Your Guide to Summer Safety for Diabetes
Photo: Getty Images/Alex Tihonov
Summertime can be kind to diabetes management. "You're eating lighter, fruits and vegetables are fresher, and you're naturally more active, so blood sugar tends to improve," says Tiffany Soper, FNP, a certified diabetes educator in the Diabetes Self-Management Education and Support Program at Massachusetts General Hospital. But here's the rub: the heat may affect people with diabetes more than those who don't have it. Diabetes complications like nerve damage can impair sweat glands' ability to sweat and keep you cool; high blood sugar and certain medications can make dehydration more likely; and the heat may affect insulin needs. But that doesn't have to stop you from having a summer that's filled with activities you enjoy.
Whether you're going to a local beach, planning a getaway or just spending more time outside in the heat, your diabetes meds and supplies need a little extra TLC.
Keep Your Gear Cool
Extreme temperatures are enemy number one to blood sugar monitors, insulin pumps, and test strips. And insulin and other diabetes medications can degrade when in extreme heat, says Grenye O'Malley, M.D., an assistant professor of medicine, endocrinology, diabetes, and bone disease at the Icahn School of Medicine at Mount Sinai.
Don't store meds or supplies in your car, and keep them out of the direct sun. Stash meds in a cooler; wrap insulin in a towel first so it stays cool but doesn't directly touch ice or gel packs. Or pack meds in a Frio Insulin Cooling Case, which stays temperature-regulated for 45 hours, O'Malley recommends. Don't forget to take the cooler with you when you leave the car!
Carry On Your Supplies
According to the Transportation Security Administration, diabetes supplies, equipment, and medications can be carried on board after they've been screened via X-ray or by hand. It's smart to keep your supplies in your carry-on, in case your checked luggage gets lost. Tell the TSA officer what supplies you have, and separate them from your other belongings for easier screening, the American Diabetes Association suggests.
Bring your Prescriptions
TSA rules don't require you to carry written prescriptions, but O'Malley advises that having this info can make it more likely you'll sail through security without a hitch.
Pack More Than You Need
Bring an extra week's worth of medications and blood sugar testing supplies with you on vacation in case of travel delays or luggage mishaps.
Pictured Recipe: Raspberry Ginger Lime Seltzer
Drinking plenty of fluids keeps your blood sugar levels in check: "If your blood sugar is high, you're urinating more … and then can become dehydrated," says Soper. Stop the spiral before it starts by sipping from a water bottle throughout the day. Unsweetened seltzer water (such as LaCroix or Waterloo) is a good option if you consider plain H2O too boring. (Remember that sports drinks are often packed with as much sugar as soda, so they're not the best choice.) You'll know you're on track if your pee is pale yellow, says Erin Palinski-Wade, RD, CDE, author of 2-Day Diabetes Diet.
Protect Your Skin
Everyone needs to practice good sun protection habits. "The inflammation from sunburn causes pain and stress, which can increase your blood sugar," says O'Malley. What's more, if you have neuropathy, you may not feel the effects of the sun until it's too late. The No. 1 rule of sun protection? Apply a broad-spectrum sunscreen every two hours to exposed skin when you're out in the sun. The American Academy of Dermatology recommends at least SPF 30, but if you're prone to burns or have nerve damage, consider going higher, suggests O'Malley.
If you use insulin, take care to keep your skin cool at your injection site. "Skin that's warm absorbs insulin faster," O'Malley explains. Heat increases blood flow to skin, so injected insulin gets into your circulation faster, rapidly driving glucose into cells. The result: you may experience an unexpected low. If you've been in the sun and now your skin is red and hot, inject into an area of your skin that hasn't been exposed.
How to stay cool and safe from head to toe
Stick With Shades
Buy sunglasses that block 99 or 100 percent of UV light. Wraparound styles are best, as they prevent light from sneaking in the sides, according to the American Academy of Ophthalmology.
Remember The Three L's
Keep clothing loose, lightweight, and light-colored to help avoid overheating, advises the Centers for Disease Control and Prevention.
Protect Your Feet
Flip-flops are easy to slip into, but they also leave your feet vulnerable to cuts and scrapes that can create problems down the road. Wear supportive, enclosed footwear.
Aim to schedule full-sun activities before 10 a.m. or after 2 p.m. to avoid peak rays.
Avoid a Stomach Bug
Cook It Through
Color isn't always the most reliable test for doneness, says Sharon McDonald, M.Ed., RD, LDN, a senior extension educator and food safety specialist at Penn State. Instead, use an instant-read thermometer whenever you are cooking meat. Other thermometers require at least one-third of the stem to be in the food, but an instant-read's sensing area is at the tip, making it the best tool to test thinner foods like hamburgers, adds McDonald. Our pick? The Taylor Digital Instant Read Pocket Thermometer (buy it $12, taylorusa.com). Cook burgers to at least 160°F, chicken to 165°F, and steaks to 145°F. Make sure eggs have yolks and whites that are firm, and check that dairy-containing dishes are made using pasteurized ingredients (most store-bought dairy products are pasteurized).
