Ask D'Mine: Diabetes Coping Strategies for the Holidays

Yep, it’s the most stressful time of the year to be a PWD (person with diabetes). Merry Christmas, and happy assorted cultural and religious holidays, to all!

This week, in a special edition of our weekly Ask D’Mine advice column, we’re addressing what makes the Holidays so hard, and what we PWDs can do about it.

Let me start by saying that when I walked into the grocery store this week for lettuce, carrots, and a sack of those mini-weenies that winter just cries out for, all I found was candy. Candy everywhere. Everywhere candy. At the end of every aisle. In the center of the produce section. In the heart of the bakery. Next to the mops. Even in the cooler section where the yogurt and cottage cheese is kept. Brightly colored bars, bags, and bins of every imaginable candy. Hard candy. Soft candy. Chewy candy… You get my drift.

Carb coping strategies

Americans have a year-round love affair with sweets, but the winter holidays really bring it out like no other time. It seems that every home is full of cookies, fudge, and brownies. Workplace parties are swamped with sweets, and even the tellers at the bank have stupid bowls of candy on their countertops. And, of course, our stores are flooded with excess sweets.

I generally just avoid the carb aisles at the big box store when I shop; there’s no point in tempting myself. But there sure were a lot of snakes in the garden on my last visit, and eventually I was worn down by the barrage of temptation, and a box of those damn white-fudge covered Oreos found its way into my shopping cart. I rationalized it by telling myself that there are only 12 in the box, and that they only sell them at this time of the year, which is lucky for me, as they are as addictive as cocaine.

And while sweets are a major challenge to PWDs at any time of the year, the sheer concentration of them around the winter holidays ups the ante. What are the options? I took a quick poll of my sugar-challenged friends and family, and here are their top mitigation strategies:

• Minimization: One popular approach to surviving the marathon of sweets around the holidays is to eat like a bird. Preferably like a humming bird, a type of sweet-loving creature who takes small sips and then burns off the carbs through frenetic activity. The idea is that getting just a taste helps you feel less deprived. So go for half a piece of candy, a bite of a cookie, a few sips of egg nog—perhaps followed up with an extra few minutes at the gym. The downside of this approach of course is that once you’ve had a taste, there’s substantial risk of triggering a full-blown binge. You really have to know yourself to know if “just a taste” can work for you.

• Diabetes vacation: Some PWDs choose to simply take a break from rigorous diabetes control and enjoy at least a few days of the season hog-wild. Just add insulin. The risks of this are obvious. And this approach to holiday carbs is more realistic for insulin-users than PWDs on other therapies, because you can always increase insulin for increased carbs. Here, at last, is perhaps reason for joy over being insulin-dependent?

• Avoidance: And then there are those who “just say no,” and refuse to change the way they eat during the holidays. While I’m not sure even the best-built bomb shelter would have protected me from those Oreos, battening down the hatches is one way some PWDs deal with the profusion of carbs at the holidays. Of course, it takes an iron will, and can be stressful, which is perfect segue into our next subject…

Offsetting holiday stress

On top of sweets, the holidays often feature large, high-carb meals. And who attends those meals? Family. Including family members who sometimes have… ah… shall we say, strained relationships? Sisters, uncles, grandmothers, in-laws and more who bicker, outright fight and/or complain incessantly. Even in fully functional families—yes, there are such things—the holidays have a way of imposing stresses, especially on the hosts and hostesses, who often operate under cultural expectations of holiday perfection.

Then there’s gift giving. The pressures to find the right thing. The crush of people at the stores. The crashing websites during peak online shopping. And let’s not even get started on the stress of the economic impact of the holidays on a population of people who have substantially less disposable income than other people, thanks to the high out-of-pocket costs of our diabetes.

And of course, for some, the holidays entail travel, with its own set of stresses and sugar-raisers.

Once again, I checked with my D-focus group for their top relaxation techniques:

• Moving the mind to other thoughts: This ranges from taking deep breaths, to hot baths with aroma therapy candles, to meditation or prayer, to disappearing into relaxing music. Many PWDs escape stress by taking their minds to another place. Others, however, prefer to get physical…

• Beat stress with a stick: The opposite technique is a heavy workout to beat stress out of the system. Hitting the gym also has the added benefit of burning off holiday carbs, and getting you out of the house and away from the aforementioned family tensions.

• Booze, or in states where it’s legal for purchase, cannabis: In a practice as old as time, many PWDs take the edge off stress by turning to psychoactive substances. A stiff drink for some, a toke for others, can melt stress as fast as the ice dissolves from your boots in front of the fire in the hearth. Ho-ho-ho, what’s Santa got in that pipe, anyway? Of course, I don’t need to lecture you about the inherent dangers of excessive use of psychoactive substances. But cannabis itself may have some health benefits for diabetes.

And, again, for those on insulin, increasing the basal shot or basal rate for the holidays, while not a cure for stress, is a great option for containing the damage that stress can cause, as stress raises blood sugar. Oh, speaking of increasing your insulin…

Winter and insulin resistance

You might have forgotten, while you lay on the beach all summer, that our bodies become more insulin resistant in the winter, requiring greater levels of basal insulin, and sometimes more aggressive insulin-to-carb ratios—even without all the holiday nonsense. To keep control of your blood sugar, you need to make seasonal adjustments to your meds. Of course, don’t do this in a willy-nilly way, but check in with your care team for advice on the best way to do this for you and your diabetes.

Another winter holiday risk is colds and flus, which tend to raise blood sugar dramatically. Be sure to review your sick day plan before kissing anyone under the mistletoe. Oh, right, and use some lip balm before you do. Winter and higher sugars harken dry skin challenges for PWDs.

Meanwhile, I’m off to the grocery store again. My shopping list includes both a red bell pepper and green bell pepper, just to stay in the holiday spirit without raising my blood sugar—but I know that not far away will be those white cookies.

I’ll be re-reading the points above before I head out, for sure (sigh).

Wil Dubois lives with type 1 diabetes and is the author of five books on the illness, including “Taming The Tiger” and “Beyond Fingersticks.” He spent many years helping treat patients at a rural medical center in New Mexico. An aviation enthusiast, Wil lives in Las Vegas, NM, with his wife and son, and one too many cats.