreme levels, either becoming too low (hypothermia) or too high (fever), damage to the body occurs.

Limited changes in core body temperature are common, related, among other things, to female hormonal cycles, the 24-hour wake-sleep cycle and the effects of severe calorie restriction.

Brown Fat Cells

When insulin is either secreted by the pancreas or injected, changes occur in so-called ‘brown fat’ cells, resulting in an increase in core temperature and a corresponding acceleration in the rate of metabolism. Brown fat cells are adipose tissue that burns calories, rather than storing them, as white fat does.

The pathway of insulin to these brown fat deposits is through the brain. Scientists experimented on rats, which have large masses of brown fat on their backs. They injected the preoptic area of the brain with insulin and then electronically scanned the brown fat. The results show the brown fat became active, burning calories and releasing heat into the core.

Humans also have brown fat, especially in the area around their necks and collarbones. Scientists have noted that older people have less brown fat than younger people, and obese individuals have less brown fat than those who are lean.

Increased Metabolism

Next, scientists looked for evidence that the activation of the brown fat leads to increases in metabolism. By measuring oxygen consumption and carbon dioxide production, they were able to make this correlation.

While scientists have noted these reactions in mouse studies, they cannot yet explain them. In fact, while the study answered some questions, it opened others. For instance, how is it that the cells in the body are unable to accept insulin while cells in the brain are? How does insulin get into the preoptic area of the brain? Can a treatment be devised that will result in safe increases in metabolism, with the result of weight loss in humans?

This is one more important research program where, with further research, there is the hope of newer, more effective treatments for diabetic patients.

Sources: NewLifeOutlook.com

Managing Diabetes in the Heat

How to keep your cool during the hottest time of year.

Did you know that people who have diabetes—both type 1 and type 2—feel the heat more than people who don’t have diabetes? Some reasons why:

  • Certain diabetes complications, such as damage to blood vessels and nerves, can affect your sweat glands so your body can’t cool as effectively. That can lead to heat exhaustion and heat stroke, which is a medical emergency.
  • People with diabetes get dehydrated (lose too much water from their bodies) more quickly. Not drinking enough liquids can raise blood sugar, and high blood sugar can make you urinate more, causing dehydration. Some commonly used medicines like diuretics (“water pills” to treat high blood pressure) can dehydrate you, too.
  • High temperatures can change how your body uses insulin. You may need to test your blood sugar more often and adjust your insulin dose and what you eat and drink.

Your Summer Checklist

  • Drink plenty of water.
  • Test your blood sugar often.
  • Keep medicines, supplies, and equipment out of the heat.
  • Stay inside in air-conditioning when it’s hottest.
  • Wear loose, light clothing.
  • Get medical attention for heat-related illness.
  • Make a plan in case you lose power.
  • Have a go-bag ready for emergencies.

It’s the Heat and the Humidity

Even when it doesn’t seem very hot outside, the combination of heat and humidity (moisture in the air) can be dangerous. When sweat evaporates (dries) on your skin, it removes heat and cools you. It’s harder to stay cool in high humidity because sweat can’t evaporate as well.

Whether you’re working out or just hanging out, it’s a good idea to check the heat indexExternal—a measurement that combines temperature and humidity. Take steps to stay cool (see sidebar) when it reaches 80°F in the shade with 40% humidity or above. Important to know: The heat index can be up to 15°F higher in full sunlight, so stick to the shade when the weather warms up.

Physical activity is key to managing diabetes, but don’t get active outdoors during the hottest part of the day or when the heat index is high. Get out early in the morning or in the evening when temperatures are lower, or go to an air-conditioned mall or gym to get active.

Your Blood Sugar Knows Best

Kids out of school, vacations, get-togethers, family reunions. The summer season can throw off your routine, and possibly your diabetes management plan. Check your blood sugar more often to make sure it’s in your target range no matter what the summer brings. It’s especially important to recognize what low blood sugarExternal feels like and treat it as soon as possible.

Play it safe in the sun with a hat and sunglasses.

Warm-weather wisdom:

  • Drink plenty of water—even if you’re not thirsty—so you don’t get dehydrated.
  • Avoid alcohol and drinks with caffeine, like coffee and energy or sports drinks. They can lead to water loss and spike your blood sugar levels.
  • Check your blood sugar before, during, and after you’re active. You may need to change how much insulin you use. Ask your doctor if you would like help in adjusting your dosage.
  • Wear loose-fitting, lightweight, light-colored clothing.
  • Wear sunscreen and a hat when you’re outside. Sunburn can raise your blood sugar levels.
  • Don’t go barefoot, even on the beach or at the pool.
  • Use your air conditioner or go to an air-conditioned building or mall to stay cool. In very high heat, a room fan won’t cool you enough.

