I live in the Washington, DC area, and we've been blasted with two record breaking snow storms this winter: the first just before the Christmas holiday and the second this past weekend.
We're still digging out from this last blizzard, with snow totals topping more than thirty inches in some local areas and temperatures only getting into the 20s. At least the utility gods were with us and restored our power within twenty hours of it going out. But a new storm due mid-week is promising another foot of snow and more cold temperatures.
There'd been a time when I, like my kids, loved a good snow storm. I welcomed the time to shut down, admitting that I was no longer in control of the way the day would unfold or what would be accomplished. Mother Nature took over for me.
Now, as a parent with a child with Type 1, snow days are not as welcome as they once had been. Outings in the snow make me sweat with fear and trepidation. We had a rude awakening shortly after my son had been diagnosed. There had been a snow day, and he'd asked to go sledding with friends at the local school which was about a quarter mile away. I agreed to allow him to go, hoping to keep his involvement in activities as normal as possible. I armed him with lots of snacks to keep his BG levels more constant: trail mix, granola bars and glucose tabs; and tucked his cell phone in his pocket.
Little did we know that outdoor temperatures can have a big impact on blood glucose (BG) levels, typically sending them low -- fast. While outside playing, he was more active than usual. That activity, coupled with the cold temperatures sent his BG levels south faster than either of us expected, and he called me to come home, feeling shaky and low after just a short time out. When he got home, he had a reading of 53.
After asking around and hearing other parents of Type 1 children talk, it is apparently a fairly common occurrence that the combination of cold weather and exercise/play results in low BG levels.
What to do?
As many can attest to, managing Type 1 is just as much art as science. The same applies when it comes to playing outside in the winter and managing BG levels.
To begin with, test before heading out. If the BG levels are below 100, encourage your child to have a snack before going out to play in the white stuff. My son has found that he's most comfortable having a 15 or even 30 gram snack, like a granola bar, South Beach Living Bar, or Glucerna shake, to bring him up over 150. As mentioned above, everyone is different, so your experiences may differ. And, as a reminder, blood glucose levels are typically highest about one to three hours after eating.
Secondly, consider adjusting the insulin dosage to accommodate for the exercise and cold. My son is a pump user, and we've lowered his basal insulin rate before he goes outside. We've also simply unplugged his pump for the short time he is out to reduce the risk of having a hypoglycemic low. Do note that adjusting insulin rates should be tailored to the individual and his or her situation.
Thirdly, make sure to pack some very fast acting glucose to use while out. A good list of items to take includes: glucose tabs, Skittles or jelly beans (carefully counted), small bottles of Gatorade, or juice boxes. Whatever works well to bring your child up fast is ideal to have on hand.
Although it's nice to have your monitor handy during a winter excursion, this can be problematic. Testing while sledding or tubing can be nearly impossible while someone is trying to manage bulky gloves and clothing. Too, the slippery conditions can make it hard to handle the monitor; my son has lost his down the slope of a local sledding hill. Icy cold fingers are tough to get a drop of blood out of to test. When the weather is very cold, it can affect how well the monitor works.
With kids who are old enough to go sledding on their own, make sure that they have a cell phone handy so that they can call you if they need you. Likewise, it's a good idea to ensure that your child has a ‘buddy' or two with him who can recognize the symptoms of a BG low and work with your child to get him the snacks he needs. The buddy system extends to the idea that your child should never be on his own in the cold for very long without telling you, even walking home. It's better safe than sorry.
And, if your child does go low while playing in the cold, take the time out to come in and warm up while indulging a little in the foods that promise a quick rise to those BG levels ... please pass the hot chocolate and cookies!
Published On: February 09, 2010