Outdoor winter exercise and type 1 diabetes: What’s the big deal? By: Carla Cox, PhD, RD, CCE
I recently had the pleasure of spending 5 days skiing in the mountains of Utah and Montana. Temperatures ranged from 0-25 degrees F. I spent hours either cross-country or downhill skiing with breaks to warm up throughout the day.
As often happens when I am out of doors in more extreme circumstances, I think about my patients with type 1 diabetes, and recognize the added daily challenges of managing blood glucose values in a challenging environment.
In one case I was with a group of 8 individuals with type 1 diabetes, helping coach insulin adjustments while downhill skiing. Glucometers several times became too cold to use, and a PDM refused to work due to the temperature. Strips were lost in the snow when cold fingers tried to pull them out of the container. Pump tubing was tucked into clothing and insulin pens were carried in inside pockets, so we did not have problems with frozen insulin, so that was a plus!
It is important that we review some tips with our patients for cold weather exercise.
Technology management:
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Polar fleece tops can be purchased with pockets that work well for glucometers or pumps, or pockets can be sewn into the inside of a warm inner shirt. Wear them close to the skin with an overlayer of clothing
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Chemical handwarmers can be inserted into a sock and placed next to a meter or pump to maintain warmth
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Handwarmers can be inserted into gloves and mittens to help keep fingers warm for blood glucose tests
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There are several glucometers that have a disk for the strips rather than a bottle of strips that requires dexterity to access when fingers are cold
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Tubing needs to be tucked into pants to prevent the insulin from freezing, or an individual might consider a tubeless insulin pump if outdoor winter sports is a common past time
Medical management:
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Insulin requirements may decrease during exercise in the cold not only due to the physical activity, but due to higher energy expenditure with more clothes. Studies on individuals without diabetes demonstrate that the cold weather itself is not the reason for the higher energy expenditure, but the added burden of layers of clothing and heavy boots.
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Carrying treatments for low blood glucose is always important, and providing some ideas for treatments that do not freeze is important. Glucose tabs and gels generally work well. Energy bars tend to freeze hard as do liquid shots.
Exercise in cold weather is invigorating and fun. However, it can create some potential barriers to participants with type 1 diabetes. With guidance from a CDE who understands the impact of exercise in the cold on diabetes management, patients can exercise even in extreme environments safely.