Monday 27 July 2020

Why is corona virus dangerous for diabetic.

There's a lot of information out right now about the coronavirus. It's safe to say almost everyone in the world is worried about either contracting or spreading the virus. It can be terrifying for an average healthy person. 



But what about those who are high-risk? And the people who get into trouble, namely who need to be hospitalized, some of whom need intensive care, are very heavily weighted towards elderly people and those with underlying conditions like chronic heart disease, chronic lung disease, kidney disease, diabetes. 



But why is diabetes on that list when coronavirus is described as a respiratory illness? The WHO and the CDC put out a blanket statement that people who have diabetes are at a higher risk. That is very scary to people. And I don't know that it fully paints the real picture of what's happening here. Actor Tom Hanks, who has Type2 diabetes, was diagnosed with the virus, bringing even more attention and concern for those living with diabetes as a Type 1 diabetic. I've been sheltering in place, but I'm still anxious as to why I'm at higher risk than everyone else. 



So we wanted to explore why is coronavirus more dangerous for diabetics? Diabetes is a complicated disease. There are different types of and many ways to treat it. In 2019, 463 million adults were living with the disease globally. When someone has diabetes, their body ability to produce insulin is impaired or completely stops. Type 1 diabetics make no insulin at all and need to inject it. Type 1 makes up 10 percent of those who are living with diabetes globally. The more common type is type 2. This could mean the body doesn't insulin properly or make enough. It has many forms of treatment that could include medication, diet, exercise, and many need to start insulin injections. Either form comes with high blood sugar and high blood sugar can make people more susceptible to other illnesses. And this is a big concern with people with diabetes is that people with higher blood sugar levels could be more susceptible to coronavirus. 



Managing diabetes isn't as simple as taking insulin. A lot of other factors come into play. That's probably one of the few topics that make the coronavirus different in people with diabetes. Assuming the immune system is the same. Is that we have to deal with the blood sugars. Many things influence how blood sugar rises and falls. Some are obvious, like the number of carbs digested and correctly dosing insulin to the number of carbs eaten. But there's also exercise, stress. Just sitting out in the sun too long can have dramatic effects. Keeping blood sugars in range reduces the high-risk of contracting coronavirus, but the chance of getting sick is still as likely as the average person. 



We spoke to a type 1 diabetic who was recently diagnosed with the coronavirus. We were told that he started feeling symptoms like slight symptoms Sunday night. I had been at my girlfriend's Sunday and Monday. That's when we saw the 103 fever. And she took me to the doctors where they gave me an antibiotic and antiviral. The next night, my fever had gone up to 103. And by Wednesday morning at 5 or 6, I was 93 and sweating. So we decided to call 911. They took me to the hospital. But because type 1, I think that's why they admitted me to the ICU and tested me. Patrick is a 30-year-old type 1 diabetic with well-controlled blood sugars. We spoke to him five days after testing positive for the coronavirus. Luckily, he is now recovered, but because of his diabetes, he was put in the intensive care unit for two nights. Yesterday was the first day I woke up without a headache and everything. And I pretty much feel the same today. I haven't had a fever. I've been monitoring my temperature. My cough is small. I feel good. The American diabetes association states people with diabetes are not more likely to get COVID-19 than the general population. 




The problem people with diabetes face is primarily a problem of worse outcomes, not a greater chance of contracting the virus. One of the things, particularly very high blood sugar levels suppresses your immune system and makes people more susceptible to infection. And we see this obviously, for example, with wound healing, with diabetes that has gone on for a long time or has high levels of blood sugar. So this is a concern when you have a novel infection like corona, people with diabetes are obviously concerned. Illness is a very common reason for elevated blood sugars. If you're sick with the flu or the coronavirus, the lack of appetite, sleep, and just the stress of sickness make it harder to manage your diabetes. If you have chronically elevated blood sugar levels, let's say over 200. Not just one time. You know, I'm talking about months and months and months. Then your immune system just doesn't work that well. The antibodies that usually attack foreign bodies just don't work as well. And so those folks are more susceptible, but the actual immune system is exactly the same. Type 2 diabetes, there's this kind of chronic pro-inflammatory situation that underlies type 2 diabetes and this kind of chronic low-grade pro-inflammatory state, the patients for type 2 diabetes have ultimately a response to an infection may be somewhat delayed and modified. And that modification is unfavorable, typically with an inadequate immune response to say agents like the COVID-19 virus. 



The coronavirus could also affect the $24 billion insulin market. Before the pandemic sent shockwaves through the economy, millions of diabetics were facing a crisis, the price, and the availability of insulin. The number one concern I hear in the diabetes community, it's actually even beyond an infection is access to insulin. A person with diabetes, type 1 can essentially go just a day or two without insulin at the most. And diabetes was a fatal disease before insulin. The good news is the manufacturer is stating publicly that the supply chain is safe right now. Another part of that is people are insecure about their employment right now and in the United States. If you're under, under or unemployed, you may lose insurance coverage and insulin is too expensive. That's another story that was in the news quite a bit before this happened. But it's still a problem. Because of the high price of insulin in the United States some diabetics have turned to Canada to get it at a lower cost. But now that the border is closed, it creates yet another hurdle for people to find cheaper options. The two biggest manufacturers of insulin, Eli Lilly and Novo Nordisk, both stated that they have policies in place for long term supplies of insulin and plans for those who can't afford it. I mean, we absolutely need to keep our business running for our patients. 



If we were to quit manufacturing products and eat into all the stock that we have and wake up one day with no product in a time of need like this is out there, it would just be horrible. So we feel a very, very important responsibility to do that. Dexcom manufactures continuous glucose monitors that allow users to see their blood sugar 24/7. The company said it had close to 650,000 patients using its CGM at the end of 2019. I don't think there's ever been a more important time for somebody to keep themselves within a very narrow band of glucose control, and the only way to do that is with the sensors. People need this product. So we've kept our manufacturing operations open. At the moment, everything seems to be running smoothly, but the uncertainty about how long this will go on is making lots of diabetics concerned for their future. They're concerned about having diabetes and with the coronavirus situation, being quarantined in-home or at least trying to stay away from everybody, as you know. 



Do you have enough medication? You've got to have insulin. You got to have the pills if you have type 2 diabetes. Pharmacies like Walgreens and CVS remain open and have waived their delivery fees. There are also smaller businesses stepping up to help get medicine to those in need. Here's what 90 days of supplies looks like for me. This will keep me alive for the next three months. Some diabetics live day-to-day and week-to-week on supplies. So it's incredibly important that manufacturers and pharmacies stay open during this time. The biggest takeaway for any diabetic is to do your best to avoid getting sick. 


The American Diabetes Association says diabetics are not more likely to get the virus but will struggle in recovery if they do. If you look at people who die that we've had reports the medical literature from COVID-19 virus at this time. Diabetes did independently standout in one study. It was suggestive. Another study was patients who were older with diabetes who also had coronary heart disease. We are really trying to reassure people with diabetes in a time of incredible fear. You can imagine this is a pandemic like we've never seen before. People with diabetes live with a chronic disease that puts them at risk for complications that can be serious. And what we're trying to do is get information out there. It starts with the fundamentals. 



Stay as healthy as possible. Isolate. Distance. Wash your hands. I live with type 1, as does my brother, taking care of ourselves now is as important as it's ever been. 

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