The authors of Seasonal Patterns in Monthly Hemoglobin A1c Values (PDF), published in 2005 in the American Journal of Epidemiology, suggest that there may be a link between cold weather and higher A1c levels. The group studied 272,722 veterans (Veterans Health Administration – VA) with diabetes. The A1c levels of patients in the study were averaged and analyzed by climate and season. The researchers found an independent seasonal pattern associated with colder temperatures. Typically, A1c levels were at their highest between February and April, while these same patients' A1c values were at their lowest from August through September. The average increase in A1c level from summer to winter was 0.22 points. Although the researchers could not say for sure, they speculated that cold weather may increase A1c levels in much the same way that cold weather increases heart rate and blood pressure. In the alternative, the researchers suggested that perhaps many patients who exercise find it hard to keep up with their exercise routine during colder months and are more active during warmer months, thus accounting for the difference in A1c levels. Whether or not you have diabetes, cold weather should not be a deterrent to exercise. A few simple tips can keep you on the right track so that you are consistently and safely exercising, even in cold weather.
As with any exercise program, it is important to have a plan, but more so when extreme temperatures like cold weather hits. The two main things that everyone needs to be concerned about when exercising in cold weather are frostbite and hypothermia. People with diabetes have additional things they need to pay particular attention to, including hypoglycemia, hyperglycemia, properly functioning meters, pumps, insulin, and strips. A couple of tips to keep your cold weather exercise safe and enjoyable are:
Meters – check the temperature range of your particular model. Some perform better in cold temperatures. Store your meter close to the body to use body heat to help keep temperature higher than outside. Prior to performing a blood sugar check, place the meter under your bare arm for 30 seconds to a minute to increase heat around the meter. Keep strips protected and ready to go when performing a blood sugar check. Have enough strips available and plan to perform extra checks especially when first starting to exercise in the cold or when the particular exercise is new.
Checking Blood Sugar – Extreme cold and wind can make it very difficult to check blood sugar. Have your meter, strip, and lancet device ready to go before exposing your finger to the cold. Try to have your finger/hand warm enough prior to using a lancet device. Move your arm in a wide circular motion to promote blood flow to the hand used for checking. Wearing mittens as opposed to gloves can also help. If using gloves, curl the finger inside the glove so it touches the palm several minutes prior to do a finger stick to increase heat to the finger. If it is windy or rainy, use protection by using a tree or yourself as a barrier to the wind/rain to help warm up the strip, prior to trying to get a large drop of blood.
Insulin – keep your insulin close to the body to help prevent it from freezing. If insulin freezes the potency may decrease and that can create problems with higher blood sugar down the line. Place a vial or insulin pen under your arm prior to injecting to increase heat.
Insulin Pump – a pump can help eliminate problems with insulin exposure due to the cartridge being encased within the pump. It is still a good idea to wear the pump next to the skin while covered by clothing and try not to have the infusion set exposed to the weather, if at all possible.
Frostbite – Frostbite often appears in fingers, toes, ear lobes, and the nose causing tissue damage from freezing. Symptoms can range from shivering, local pain, numbness, and swelling to local blisters and blackening of the skin. Other symptoms which may be mistaken for low blood sugar are slurred speech and memory loss. If any of these symptoms appear, you should address a potential low blood sugar first and then a possible frostbite next. Treatment of frostbite consists of getting out of the cold/wind and moving to an area of warmth. It is best to do a slow warming (do not warm by a fire) and do not massage the area where potential frostbite exists. Warming by drinking warm fluids and using warm blankets is best. If hypothermia (abnormally low body temperature, non reacting pupils, blurred vision, slow breathing and heartbeat along with other symptoms mentioned above) is suspected, get to a hospital as soon as possible where treatment can be administered by professionals.
Hypoglycemia – It can be difficult to notice the difference between hypoglycemia and symptoms of a tough workout (i.e., sweating, fatigue, trembling, disorientation, etc.). If your meter does not work and you are experiencing any of these symptoms, treat them as you would for hypoglycemia. It is better to deal with a high blood sugar later on than risk severe hypoglycemia in cold weather.
In summary, cold weather is not a reason to stop exercising but following some safety precautions will make exercise more enjoyable and allow you to maintain a consistent exercise program. Some genreal safety tips are:
- Carrie food that does not freeze in a plastic bag to protect it from the elements (i.e., dried fruit, granola bar). Fresh fruit will tend to freeze.
- Stay well hydrated (i.e., check for clear/pale urine which indicates you are well hydrated). Water is the best for activities under one hour.
- Dress warmly with layers and always wear a hat and mittens/gloves. There are materials (i.e., Under Armour) that are made specifically for protecting the body in cold weather. The "Coldgear" material claims to lock in heat and wick away moisture. Make this your first layer.
It is important to check blood sugar levels often and recognize trending. Following the guidelines mentioned above will allow a safe, consistent exercise program during the cold months and debunk the myth that cold weather will increase your A1c levels.
Rick Philbin, MBA, M.Ed., ATC
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Last Updated: Friday September 07, 2012 11:17:30
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