Extreme heat can make diabetes difficult to manage, but millions of diabetics can’t afford to run their air conditioners during dangerous heat waves. A federal proposal to increase cooling subsidies has been introduced in the U.S. Congress but has not made it out of committee, leaving states scrambling to keep their residents safe as summer weather arrives.
How heatwaves affect people with diabetes
Hot weather can be unpleasant for everyone, but it poses a special risk for people managing diabetes.
Dehydration concentrates blood sugar levels, while heat stress reduces the effectiveness of insulin. At the same time, high temperatures can increase the risk of hypoglycemia if people eat less, absorb insulin more quickly, or change their daily routines.
These changes can destabilize blood sugar control and increase the risk of serious complications that can land you in the emergency room.
Healthcare professionals often advise patients to stay indoors with air conditioning, protect temperature-sensitive diabetes medications, stay hydrated, and limit exercise. But it only works if people can afford to do so.
A patient that one of us (Shaun Johnson) treats describes a heat wave as a series of trade-offs. Many of them walk or wait at bus stops to get medicine, making it nearly impossible to endure the extreme heat. They also worry about whether insulin can be safely stored in overheated housing.
Many people report more erratic blood sugar readings, sometimes staying high despite high doses, and sometimes dropping suddenly when appetite changes. For patients using continuous blood sugar monitors, excessive sweating can deactivate the sensor and increase the likelihood that rapid changes in blood sugar levels will go unnoticed.
These barriers are characteristic of cooling poverty, a form of energy insecurity in which households cannot reliably maintain safe indoor temperatures because air conditioning is unavailable, unaffordable, or constrained by housing circumstances.
The combination of cooling poverty and diabetes further exacerbates the risks. Small adaptations to heat and lack of energy have an effect on the body over time, which accumulates.
Federal support in volatile situations
The Heating and Cooling Relief Act, introduced last year by Rep. Yasamin Ansari, a Democrat from Arizona, would expand and modernize the Low-Income Home Energy Assistance Program (LIHEAP), a federal program that helps people pay their utility bills. The proposed bill acknowledges that extreme temperatures pose health risks and that energy assistance programs need to be updated to account for a warming climate.
The bill has not made it out of committee and faces political headwinds. In April, the Trump administration again proposed eliminating LIHEAP after a failed attempt to shut it down in 2025.
In Connecticut, state officials were preparing to temporarily suspend state-funded energy assistance at a cost of millions of dollars a month when federal LIHEAP dollars were delayed. The plan reflects an understanding of energy access as a public health need. However, Connecticut’s program remains primarily winter-oriented and does not provide dedicated durable support for cooling in the increasingly dangerous summer heat.
Pennsylvania has provided limited summer cooling assistance in recent years. However, these efforts relied on surplus winter LIHEAP funds, which did not cover ongoing electricity costs, and were discontinued when heating demands depleted available funds.
In the case of Florida
In contrast, Florida provides crisis assistance year-round and can allocate funds for summer needs in advance.
The impact is really visible. Florida has consistently served more households with cooling assistance than heating assistance. Steady funding from the state allows administrators to plan for summer demand, staffing, outreach, and enrollment, rather than relying on delayed emergency responses after heat exposure is already dangerous.
Analysis: How policy can improve diabetes care
Prevention is key in medicine because crises result in foreseeable and preventable harm. For people with diabetes, access to climate-controlled indoor temperatures is becoming increasingly important as part of the prevention of acute complications.
It’s not just a matter of comfort. It is a prerequisite for stable disease control.
From a policy perspective, LIHEAP funding should be stable and explicitly support cooling assistance. Expanding access to cooling is a public health intervention. Programs that treat cooling as optional or incidental shift predictable harm downstream to patients, families, caregivers, hospitals, and state governments through preventable emergencies.
Utility shutoff protection during heatwaves must also consider medical vulnerabilities such as diabetes. Even a temporary interruption can be dangerous for people who rely on refrigerated medicines, powered monitoring equipment, and stable indoor temperatures to safely manage their illnesses. Although Connecticut, Pennsylvania, and Florida each recognize this risk in limited ways through physician certification and crisis protection, safety measures remain uneven and inconsistently aligned with extreme heat exposure.
Finally, energy aid must reflect today’s climate, not historical temperature patterns. A winter-centered framework no longer captures the full range of health risks. Although federal legislation to modernize heat-related protections has been introduced, the lack of progress highlights how policy lags behind both clinical evidence and climate reality.
Extreme heat waves will continue to test public health systems. The association between heat exposure, energy anxiety, and diabetes outcomes is no longer speculative. The remaining question is whether energy policy will adapt to that evidence, or whether clinicians will continue to advise patients to take protective measures that are difficult or impossible to follow under existing systems.
Dr. Charles E. Leonard is an associate professor of epidemiology and a pharmacoepidemiologist at the University of Pennsylvania, where his research focuses on drug safety and the health effects of environmental exposures.
Dr. Sean M. Johnson is a family medicine physician board-certified in both family medicine and OMT and is the associate program director of the Mercy Health Fairfield Family Medicine Residency Program and program director of the Transition Year Residency Program. Dr. Johnson’s professional interests include preventive and lifestyle medicine, human services, medical education, and global health.
thisarticleteeth,Yale Climate Connections First published inCreative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
