Managing type 2 diabetes through a Spokane winter

Every year, between roughly November and March, the average A1c in our diabetes panel rises. It is not dramatic and it is not universal, but it is consistent enough that we now plan for it.

The causes are mostly mundane. It gets dark at four, the Centennial Trail is icy, holiday food arrives in waves, and people who walked 8,000 steps a day in August are doing 2,000 in January. None of this is a moral failing. It is a season, and it can be planned around.

Movement that survives the weather

The single biggest winter change for most patients is the collapse of incidental activity. The answer is rarely a gym membership bought in January and abandoned in February.

What tends to work is finding something indoors that does not depend on motivation: walking laps at NorthTown before the shops open, a stationary bike in front of something you actually want to watch, a standing desk hour at work, or two ten-minute walks instead of one thirty-minute one.

• Ten minutes after each meal does more for post-meal glucose than one long session
• Indoor mall walking is free and the surface is predictable
• Resistance bands at home cover the strength side, which matters for insulin sensitivity
• If the sidewalk is ice, do not be a hero about it. Falls set people back months.

Food, without a lecture

Winter eating in this part of the world is heavier, and telling people to stop is neither realistic nor kind. What helps more is sequencing and portion.

Eating protein and vegetables before the starch on the plate measurably blunts the glucose spike. Keeping the carbohydrate portion to roughly a quarter of the plate does the same. Neither requires giving up anything.

Holiday weeks are worth planning rather than white-knuckling. If you know there is a large meal on Thursday, the question is what the rest of Thursday looks like, not whether to skip the meal.

Vitamin D, sleep and the things that are not food

Spokane gets little usable sun between November and February, and low vitamin D is common here. It is worth checking, and supplementation is cheap where it is low.

Sleep matters more than most people expect. Short sleep raises insulin resistance measurably within days, so a run of five-hour nights will show up in your readings even if nothing else changed.

If your numbers drift in January, the first question is not what you ate. It is how much you moved and how you slept.

Monitoring and when to call

Winter is the season to check more often, not less. If you are taking readings at home, send them through the portal rather than saving them for your next appointment in April. A dose can often be adjusted without you coming in at all.

Call sooner if your fasting readings run consistently above your agreed target for more than a week, if you are having lows, if you develop a foot wound of any kind, or if you catch something and cannot keep fluids down. Illness raises glucose even when you are eating less.

Set the plan in October

We now bring most chronic care patients in during October rather than waiting for the January drift to show up in bloodwork. It is a twenty-minute conversation about what the winter looks like: the schedule, the travel, the walking plan, whether the flu shot is done, and whether the current medication regimen is the right one for a less active three months.

That single appointment does more than any amount of advice given in March, once the number has already moved. If you have diabetes and we have not booked your autumn review, call the front desk.

None of this is medical advice for your particular situation. Bring it to your own provider and make a plan that fits your life.