The cold winter season is a time that requires extra vigilance for many people with diabetes. As the saying goes, "when the temperature drops, blood glucose rises," and this is not unfounded. In low-temperature environments, sympathetic nervous system activity increases, secretion of hyperglycemic hormones such as adrenaline rises, outdoor activity decreases, and dietary patterns may change — all of these factors can lead to blood glucose fluctuations.

Song Shuhua, associate chief physician and outpatient specialist at Lanzhou Ruijing Diabetes Hospital, points out that blood glucose elevation is often not silent; the body will send warning signals, especially during nighttime rest. If you experience the following three manifestations when sleeping on winter nights, it may be your body alerting you that blood glucose could be elevated or that the condition has worsened!

01

Frequently having nightmares, waking with headache and fatigue

Hint: This may indicate nocturnal hypoglycemia and is a sign of worsening diabetes.

Director Song Shuhua explained that nocturnal hypoglycemia often occurs between 1–3 a.m. and can sometimes be silent; some elderly diabetic patients even experience hypoglycemic coma in their sleep, which, if not detected in time, can have serious consequences. After nocturnal hypoglycemia, the body may activate counterregulatory mechanisms to raise blood glucose, leading to a rebound increase in fasting blood glucose in the early morning; this phenomenon is medically called the "Somogyi effect."

Director Song recommends:

Increase monitoring: Check blood glucose at 2–3 AM and 7–8 AM to understand nighttime glucose patterns.

Pre-sleep snack: If pre-bedtime blood glucose <5.6 mmol/L, consider a small snack, such as drinking 200 mL of milk, or eating 100 g of low-sugar fruit (e.g., strawberries, pomelo), or having 2 sugar-free biscuits.

Adjust regimen: If this occurs frequently, seek medical attention promptly and adjust the pre-sleep medication dose or regimen under physician guidance.

02

Frequent night awakenings, restless sleep

Implication: Elevated blood glucose may indicate early signs of diabetic complications.

First, being awakened by the need to urinate.

Director Song used a vivid metaphor: just as excess salt in pickling radishes draws out water, hyperglycemia reduces the kidney's ability to reabsorb primary urine, producing "osmotic diuresis," which increases nocturia (more than twice per night). At the same time, hyperglycemia raises plasma osmolality, stimulating the thirst center and causing dry mouth and polydipsia.

She specifically warned that if fine bubbles appear in the urine during urination and do not dissipate for a long time (over 10 minutes), diabetic nephropathy should be suspected.

2. Light sleep, easily awakened.

Chronic hyperglycemia can affect the autonomic nervous system, disrupting normal sleep rhythms, leading to reduced sleep quality and easy awakening.

03

Abnormal skin itching, difficulty falling asleep

Indicates: elevated blood glucose, possible microvascular or neuropathic complications.

Dry, itchy skin in winter is common, but it is often relieved after applying moisturizers. Director Song Shuhua emphasizes that if the skin (especially the limbs) is abnormally itchy and routine moisturizing is ineffective, high blood glucose should be suspected.

"Increased blood glucose raises sugar content in skin tissues, which can stimulate nerve endings and directly cause itching," Director Song further explained. "In addition, peripheral neuropathy caused by long-term hyperglycemia can make skin sensations abnormal (such as itching or formication); microvascular disease can affect skin blood supply and nutrition, which can also lead to skin dryness, hyperpigmentation, and itching."

If nighttime skin itching in winter is severe and affects sleep, Director Song recommends:

Test blood glucose immediately.

Check your limbs (especially both feet) for any sensory abnormalities (numbness, pain, reduced temperature sensitivity), or abnormalities in skin color or temperature.

Seek medical attention promptly to screen for complications.

Director Song Shuhua’s “small tips” for stabilizing blood glucose in winter

In addition to being alert for the above nighttime signals, Director Song also brought several practical winter blood-glucose control tips for people with diabetes:

Keep warm appropriately to avoid "stress hyperglycemia": be sure to dress warmly when going out, but take extra care when using hot water bottles or electric blankets, as diabetic neuropathy may cause reduced temperature sensation and increase the risk of burns.

Eat regularly and choose warming foods wisely: appetite may increase in winter, but maintain regular timing and portions. Prefer warming foods such as chicken, beef, pumpkin, and Chinese yam in soups, but include them in daily total calories. Avoid greasy rich broths; opt for clear soups and drink the soup before eating, which helps increase satiety.

Maintain indoor exercise: when cold weather limits outdoor activity, do Tai Chi, yoga, aerobics, or other indoor exercises to ensure at least 150 minutes per week of moderate-intensity activity. Exercise is recommended about one hour after meals.

Monitor blood glucose frequently and stay informed: blood glucose fluctuates more in winter, so increase monitoring frequency, especially fasting, 2-hour postprandial, and bedtime glucose. Keep records to provide to your physician at follow-up.

Protect feet and prevent dryness, prevent infection: wash feet daily with warm water and dry thoroughly, inspect the feet for any lesions. Use moisturizer to hydrate the skin (avoid toe web spaces). Wear loose, soft cotton socks and warm shoes.

Prevent respiratory infections: during the high-incidence flu season, people with diabetes have reduced immunity; vaccination against influenza is recommended, avoid crowded places, and wear a mask when going out.

Final reminder from Director

Winter is a critical period for blood glucose management; people with diabetes must adhere to a regular routine, balanced diet, moderate exercise, standardized medication, and regular monitoring. Seek professional medical help promptly when abnormal signs appear. May every person with diabetes get through winter safely and keep their blood glucose as steady as a mountain!