A safe & enjoyable winter sports holiday

Written by Carolien Koreneff, CDE-RN

When skiing, snowboarding, ice-skating, or engaging in similar winter sports, some of the biggest issues we encounter relate to insulin pumps, blood glucose monitors, and Continuous Glucose Monitors (CGM). These challenges primarily arise due to the temperature and altitude, although the change in physical activity must also be taken into consideration.

Monitoring glucose levels

Skiing is a moderate to vigorous intensity anaerobic activity, typically performed for short-duration intervals. Given the nature of this activity it is recommended glucose levels are monitored more frequently. The general recommendation is glucose levels are check every 2 hours, particularly when on insulin or sulphonylurea medications.

For people using a CGM in such conditions, it is advisable to occasionally cross-verify their blood glucose levels through fingerprick blood glucose monitoring. This helps check accuracy.

Obtaining an adequate blood sample in cold weather can be tricky, so suggest moving inside where it is warmer. A warmer environment will also help the meter to work better, as cold conditions can cause error messages. If the meter has been exposed to cold temperatures, placing it under their armpit for a short period can assist in warming it up.

Additionally, to prevent equipment such as insulin pumps, blood glucose meters, or CGM devices from freezing, it is recommended to store them in an inside pocket as close to the body as possible.

Insulin considerations

If insulin is exposed to extremely cold conditions, it can freeze and become less effective at managing blood glucose levels. For people taking daily or multiple daily injections, their insulin should be ideally stored in a warmer and more stable environment, like their ski lodge. Those on an insulin pump should keep the tubing tucked in and carry a rapid-acting insulin injection pen as back-up. For people using tubeless pumps, freezing is not an issue as their body heat will keep the pump warm enough under their clothing.

Hypoglycaemia

Participating in winter sports elevates the risk of hypoglycaemia due to increased energy requirements for maintaining the body’s core temperature, the physical exertion and potential routine changes. Always recommend they ski with people who know they have diabetes and know what to do in case of a hypo. These individuals will understand occasional breaks might be necessary to manage glucose levels Also, encourage them to check their glucose level prior to getting on a chair lift or commencing an extended run, to prevent mid-activity hypos. Facing a hypo mid-lift can be a terrifying and challenging experience.

Alcohol’s hypoglycaemic effect also needs to be considered. Après-ski is a popular way of extending the enjoyment of the day and an alcoholic drink is often considered an integral part of this social activity. However, drinking should only be done in moderation and insulin doses will need to be adjusted accordingly.

Insulin dose adjustment

Participating in physical activities at high altitudes also results in an increased heart rate. This, in turn, can lead to insulin being absorbed quicker.  A Temp Basal Rate may be required – credentialled diabetes educators (CDE) and endocrinologist as perhaps best equipped to advise on this. Interestingly, snowboarders and cross-country skiers tend to experience greater energy expenditure, necessitating larger insulin reductions during participation in these sports.

Additional recommendations

It is advisable that the person carries a backpack with additional hypo food, snacks and spare equipment such as infusion sets and their blood glucose meter. Given that exhalation and perspiration increase at higher altitudes, additional water is also important to avoid dehydration, which can worsen diabetes management. Additionally, exposure to cold conditions often leads to skin dryness, so moisturising is another good thing to recommend.

For those on continuous subcutaneous insulin infusions having a spare pump is sensible. Accidents can occur, and a fall might potentially damage the pump. They should also take care when positioning the pump to avoid snagging the tubing.

Additionally, recommend they take out travel insurance with extra cover for their pump/CGM.

Lastly, always bear in mind the adage “better safe than sorry.” If you are not a diabetes healthcare professional yourself, recommend that they speak to their endocrinologist or CDE for more in-depth, personalised advice.