COVID-19: FOR DIABETICS, PRECAUTION AVOIDS COMPLICATION

In America, we’ve been dealing with COVID-19 for a year now. According to the Johns Hopkins University (JHU) timeline, on January 21, 2020, the Centers for Disease Control (CDC) confirmed the first U.S. case, a thirty-something male from Washington state who had returned from Wuhan, China.

On January 12, 2021, JHU reported 4,462 COVID deaths in just one day. Experts attribute the record-high number to pandemic fatigue, people letting down their guard because they are tired of taking precautions. This carelessness is particularly problematic for someone with diabetes.

There are a few types of diabetes mellitus, which the International Diabetes Federation explains as a chronic disease where the pancreas is no longer able to make insulin or when the body cannot make good use of the insulin it produces. They are the following:

  • Type 1, an autoimmune disorder that usually occurs in children and adolescents, although it can develop at any age. In this type, the body produces little or no insulin, and Type 1 diabetics rely on daily insulin injections to control blood glucose levels.
  • Type 2, in which the body does not make good use of the insulin it produces, accounts for ninety percent of cases and is more common in adults. The key treatment is lifestyle-centered – nutrition and exercise – but over time most Type 2 diabetics require oral drugs or insulin to control their diabetes.
  • Gestational diabetes is high blood glucose during pregnancy and presents complications for mother and child. Although it normally ceases after pregnancy, these women and their children face an increased risk of developing Type 2 diabetes.

Among many other underlying medical conditions, like cancer, chronic obstructive pulmonary disease (COPD), and heart conditions, the CDC has determined that Type 2 diabetes creates increased risk of severe illness from COVID-19 in adults of any age. Type 1 diabetics may be at increased risk for severe illness. The CDC defines a severe illness from COVID-19 as “hospitalization, admission to the ICU, intubation or mechanical ventilation, or death.”

The Mayo Clinic reports that a higher proportion of people hospitalized due to COVID-19 have diabetes. They note that diabetic patients are not at a higher risk for contracting COVID, but when they do they experience more severe symptoms – particularly diabetics whose glucose control is sub-optimal.  Type 2 diabetics, as compared with Type 1, frequently have coexisting conditions, like obesity, heart disease, or kidney disease, which increase complications.

The American Diabetes Association (ADA) explains that diabetics are generally more likely to have more severe symptoms and complications when infected with any virus; however, COVID-19 is proving more serious than the seasonal flu in everyone, including diabetics. The ADA reiterates the Mayo Clinic’s observation that ill-managed diabetes worsens outcomes: one, having more than one condition makes it harder for the body to fight an infection; two, viral infections can increase inflammation, or internal swelling in diabetics, which contributes to more severe complications.

A December 2020 Consumer Reports article entitled “Why Diabetes + COVID-19 is So Dangerous” relates that in COVID patients with diabetes doctors have observed an increase in insulin resistance, creating skyrocketing blood glucose levels, as well as cases of first-time ketoacidosis. Ketoacidosis is a diabetes complication that is commonly experienced in Type 1 diabetics. It causes the body to break down fat instead of glucose for energy, resulting in a potentially fatal buildup of acids, called ketones, in the blood. Furthermore, the steroids that physicians sometimes use to treat COVID-19 can cause dangerously high blood sugar levels.

Of late, there is some bright news for diabetics! ScienceDaily reports that a study at the University of Alabama found that use of the diabetes drug metformin before a diagnosis of COVID-19 is associated with a threefold decrease in mortality in COVID-19 patients with Type 2 diabetes. Prior insulin use did not affect mortality risk. Future research will explore how metformin is protective and assess the risks and benefits of metformin treatment.

diaTribe Learn is an on-line publication covering topics relevant to diabetics. In its recent issue, its editors encourage people with diabetes to seek vaccination as soon as possible, stating that both the Pfizer and Moderna vaccines appear to be safe and effective for adults with diabetes, as they have been rigorously tested in adults with chronic health conditions. They urge that, similar to when they get a flu shot, diabetics should monitor their blood sugar levels and have a sick-day management plan ready pre-vaccine in case they experience CDC-reported common side effects, including fever, chills, fatigue, headache, and pain or swelling in the arm where the shot is administered.

diaTribe notes that since researchers don’t know whether vaccinated people may be able to carry the virus and pass it on to others, it will continue to be important even after vaccination to wear a face mask, avoid contact with people not of your household, social distance, wash hands properly, and monitor your health to protect others in the community.

If you are a diabetic, it’s imperative to stay in contact with your health care providers because they are most familiar with your individual circumstances, and they are learning more about COVID-19 every day. Seek medical attention without delay if emergency warning signs for COVID-19, including difficulty breathing or shortness of breath, inability to wake or stay awake, and bluish lips or face develop.

We’re all weary of COVID, diabetic or not, but we have to deal with it. The strategies you employ as a diabetic under all circumstances to stay healthy – appropriate nutrition, weight management, exercise and relaxation, adequate sleep, proper hygiene and infection control, visiting your physician as directed, and adhering to instructions for medication – are ones everyone would benefit from adopting immediately. In our present environment, continue to set your excellent example by adhering to the COVID maxim: wear a mask, social distance, wash your hands. Precaution avoids complication.

Do you need help managing your diabetes?  Our registered dietitian will evaluate your nutritional needs and develop a meal plan that can help enhance health, based on your medical condition, and will take into account your personal preferences as well as any restrictions based on religion or ethics. If you or your loved one has or develops conditions that can complicate current health problems, additional dietary adjustments may be warranted.

Call us at (304) 263-5680 to discuss your needs.

 

 

 

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