When the first snowflakes begin to fall and the snow thickens, it is time to start enjoying the winter outdoors. With the right preparation, children and adolescents with diabetes are just as able to romp around in the snow as all the others.  

There is nothing better for children—young or old—than to snowboard, ski or toboggan at high speed down the ski slopes. Even couch potatoes cannot resist the thrill of getting out on a decent hill or mountain with friends, relatives, or in large groups to try it out.

Diabetes is absolutely no reason for anyone not to be able to partake in winter sports. With a little bit of preparation and awareness of the condition, one can enjoy all kinds of winter sport. For those out of practice, i.e., the ones that venture out equipped with ski or snowboard once a year, the following advice applies: Prior to the holiday, do enough ski exercises and fitness training in order to avoid injury. Do not overestimate your own level of skill, don’t go off alone on raw slopes over the other side and, above all, don’t mix skiing with alcohol. These things are well-known traps. They apply to all—with or without diabetes.  

Insulin and sub-zero temperatures
There are certain things, however, that only people with diabetes need to watch out for. A great ski slope can only exist in sub-zero temperatures against which one can protect himself by dressing accordingly. One must also protect insulin from these kinds of temperatures. Once insulin has frozen, it loses its effectiveness, even if it has thawed and looks quite normal. For this reason, insulin pens and pump catheters taken onto the slope must be kept under the clothing and as close to the skin as possible. Remember never to leave the insulin supplies outside in a parked car, only to be left for hours or days in the cold.

Pump-carrying backpackers should ensure that the straps are not pressing down on the catheter tube, possibly blocking the insulin flow. Of course, insulin should not be stored in the back pack itself, but kept in a little bag under the clothing, next to the skin.  

The art of measuring blood sugar in sub-zero temperatures
Sub-zero temperatures also make it exceedingly difficult to carry out self-monitoring of blood sugar. Most manufacturers can only guarantee accurate readings between 10°C and 40°C. Hence, one must check the instructions to see in which temperature range the device works best. In no way will one be able to accurately measure blood sugar at, for instance, -15°C! Even if the device shows a reading, it cannot be taken as a sure indication. A good feel for one’s own physical condition, to signs of hypoglycaemia, and to the proper insulin dosage prior to exertion should make for good protection. Nowadays, in nearly every winter sport region, there are usually possibilities to be able to warm yourself as well as the device to such a degree that an accurate measurement can be taken. In any case, the device and a sufficient number of strips should be taken onto the slopes, as well as dextrose in the form of a lolly or special gel, just in case. 

Adapting the insulin dosage
When children and adolescents spend all day outside on the slopes using up lots of energy, there is less demand for insulin—just like with other sports. There is, however, no universal hard and fast rule here. How many units of insulin, or percentage of basal insulin, should be administered depends on individual fitness levels, the extent of activity and its duration. Being outside in the fresh air is sure to build up a hefty appetite, so most children will eat well. Even so, they will still usually require less insulin than at home or in the classroom. Here, the parents need to fall back on their experience with the child’s usual insulin needs when carrying out sport back at home.

After a strenuous day outside in the cold, followed by a cosy evening back in the hut, most children will tire quickly and fall happily to sleep. Before sleep, however, the blood sugar should always be checked one last time, just to make sure there is no delayed hypoglycaemia. The basal insulin used for the night should also be reduced somewhat according to the day’s activity level. Families of children who have been newly diagnosed, and in which previous experience is lacking, may feel a little intimidated. This being the case, their paediatric diabetologist should be consulted.

Besides, when the snow has fallen and the ground is covered, tobogganning, snowball fights, building snowmen, boarding, skiing and everything else that makes for fun outside should be nothing less than absolute priority for any self-respecting kid. 

Professor Karin Lange
Deputy Editor-in-Chief
Diabetes-Parents-Journal
E-mail: Lange.Karin@MH-Hannover.de