Staying Healthy and Fit

Bethany Doak, RN, CDCES

As the weather warms up, many of us spend more time outside—at ballgames, picnics, visits to the park, gardening, and/or doing yardwork. Time outdoors can boost our moods and inspire us to move our bodies more and, therefore, improve our blood sugar levels; however, those of us with diabetes should also keep in mind a few extra things that can impact our health.

1.        Hydration—Most of us know that we need to replenish fluids more when we spend more time outdoors, especially if we are sweating and moving our bodies more.

·      Keep those fluids handy!

·      Remember that high blood sugars can also cause dehydration, so when you choose fluids, try to choose options without added sugar, unless you are trying to treat a low blood sugar and/or if you are needing extra calories during activity/exercise or for other reasons.

·      Pay attention to your blood sugar levels and keep available treatment handy to respond if needed.

·      Fluids that contain additional electrolytes, such as sports drinks, can be helpful if you are active/sweating a lot, but be aware of added sugars and how these may affect your blood sugar levels. Many electrolyte drinks are available in low- or zero-sugar options. Talk with your doctor about these if you have kidney disease and/or hypertension.

·      Call 9-1-1 for emergency help immediately if you:

·  Feel very weak, like you cannot stand; if skin is cool/clammy and/or blue/gray-colored

·  Have severe abdominal pain

·  Have Chest Pain or trouble breathing

·  Pass out

2.      Skin protection – did you know that your skin is your first line of defense against illness? We normally think of washing our hands to protect ourselves from germs, but we also need to protect our skin from sunburns and insect bites as we go outside, which can wreak havoc on blood sugar levels.

·      Choose broad-spectrum sunscreen that has at least SPF-30 and apply to all sun-exposed skin (including your ears!) and consider wearing clothing with tightly-woven fabric that covers your skin. Reapply sunscreen every 3-4 hours or more often as needed, depending on type of activity, etc.

·      If temperatures rise and you intend on yardwork, fishing, exercising, and/or spending extended time outside, consider wearing a water-friendly long-sleeved fabric with an SPF rating that stays wet for a long time and can help your body stay cool.  

·      A brimmed hat or an umbrella can also help to shade your face and scalp from the sun’s rays, as well.

·      A thin layer of insect repellant on exposed skin and/or clothing can help to reduce your chance of insect bites when you are outside. Avoid inhalation, as well as contact with eyes, mouth, or genitals by washing palms of hands after applying repellant. No need to reapply.

·      Check your skin and/or have someone help to check you for bites/insects—especially groin, armpits, etc. immediately after you spend time outdoors, especially if you are in an area known to have insects, such as ticks/chiggers, etc., and remove any insects that may be found.

·      Discuss any concerns with your HealthCare Provider (HCP) regarding: sunburns, insect bites, blood sugar levels, etc. Remember that stress tends to increase blood sugar levels and higher blood sugar levels can make it harder for your body to heal well. Notify HCP promptly if you experience pain, swelling, redness, fever and/or any signs of infection and seek appropriate treatment.

3.        Foot care/protection – be sure to protect your precious feet by ALWAYS wearing shoes!

·      NEVER GO BAREFOOT—especially outside!

·      People with diabetes sometimes develop a complication called peripheral neuropathy, which commonly results in numbness/pain/burning in the feet. An injury to the foot can occur sometimes without notice and can progress to a much more serious problem if not treated quickly—especially if blood sugars are too high. Remember, bacteria like sugar!

·      If you have diabetes and you are not checking your feet daily—start! Check all over your feet everyday so that you will notice any problems or concerns that you should discuss with your HCP, including cuts, blisters, sores, callouses, warts, etc.!

·      Wear quality, protective footwear that has good support and is fitted to your foot and allows room for your foot to swell slightly without rubbing or causing irritation.

·      Talk with your doctor about whether you would qualify for special “diabetic shoes,” made especially for you.

·      Along with your shoes, choose stretchy, breathable, moisture-wicking socks (there are specific socks made for people with diabetes) to prevent blisters/irritation--especially if you are walking quite a bit.

·      Avoid using over-the-counter treatments for corns or callouses, and discuss these or any concerns with your HCP. Trim toenails straight across to help avoid ingrown toenails.

