You’ve read too much already about COVID-19. Me too. Fortunately lots of the information has given us advice, recommendations and ways to stay healthy during this time. Here’s the latest information I received today from JDRF.

One uplifting early finding is that people with well managed diabetes, particularly type 1- because we tend to have less comorbidities than people with type 2, like heart disease and high blood pressure – is that we’re not more susceptible to the virus than someone without diabetes. Yet I’m also reading conflicting opinions about whether if you get it, you’ll have worse outcomes because of your diabetes.

One thing I don’t think I’ve read anywhere is someone with type 1 who got through it and found herself stronger to do so – because of her diabetes, “I had COVID-19 and type 1 diabetes” on diaTribe.

Excerpt:

“I’m sharing my story of coronavirus to suggest to you that maybe diabetes isn’t the weakness we’ve been told it is. Yes, I did get sick from COVID-19, but so did many others without chronic illness. Maybe the burden of dealing with a chronic illness makes us more likely to find ways to fight an infectious disease, and that resilience assists our battle…

Read the full article, and remember, diabetes may just be something that’s made us stronger.

In these days of coronavirus and unemployment Dexcom is launching a patient assistant program. If you’ve lost your job, and therefore lost your health insurance, Dexcom is offering help. The world’s recognized leader in continuous glucose monitoring will make six months of supplies available:

1. Two 90-day supply shipments of CGM supplies including sensors and a transmitter
2. Reduced $45 for 90 day supply

Click here for details and to see if you are eligible Note, if you receive medical coverage under a federal or state government program like Medicare or Medicaid you are not eligible.

Below the results of a survey conducted by DiabetesDaily, one of the longest running and credible news magazines. Interesting snapshot of how 20,000 people living with, or caring for someone who has, diabetes feel right now regards COVID-19.

 

Novo Nordisk announced that people with diabetes using Novo insulins, who have lost health insurance coverage because of a change in job status due to COVID-19, may be eligible for enrollment in their Diabetes Patient Assistance Program (PAP). That would provide insulin free-of-charge for 90 days.

Patients who wish to use this program will only need to provide a notice of insurance termination or a COBRA notification. Novo Nordisk will not require documented proof of income to qualify.

Eligible patients will receive their insulin at no cost for 90 days. Assistance can be extended to the end of 2020 if Medicaid benefits have been denied, and Medicare patients will be enrolled for the rest of 2020.

Find out if you meet eligibility criteria at NovoCare.com or by calling 1-844-668-6463.

 

I wrote on ThriveGlobal what it’s been like to live where I live, New York City. We are the epicenter of the coronavirus.

Today’s briefing by New York Governor Andrew Cuomo, told us the number of deaths in NY state is over 10,000. The good news is hospitalizations are lessening. The bad news is frankly incalculable, and there may be a second, and even third, wave.

My husband and I have been “sheltering in place” or “on pause” as Cuomo calls it for four weeks. We began March 12 when we learned someone in our small building had the virus.

Just the night before my husband, who is Dutch, suggested, “Maybe we should leave for Holland. I think we’ll be safer there.” I couldn’t imagine what was coming. I couldn’t imagine packing, getting on a flight, leaving my 90-year-old mother – so here we are. Here, in the epicenter of the storm…

Full article here.

Anne L. Peters, MD, is one of our favorite docs in diabetes and with good reason. She’s smart, translates science into ordinary speak and makes us feel seen and safer relating to everyone with diabetes on a human level. Dr. Peters is a professor of medicine at the University of Southern California (USC) Keck School of Medicine, Director of the USC clinical diabetes programs, author of more than 200 articles, reviews, and abstracts and three books, and has been an investigator for more than 40 research studies. 

From Dr. Peters:

The data that we have suggest that people with diabetes are actually not at increased risk for catching the novel coronavirus, but once they become infected, they may do less well, particularly if they’re in an ICU setting.

However, we don’t know if there are any differences between people with type 1 versus type 2 diabetes, or between people whose diabetes is well controlled versus less well controlled. We do know that younger people as a whole do better than older people. The more comorbidities present, such as cardiovascular disease and chronic kidney disease, the higher the risk for mortality and doing poorly.

Historically, we’ve believed that people with higher glucose levels are likely to be at greater risk for infection than those with more normal glucose levels. This is because high glucose levels can inhibit white cell function. We obviously want our patients to be as well controlled as possible in order to help them do better.

Some Patterns Emerge

I have now seen patients with diabetes who have been infected with COVID-19 and heard cases of many others. No one in my personal practice with type 1 diabetes has developed COVID-19, but I have seen a number of people with type 2 diabetes who have had it.

What I know for sure is that I can’t predict this virus. I have had people with every known risk factor for a poor outcome do incredibly well, and those with fewer risk factors do worse than I expected. I’ve seen families in whom everybody was infected, and families where only one member became ill.

However, some patterns have emerged. Unscientifically, I divide my patients into three groups of illness severity: mild, moderate, and severe. Mild is when COVID-19 is a slightly annoying head cold and nothing more. Moderate is where people feel miserable; they’re feverish, they have muscle pain, they have headaches, their lungs hurt, they cough, and they feel wretched—but they don’t need to be in the hospital and they survive. Then there are the severe cases; these patients are hospitalized, and some of them end up in the ICU.

In terms of diabetes management, it’s the moderate category where we really have to do our most aggressive outpatient care. We don’t want these patients to end up in the hospital. The biggest issue I deal with is dehydration. My patients are febrile and they’re often anorexic, not wanting to eat or drink much, so I really have to encourage hydration.

