Warm or cold, winter or summer, outside days are a whole different metabolic experience for kids with diabetes. The bad news is there is no set way of reacting to weather for all kids with diabetes. Some find cold makes them go low; others find blood sugars soar in the frigid air. Some children (many, really) find that heat and humidity seem to mean less and less insulin is needed; a rare few climb high on sticky days. Your challenge is to find out what different weather (and different levels of activity) means to your child. Again, it comes down to gathering data (blood checks), looking for patterns, and figuring out what happens to your child in these situations.

If It's Cold Outside

Winter, particularly frigid winters, can mean big changes for your child and his diabetes. First, there's the inactivity for much of the day. Cold, cold days can mean hours playing video games, reading, or watching television. If your child is relatively active, such a drastic change may cause some higher blood sugars. What's the right reaction?

Simple: Watch carefully for trends. One day of inactivity, if the weather looks better, should not mean a change in an insulin dose or basal rate. Look at it this way: If you change your child's basals or long-acting insulin doses based on one day's information, you'll be changing them every day, a near impossible situation. Rather, on such a quiet day, check a bit more often, and expect to do one or two correction shots or boluses. Remember, as long as you check, you can correct.

Then there is the cold active day. Most parents or caregivers will tell you: There's something about sledding that just drags that blood sugar down. Whether it's the trudging up and down the hill, the surge of endorphins while flying downhill, the cold air, or the drastic change from sitting inside, most parents find that sledding means an extra snack or two.

Your best bet on the first day out is to err on the side of caution. If your child's blood sugars are toward the low side of normal, you may want him to eat a small snack. If, in an hour or so, sledding does drop his blood sugar, he'll be thrilled to take a hot chocolate break without a shot or bolus. In time, the hot chocolate/snack break could become a happy part of your child's winter outdoor play expectations, and you can rest easy with the special snack, knowing the energy burned out in the cold makes it a necessary event. If your child is pumping, read your manual for details on what temperatures are of concern. Then purchase some kind of neoprene fanny pack– type device (available on pump accessory sites) for your child to put his pump into, and then have him place it under at least one layer of clothing. It will stay warm, toasty, and fully functional there, and not get in the way of winter fun.

If It's Hot Outside

And then there is the sweltering heat of summer (or for those who live in the South, most of the year). Families in more seasonal climates find that the change in insulin need from cold to warm can be almost shocking. Perhaps it is the extra activity that keeps children outside more, the longer days that mean they are more active or the effect of heat on the body, or a combination, but summer weather usually means cutbacks in insulin needs.

Your first summer, it's a good idea to be on your toes. Talk to your medical team and see if they want to cut back on a dose or basal rate right from the get-go or if they'd rather wait and see how your child does.

If they choose the latter course, hot weather is a time to make doubly sure you are up to speed on blood sugar readings and have fast-acting snacks within reach. If your child is small, the first days of summer, with you hanging on and watching her every move, won't be a big deal. Just bring a logbook, take extra blood sugar readings, and track how things go. Have this information gathered after a couple of days of summer and call your medical team to discuss any summer dose/basal changes. If your child is older, hanging around with her and gathering information all day might be a problem. Explain that you want her to be able to live her usual summer life with all this new responsibility, but you need to help her figure out how. Remind your child that, like any other responsibility she has in life, readings must be adhered to in order to keep freedom.