Diabetes and Covid-19
People who live with diabetes are used to making multiple decisions per day that may affect their health. They are used to planning in advance for meals, medication, travel and exercise. This hypervigilance will have been good training for the present situation. However, the uncertainty we're living in because of the Covid-19 virus can cause extreme anxiety; and stress is not good for persons living with diabetes.
The best way to reduce this stress is to be prepared. Many people in our community living with diabetes unfortunately do not have a good emergency plan in place. In this and future articles, I will share a few tips to help those living with diabetes and their families prepare.
People who have diabetes are more prone to having have more heart disease, stroke, chronic kidney disease, amputations and blindness. These poor associated outcomes are related to how well an individual has managed their blood sugar over the years.
Healthcare providers are always encouraging people to do their best to have normal blood sugar levels to prevent these long-term complications.
Today, with this novel strain of coronavirus in our community, we're hoping that they are more careful than ever to control their sugars, as people with diabetes seem to be more likely to develop more severe illness when they contract this virus.
Having diabetes doesn't mean you are more likely to catch any virus, but it can mean that your body's ability to cope with an infection is impaired. We don't have data on whether having type 1 or type 2 diabetes is worse if you catch Covid-19, but we do know those who are older and have other conditions such as heart disease and high blood pressure suffer more severe symptoms from the virus. The majority of deaths from Covid-19 have been in people over 60 years old.
If diabetes is well managed, the risk of getting severely sick from Covid-19 is about the same as the general population. High blood sugars (hyperglycaemia) cause generalised inflammation in the body. If your body is already coping with inflammation, it's going to struggle when it encounters another threat and the immune response will not be as good.
This is how chronic hyperglycaemia negatively affects immune function, increasing risk of poor outcomes owing to any infection, and any associated complications. Therefore, people with uncontrolled diabetes are certainly more likely to develop more serious complications of Covid-19.
Those who have developed other diabetes-related health problems are likely to have worse outcomes if they contract Covid-19 than people with diabetes who are otherwise healthy, whichever type of diabetes they have.
How do you avoid getting sick?
Frequently wash your hands.
Cover your coughs or sneezes with a tissue or your arm.
Don't touch your face.
Wear a mask.
The masks that healthcare workers need are N95 or higher spec. This means that 95 per cent of tiny particles, including viruses, are blocked by the mask. You can make your own mask from materials you have at home — a tea towel is apparently very effective — and some protection is better than nothing. Most home-made masks will stop at least 50 per cent of the particles. Remember, it's possible to have the virus and have no symptoms. You are protecting others as well as yourself.
Be prepared — you've got this!
Social isolation and lockdown — preparing for this is where people who have been living with diabetes may be experts already. They have had to be more thoughtful about travel and routine than most of us ever need to:
1, If it has been a while since you have been reviewed by your diabetes team and you haven't been checking your sugars, dig out your meter, start monitoring and give them a call if your readings are high.
2, Stock up on healthy food options — these are the key to avoiding high blood sugars. This means choosing foods that are lower in carbohydrates, especially simple sugars (juice, soft drinks, candies, cakes). If you have problems with blood pressure, try to choose food that is low in salt (sodium), especially if you are eating out of tins.
3, If you are prone to hypos — low blood sugar, hypoglycaemia — have some hard candies or small juice boxes to hand.
4, Make sure you aren't going to run out of your medicines. Look at your medications and make sure you have refills. Call your doctor for your prescriptions to be sent to your pharmacy if you're going to run short. The Bermuda Pharmacy Council has directed that only two months' supply be given at a time to mitigate against hoarding and to prevent challenges later if our geography makes it more difficult to replenish supplies. Many patients have started inquiring about running out of insulin or other diabetes medications and test strips, glucose sensors and pump supplies, should there be a supply-chain interruption. Being on an island, we all understand the logistics of importing goods can lead to delays and we don't want our health to be compromised because we were not prepared. Make sure you don't wait until the last minute to call for your supplies to be replenished.
5, Have emergency contacts on speed dial — friends, family and/or trusted neighbours. This is especially important for those who are living alone.
6, Know your sick day rules.
7, Stay in touch with your healthcare providers. Many are offering virtual/telemedicine visits and can help you to control your blood sugar, blood pressure and any other chronic conditions you may have from the safety of your own home.
8, Try not to catch the virus!
• If you have questions about the coronavirus, call the Bermuda Government Covid-19 helpline at 444-2498, available 9am to 9pm daily. If you are encountering a medical emergency, call 911
• Annabel Fountain, MD, is a Bermudian physician who is board-certified in endocrinology, diabetes and internal medicine. She is the owner and medical director of Fountain Medical Group
Tomorrow: How to manage infection with Covid-19