I’ve also seen patients with glucose levels lower than normal, which is different from what I’m used to seeing in patients with infection. Glucose monitoring is incredibly important in patients with COVID-19.

Changes to Medications

My first step in all patients who are on an SGLT2 inhibitor is to stop the drug at the first sign of symptoms. I’ve had a lean person with type 2 diabetes on an SGLT2 inhibitor go into diabetic ketoacidosis (DKA) when they developed COVID-19, so this is very important. This patient had already stopped their SGLT2 inhibitor for a day when they became quite ill.

Other practitioners, such as my dear friend, Dr Irl Hirsch, suggest that we stop SGLT2 inhibitor therapy in all people with type 1 diabetes who are using them off-label because it increases the risk for DKA. I haven’t done that in my patients except for those who I feel are on too low a dose of insulin or who seem to be at higher risk for DKA than others. For my patients who are able to test for ketones and connect with me, I’ve kept them on their SGLT2 inhibitor, but I suggest monitoring this on a case-by-case basis.

In my patients with type 1 diabetes, I make sure that they are prepared with glucose-containing fluids at home, and that they’re able to give injected insulin. I also make sure that they have ketone test strips at home and some sort of antiemetic so they can keep down fluids.

Preparing a Hospital Kit

There has been an issue in hospitals where patients on insulin drips can’t get hourly blood glucose readings because the staff doesn’t have enough personal protective equipment to go in and out of patient rooms to do the testing. Patients must be prepared to do self-monitoring of glucose levels in the hospital if they happen to end up hospitalized. I encourage patients with type 1 diabetes and those with type 2 diabetes on insulin to prepare a kit that they could bring with them to the hospital. This kit includes testing supplies (if people are doing self-monitoring of blood glucose) and sensors (if people are on a sensor).

People need to remember such details as bringing charger cables for their iPhones, iPads, and anything else they may need to help self-monitor their glucose levels if hospitalized. This is particularly important now because family members aren’t allowed into hospitals to bring the pieces that someone may have forgotten at home.

In people with type 2 diabetes who are on insulin secretagogues and/or insulin, I have needed to lower the dose of medication, and in some cases, to stop it. Again, self-monitoring is important.

As patients recover from their COVID-19 infections, they may still not feel much like eating and have relative anorexia. There have been some cases where I have held the GLP-1 receptor agonist therapy for a week or two after the illness has resolved to make sure my patients return to their fully normal baseline state.

The most important advice I give patients is to reach out to us, their healthcare team, if they need us. None of us want anyone to go to the hospital, but there are patients who develop DKA and can’t keep down fluids, and they need to be hospitalized. Patients shouldn’t wait, because the DKA may become even more severe by the time they’re admitted.

We all need to keep in mind that most people are going to be okay, with or without diabetes—although, tragically, some will die. As a healthcare provider, I am encouraging my patients to use this time to take extra good care of themselves, to learn to optimize their diabetes control when not being distracted by going out to social events, dinner, or work.

I think we are helping our patients establish a new baseline that will hopefully translate into sustained health over time. Please be sure to take care of yourselves, your families, and your patients. Be well.

Like most people during this time, I don’t know what I do during the day. Well, first, I no longer know what day it is…but when it’s over I’ve been busy. I do know that one of the things I’m doing is baking my favorite low carb foods a lot, since being house-bound we’re eating more of them.

So here are some of my faves if you also want to spend some of your free time in the kitchen creating something healthy and delicious for you and yours. There’s a flax seed muffin, outrageous nut and seed bread and chocolate biscotti recipe I posted some years ago on HuffPost here. Mind you, I only use a toaster oven for baking. Like any real New Yorker, my oven dutifully stores pots and pans.

Below, more favorites:

Keto rolls – Pictured above and below. When I was able to go to Trader Joe’s I’d buy their almond meal and mix almond meal and almond flour. This recipe makes six rolls. I use them for the husband’s lunchtime sandwiches. He cannot get enough, and I might mention he was raised in Holland where “real” bread is king.

Pizza – Delicious and easy! I typically use very finely chopped veg, like broccoli and Brussel sprouts as topping along with some cheese.

Chocolate biscotti– Yes, there’s one in the HuffPost article, but this one shows you the process with pictures. Just leave out the xantham gum. I always leave out things I can’t pronounce.

Keto cheesecake with blueberries (I leave out the blueberries to stay lower carb) – Before coronavirus my 90 year old mom and I would make this every time I visited. It was a wonderful afternoon, we’d go shopping for the ingredients and she’d be the prep chef, melting butter and laying out out all the pans and measuring cups.

When she’d get tired, she’d sit on the stool and watch me finish. As good as any cheesecake as far as I’m concerned, and the best way to fill the kitchen with the warm scent of melting butter and our laughter. I hope we get to do it again soon. Miss you mom.

CDE Carolyn Robertson advises people with diabetes, particularly type 1 or type 2 who use insulin, to have a letter from their doctor should they need to go into the hospital with coronavirus. Of course, I’m glad to have this letter should I need hospitalization for any reason. According to Carolyn the letter should make these points:

• You have insulin dependent diabetes and require insulin continuously to survive
• Your medical conditions, medications with dose and timing, allergies
• Diabetes team member name and phone number

I wrote my doctor a draft letter based on this information and then he finessed it and put it on his hospital’s stationary.  Feel free to use this as a sample for your own doctor. (I have omitted my doctor’s identifying information).

At the bottom of the letter my endo put his name, telephone number and the hospital he’s affiliated with.

I asked my endo to do this over email and he sent it back in three days. Three years ago I lost my last endo after 9 years with her when her hospital stopped taking my insurance. My current endo is definitely the silver lining that emerged from that fiasco.