by Charles E. Leonard and Sean Johnson, Yale Climate Connections
June 2, 2026
Extreme heat makes it harder to manage diabetes – yet millions of people with the disease can’t afford to run air conditioning during dangerous heat waves. A federal proposal to increase cooling assistance has been introduced in the U.S. Congress, but it hasn’t moved out of committee, leaving states scrambling to keep their residents safe as summer weather arrives.
How heat waves affect people with diabetes
Hot weather can be uncomfortable for anyone, but it poses special risks for people managing diabetes.
Dehydration concentrates blood sugar, while heat stress makes insulin less effective. At the same time, high temperatures can also increase the risk of low blood sugar when people eat less, absorb insulin more quickly, or alter their daily routines.
Together, these changes can destabilize glucose control and increase the risk of serious complications that can land people in the emergency room.
Health care workers often advise patients to stay indoors in air-conditioned spaces, protect temperature-sensitive diabetes medications, stay hydrated, and limit exertion. But that works only when people can afford to do so.
The patients whom one of us (Sean Johnson) treats describe heat waves as a cascade of trade-offs. Many of them walk or wait at a bus stop to obtain medical supplies, and extreme heat can be nearly impossible to endure. They also worry about whether insulin can be stored safely in an overheated residence.
Many report more erratic glucose readings, sometimes stubbornly high despite higher doses, other times suddenly low when appetite changes. For patients using continuous glucose monitors, heavy sweating can also mean sensors will not stay on, increasing the chance that rapid sugar changes go unnoticed.
These obstacles are a hallmark of cooling poverty, a form of energy insecurity in which households can’t reliably maintain safe indoor temperatures because cooling is unavailable, unaffordable, or constrained by housing conditions.
When cooling poverty intersects with diabetes, risks compound. Each small adaptation to heat and energy scarcity carries consequences to the body that accumulate over time.
Federal assistance on shaky ground
The Heating and Cooling Relief Act, introduced last year by Rep. Yassamin Ansari, a Democrat from Arizona, would expand and modernize the Low Income Home Energy Assistance Program, or LIHEAP, a federal program that helps people pay their energy bills. The proposed legislation acknowledges that extreme temperatures pose health risks and that energy assistance programs need updating to account for the warming climate.
The bill has not advanced beyond committee, and it faces political headwinds. In April, the Trump administration again proposed eliminating LIHEAP after unsuccessfully attempting to shut down the program in 2025.
In Connecticut, state officials prepared to temporarily backstop energy assistance with state funds at a cost of millions of dollars per month when federal LIHEAP dollars were delayed. The plan reflected an understanding of energy access as a public health necessity. Yet Connecticut’s program remains largely winter-oriented, offering no dedicated, durable support for cooling during increasingly dangerous summer heat.
Pennsylvania has offered limited summer cooling assistance in some years. But those efforts have relied on leftover winter LIHEAP funds, have not covered ongoing electricity bills, and have been canceled when heating demand depleted available dollars.
The case of Florida
In contrast, Florida provides year-round crisis assistance, allowing funds to be allocated to summer needs in advance.
The implications are visible in practice. Florida has consistently served more households through cooling than heating assistance. Stable funding from the state allows administrators to plan for summer demand, staffing, outreach, and enrollment, rather than relying on late emergency responses once heat exposure has already become dangerous.
Analysis: How policy can improve diabetes care
In medicine, prevention matters because crises carry foreseeable and preventable harms. For people with diabetes, access to climate-controlled indoor temperatures is increasingly part of preventing acute complications.
It is not simply an issue of comfort. It is a prerequisite for stable disease management.
From a policy standpoint, LIHEAP funding must be stable and explicitly support cooling assistance. Expanding access to cooling is a public health intervention. Programs that treat cooling as optional or contingent shift predictable harms downstream onto patients, families, carers, hospitals, and state governments through preventable emergencies.
Utility shut-off protections during periods of extreme heat should also account for medical vulnerability, including diabetes. Even brief interruptions can be dangerous for people who rely on refrigerated medications, powered monitoring devices, and stable indoor temperatures to manage disease safely. Connecticut, Pennsylvania, and Florida each recognize this risk in limited ways through medical certification or crisis protections, but safeguards remain uneven and are inconsistently aligned with extreme heat exposure.
Finally, energy assistance must reflect today’s climate, not historical temperature patterns. Winter-centered frameworks no longer capture the full spectrum of health risk. The fact that federal legislation to modernize heat-related protections has been introduced but not advanced underscores how policy has lagged both clinical evidence and climate reality.
Extreme heat will continue to test public health systems. The links between heat exposure, energy insecurity, and diabetes outcomes are no longer speculative. The remaining question is whether energy policy will adapt to that evidence, or whether clinicians will continue advising patients to take protective actions that existing systems make difficult, or impossible, to follow.
Dr. Charles E. Leonard is an associate professor of epidemiology at the University of Pennsylvania and a pharmacoepidemiologist whose research focuses on the safety of medications and the health impacts of environmental exposures.
Dr. Sean M. Johnson is a family medicine physician dual-board certified in family medicine and OMT who is the associate program director for the Mercy Health Fairfield Family Medicine residency program and the program director for the Transitional Year residency program. Dr. Johnson’s professional interests include preventive and lifestyle medicine, well-being, medical education, and global health.
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