Too Hot to Handle

Know what else feels the heat? Diabetes medicines Cdc-pdf, supplies, and equipment:

  • Don’t store insulin or oral diabetes medicine in direct sunlight or in a hot car. Check package information about how high temperatures can affect insulin and other medicines.
  • If you’re traveling, keep insulin and other medicines in a cooler. Don’t put insulin directly on ice or on a gel pack.
  • Heat can damage your blood sugar monitor, insulin pump, and other diabetes equipment. Don’t leave them in a hot car, by a pool, in direct sunlight, or on the beach. The same goes for supplies such as test strips.

But don’t let the summer heat stop you from taking your diabetes medicine and supplies with you when you’re out and about. You’ll need to be able to test your blood sugar and take steps if it’s too high or too low. Just make sure to protect your diabetes gear from the heat.

Stormy Weather

June 1 marked the beginning of hurricane season. Severe thunderstorms with hail, high winds, and tornadoes are more likely in warm weather, too. People with diabetes face extra challenges if a strong storm knocks out the power or they have to seek shelter away from home. Plan how you’ll handle medicine that needs refrigeration, such as insulin. And be prepared by packing an emergency go-bag—a supply kit you can grab quickly if you need to leave your home.

Here’s to staying cool, staying safe, and enjoying the long summer days!

Heat and Type 1 Diabetes

Note: This article is part of our Daily Life library of resources. To learn more about the many things that affect your health and daily management of Type 1, visit here.

Whether experiencing hot summer temperatures or a tropical vacation, it is important for everyone to beware of the heat – and the various effects that it can have on our bodies. Have you ever noticed your blood sugar either spiking or dropping rapidly in severe temperatures? Many people with Type 1 diabetes run into this issue and have been baffled as to why. Heat may have much more of an impact on your blood glucose levels than you realized! Keeping a close eye on your BG becomes even more important when in areas with higher temperatures.

Here are some possible explanations to the heat’s role in blood sugar fluctuations, and some factors to keep in mind while enjoying your summer fun in the sun with Type 1!

High blood sugar

Heat can spike blood sugar levels easily if we are not properly hydrated. When the body is dehydrated, blood glucose becomes more concentrated due to the decrease in blood flow through the kidneys. This makes it much more difficult for the kidneys to remove any excess glucose from urine.

How to fix it? Adjust insulin dosages as instructed by a medical professional, and most importantly drink plenty of water!

Low blood sugar

Blood glucose levels have been known to plummet in the heat – especially when combined with exercise. Why is this?

Heat can cause the body’s blood vessels to expand, which in turn can speed up insulin absorption and potentially lead to hypoglycemia. This can be made worse when exercising due to the increased blood flow to certain areas, especially if insulin is injected in the legs. Also consider that hot tubs/jacuzzis or hot showers/baths can have the same affect, leading to hypoglycemia.

Dry heat vs. humidity

It is important to stay hydrated and closely monitor BG levels in both humid and dry weather. However, sweat evaporates more easily in dry heat allowing the body to naturally cool itself, whereas in humidity sweat evaporates very slowly. Due to variables such as the heat index, the heat feels exaggerated in humid climates.

All beverages are not created equal

Water is always the best option to keep yourself hydrated in high temperatures, but drinks such as non-caffeinated iced herbal teas are effective as well.

Drinks that act as diuretics or that have a high caffeine or sodium content can actually dehydrate you (which could lead to BG malfunctions!)

Some examples are:

  • Alcohol
  • Sodas and most energy drinks
  • Coffee
  • Milk
  • Caffeinated tea

Sports drinks such as Gatorade can be effective, but beware of the high sugar content and perhaps reserve those carb heavy drinks for a low blood sugar.

Similar symptoms

The symptoms of heat exhaustion and hypoglycemia (low blood sugar) can feel very similar! It is important to check your BG levels even if you think that you are simply feeling the effects of the heat.

Symptoms of both scenarios can include:

  • Sweating
  • Shakiness
  • Dizziness
  • Lethargy
  • Blurred vision
  • Hunger
  • Irritability

Heat can tamper with medications

If insulin is exposed to extreme heat for too long, it will become ineffective, which would certainly cause blood sugar spikes! The heat can also alter the effectiveness of supplies such as test strips and BG meters. Be sure to check the labels on all of your supplies for specific temperature requirements.

