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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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Winter Challenges in Managing Diabetes

Feb 22, 2017, 22:35 PM


inter is here – and challenges can arise when managing diabetes

Hockey, downhill skiing, cross-country skiing, snowball fights, skating and dogsledding are all a part of winter in the north. Many of us bundle up in layers of clothing in spite of the frigid temperatures and head out to enjoy our favorite activities.

However, when winter hits – so do some challenges in managing diabetes in the great outdoors. Glucometers can become too cold to use, PDM’s can refuse to work and fingers can become so cold, getting a drop of blood becomes quite difficult. To add to these challenges, opening up a bottle of strips with gloved hands and removing a small strip can result in dropping dozens of strips into the snow.

Not too many years ago, a dog sled driver in the Iditarod in Alaska ended up in DKA due to frozen insulin pump tubing! Luckily he was able to sit out a few days in a village with fresh insulin and supplies and was able to complete the race safely.

Here are a few tips to review with our patients for cold weather exercise.

Technology management:

  1. 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. An over-jacket adds another layer of protection for technology. Insulin pumps worn next to the skin with a “spy belt” can also work well.
  2. Chemical hand warmers can be inserted into a sock and placed next to a meter or pump to maintain warmth.
  3. Hand warmers can be inserted into gloves and mittens to help keep fingers warm for blood glucose tests
  4. Insulin pump tubing should 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.

With guidance from a CDE who understands the impact of exercise in the cold on diabetes management, patients can safely exercise even in extreme environments.

Medical management:

  1. Energy expenditure can be high due to moving with multiple layers of clothing. 
  2. The occasional weekend activity such as skiing or snowboarding utilizes different muscle groups than the usual weekday fitness routine and can result in blood glucose values that drop more quickly than one might predict.
  3. Treatments for low blood glucose need to be easy to access, and should be foods that don’t freeze solid! Glucose tablets, though not loved by many, offer an easy to carry, easy to chew treatment in the cold, or a thermos with hot cocoa can be a treatment strategy during backcountry activities.
  4. Using a sensor with a receiver makes following blood glucose levels easier and handier than having to do finger pokes on every lift ride or after a steep climb while backcountry skiing.

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 safely exercise 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 25 years, and served as an assistant adjunct professor for 14 years, teaching in areas of sports nutrition and exercise physiology. Currently she works in Missoula, Montana as a diabetes educator in both in- and outpatient settings.
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