Why are diabetics at an increased risk of blood sugar fluctuations in winter?

Every year, many people wait for winter as the season brings respite from the sweltering heat, and is all about festive cheer, exuberance, and good food. On the flip side, the cold months can exacerbate health ailments such as cough, cold, flu, digestive issues, and heart disease, among others. But, did you know this season can be particularly concerning for diabetics, too? Today, as we mark World Diabetes Day — which was created in 1991 in response to growing concerns about the escalating health threat posed diabetes — let’s delve deeper into the crucial link between winter season and diabetes, and how people with high blood glucose levels can ensure their well-being in the coming months.
Studies have shown that more cases of diabetes are diagnosed in the winter months as compared to the summer months as patients with diabetes mellitus have higher HbA1c levels during this season, Dr Aishwarya Krishnamurthy, Consultant – Endocrinology and Diabetes, Max Super Speciality Hospital, Vaishali said, explaining that this difference is seen in all sex, race, age, and diabetes severity groups.
A 2014 study, published in the National Library of Medicine, stressed the link between blood glucose control in patients with diabetes mellitus (DM) and the seasons, “with haemoglobin A1c (HbA1c) levels decreasing in the summer or warm season and increasing in the winter or cold season”.

For the unversed, the haemoglobin A1c (HbA1c) test measures the amount of blood sugar (glucose) attached to your haemoglobin that “is the part of your red blood cells that carries oxygen from your lungs to the rest of your body. It is an important blood test that gives a good indication of how well your diabetes is being controlled,” Diabetes.org.uk explained.
So, what possibly explains the rise in HbA1c levels during the winter months? According to Dr Raj Kumar, Consultant, Internal medicine, Indian Spinal Injuries Centre, Delhi, the cold temperature strains the body more than usual, causing it to release stress hormones such as cortisol and adrenaline. “These hormones cause your liver to release more glucose for energy, leading the blood sugar levels to rise,” he explained.
Winter illnesses, too, contribute to increased blood sugar levels (Source: Getty Images/Thinkstock)
The secretion of these stress hormones is also accelerated during any illness or infection, which is common during this season. “Whenever the body faces any infection, there is a release of stress hormones such as adrenaline and cortisol, which reduce the effectiveness of insulin — the hormone responsible for lowering glucose levels. This results in high glucose levels that may be difficult to bring back to normal levels,” Dr Krishnamurthy said.
Agreeing, Priya Bharma, Chief Nutrition, Sri Balaji Action Medical Institute added that being ill makes diabetes more difficult to manage. “You will feel worse and have less energy. To make matters worse, sugar levels often climb much higher in reaction to colds, flu, and viruses,” she said.
But, these stress hormones alone aren’t responsible for increased blood sugar levels in the winter season. Experts highlighted that the changing patterns in diet and physical activity, too, play a major role. “During winters in north India, people tend to consume high-calorie foods like jaggery, sesame seeds etc., as a cultural practice that could worsen glycemic control. There are also several important festivals like Diwali, Dussehra, Lohri, Chrmas and New Year during this period when people consider the consumption of certain specific foods as auspicious. This is also the time when there is excessive pollution and cold which prohibit elders and other vulnerable diabetics from getting regular exercise,” Dr Krishnamurthy said.
Bharma concurred and said there is a tendency to eat more during the winter season because people are more prone to eating ‘comfort foods‘. “Your body may call for more calories to feed itself against the cold. This is a natural response from the body,” she said.
Winter blues, too, contribute to increased woes for diabetes. “People feel low during the winter season because they go out less and prefer to stay indoors. Less outdoor exercise during this season can sometimes cause mood swings or depression, which might raise blood sugar levels in their body,” Dr Kumar said.
What further worsens the situation for diabetics during this season is the difficulty in blood testing. “Diabetics face difficulty in self-testing of blood glucose levels during the cold winter months as their hands feel cold and painful to the testing,” Dr Krishnamurthy said, to which Dr Kumar added, “If your feet do not stay warm in the cold weather, you will experience nerve discomfort and infection. Warm up your hands before taking a blood glucose test. Otherwise, the machine will give erratic results.”

This struggle in getting accurate blood test results in winter months can be a problem as regular monitoring of blood glucose levels is very important for diabetics. “This is particularly true for those taking insulin or those who are at risk for developing dangerously low blood glucose levels. The latter group includes those who are on certain powerful anti-diabetic medications or who suffer from some diabetes-related complications that make them particularly vulnerable to ill effects of low blood glucose levels such as those with chronic kidney failure or heart disease. If the patient is not checking his blood glucose levels, doctors will be unable to adjust his medications to correct his blood glucose levels at the optimal range. Similarly, he will be unable to detect and manage low glucose levels which, if severe and untreated, can result in serious complications like loss of consciousness or seizures,” Dr Krishnamurthy told .
There is a tendency among people to eat more during the winter season (Source: Getty Images/Thinkstock)
As such, what can you do to ensure accurate test results? “If your hands are cold, place them on a heated mug or a heater with a towel or thick clothing over them before performing the test,” Bharma said.
Experts suggested consuming a nutritious diet and exercising regularly to ensure controlled blood sugar levels. “They should consciously avoid eating high-calorie foods despite the cravings, which are quite common in winter. They have to try and adhere to the restrictions advised to them. Conscious effort must be made to indulge in healthy eating practices and healthier substitutes during the festival and holiday seasons like replacing high-calorie sweet dishes with fruit, baked instead or fried snacks and portion control of meals,” Dr Krishnamurthy said.
She added that winter, in India, is usually associated with better availability of fresh vegetables and fruits, which should be consumed in preference. “Hot beverages which can be consumed in weather should preferably be taken without added sugar, or replaced with nutritious soups.”
Highlighting the benefits of exercise for diabetics, Bharma said, “A little exercise every day will improve insulin sensitivity (in all kinds of diabetes), allowing the body to better regulate sugar levels. Keep an eye on your blood sugar levels, especially if you use insulin, in case your insulin needs decrease. Keep in mind that physical activity might have an effect on blood glucose for up to 48 hours.”
If pollution is restricting you from venturing outside, continue physical activities at home. “One can take up yoga, dancing, indoor sports like table tennis or basketball or practice simple exercises at home. Exercising like this will also help keep you warm and help keep the mood uplifted,” the experts suggested.
Some other tips for diabetics to follow this season:
*Take your medications regularly.*Keep your diet balanced and follow restrictions as advised the doctor.*Avoid excessive indulgences associated with the holiday/festive season.*Get timely flu vaccinations and take precautions to avoid common colds and viral infections through proper hand hygiene and masks.*In cold weather, diabetics need to take care of their feet – regularly mourise and examine your feet and avoid keeping them very close to heaters or soaking in boiling water as they can develop burns or ulcers from the same.
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