Read Cold Weather and Type 1 Diabetes, Navigating the BBQ with Type 1 Diabetes and Your Type 1 Guide to Music Festivals.

WE can all agree that the recent glorious hot weather has got slightly out of hand… especially for diabetes sufferers.

From fluctuating blood sugar levels to keeping your insulin cool, here’s everything you need to know about managing diabetes during the heatwave.

4 The key to keeping blood sugar levels regulated is regularly monitoring themCredit: Getty – Contributor

How does the hot weather affect diabetes sufferers?

Let’s just say, the recent spell of ridiculously warm weather plays havoc with blood sugar levels.

And as diabetes sufferers struggle to produce insulin, the extreme heat only exacerbates the problem by causing blood sugar to either crash or soar through the roof.

Even if sufferers are staying well-hydrated and out of the sun, chances are the heat will have an affect on the condition.

So regardless of your usual dosage, Diabetes UK recommends sufferers staying extra vigilant when monitoring the glucose levels in their blood.

4 Insulin should also be kept in the fridge during periods of intense heatCredit: Getty – Contributor

Why do blood sugar levels fluctuate in the heat?

Unsurprisingly, extreme heat cause blood sugar levels to fluctuate drastically.

On the one hand, sweating, dehydration, and sunburn typically leads to a rise in glucose in the blood.

But on the other, an overall higher body temperature can lower your blood sugar levels and cause them to crash.

As such, sufferers need to monitor their blood sugar closely and adjusting insulin intake accordingly.

4 The intense heat plays havoc on blood sugar levelsCredit: Getty – Contributor

What precautions should diabetes sufferers take?

Luckily, there is plenty of medical advice for helping diabetes cope with the extreme heatwave.

According to Diabetes UK, insulin is “best kept in the fridge or a cool bag” especially during a heatwave.

The tell-tale sign of sun-damaged insulin is whether the clear liquid has turned cloudy or “becomes grainy and sticks to the side of the glass.”

4 Diabetes sufferers need to stay hydrated in the heat and not spend too long in the sunCredit: Getty – Contributor

Along with repeatedly checking your blood sugar levels, they also recommend keeping blood glucose meters and test strips at room temperature.

After all, extreme weather can damage the equipment and leave you with “misleading results.”


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It is also incredibly important for diabetes sufferers to stay hydrated in the heat and to consume electrolyte sports drinks when exercising.

While it is always a good idea to keep a snack on you, it is also worth carrying glucose gels and a glucagon kit in case your blood sugar crashes.

Also protect yourself from sunburn (and soaring blood sugar levels) by slathering on the SPF before leaving the house.

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How To Manage Your Diabetes In Cold Weather

How does the cold affect diabetes and blood sugars

You probably know by now that pretty much everything affects type 1 diabetes, it’s one of those simple joys. (I hope you can detect my sarcasm), even so, it’s important to be prepared in cold weather, because it can have a significant effect on our blood sugars. Actually, we tend to have a higher HBA1C in the winter months…and there is a lot of factors that contribute to that.

Firstly, we tend to have weaker immune systems in colder weather which means we can catch sickness easier, even a simple “cold” and “a cough” is enough to send our blood sugars higher. Not only that but the cold in general means our general blood flowing around our bodies is reduced and this can put us at risk of a number of things and reduce the effectiveness of our insulin. Then, on top of all that, our insulin can die in the cold AND our diabetes equipment can break. It hardly seems worth it now eh? 😛

Not to worry, below are some tips to help you manage your blood sugar and diabetes in the cold weather.

Boost that immune system

A lower immune system means you are more prone to illness, illness means your blood sugar runs higher, your blood sugar running higher means you need more insulin, it also means you’re dehydrated, and at risk of DKA. Therefore, it is vital that you give your body the best possible chance to fight off infections.

Always get your flu jab (which is offered free in the UK), and in the USA, the cost of a flu shot varies by location but typically ranges between $5 and $30, however, this may or may not be included in your insurance, so discuss with your doctor.

You can also help boost your immune system by taking vitamin supplements, eating healthy and drinking lots of water.

Be aware of those high blood sugars

Higher blood sugars make you “feel” warmer in cold temperatures. This happens because the sugar content in our blood makes it harder to freeze or cool down. Don’t let your blood sugars stay high as an excuse to stay warm. Take different precautions. Whether you need to adjust your basal rate or increase your bolus, do what’s necessary to manage your diabetes in cold weather.