Mind Your Leftovers
Perishable foods like salads, cheese, meats, and dips should sit at room temperature for no longer than two hours (or one hour on days hotter than 90°F), according to the U.S. Department of Agriculture. Why? Foods that sit out longer may enter the "danger zone" of 40 to 140°F, the window in which bacteria thrive. Throw away any foods that sit out longer than the safe window: while reheating leftovers to at least 165°F will kill any bacteria, it won't remove the byproducts the bacteria create that can also make you sick.
Don't Wait To Eat
A good rule of thumb to stay safe: eat hot foods while they're still hot and cold foods while they're still cold. "The longer something sits at an unsafe temperature, the quicker bacteria in that food grow," says PalinskiWade. If there's any question about when food was put out, politely take a pass.
Pictured Recipe: Grilled Flank Steak with Tomato Salad
Picnics, BBQs, and backyard get-togethers all have one thing in common: a yummy spread of food. These dietitian-approved tips can help you enjoy the eats at any party.
Divide Your Plate
Make a beeline for the veggies and fill half of your plate with vegetables like salad or crudités (there's always a raw vegetable platter, right?). Fill one quarter with protein like grilled chicken, and the last quarter with carbs (corn on the cob, the bun for your burger, or fruit salad), advises Martha McKittrick, RD, a certified diabetes educator in New York City.
Bring The Veggies
Take the opportunity to bring a vegetable side dish you like, so you know you'll have something healthy that you want to eat.
If you know you'll want dessert around the campfire, or a snack while stargazing on the deck—and your meal plan allows for some flexibility—have a lower-carb dinner to save some carbs for late-night munching, says Palinski-Wade.
Pictured Recipe: Peach Sunrise Refresher
If you're having an alcoholic beverage, factor that into your carb count. On average, beer, light beer, wine, and hard liquor have 13, 6, 4, and 0 grams of carbs, respectively, per serving, although the amount of carbs in beer varies by style. Most mixed drinks are packed with sugar, so check the Nutrition Facts label for carb amounts in any mixers.
Remember, imbibing on an empty stomach, drinking in excess, or drinking without having eaten enough carb-containing foods can lead to low blood sugar levels—and the risk can last for 24 hours. Alcohol is also a diuretic, so be sure to drink plenty of water if you choose to imbibe. Mix hard liquor with club soda or dilute wine by making a spritzer (half wine, half flavored seltzer), suggests Palinski-Wade.
Watch out for these common warm-weather missteps, say the experts:
Too Much Watermelon
"I warn patients about watermelon all the time," says O'Malley. "While it's healthy, it also contains a lot of sugar, so you have to eat it in moderation." The standard serving—1 small (1-inch-thick) slice or 1 cup of diced watermelon—has 12 grams of carbs.
"I had one patient who was sailing and kept her insulin in a backpack on the deck in the sun," Soper says. "Her blood sugar was running high and she couldn't figure out why. The next day, she opened a new bottle of insulin and her blood sugar went back to baseline." The lesson: If you and your meds have been out in the sun all day and your numbers are up, consider opening up a new bottle of insulin or changing your infusion set reservoir if you're on an insulin pump.
The Exercise Effect
Movement in every season is key for managing blood sugar (and boosting your mood), so don't hold back! But be aware that being more active than usual may affect your blood sugar. Long backyard play sessions with the kids, Sunday hikes with the family, or days spent at a theme park all result in extra exercise that could make you hungrier and cause low blood sugar, depending on your medications. Prepare by bringing good snack options with you. (See page 86 for ideas.) Hot temps call for an additional layer of caution—be sure to stay hydrated.
If you take diabetes medications, Soper recommends checking your blood sugar before and after activity. This can be a great motivator too! "If you notice that your blood sugar went from 180 to 120 after a 45-minute post-dinner walk, the positive feedback can be really motivating to stay active," she says.
If you take insulin or any medication that might cause hypoglycemia, you're going to want to be prepared by taking your monitor and a source of fast-acting carbs with you, says McKittrick. "If you feel weird—weak, headachy, shaky—check your blood sugar. Symptoms of heat exhaustion and dehydration are similar and can mimic those of low blood sugar," she says. And problems can arise if you treat hypoglycemia when you aren't experiencing a low. If your blood sugar is normal, those symptoms may be a sign that you need to drink water and cool down in a shaded area. But if your blood sugar is low, follow the "15 every 15" rule, McKittrick says. That means eating 15 grams of carbs (fast-acting glucose tabs, four dried apricots, or half of a large banana), then waiting 15 minutes and rechecking.
Not on insulin or insulin secretagogues? You'll still want to tote a healthy snack along for a burst of energy when you need it. If you continue to feel faint or ill after snacking, hydrating, and/or cooling down, seek medical attention.
This story originally appeared in Diabetic Living Summer 2020.