Perspectives on Diabetes Care

Oh Baby It Is Cold Outside

Jan 14, 2014, 01:00 AM

I recently spent 4 days in a forest service cabin with my family.  The cabin has a wood burning stove, bunks and an outhouse.  The way to the cabin is 11 miles of snowmobile, cross country skiing, and in our case, dog sledding.  It’s our annual adventure, and many times the temperature dips to 10 below zero (or colder).  Once at the cabin, we backcountry and cross country ski, dogsled, have hot chocolate, prepare wonderful meals over a Coleman stove, and get away from it all.  It takes a lot of planning, but we are ready for minor emergencies and have an emergency locator in case we need immediate help for more serious emergencies (there is no cell coverage).

As I so often do, I think about my patients with type 1 diabetes, and the added layer of planning they must do to make sure their lives are safe when they adventure in the cold.  This is especially true on extended adventures into the backcountry. 

I’m fortunate to have a number of very adventuresome souls in my practice that also enjoy a multitude of winter activities.  Problems arise such as dropping test strips in the snow, infusion sets that come loose, and meters that are too cold to use.  So how do we coach patients with type 1 to be ready for those great outdoor winter adventures, whether for a day or a week?

1. Always have a back-up plan!  If the individual is on an insulin pump, there is always the potential for a site to pull out.  Encourage taking an insulin syringe or insulin pen and a copy of their multiple daily injection plan in case of pump failure.  Changing a site at 10 below zero is close to impossible, especially under layers and layers of clothes.
2. Make sure there is an inside shirt pocket.  Even wearing a pump or glucometer inside a jacket may not keep it warm enough.  I once froze a water bottle while inside my heavy 40 below down jacket!
3. Remember activity in the cold will use more energy than in normal conditions.  Movement with so many clothes is more effort:  coach on lowering basal rates, or taking less long-acting insulin the night before and adjusting bolus dosing for activity. 
4. Take lots of glucometer strips and keep the meter buried under lots of clothing.  Taking Chemstrips (urine) as a back-up is an excellent plan for extended trips.  I also recommend taking a second glucometer for a friend to carry. 
5. Do not run out of glucose tabs!  They don’t freeze, are easy to get to and they work quickly!  Gels, bars, juices, and other treatments can freeze and be impossible to chew.  Crackers are also a good back-up treatment.
6. If the patient is staying for an extended period of time and needs to charge their insulin pump/meter, there is a new cook stove on the market that actually will charge a pump (or phone) using a USB connection.  How awesome is that!
7. The more remote the patient is, the less likely for cell phone coverage.  I recommend ALWAYS carrying an emergency locator device.  SPOT is one that comes to mind, one we carry everywhere in the backcountry now. 

Of course, people with diabetes can recreate just like people without diabetes, the planning list is just a lot longer! 

I hope your patients are also enjoying the winter season.  Please share any tips you might have with us!