Take care of your feet

Those who suffer from neuropathy typically have less sensitivity in their feet which means they may not realise that their feet are extremely cold which could lead to frostbite. Wrap up super warm and do not walk around barefoot in the cold. You should also limit the amount of time your feet are exposed. The winter cold air can dry out and crack the skin, especially our feet, which could potentially lead to infections and wounds. You should apply moisturiser to your feet to help ensure your skin is healthy and check for any little cuts. If you notice there is a cut that is not healing, then you should seek advice from your doctor.

Don’t let your insulin freeze

Use your Frio bag!

When we are trying to protect our insulin when traveling at extreme temperatures, the cold is another factor to contend with. I will recommend the same product I always recommend, and that is Frio bags. You know your insulin has frozen if it forms crystals and clumps and this will typically happen when it is exposed to temperatures of around 26°F (-3 °C).

It is extremely dangerous if you use insulin that has died, so avoid it at all costs.

If you are hiking with diabetes in the cold weather or conducting any sort of outdoor/exercise activity, then remember to wrap your Frio bag in something “warm” too, such as a jumper or scarf, as in extreme temperatures it could still freeze.

Look after your diabetes equipment too

Your diabetes equipment can also stop working in cold temperatures. Just recently I was skiing in Austria and my actual diabetes blood sugar monitor would not work at the ski resort because it was too cold. Every time I tried to test it simply said: “temperature error, return the monitor to correct temperature then try again”.

However, fortunately, I had my FreeStyle Libre on me too, and it still scanned in the cold temperatures!

The specific working temperature of different CGMs, monitors etc varies, so you should check the manufacturer model/handbook that you received when you first got your device. It will indicate the temperature in there, but IF you have lost your copy (I instantly throw out manuals- whoops), then there is usually a digital copy available on the website, or simply drop your company a message.

Wrap your equipment in warm items. Girls, if you keep your insulin pump or diabetes monitor in your bra, it helps keep them warm thanks to the natural body temperature there.

If your testing device issues a “cold warning”, then turn it off, remove the batteries, and warm them up in your hands, as well as trying to warm your device. Then after a couple of minutes try again, usually, they start to work.

Test frequently

I know that there is nothing worse than taking off gloves and trying to test your blood sugar when it is freezing. Firstly, I struggle to get any blood out of my fingers, and secondly, it’s FREEZING! But, you still need to test.

A “solution” to this is the use of a CGM or device like the Freestyle Libre which doesn’t require fingerpricking, but this certainly isn’t a cost-friendly solution.

Don’t rely on your feelings

When it comes to managing your diabetes in cold weather, there is something you shouldn’t rely on….how you feel.

When you’ve had diabetes for a long period of time, you can recognise the signs of feeling high and low on your body right away. But, when you are in extreme temperatures these feelings become mixed up and confusing. You can get false hyper and hypo warnings, so TEST!

Follow these tips to help you manage your blood sugar and diabetes in the cold weather! If you have any more tips for managing your diabetes in the cold weather then comment below.

Don’t forget you can get the eBook HERE!

Happy Travelling!


Diabetes and the cold weather

A little activity each day will help with insulin sensitivity (in all types of diabetes) which can help the body to better regulate sugar levels.

Particularly if you are using insulin, keep a watch of your blood sugar levels in case your insulin requirements go down. Bear in mind that activity can affect blood glucose for up to 48 hours.

A little bit of exercise helps to keep you warm. We all know that whilst exercising we heat up, but the effects don’t stop as soon as we stop exercising.

We may feel cooler after stopping, if we’ve built up a sweat, but the longer term effects of exercise is to help with metabolism which can help to keep our body temperature up even hours after exercise and helps improve fitness levels.

If you tend to feel cold during the winter months, a little more activity in your day could be just the thing.

The saying ‘healthy body, healthy mind’ rings true. If you keep your body active you’ll find the mind stays more active too. With a fresh feeling mind you’ll be able to cope with more of the rigorous of the day and be in a better position to make decisions in the management of your diabetes. And don’t forget to use The Spike App for insulin reminders!

Managing your diabetes in cold weather

It may become more challenging for you to manage diabetes in cold weather. Here are some tips to stay healthy during the winter months and keep your diabetes under control.

It is important to keep your diabetes supplies away from cold temparatures since extreme cold can affect some of your medication such as insulin. It can also affect your glucose monitor as well. Do not leave your supplies in the car and take them with you.

