Diabetes Management in Winters

Many viral and bacterial infections are prevalent in winters, hence prompt detection and treatment

Dr Muhammad Ashraf Ganie
Srinagar, Publish Date: Dec 12 2017 10:26PM | Updated Date: Dec 12 2017 10:26PM
Diabetes Management in WintersRepresentational Pic

Background

Diabetes is a metabolic disease characterized by high blood glucose (hyperglycemia) due to insulin (hormone secreted from pancreas that helps in glucose transport from blood circulation in to cells) deficiency in type 1 (T1DM) and insulin resistance (ineffectiveness of insulin) in type 2 diabetes (T2DM). In the long run, both forms are associated with debilitating complications like diabetic kidney disease (nephropathy), eye disease (retinopathy), nerve disease (neuropathy); and macrovascular complications like stroke (paralysis) and coronary artery disease (heart attacks). While in T1DM the treatment consists of daily subcutaneous insulin injections, T2DM is best managed with lifestyle changes in the form of regular physical activity and dietary modification, along with medicines in the form of oral anti-diabetic drugs with or without insulin. Kashmir valley, like other cold regions of the world, faces very harsh winter. Accordingly winter months pose a different set of problems in management and patients and clinicians need to be aware of them. Briefly in winter months people remain largely indoors, are relatively physically inactive, day length is shorter leading to crowding of meals with prolonged night time fast. In this write-up, we discuss these challenges and smart tips for winter care of diabetes.

 

1. Changes in lifestyle

At the heart of management of T2DM are therapeutic lifestyle changes in the form of calorie restriction (less eating), consuming regularly spaced and frequent meals and indulging in regular physical exercises (spending the energy). Patients are unable to engage in outdoor activities like brisk walk, jogging, aerobic exercises etc. Due to inclement weather patients remain indoors for longer periods of time and therefore have tendency to gain weight. This increases body weight and hampers insulin sensitivity further, aggravating blood glucose levels. To avoid these issues, it is advisable to consume a bedtime snack at night, have tea early in the morning and go outdoors for a stroll during afternoons as far as possible. Moreover less physical activity and less sun exposure is associated with higher rates of depression.

2. Variations in blood glucose levels 

During the winter months day-lengths become short, so, meals are less spaced and there is crowding of meals during the days.  Patients generally take dinner early and end of in skipping routinely recommended bedtime snack. This is of particular concern in those patients who are on insulin or glucose lowering treatment since they are predisposed to develop low blood glucose (termed hypoglycemia) during the prolonged night time fast. The low blood glucose in wee hours may lead to morning headaches, night sweats, night terrors, seizures or even coma if not treated in time. On the other hand meal crowding during the day leads to rise of blood glucose levels after lunch and towards the evening.  This may cause panic and care givers may tend to increase the evening dose of insulin or oral tablets (sulphonylureas). Sometimes after night time dip blood glucose may show rebound rise (Somogyi phenomenon) again leading to erroneous tendency to escalate the doses.

 

3. Heart attack/stroke risks

Blood pressure tends to remain higher during winter months. This coupled to the stress of low prevailing temperatures predisposes patients of diabetes to develop myocardial infarction (commonly termed heart attack). Of particular concern is the fact that these infarctions in diabetes can be painless owing to the affection of nerves supplying the heart, so medical attention is often sought late. To circumvent these issues, it is advisable that one must cover self with appropriate winter clothing, keep warm, avoid moving outdoors during early mornings and avoid subjecting self to sudden changes in temperature. Blood pressure is to be monitored regularly and as per physician’s advice, BP lowering medications are to be consumed regularly.

 

4. Risks of diabetic foot and its prevention

 

Diabetic foot care is always important, but winter can make keeping your feet healthy an even bigger challenge, considering the health threats like numbness and decreased circulation, which can be further compromised by wearing tight socks, and the possibility of suffering burns with hot water bottles commonly used to keep oneself warm. Many people with diabetes end up in the hospital because of a foot ulcer or infection, and in some cases these foot problems can lead to amputation. This can be prevented by some simple tips. Anyone with diabetes needs to have a daily protocol for foot inspection. One must look carefully at all the pressure areas of feet and between the toes, inspect for any breaks in the skin, discharge, changes in color, changes in odor, and painful corns or calluses. The choice of footwear has to be proper. Shoes and boots should be chosen so as to provide warmth, protection from snow and ice (to avoid frostbite), and proper padding, and that they should be roomy enough not to constrict blood flow to the feet. Further, feet have to be kept dry. Moisture that collects between the socks and the feet and between toes for too long can invite unwanted bacteria to gather. When feet get wet from being outside or bathing, one must dry them carefully and gently. Use of hot water bottles, kangri (traditional fire-pot), hammam, heaters, blowers etc. need to be USED WITH CAUTION since most diabetics have neuropathy in feet and they are unable judge the temperatures. Patients use hands or take help from Care-givers or family members to check temperatures of water  to avoid burns, given that patients with diabetes tend to have insensate feet first. Also, untrimmed or infected toenails are a frequent cause of infections and ulcers. One must ask his diabetes doctor how to trim toenails correctly. Feet are to be soaked first to soften the nails and then they are to be cut straight across. Tight and nylon socks cause impairment of blood circulation and lead to gangrene. Cotton or woolen socks without elastic bands are preferable. 

5. Infection prevention 

Many viral and bacterial infections are prevalent in winters and hence need prompt detection and treatment. Flu is invariable in winters and the infection tends to elevate blood glucose. Blood glucose in turn predisposes to infection and hence the vicious cycle continues. Therefore vaccinations of Pneumococcus and influenza viruses should be encouraged among diabetics. 

Finally, keeping in view the challenges of winterS both physicians and patients need to gear up and plan the management according to anticipated problems. Besides one must monitor blood glucose regularly, as per doctor’s advice. With frequent monitoring and with these tips of keeping up the diabetes care during winters, one can enjoy the season and remain healthy and hearty!!!!

Mohammad Ashraf Ganie is Professor of Endocrinology SKIMS Srinagar 

 

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