Living with diabetes and the cold: Ski trip edition

Setting out on a new adventure, like skiing, is a lot of fun — but it can also be intimidating for people living with diabetes. The winter season poses a new set of opportunities and challenges, necessitating that individuals take extra steps to balance their diabetes and the cold.

But I've found there's no reason to fret! With a little foresight and creativity, you can absolutely have a positive experience while managing your condition in colder weather. If you're looking to hit the slopes, or simply enjoy a winter weekend getaway, here's some helpful advice for planning ahead as well as suggestions for having fun and avoiding diabetes complications.

Dress for diabetes

Before venturing out in low temperatures, it's important to consider how you'll cover your skin and which spots you'll use for insulin pump sites, continuous glucose monitor (CGM) sensors, multiple daily injections (MDI), and finger pricks. Once you have an idea of your cold weather wardrobe, you can layer in your diabetes devices and management equipment as needed.

For insulin pump site placement, choose a location where you've had traditionally good absorption and is the least likely to get ripped off while getting into (and out of) those bulky winter garments. For me, that typically means an insulin pump site placement on my thigh.

Be sure to map out how you'll route your tubing and where you'll store your pump or Personal Diabetes Manager (PDM). I suggest choosing somewhere that's easily accessible but protected in case of a crash or tumble. For example, I typically stash my pump/CGM receiver within an interior breast pocket.

If you'll be storing your PDM or CGM receiver in a backpack or other external bag, check the device's operating manual to understand the temperature limits. The cold weather may affect the device's sensitivity and potentially cause inaccurate readings.

Additionally, the American Diabetes Association cautioned against using insulin that has been exposed to extreme temperatures (less than 36 degrees Fahrenheit or above 86 degrees Fahrenheit). Try storing insulin pumps and backup insulin pens close to your body to avoid freezing the mechanical devices or the insulin itself. If you plan to store extra insulin (beyond just an immediate backup supply) elsewhere, like your car, use an insulated container — even an insulated thermos or water bottle can help avoid freezing your insulin.

Determine insulin dosing

In addition to the cold temperatures, there are many insulin dosing methods to investigate when preparing for a high-intensity activity like skiing. It's important to always check with your doctor before implementing a new insulin delivery scheme, but here are some ideas to get the conversation started:

• Using devices' built-in technology, like "exercise mode," before and during high-intensity activity
• Setting a temporary basal rate
• Decreasing a dose of long-acting insulin if on MDIs
• Increasing "insulin-on-board" time to mitigate insulin stacking
• Packing snacks with a specific mixture of carbohydrates and protein to counteract fast blood sugar drops

Asking your doctor for general advice about how to manage diabetes and the cold is also a great idea. They're there to help, and will likely appreciate your proactivity — it's always best to get the facts before jumping into new situations.

Prepare the backup plans

Even the best diabetes management plans require backup options because there are just so many unknowns and what-ifs. At the very least, make sure to carry the most essential backups with you in a backpack or jacket compartment, including:

• Fast-acting glucose that isn't susceptible to freezing (like glucose tablets)
• Insulin pen and a few needles
• A glucagon kit
• Heat packs to help warm up equipment (or fingers) before a blood sugar check

Whether you're a seasoned skier or just starting out on the bunny slope, having these items on hand can help you rest assured and have fun. Also, it's a good idea to always wear a medical ID, and, whenever possible, ski with a buddy who knows how to help you in an emergency.

Adapt to the variables

When living with diabetes, it can feel like second nature to assess all of the variables associated with diabetes and the cold, and make plans to solve for them. But there are just some things that are impossible to plan for and will require your real-time expertise and skill.

Here are a few points to keep in mind as you prepare:

• Altitude. Studies, such as those published in BMJ Open Sport & Exercise Medicine, are still ongoing to determine the precise effect altitude has on blood sugar, but be aware it will probably affect you one way or the other.
• Adrenaline. There are indications that adrenaline can act like glucagon in the body of someone with diabetes, helping to raise blood sugar when secreted, according to the British Journal of Pharmacology. If your body doesn't produce its own insulin (like mine!), this surge can raise blood sugar unexpectedly, especially because high-intensity activity is often associated with lowering blood glucose levels.
• Mountain conditions. Fresh powder requires different muscles and focus than slushy and icy conditions. It's possible (and likely) the conditions won't be equal across the spectrum of just one downhill run, so prepare to adapt throughout your day on the slopes.
• Experience level. With experience comes a deeper understanding of how all of these variables work together in affecting your personal diabetes management. It takes time and trial and error to build a robust understanding of how to best manage diabetes during such a dynamic activity. Cut yourself some slack and don't forget to have fun.

An old Army friend used to say, "Slow is smooth, and smooth is fast." I think this is a great approach when accomplishing any new activity with diabetes on board but especially something as nuanced as skiing. Work together with your ski partners to build in checkpoints, and be gentle with yourself as you learn how your body reacts to the cold and physical activity.

Are you ready to take on more adventures with diabetes? Find other helpful articles on Health Insights.