Winter does not only bring cold weather, but the flue season and common colds as well. Do your best to avoid getting sick because illness can affect your apetite and can cause you stress, which can affect your blood sugar levels. You can avoid getting sick by taking preventive measures such as washing your hands properly and getting vaccinated againsit the flu. Stock your pantry with remedy foods in case you need them such as soups, cold medication, or anything that can make you feel better when sick.

During winter, many people tend to become less active, which can cause putting on some pounds. Try to avoid that by avoiding foods high in fat and carbohydrates- the foods usually served during the holidays, and make sure you eat your non-starchy vegetables and mainting exercising to control your weight and blood glucose levels. If it’s too cold to exercise outdoors, escersice indoors by walking, taking the stairs, or even lifting weights.

Do not forget taking care of your feet. Protect your feet from wet weather and snow and keep them warm. Apply moisturizer and avoid direct heat to your feet to prevent excess dryness. If Lastly, stay warm this season by keeping your hands warm. It is important to warm up your hands before taking your glucose reading.

To find out more about health and nutrition programs, visit the Michigan State University Extension website.

Whether you are going on holiday or simply spending some time outdoors in the heat, high temperatures and the close humidity can have an influence for people with diabetes.

This may partly be explained by increased activity in hot weather, but there is no doubt that the heat does affect some people with diabetes in other ways.

What problems can hot weather cause for people with diabetes?

Dehydration can be an issue in hot weather, and higher blood glucose levels can further increase this risk.

People with diabetes may need to increase their intake of fluids in hot weather, drinking water regularly through the day.

One of the major concerns regarding diabetes and hot weather is the risk of blood sugar levels rising or falling and causing hypoglycemia or hyperglycemia.

What are the hypo risks from hot weather?

Hot weather can increase the risk of hypoglycemia for those on blood glucose-lowering medication such as insulin.

The body’s metabolism is higher in hot and humid weather which can lead to an increased chance of hypoglycemia as insulin absorption can be increased.

Hypos may be slightly harder to spot in hot weather. Don’t be tempted to disregard hypo symptoms, such as sweating and tiredness, as a result of hot weather as it could be a sign of hypoglycemia.

Take extra care when driving. Test your blood sugar before and after each journey and stop regularly to check your blood sugar during longer journeys.

To prevent hypos, be prepared to test your blood glucose more often, particularly if taking part in physical activity in hot weather. Keep a source of fast-acting carbohydrate at hand, such as glucose tablets or a sugary drink.

You may need to adjust your insulin levels during changes in temperature. If you are experiencing higher or lower blood sugar levels and need advice about adjusting your insulin levels, speak with a member of your healthcare team.

What are the symptoms of heat exhaustion?

The NHS notes that people with diabetes are at higher risk for heat exhaustion. Heat exhaustion can occur if you get very hot and lose water and/or salts from the body.

Symptoms of heat exhaustion include:

  • Sweating more than usual
  • Dizziness
  • Cramping muscles
  • Clammy skin
  • Headaches
  • Fast heartbeat and
  • Nausea.

By resting away from the glare of the sun and drinking more water you can avoid heat exhaustion.

What about hot weather and medicine?

When carrying diabetes supplies which need to be kept cool, such as insulin, the heat of summer can be a problem.

Get around this by keeping your medication away from direct sunlight and carrying cooling packs, which keep medication cool.

  • View our range of cooling wallets

Test strips are sensitive to temperature as well. Test your blood sugar in a cool, shaded place and keep your test strips away from direct sunlight as well.

Blood testing in hot weather

  • Read more on blood testing accuracy

With good preparation, there is no reason why hot weather can’t be a real pleasure!

What the community are saying about diabetes and hot weather

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The Link Between Diabetes and Body Temperature

Diabetes and Body Temperature: Managing Cold, Numb or Tingly Feelings

When you live with diabetes, it’s not uncommon to feel cold or numb, especially in your extremities. Your core body temperature is closely tied to your metabolism, and since diabetes wreaks havoc on your metabolic processes, you’re bound to sweat, shiver and shake more than the average person.

Part of the problem comes down to your diabetes management, but that’s not the only force at play. Circulation, insulin levels, nerve problems, and other lifestyle factors could be interfering with your natural heat regulation.

Find out what’s behind your cold, numbness or painful tingling, and take steps to kick-start your internal heating system.

