Diabetes and Winter

Between frigid temperatures and holiday seasons it is tough to control blood sugars. Days are shorter and nights are longer, leading to overeating in day time and longer nights predisposing to nocturnal hypoglycemia. Colder weather can lead to increase in insulin requirements as well as oral hypoglycemic agents (OHA) which further leads to increased chances of hypoglycemia. Overlapping meals in day time, high carbohydrate diet, less exercise and sedentary lifestyle lead to weight gain and difficulty in controlling blood sugar.

High blood sugar levels over a period of time creates oxidative stress because of AGE (advanced glycation end products) which can lead to complications of diabetes like diabetic retinopathy, nephropathy and neuropathy. Caring of feet is very important in winters, as most of the patients with uncontrolled blood sugars have diabetic neuropathy which can lead to decreased sensation, numbness and cold feet. Diabetics tend to heat their feet quite often without sensing the heat burns because of radiators, hot water bottles, and locally used Kangri .

Injuries to the foot because of inappropriate footwear which can lead to ulcers in the foot. Dampness of the inter digits there are more chances of fungal infections of feet which can further deteriorate the blood sugar control. Cold temperatures can lead to frostbite of foot, non-healing ulcers which if not treated properly can end up in amputations. To prevent all the said complications of diabetic neuropathy foot care is very important in winters.

Immunity is compromised in diabetics, therefore chances of upper and lower respiratory infections are more, flu injections as well as pneumococcal and covid booster doses should be given before the winter season to prevent the infections which further deteriorate the blood sugars. Apart from sugar control, blood pressure and cholesterol should be kept in control as there are more chances of myocardial Infarctions and strokes in winters in view of high blood pressures as acclimatisation to winter season.
How to take care of your sugars

Diet pattern

As we stay indoors in winters, binge eating and eating junk foods is synonymous with winters. Watch for high cab comfort foods and take a low carbohydrate diet with more vegetables and lean proteins. Small frequent meals should be taken with small snack to be taken at 11 PM as nights are longer which decreases the chances of hypoglycemia
Portion Control: Watch portion sizes to help regulate calorie and carbohydrate intake.

Complex carbohydrates. Include whole grains, legumes and fiber in the diet for slow and steady energy and consider low glycemic index carbohydrates.
Lean Proteins: Choose lean sources like poultry, fish, tofu, or legumes to maintain muscle health.
Vegetables: Prioritize non-starchy green leafy vegetables for vitamins, minerals, and fiber.

Regular Meals and Snacks: Maintain a consistent eating schedule to help stabilize blood sugar levels.
A balanced meal is important for managing diabetes

Exercise and stay active.

The World Health Organization (WHO) recommends that adults, including those with diabetes, engage in at least 150 to 300 minutes of moderate-intensity aerobic physical activity or at least 75 to 150 minutes of vigorous-intensity aerobic physical activity throughout the week. Additionally, muscle-strengthening activities on two or more days a week are advised. But in winters, going out for a walk can be challenging, so diabetics should be advised to do indoor exercise routines to keep the blood sugars under control.

Walking or Marching in Place: A simple and effective cardiovascular exercise that can be done indoors
Bodyweight Exercises: Include activities like squats, lunges, and push-ups to build strength

Pilates: Beneficial for flexibility, balance, and stress management
Resistance Band Workouts: Use resistance bands for strength training exercises targeting different muscle groups

Chair Exercises: Especially helpful for individuals with limited mobility, offering a range of seated exercises
Cycling on a Stationary Bike: Provides a low-impact cardiovascular workout

Foot Care

Caring of feet is very important in winters, as most of the patients with uncontrolled blood sugars have diabetic neuropathy which can lead to decreased sensation, numbness and cold feet. Always clean the feet with lukewarm water, inspecting the feet carefully every day. Diabetics tend to heat their feet quite often without sensing the heat burns because of radiators, hot water bottles, and locally used Kangri.

Injuries to the foot because of inappropriate footwear which can lead to ulcers in the foot. Dampness of the inter digits there are more chances of fungal infections of feet which can further deteriorate the blood sugar control. Cold temperatures can lead to frostbite of foot, non-healing ulcers which if not treated properly can end up in amputations. To prevent all the said complications of diabetic neuropathy
foot care is very important in winters. Keep feet clean and dry, cold weather can cause moisture to collect between toes.

This can cause fungal infection to grow in between the toes. Cold weather can lead to decrease in functioning of the glands and can cause skin breakdown, exposing skin to infection. Wearing of tight socks in the winter seasons can lead to decrease in the blood supply, leading to gangrene of foot which can lead to amputation. Toe nails should be trimmed short to prevent ulcers and toe nail abscesses. Choose the right footwear with padded soles to prevent injuries to the feet.

Winters and depression

As the days are shorter, we experience less sun, accompanied by increased stress and tiredness which leads to physical challenges in diabetics. Indoor sun exposure should be advocated. Vitamin D supplementation should also be given to decrease these symptoms

Important take away messages

● Insulin is a protein that degrades at extreme cold. If you see that your blood sugars are not controlled by the same dose of insulin which you are taking. Change the insulin vial and have proper monitoring for a day, if it is still high visit the treating doctor. Don’t not freeze the insulin vials as it can decrease the efficacy of the drug. Always visit your doctor if you see deranged blood sugars, for an appropriate drug regime.

● Decrease your salt intake in your diet as there is always a risk of accelerated hypertension in winters.

● Always warm your hands before doing blood sugars, cold fingers and decreased blood flow, can be painful.

● Do exercise indoors.

● Cardiovascular disease with diabetes, it increases the risk of heart attacks so be vigilant about any symptoms related to the same

● Avoid going outdoors before 10 am and after 6 PM as there is a further dip temperature as it increases the chances of cardiovascular events.

● Always keep additional stores of medications in winter seasons.

● Influenza, Covid, Pneumococcal, Diphtheria tetanus pertussis (Tdap), hepatitis B vaccination should be given to all diabetics.

BY DR. MOHAMMAD HAYAT BHAT DR NAIRA TABAN

Dr. Mohammad Hayat Bhat, Dr Naira Taban, Department of Endocrinology, Government Medical college, Shereen Bagh