With Coronavirus in the news and on our minds, I thought it would be a good idea to do a COVID-19 diabetes specific episode of the podcast. I spoke with Gary Scheiner, the owner and clinical director of Integrated Diabetes Services, a company that specializes in remote consulting for people who use insulin. Gary lives with type 1 diabetes and is the author of many books, including “Think Like a Pancreas” and his newest, “Diabetes – How to Help, Your Complete Guide to Caring for a Loved One With Diabetes.” Gary was named the 2014 Diabetes Educator of the Year by the American Association of Diabetes Educators.
We spoke on 2/26 so please keep in mind information may have changed. I’ll try to update as we move forward. The podcast originally aired 2/27. However, I know many people prefer to read the information so we created a transcript and this blog post. You can hear the original episode (which includes some editorial from me on how to consume media in these situations) via the player below or any podcast app:
Stacey Simms: Gary, thanks for jumping on with pretty short notice to talk about this. I really appreciate it.
Gary Scheiner: My pleasure.
Stacey: I don’t want to downplay anything, but I have to say, I’m really concerned with what I’m seeing online. Are you hearing from people who have have these concerns in the diabetes community and, frankly, getting frightened?
Gary: Yeah, I mean, with good reason. It’s a pretty serious viral infection that’s spreading around. It’s not that much different from other viruses like the flu. And you know, the way we contain it and control it and prevented for that matter are very similar. But when people do get it, it’s a tough one to fight. You don’t have effective ways of treating it.
Stacey: Do people with diabetes in general, get more viruses. Can you speak to that? Because I’ve been told time and time again, type 1 diabetes is an autoimmune disease, it doesn’t mean that your immune system is suppressed,
Gary: If anything, our immune systems are hyperactive! But yes, people with diabetes generally are higher risks for all kinds of infections, both bacterial and viral, but it really comes down to the degree of glucose control that a person has. There are certain things that impair proper immune function and one of those is high blood sugar. Chronically elevated glucose levels can impair immune function. The other things are things like lack of sleep and a very poor diet and very high stress levels. But for someone with diabetes who’s not managing their glucose, their risk for infection is certainly increased.
You also have to consider glucose variability in the equation as well, which is a stress on the body. It seems to cause inflammatory responses. So you know what we’re talking about. You can have a beautiful looking A1C but have a lot of peaks and valleys, highs and lows throughout the day. And that sets us up for all kinds of acute and chronic health problems.
The other issue is managing the glucose if you do get sick, which becomes more challenging, but even more important, because when glucose levels are elevated; you’re sort of aiding and abetting the infection that virus or bacteria has a lot of fuel to grow off of. So you’re feeding the enemy in a way if your blood sugar is poorly controlled, when you’re sick, running a lot of high blood sugars is going to extend your recovery time and cause your symptoms to become that much worse.
Stacey: Well that’s tough to begin with because, at least in my personal experience, when my son gets any kind of illness, his blood sugar goes up.
Gary: There are strategies for managing it though. We teach most of our patients about self-adjusting their basal insulin doses. Whether you’re on a pump or shots, ramping up the basal insulin is a very effective way to combat the insulin resistance that’s caused by the illness.
Stacey: I guess step one, then is with Coronavirus or any illness have a sick day plan, right? Call your health care provider, call your endo if you don’t have a sick day plan.
Gary: Yes. It has to be customized a little bit depending on what kind of treatment every patient is receiving. There are certain tenants thought that apply to almost everyone who’s on insulin – the insulin dose is likely going to need to be increased, especially if they start noticing elevated blood sugar. Ketone checks become pretty important. It helps us figure out the severity of the illness and the magnitude of insulin increase that’s going to be required. Hydration is extremely important as well and people with diabetes are more prone to dehydration when they’re sick and then someone without diabetes and adequate nutrition. Also, the body still needs energy to combat the illness so you don’t want to starve a person. I think parents used to refer to this as the BRAT diet. It’s just easily digested simple foods that you don’t have to work too hard to break down.
Stacey: BRAT: That’s bananas rice, apples, toast?
Gary: Apple sauce.
Stacey: Yes, apple sauce!
Gary: We tell people you know all those foods they avoid because they spike their blood sugar. Those are the things you want to eat when you’re sick. You know, the soft fruits, cereals, things like that. Oatmeal, things that just digest quickly and easily just to lessen the load on the body
Stacey: With Coronavirus itself do we know enough to know how it might affect people with diabetes yet?
Gary: Well, it’ll affect them just like it affects a person without diabetes, (the main different is that) it’s going to cause the glucose levels to rise as well. But with or without diabetes you’re going to see some intense inflammation of the respiratory tract. One of the unique things about it compared to some other viruses like the flu is it can cause some severe shortness of breath which we don’t always see with with other communicable common illnesses. So that’s something to watch for.
The preventive measures are the same. We would do the same things to prevent Coronavirus as we would for the common cold and the flu. Frequent hand washing is a very important thing. I tell patients to be a bit OCD about your hand washing, be very compulsive about that. Get a flu shot, because you can prevent any form of the flu it anytime that’s beneficial. Be very careful around people who have signs of respiratory illnesses who are coughing, sneezing, etc. Keep your distance or just try to be very cautious about physical contact with them.