How Peripheral Neuropathy Leaves You Cold

When diabetes goes uncontrolled for a long time, the nerves in your hands and feet could sustain permanent damage. This sort of nerve damage in the extremities is known as peripheral neuropathy, and it can interfere with all sorts of regular sensations.

For many people, nerve damage leads to pain, numbness or tingling. You may feel a “pins and needles” sensation in your fingers that lingers for a long time, or you could lose sensitivity, making it more difficult to pick things up or feel different textures. In some cases, the opposite is true — heightened sensitivity makes any contact agonizing.

Since the nerves in your limbs also monitor temperature and send those signals to your brain, it’s not uncommon for hands and feet to feel abnormally cold, too. Coldness or numbness that stems from peripheral neuropathy often brings along some other common symptoms, like:

  • Sharp pains
  • Cramps
  • A burning sensation
  • Loss of reflexes
  • Loss of balance

If you haven’t noticed any strange symptoms in your extremities other than the cold feeling, you may be dealing with a different diabetic complication. Another type of neuropathy may be causing the trouble, or it could have more to do with your blood sugar levels or insulin usage.

How Insulin Impacts Your Body Temperature

Recent research has uncovered a link between insulin and temperature: insulin seems to work as an internal thermostat, helping to raise your core body temperature by triggering the burning of “brown fat” cells.

Since insulin heats up the body, it’s no surprise that many type 1 diabetics (who have a depleted insulin supply) have a low core body temperature — in fact, a body temperature below 97 degrees is one of the earliest signs of the disease. It follows that the elevated insulin levels associated with type 2 diabetes should warm your body rather than cool it. However, it’s not quite so straightforward.

One theory behind the chill of type 2 diabetes centers on how long your insulin has been elevated. Chronically high insulin could exhaust the circuits that trigger the fat burning process, so the heat is never created.

Since your body still needs heat for important metabolic reactions to take place, it begins to store insulating fat instead of burning fat. Extra fat on your body interferes with blood circulation, and that can leave your arms, legs, fingers, and toes feeling particularly cold.

The Blood Sugar Factor

When your body is in need of glucose, it sends out a variety of signs and signals. From headaches and irritability to trembling hands and ravenous hunger, most people will feel a few discomforts that are difficult to ignore.

As your blood sugar drops and hypoglycemia begins to set in, you might start to sweat even if it’s not hot out, or your hands will get cold and clammy. This cold sweat can come shortly after blood sugar drops; in the case of severe hypoglycemia, the core body temperature could fall very low, leading to hypothermia.

Tips to Build Body Heat

If your cold extremities can be traced to neuropathy, insulin issues, or poor blood sugar control, the next step is to treat the source of the problem. Cooler weather can make things worse, so you may need to take extra precautions and be more proactive when it comes to warming up your body as winter approaches.

Stay Active

When the thermometer drops and the wind whips against the windows, working out seems easier said than done. However, your diabetes and body temperature will improve, so you should make an effort to get some heart-pumping exercise each and every day. Exercise helps to improve insulin sensitivity and keeps your blood circulating efficiently.

The great thing about exercising is that the effects last much longer than the activity itself. Your metabolism will stay elevated for hours after your workout, and that will keep you energized and warm.

Pack on Some Muscle

Along with cardiovascular exercise, add in some resistance training or light weight training to build muscle. While fat is a good insulator, muscle generates heat; since it also revs up your metabolism, building more muscle could make a significant difference in your body temperature.

Get a Good Night’s Sleep

Trouble sleeping could account for your chilly feelings, especially if you’ve gone a few nights without quality sleep. The problem could be traced to problems with the hypothalamus, a region in the brain responsible for regulating body temperature.

Other experts suspect sleep causes metabolism to slow, and that leads to a drop in body temperature. Whatever the precise cause, it’s common to feel particularly cold and shivery when you’re sleep-deprived.

You May Also Like:How Diabetes Causes Mood Swings (and What to Do About It)

Up Your Iron Intake

Iron helps your blood transfer nutrients and heat to every cell in your body, so if you’re not getting enough, your extremities aren’t getting the energy they need to keep you warm. Moreover, your thyroid will lag if you don’t take in enough iron, and that will make you feel even colder.

It’s vital you don’t let the cold interfere with your blood sugar testing. If your hands are too cold or numb to perform the test, warm them (carefully) with a hot water bottle, or around a mug of warm tea. Regular testing is the best way to stay on top of your diabetes management and make sure that cold or tingly extremities don’t lead to anything worse.

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