#505 Diabetes Variables: Temperature

July 12, 2021Scott Benner

Diabetes Variables: Temperature

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

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Scott Benner 0:00
Hello friends, and welcome to Episode 505 of the Juicebox Podcast.

Today I'm bringing you the second in our diabetes variable series. Today's topic is temperature. Don't forget while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. Obviously today Jenny Smith will be with me Don't forget that Jenny Smith has had Type One Diabetes for 33 years. She holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitors. Besides that, she's Jenny. So if you don't know what that means, you got to go check out the pro tip series, the defining diabetes episodes and get yourself a good dose of Jenny Smith.

This episode of The Juicebox Podcast is brought to you by touched by type one. To learn more about them go to touched by type one.org or find them on Facebook and Instagram. Touched by type one started as a community fundraiser organized by a middle school student in a small group of her trusted advisors. It has blossomed into an impactful and well respected nonprofit organization, spreading awareness about type one diabetes. Seriously, they do amazing work. Check them out at touched by type one.org. It's the number one touched by type one.org. Their founder Elizabeth is featured in Episode 454 of the Juicebox Podcast. If you haven't heard it, check it out. Okay, here comes Jenny, and our second diabetes variable. Jenny, we've been just started with the variables. And like I said, we've got this list of like 150 different variables that listeners brought up that impact their blood sugar. So today, I was hoping to talk about the temperature meaning like your body temperature, the outside temperature, I guess times of year fits in there. I have to admit, I don't know that I see it that often. I can remember Arden playing softball in like high heat situations. But she was so active that her blood sugar's were always pretty stable. But I do have to admit, I guess after those softball games, she was more her blood sugar tended to rise afterwards. But I never associated that with temperature. I always associated that with shoes playing playing was holding her pretty stable, almost acting as extra basil and she was eating throughout the day too. So I always thought that that eventually that that drift up might have been from the food that happened in betray games and stuff like that. But what do people I mean, I guess we should just start with you Like, you live in a pretty interesting part of the country where the temperature fluctuates, do you see differences with your blood sugar's cold, the hot

Jennifer Smith, CDE 3:41
not for short durations of time? No. And I think this kind of crosses over into the majority of people, if you're going to see something, it's more the length of time you spend in a particular temperature that's kind of out of the normal like comfort level zone, right? Of what I would just say is like room temperature, let's say, you know, the extremes in winter, winter can get cold where I live,

Unknown Speaker 4:07
but and

Jennifer Smith, CDE 4:10
if I'm outside in the cold, I've got loads of clothes on, I'm usually moving, I might be pulling a sled or shoveling or something like that. And so the cold in and of itself isn't my concern. And it doesn't seem to be what the impact on my blood sugar is. It's more the movement in that extreme right. And the fact that I've probably got many more layers on than I would in spring or summer, even fall. And I think with that if there is a temperature consideration, maybe it's just that I'm warmer and moving, and I've kind of metabolically kicked up, then you know what I need? I see lower blood sugars, essentially.

Scott Benner 4:51
Let me break this down for a second. So let's start with something unnatural. What if I just lowered your blood your whole body type What if I just made you 50 degrees? Would your blood sugar move? Like, I know that that's not what like natural life is. But so because I want to work off of that idea, because what I'm feeling like is that people probably think, oh, cold weather makes me low. But they're really going outside in the cold and then being more active and not recognizing it, like so. So at its core, does just the temperature lowering change?

Jennifer Smith, CDE 5:26
Well, it could a could for me, I've not noticed that in particular, I mean, my, my temperature overall, runs lower Anyway, my normal core body temperature is not 98.6. I mean, that's just an average standard that's been given out, I run in the 97. That's my normal kind of temperature. So I would say just knowing physiology, that if your temperature core temperature had dropped, then metabolically, your body is actually working harder to keep you warm, which I would expect then that metabolically burning heavier, you're going to use insulin better, you are going to have a drop in your blood sugar.

Scott Benner 6:13
Okay, so whether you see that happening to you or not, it's still a variable that could impact you. That's a good so like, you could start shivering and your body starts trying to keep you warm, and that uses up resources. And some of those resources are glucose in your blood. Right? Interesting. But isn't it funny how, like one thing we talked about this a lot, but you see one thing? You think, oh, the cold weather makes me low? And I guess it could but then you're like, well, what if I put on a big heavy coat and I'm not really cold? And I'm still getting low? Maybe that's because I'm outside frolicking about fairness. You live in United States, Canada, so?