Stacey: Do those masks that people are buying work? I’ve heard mixed results
Gary: They will only work if you’re within coughing vicinity of somebody who is contracted the illness. In general they don’t work. I mean walking around the airport, etc with these masks on is going to do virtually no good. These airborne germs can still get into your nasal passages and into your lungs and spread from there. So in general, the masks are not a very effective preventive option. It’s more the traditional stuff. You know the hand washing, get your flu shot. Try to avoid indoor air too much recirculated air is no good. To be in a humid environment is also beneficial. If your house is dry, especially in the wintertime, use a humidifier. That’s the first place where germs can penetrate into the body is the nasal passages and if they dry out due to dry air, you’re kind of opening the door and marshaling the germs into your system. So a humid environment does help.
Stacey: You mentioned hand washing, do hand sanitizers work at all,
Gary: They’re a little bit beneficial, but just washing with soap and water is generally sufficient. It may not be convenient to do that anytime, anywhere. So carrying hand sanitizer after you’ve been at a meeting, shaking hands, etc is a good idea. Even places like the grocery store where your hands are on the cart and you’re touching a lot of things, using a hand sanitizer is a good idea.
Stacey: One of the things that’s been reported, and this may change as we learn more and more about the Coronavirus, is that we may see more of a social or societal disruption. In other words, there may be times when your municipality says: stay home. Or they ask people not to travel or there are disruptions in trade. That hasn’t happened yet of course, but should we be stockpiling diabetes supplies now?
Gary: I just got off the phone with a patient in Cincinnati who asked me the same exact question that you brought up, should I be stockpiling insulin and strips and sensors and this and that, and right now, the answer is no. You really don’t need to do that. The pharmaceutical companies manufacture things under very sterile conditions, and even their distribution channels handle things in a very sterile way. So you should be fine, as far as getting supplies and getting supplies that are guaranteed to be safe and clean. So you really don’t need to be hoarding supplies at this point. That kind of response is kind of dangerous, because you may cause shortages for people who really need things.
Stacey: Just to clarify – and this is something I’ve seen asked a lot on social media – there is a question about medication from overseas and from China. Is there anything diabetes-related that is make in China that we should be concerned about? I couldn’t think of anything diabetes-related that we can’t track to where it is manufactured.
Gary: Right. Virtually everything we’re using in the states is manufactured here. And you have to also consider the Coronavirus is like any virus, it’s a living organism; it has to be attached to something that is providing it with some form of nutrients. Plastic packaging and pills and bottles are not going to provide nutrients that keep a virus alive. So generally speaking, you don’t have to be concerned about contamination that way.
Stacey: I think a lot of us have these misconceptions, so thank you for clearing them up. It’s interesting to look back at other scares in the past. When we had the SARS scare that’s when a lot of grocery stores decided to test allowing people to order in advance and just drive by to pick up They were concerned that people wouldn’t want to go to the store. And now people still do that, but it’s because it’s just convenient.
Gary: Right. It’s the same reason we’ve been providing tele-healthcare people for years now. It’s about convenience. It’s also it’s it is a little bit safer than going out and being in an office with a lot of other people. Who knows what you could catch.
Stacey: When we talk about sick days, is there anything that you would recommend people have on hand? We always liked to have full-sugar popsicles. They were great for a little kid who didn’t want to eat but needed insulin for ketones. Anything like that come to mind?
Gary: Well, something that I keep around is is something like Gatorade, or with kids, Pedialyte. Just beverages that have a low sugar concentration that are easily absorbed, easily digested so that even if somebody has an upset stomach or is nauseous and weak, those things provide some electrolytes. They provide a little bit of carbohydrate and fluids which is critical. Things like ibuprofen and/or acetaminophen are good to have around in case there’s fever. Imodium is a good product for for diarrhea, just those kind of things are are helpful.
KetoStix. Most people don’t think they’ll ever need them. But when you’re sick, it’s very important to be checking for ketones. That’s something to get a hold of now.
Stacey: Does it matter if you use the sticks or the blood ketone meter? Do you have a preference as an educator?
Gary: Well, the blood meter is better, it’s a more timely measurement. It’ll take several hours for ketones in the bloodstream to show up in urine; you catch ketones sooner with a blood test. The blood test also gives you a more specific measurable value. The urine strips you’re you’re comparing different shades of pink and tan and it’s a very subtle difference. So to be able to communicate with your health team and say “I don’t know how high. It’s pink it’s tan,” but on a blood meter you will get a specific measure of ketones in the bloodstream, you’ll get, like 1.3. That’s a number that’s easier to share with your clinicians.
Stacey: As a person who lives with type one, in addition to being an educator and a healthcare provider for many people, when this kind of thing happens, do you worry more because you live with type type one?
Gary: I really don’t. I feel like the things I’m doing day in and day out, minimize my risk. You know, there are some things that we have control over in life and some things we don’t. The things we do day in and day out to manage our diabetes, that’s within our control. Whether those blood sugars look great or not, is not always in our control because of all the variables. It’s the same thing with with an illness like a Coronavirus or the flu or pneumonia. You take certain precautions, you put yourself in a position to avoid them. But if you sit around just worrying about that that doesn’t do any good. In fact, the stress that that cause can compromise your own immune system. So it’s really best to just do the right things, feel good about that, and then let the chips fall where they may.
