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managing diabetes in all seasons: high blood sugar harms 'backbone of your immune system'
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diabetes, like other chronic diseases that impair immunity, calls for vigilance about healthy lifestyle habits. if you stray from these, the long-term impacts of diabetes can happen sooner, like heart disease, vision problems, and nerve and kidney damage.
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people with diabetes typically have a higher rate of infections than people who don’t have diabetes, especially those who are poorly controlled with their diabetes. while this can happen at any time of year, heading into the cold and flu season can put people living with diabetes at risk of serious illness.
dr. alex abitbol,leading endocrinologist
practicing in toronto and oakville, ont.
, has long been interested in the science of diabetes—the ‘why’ behind certain vulnerabilities and outcomes. for a conversation about how seasons can affect diabetes care, his bottom line comes back to maintaining blood sugars in a good range.
diabetes happens when the pancreas no longer produces the insulin hormone as it should, or the body is resistant to insulin, harming the ability to use glucose in the blood as energy. keeping blood sugars from going too high or low takes planning and close attention. it’s key to maintaining health.
“your white blood cell, which is the backbone of your immune system that fights off infection, doesn’t work so well when your sugar gets higher. and so your first line of defence is impaired to a certain extent,” he says.
“blood sugar being elevated and blood flow can also all be impaired as complications of diabetes and can obviously further compound that risk of infection. absolutely, we’re touching on an important point.”
diabetes, like other chronic diseases that impair immunity, calls for vigilance about healthy lifestyle habits. if you stray from these, the long-term impacts of diabetes can happen sooner, like heart disease, vision problems, and nerve and kidney damage.
dr. abitbol talks about habits like activity levels, nutrition and hydration, adherence to medication, vaccinations (flu, rsv, shingles), and being prepared to treat low blood sugar with carry-everywhere glucose tablets or apple juice, for example, or deal with the environmental stresses of travel to a hot, humid climate.
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“hot, more humid weather tends to make it actually very difficult to maintain hydration. so we commonly counsel that if people see high blood sugar, if they’re using insulin, they can take more. if they’re not, it’s both a reflective exercise to try to prevent that from happening again and maintain hydration so that they’re not affected by their high blood sugar.
we recommend that year-round, but certainly in warmer weather.”
dehydration can make it more difficult for your body to absorb insulin and, as the concentration of blood sugar in your system increases because you have less fluid, blood sugar levels increase.
as well, when planning tropical vacations during winter, he says, “the most important recommendation for travel is to consider people on injections, consider people on ozempic, consider people who are on insulin pumps. all of this can fail when you’re away, and it often does, because you’re travelling and you’re not near your pharmacy or near your home,” dr. abitbol cautions.
diabetes makes travel more complicated
“so, it’s really about taking backups so that you don’t have to try to figure out where to get your medicines. if your pump fails, you’re not looking for injections. you already have your backup injections. so it’s more that accident avoidance and being prepared for what you’re not expecting, especially when you’re away from home.”
when winter’s cold settles in, many people naturally stay indoors more. for people living with diabetes, that means more of an effort to get in regular physical activity. exercise lowers blood sugar levels in a good way and protects against heart disease, also improving energy, stability and muscle strength.
“some people walk in malls, some don’t walk at all,” says dr. abitbol. “people who are affected with anything from knee arthritis are probably not doing as much swimming in pools. so unfortunately, we do see a natural rise in sugar, particularly over the holidays, which we do our best to try to combat. but it is a seasonal pattern that’s shared by a lot of canadians.”
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he also talks about allergies that often come in spring and fall when pollen from trees, grasses and weeds is at its highest. while allergies generally don’t cause much disturbance in blood sugar, the medicines that people use for seasonal allergies can affect everything from blood sugar to blood pressure.
“even nasal corticosteroids, essentially like a nasal cortisone, can affect blood sugar, usually in the short-term because they don’t last so long. but if you’re using these regularly because you’ve got a pollen or ragweed allergy, then that could certainly be an important component,” he adds of impacting blood sugar management. he advises consulting your doctor about allergy medication.
behaviour affects blood sugar
“when you’re contending with any kind of chronic disease, it’s less about what you have to watch out for and more about the general education of the patient. the vulnerability to infections, the seasonality of being more sedentary and seeing more flus and colds in colder weather and the preparation for travel that just requires some thinking about what can go wrong when i’m away from home,” he notes of points to discuss with patients. “and worry less about the immediate impact of stress. worry more about your actions that you contend with when you’re dealing with a chronic disease that relies very heavily on your behaviour.”
modifying behaviour takes willingness and buy-in on the part of patients and for health-care providers to meet people where they’re at.
“they come with all kinds of different personalities and all kinds of different willingness, but the fact that they’re usually already referred and willing to come to the appointment means that they’re probably contemplative of some changes. but it is no different than the person who’s trying to quit smoking. some are contemplative. some are in the action phase. some were in the action phase and, you know, they burnt out. they don’t want to manage this anymore.”
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there’s psychology that comes into play, something dr. abitbol finds fascinating and rewarding when someone is motivated and has good outcomes in managing diabetes.
“when you’re dealing with someone’s perceptions, their upbringing, their socioeconomic status, their culture, their livelihood that may tie to whether or not they have private insurance, their understanding of the condition and how much shame and blame they’re actually putting upon themselves really tends to be something that we have to figure out almost immediately with these patients,” he says.
“i can make all the recommendations in the world, but i’m not going to manage their condition as well as if we can actually get at the underlying reason, give them a better understanding of what a carbohydrate means, overcoming sedentary behaviour so that they can see the impact that walking has on their blood sugar. everybody’s different and we meet them at all stages of the disease.”
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