Perspectives on Diabetes Care

This is the official blog of the Association of Diabetes Care & Education Specialists where we share recent research and professional opinions on diabetes care and education.


Explore Helpful Views on Diabetes Care & Education

If you're looking for professional opinions on diabetes care and education, you're in the right place. Perspectives on Diabetes Care is the official ADCES® diabetes care and education blog that shares helpful views on diabetes care and education. 

This is where you'll find practical tips on working with people affected by prediabetes, diabetes and related cardiometabolic conditions and the latest research and viewpoints on issues facing diabetes care and education specialists and the people they serve.



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Outdoor Winter Exercise and Type 1 Diabetes: What’s the Big Deal?

Feb 3, 2016, 15:55 PM


recently had the pleasure of spending five 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 outdoors 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.

Several times, glucometers became too cold to use, and a PDM refused to work due to the low temperature.

In one case I was with a group of eight individuals with type 1 diabetes, helping coach insulin adjustments while downhill skiing. Several times, glucometers became too cold to use, and a PDM refused to work due to the low 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. That was a plus!

It is important to review cold weather exercise tips with our patients.

Technology management:

  1. 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.
  2. Chemical handwarmers can be inserted into a sock and placed next to a meter or pump to maintain warmth.
  3. Handwarmers can be inserted into gloves and mittens to help keep fingers warm for blood glucose tests.
  4. There are several glucometers that have a disk for the strips rather than a bottle of strips, which requires dexterity to access when fingers are cold.
  5. 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:

  1. Insulin requirements may decrease during exercise in the cold not only due to physical activity, but also to higher energy expenditure while wearing more clothes. Studies on individuals without diabetes demonstrate that the cold weather itself is not the reason for higher energy expenditure, but the added burden of layers of clothing and heavy boots.
  2. 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, while energy bars tend to freeze, 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 safely, even in extreme environments.

Carla CoxAbout the Author:

Carla Cox is a registered dietitian and certified diabetes educator. She has been a certified diabetes educator for over 15 years, and has served as an assistant adjunct professor for 14 years, teaching in areas of sports nutrition and exercise physiology.