Winter tips for diabetics

Novo Nordisk South Africa shares five winter tips for diabetics.


Beanies, gloves, boots and jackets. These are the clothing items that help us keep warm during the cold winter months we find ourselves in currently. Coupled with heaters and hot beverages, many of us feel ready to brave the cold and chilly days ahead.

For people living with diabetes, winter is a time of adjustments. This is because during colder months diabetes patients have higher HbA1c levels than over the warmer months.[1]This increase can be attributed to changes in their diet and exercise, and the prevalence of colds and flu[2]. Therefore, people living with diabetes need to be extra vigilant and adjust their management plans during the colder months. Here are some tips and tricks to help you get through winter:

  1. Keep testing your blood sugar levels

Did you know that cold hands can make testing your blood glucose levels difficult? The trick is to try and warm your hands before you do the blood glucose test. Testing regularly will assist with catching any highs, or lows, and keep your sugar levels under control[3].

  1. Keep active even in the cold

Keeping active is important. Even though all you may want to do is stay indoors, under warm blankets and heaps of clothing. Even if the amount of physical exercise decreases, that is okay. As long as you do some form of exercise. It will help keep your blood glucose levels under control and keeps you warm in the process.

You can even start an indoor workout routine if bracing the cold doesn’t sound very appealing. A little activity each day will help with insulin sensitivity (in all types of diabetes) which can help the body to better regulate sugar levels[4].

  1. Watch what you eat

Winter food can be thought of as ‘comfort food’ because our bodies may require extra intakes to defend itself against the cold. So, where possible, stick to your meal plans.

You can also take advantage of diabetes-friendly seasonal fruits and vegetables in moderation, such as citrus fruits, nuts, root vegetables, and varieties of squash. Be careful of the easy and quick meals which only raise blood glucose[5].

  1. Boost your immunity

We know winter is when colds and flu take over and living with a chronic disease means taking even more precautions. Speak to your doctor about whether you should be taking medication in the event that you do get a cold or even about getting the flu vaccination. Bear in mind that when you do catch a cold or the flu, your energy levels decrease and your blood glucose levels could rise in response to the illness[6].

  1. Avoid the winter blues

Cold, unpleasant weather, lack of sunlight and stress in itself can cause blood sugar to rise. This is due to the body tapping into its stored glucose supplies and releasing sugar into the bloodstream – ‘preparing for battle’, i.e. making more sugar available to have the energy to fight whatever is causing you to feel stressed.  This is an example of how emotional and physical health are finely balanced in diabetes. So, it’s crucial to take care of both during winter[7]. It is therefore important to speak to friends and family if you are feeling overwhelmed, anxious or if you think you may be suffering from depression.

All it takes is a bit of extra effort to get through the shorter days and lack of sunlight. Making the necessary adjustments will ensure you are well equipped to make it through this winter.

Article supplied by Novo Nordisk South Africa.


References:

  1. 7 Tips to Keep Blood Sugar Under Control in Winter: https://diabeteshealthpage.com/tips-blood-sugar-control-winter/ Last accessed 08 June 2018
  2. 7 Tips to Keep Blood Sugar Under Control in Winter: https://diabeteshealthpage.com/tips-blood-sugar-control-winter/ Last accessed 08 June 2018
  3. Diabetes and Cold Weather: https://www.diabetes.co.uk/diabetes-and-cold-weather.html Last accessed 11 June 2018
  4. Diabetes and Cold Weather:https://www.diabetes.co.uk/diabetes-and-cold-weather.html Last accessed 11 June 2018
  5. 7 Tips to Keep Blood Sugar Under Control in Winter: https://diabeteshealthpage.com/tips-blood-sugar-control-winter/ Last accessed 11 June 2018
  6. [1]Diabetes and Cold Weather: https://www.diabetes.co.uk/diabetes-and-cold-weather.html Last accessed 11 June 2018
  7. Taking care of your emotional health: https://www.novonordisk.com/patients/diabetes-care/type-2/Living-type-2-diabetes/Emotional-health.html Last accessed 12 June 2018

No chilblains this winter

With winter gracing us with his chilly presence, Anette Thompson speaks about chilblains – what they are and what causes them?

Chilblains are small, itchy, painful bumps on the skin caused from an abnormal response to cold temperatures. They usually go away after a week or two if further exposure to cold is avoided, but can be very dangerous to people living with diabetes.

What are chilblains and what causes them?

Chilblains (also called pernio) are small, itchy, painful, red swellings on the skin caused by an abnormal reaction to cold weather. They most frequently occur on exposed toes, fingers, ears and nose; and are usually red in colour but may change to purple. Other areas of skin can also develop painful and tender chilblains if exposed to cold, e.g. heels, lower legs and thighs.

Chilblains are quite common. Small blood vessels, called capillaries, become narrow (constrict) when the skin becomes cold. In addition, the cooled blood will flow slower. When the skin is re-warmed, there is leakage of fluid from the blood vessels into the tissues. This is thought to cause the inflammation, swelling and itching associated with chilblains.

The speed (rate) of temperature change may play a part. Some people develop chilblains if they warm up cold skin too quickly. For example, with a hot water bottle or by sitting very close to a fire, stove or heater. Natural ways of warming the skin better are with warm water (not hot!), real wool or mohair socks and gloves.

People are more at risk of developing chilblains, if they:

  • have poor circulation and other problems associated with their blood vessels.
  • have a condition called systemic lupus erythematosus (SLE).
  • smoke because nicotine constricts blood vessels.
  • have a family history of chilblains.
  • have frequent exposure to cold, draughty or damp weather.
  • have a poor diet or low body weight.
  • wear shoes that create pressure points, e.g. over a bunion or squeezing the toes so that blood flow is constricted.
  • suffer from Raynaud’s phenomenon – a condition that affects blood circulation to the extremities.
  • take medications that have the side effect of constricting their blood vessels, e.g. beta blockers.
  • suffer from microangiopathy (damage to small blood vessels) e.g. due to diabetic complications.
  • suffer from peripheral neuropathy (unable to feel their feet) e.g. due to diabetic complications.