·      Be sure to talk with your HCP about your feet and ask them to check your feet at each visit for any problems/concerns and/or to screen for neuropathy and to learn more about taking care of your feet.

4.        Sunglasses/Eye protection – Help protect your eyes from bright ulraviolet rays by wearing sunglasses and/or transition lenses when you are outside and/or driving. This is especially important in very bright environments, such as near a body of water when the sunlight is reflecting off the water.

5.      Medication considerations –

·      Many people with diabetes notice a change in their blood sugar levels and/or medications—especially insulin doses—when the seasons change. If you are more active, your body is likely using insulin better than usual and your blood sugars may tend to run lower. If you take insulin and/or other medication for your diabetes, discuss concerns about your doses and/or patterns of high or low blood sugars that you notice with your HCP for possible adjustment.

·      Are your medications safe in the heat? Do you need to bring your medications along with you on a trip or for a full day outside? Consider what medication(s) you may need while you are outside and whether those need to be stored in a cooler bag or box, such as insulin.

·      For those who take insulin: Unopened insulin pens or vials need to be refrigerated; but, once opened, many insulins can last about a month if stored at room temperature. The June sunshine or a hot car won’t be cool enough to store your insulin for very long if you want it to work the way it’s supposed to. If you feel too hot, chances are that your insulin is too hot and it can go bad and not be effective to keep your blood sugars safe. Consider a cooler bag/pouch or box if you’ll be in the heat for more than an hour.

·      If you use an insulin pump, you may have to fill a new cartridge or reservoir with fresh insulin if your insulin gets too hot after a long day outside. If your blood sugars are trending high and not responding to your insulin, consider that your insulin might have gone bad. If it’s just a short time, consider where you store your pump—keep shaded—and try to take breaks frequently to cool off both you and your insulin if possible.

·      If you are going on a trip, bring extra back-up supplies and medications and store these in a cool environment just in case!

·      Consider whether any of your medications or treatments for other health conditions cause photosensitivity as a side effect. If so, you will need to take extra care to avoid or reduce sun exposure to help prevent medication reactions/skin irritation.

CGM Adhesive Issues and Product Review:

Do you wear a Continuous Glucose Monitor (CGM), such as a Freestyle Libre3 or Dexcom G7? These devices have become increasingly common and have dramatically improved life with diabetes, enhancing safety by providing alerts for low or high blood sugar levels and real-time information about the changes in our glucose levels throughout the day. Unfortunately, many people experience problems with keeping sensors in place from time to time—especially in these warmer months when we tend to move and sweat more.   

What can we do?

·      Consider skin condition, skin prep, and presence of hair. Is there a lot of hair on your arm or in the site you are choosing to place your sensor? If so, you may need to shave the hair to make for a smoother spot. Antibacterial soap and water is best to cleanse skin! Avoid moisturizing soaps, which increase the oiliness on skin and make sensors harder to stick. Alcohol swabs are not needed if skin has been cleansed thoroughly with antibacterial soap and water. Let skin dry thoroughly prior to inserting sensor.

·      Consider additional products, such as Skin Tac wipes, after cleansing skin prior to sensor insertion that might help improve adhesiveness.

·      If you don’t already, try using additional tape to secure your sensor. Dexcom G7 sensors come with an overpatch tape that you can use with each new sensor and other brands also have tapes/recommendations that can be used to help their sensor stay in place. You may also choose to purchase an overpatch tape that you find on your own.

·      Example Product: KT-Tape is a brand of athletic kinesiology tape used to aid in a variety of athletic injuries and is sold at athletic/department stores and can be cut into patches to fit your need. This tape is flexible and works well with both movement and sweating.

o   KT Tape has also come out with CGM Patches (pictured below) that is sold at many local pharmacies (including Walmart) in the diabetes section:

·      If your sensor does not last for the expected duration, contact your CGM company to report your issue and to request a replacement sensor, if possible.

·      If you tend to have problems with removing your sensor, rather than with keeping it on, consider using baby oil or adhesive-remover wipes to help loosen the sensor backing prior to removing it so that your skin will not tear or become injured.  

·      Contact your HCP about other concerns regarding skin irritation or sensor issues, such as allergic reactions, itchy, red skin, or signs of possible infection.