Jennifer Smith, CDE 6:52
Not really. But

Scott Benner 6:53
it's pretty normal. Yeah. And there's there's a north. Yeah. But being serious the place where you live? Like you you involve yourself in outdoor activities in the cold. Correct, right. So if so I could go skiing and some and somehow misinterpret the skiing impact for the coat legs, it could get confusing, but still, on a metabolic level, there is a possibility there that that would happen there

Jennifer Smith, CDE 7:22
is and I think you bring in another variable that we'll talk about, which is altitude when you talk about skiing. Yeah, that's another piece. A different episode. We'll get there. Yes. But on the opposite of cold, though, is hot.

Scott Benner 7:37
Okay, so what happens when I get hot my blood vessels.

Jennifer Smith, CDE 7:41
So you you're like your blood vessels are the little capillaries, they kind of get closer to the surface of the skin to allow cooling of the body to again, keep your core temperature kind of around that 98.6 where it's meant to be right. So the more cooling effect that you get. And also Where is your insulin being infused and or even injected, it's being infused or injected into that like sub q layer, right. And as the vessels get closer to the surface of the skin, the body works harder to cool itself off. Potentially, you could have more circulation around that area of insulin infusion or absorption. And so that could increase the rate of the insulin working. I know myself for hours outside in the warmer temperature. We lived for a short time after we got married in Orlando. And it was for about a year. And there's no real weather change down there. I mean, people think that it gets cold in the winter, and they bring out their like fur lined parkas, and I was outside and a T shirt and like shorts, and I was like you people are kind of funny. But it is just what you know, it's the extremes. I mean, it is what it is. It's just the norm. But Florida is pretty like it's just warm. I think of it as warm, right? And so the year that we were there, the time period outside, when it was really hot in the summer. I know that I needed less insulin, if I was going to spend time out. I mean, we had passes for Disney. So I would take less basil on the days that we would go walk around at the parks. Some of it I know was the heat and some of it I know was the heat and the movement that was consistent in that type of day.

Scott Benner 9:28
Okay. Did humidity make a difference?

Jennifer Smith, CDE 9:32
humidity seemed to make a difference. Yes. The more humid it was, again, the more your body is trying to cool off and so that like the stickier you're going to be, and along with that temperature and humidity then comes hydration. Okay, are you taking in enough fluid, you know, if you're dehydrated, you may actually see blood sugars that go up, which would be kind of counter to what you would think would be happening if you're well hydrated, then likely you're responding more appropriately to blood sugars, your CGM works better, etc.

Scott Benner 10:06
So if it's hot out, I might see an advanced use of the insulin. And so might work more efficiently. Correct more so than I normally say. But if it's hot out and I get dehydrated, those two things could conflict with each other. Yes. And the dehydration might went out over the. That's enough. Yeah, right. So again, it's what we're saying is that there are things hat variables that happen, that are hard to see in the moment, because you see the big stuff go, it's hot outside, my blood sugar went down, and then somebody else will come along and say, oh, when it's hot outside, my blood sugar goes up. But they also don't say I only drink 16 ounces of water every day. They're missing that piece when they that's what's interesting about online, it's funny not to get too far into this. But you and I were just talking about this privately about something else that the ability to explain the entire scenario. Not everyone has that. So sometimes they just come in with a piece of the puzzle, which then makes it more anecdotal. But then right, you hear four or five people say something like that, and it feels like a rule all of a sudden, right? Yeah. So there are, and by the way, 150 other variables on this list, it could be hot out, you could be dehydrated, while you're going for a walk or on an airplane, or like, you know, like, there's

Jennifer Smith, CDE 11:23
no, that's the variables overlap each other, right? You're not just going to experience one variable in a setting of a day and be like, yep, it was that it was the temperature, right? Totally know.

Scott Benner 11:36
That, and that's why people make the I know this is gonna, cause colloquially, this makes sense. But when people say something like I can do the I can eat the same thing one day, and then the same thing the next day and something completely different happens. Diabetes is so unknowable, except there are other things happening that I guarantee you're not thinking over. See. Okay, did we cover that?

Jennifer Smith, CDE 11:58
I think so. Yes.

Scott Benner 11:59
Nice. We're getting very good at this. Thank you so much, to touched by type one, for sponsoring this episode. Of course, check them out on Facebook, Instagram, and it touched by type one.org. And Jenny Smith, Jenny is I mean, she's the best, it's obvious, right? But she also works for a place called integrated diabetes Comm. So if you ever wanted her input, what she does for a living, go find Jennifer Smith at integrated diabetes.com. Thank you so much for listening. I hope you're enjoying the new variable series. We're going to put a couple of them out in a row here. So look up for another one. There might actually be an episode every day this week. I got to catch up a little bit. If you're not subscribed in a podcast app, this is a terrific reason to be.