How do you prevent chilblains?

  • Keep your hands and feet warm when out in cold weather by using warm gloves and socks. Consider special polar gloves and socks, if chilblains are a recurring problem. Look for real wool, angora or mohair socks as their fibres trap more heat than acrylic wool.
  • Keep your head and ears warm by wearing a hat and scarf or a beanie. Remember that 40% of the heat of your body can be lost through the top of your head if it is exposed to cold.
  • You should keep as warm as possible in the cold. Wearing several loose layers is ideal to trap body heat. You should also keep as dry as possible.
  • Insulate your feet and legs by wearing long johns, long boots, tights, leg warmers or long socks. It’s a good idea to wear a clean pair of warm socks if you get cold feet in bed. 
  • If your skin gets cold, it’s important to warm it up gradually. Heating the skin too quickly, for example, by placing your feet in hot water or near a heater, is one of the main causes of chilblains.
  • Side effects from some medicines may narrow (constrict) tiny blood vessels. This may be enough to make you prone to recurring chilblains. For example, beta-blockers can have this effect. Tell your doctor if you become prone to chilblains following starting any medication.
  • Look after your feet, examine them carefully every day, especially if you have diabetes as people with diabetes may not be able to feel their feet and could have infected chilblains without realising it. Moisturise them regularly – this stops them drying out and the skin from cracking.
  • Take steps to improve your circulation; keep active – this helps improve your circulation.
  • Stop smoking – nicotine causes the blood vessels to constrict, which can make chilblains worse.
  • Avoid tight shoes and boots – these can restrict the circulation to your toes and feet.
  • Eat at least one hot meal during the day – this will help warm your whole body, particularly in cold weather.
  • Warm your shoes in front of a heater before you put them on. Make sure damp shoes are completely dry before you wear them; if your feet are already cold, make sure your shoes aren’t too hot. 
  • Warm your hands before going outdoors; place them in warm water (not hot water) for a few minutes and dry thoroughly, and wear cotton-lined waterproof gloves, if necessary. If your hands are already cold, make sure not to warm them up too quickly.
  • Keep your house well heated – try to keep one room in the house warm and avoid drafts.
  • A range of creams and lotions, claiming to be beneficial for chilblains,can be bought from a pharmacy. However, there is no evidence that any of these OTC creams ease chilblains, so therefore not recommended.
  • It may help to use a soothing lotion, such as calamine or witch hazel, to relieve itching.
  • Steroid creams are no longer recommended for the treatment (or prevention) of chilblains as they thin the skin and can be implicated in the breakdown of the skin.
  • Medicines are not usually needed. However, nifedipine can open (dilate) the small blood vessels and may help to treat chilblains, which are not settling within the normal time. Occasionally, it may also be used to prevent chilblains in the winter months in people who have recurring symptoms. A doctor will have to prescribe it.

Complication of chilblains for people living with diabetes

  • Occasionally, the skin breaks down to leave a small ulcer, which is prone to infection.
  • Permanent discolouration of the skin.
  • Scarring of the skin.
  • In some cases, the skin over a chilblain may blister, which may delay healing.
  • It’s important not to scratch the skin as it can break easily and become infected. You can also help reduce your risk of infection by cleaning any breaks in your skin with antiseptic and covering the area with an antiseptic dressing.  The dressing should be changed every day until the skin heals.

 Signs of infection may include:

  • Redness and heat.
  • Swelling and pus forming in the affected area.
  • Feeling generally unwell.
  • Blood glucose levels rise.
  • A high temperature (fever) of 38C (100.4F) or above.
  • Swollen glands.

If the skin does break down and become infected, see your podiatrist or doctor immediately. Diabetic ulcer wound treatment will need to be initiated and antibiotics are likely to be prescribed to treat the infection.

MEET OUR EXPERT - Anette Thompson

Anette Thompson
Anette Thompson (M Tech Podiatry (UJ) B Tech Podiatry (SA)) is the clinical director at Anette Thompson & Associates, Incorporated, a multi podiatrist practice in KwaZulu-Natal. Tel: 031 201 9907. They run a member service for Diabetes SA members at their Musgrave consulting rooms as a service to the community.

Winter Beetroot and Halloumi Caprese Salad

Serves 4

Ingredients

  • 6 large beetroots, cut into thick slices
  • 1 dash olive oil
  • 1 dash salt and milled pepper, to taste
  • 200 g halloumi, sliced
  • 100 g hazelnuts, roughly chopped
  • 2 sprigs rosemary
  • 100 g baby spinach

Dressing

  • 45 ml balsamic vinegar
  • 60 ml olive oil
  • 1 half clove garlic, crushed

METHOD

  1. Preheat oven to 200°C
  2. Toss beetroots on a baking tray with olive oil and seasoning
  3. Roast until tender, about 40 minutes
  4. Toss halloumi with beetroots, hazelnuts and rosemary
  5. Roast for 5 minutes or until cheese is golden
  6. Arrange beetroots and halloumi on a platter
  7. Pile spinach on top
  8. Whisk dressing ingredients together
  9. Drizzle dressing over salad and serve

 


Pick n Pay is committed to promoting health and wellbeing among South Africans, and employs the services of a registered dietitian to provide food and nutrition-related advice to the public. For all your nutrition and health-related queries, email healthhotline@pnp.co.za or call 0800 11 22 88.