Diabetes + COVID Vaccines: What You Need to Know

This content originally appeared on Beyond Type 1. Republished with permission.

By Lala Jackson

COVID-19 vaccines are here. If you have diabetes and/or other underlying health concerns, you may have questions about timing, safety, and what to expect.

It’s important to remember that having well-controlled diabetes alone does not seem to put anyone more at risk for contracting the novel coronavirus, but other factors like older age, high-exposure employment, consistently elevated blood glucose levels, or other non-diabetes related health factors like obesity and hypertension may increase your risk of infection.

We also know that diabetes care itself is made far more complicated after contracting COVID-19 and protecting anyone with diabetes from getting COVID-19 is our ultimate goal. That’s why we encourage everyone with diabetes to get vaccinated as soon as possible.

Immediate side effects from the vaccines are similar to many people’s experience with the flu shot – soreness at the injection site, general muscle aches, some nausea, and tiredness. Some – but not all – people with diabetes are experiencing slightly elevated blood glucose levels. These side effects are typical, indicate the immune system is learning how to fight the virus, and go away within 24 to 48 hours.

Once you are able to get your vaccine, keep practicing safety measures. A vaccine protects you from severe outcomes from COVID-19, but it may still be possible to spread the virus to others. Keep wearing a mask and keep social distancing to help keep us safe until we’re all safe.

Want a deeper dive? Here’s everything you may want to know:

What Vaccines Are These?

In November 2020, Pfizer and BioNTech announced positive results from the conclusion of their COVID-19 vaccine clinical trials, quickly followed by Moderna. In February 2021, Johnson & Johnson’s announced the same.

Each has now been approved for use in multiple countries across the globe, with a few other vaccines rolling out on a country by country basis. Worldwide, more than 60 other vaccines are in various stages of clinical trials.

Each vaccine went through the standard three phases of clinical trials – Phase 1, where it is administered to a small number of people to show initial safety, Phase 2 to hundreds of people split into groups by things like age, ethnicity, and background to show how different types of people react to the vaccine, then Phase 3, in which it is given to tens of thousands of people, tested against a placebo. Because of the speed needed for development, both vaccines were approved to go through animal clinical trials at the same time as human Phase 1 clinical trials.

To be approved, the FDA requires the vaccine work in at least half of those who receive it. Early analysis from the National Institutes of Health independent data review board (DSMB) saw that 94-95% of those who received the Pfizer/BioNTech and Moderna vaccines in the trials became immune to the coronavirus. Johnson & Johnson’s vaccine showed 66% effectiveness against the virusMost importantly, all three vaccines provide significant protection against severe outcomes from the virus.

The Pfizer/BioNTech and Moderna vaccines are mRNA vaccines, a type of immunization that does not use the real virus in the vaccine, but instead employs a piece of genetic material to create antibodies against the novel coronavirus. Each of the mRNA vaccines requires two doses, given three to four weeks apart. The Johnson & Johnson vaccine is slightly different, which makes it easier to store and only requires one dose.

Other vaccines – different types of immunizations made by multiple companies – are currently in clinical trials with results expected early (and throughout) 2021. More than 50 vaccines are currently going through human clinical trials; in any trial where participants exhibit worrisome symptoms, the trial is paused and cannot proceed until any issues are corrected.

  1. More than 60 vaccines are under development worldwide. In the US, the three currently being distributed are from Pfizer/BioNTech, Moderna, and Johnson & Johnson, with some others being rolled out in certain countries.
  2. All three vaccines approved for emergency use in the US provide protection against severe complications or death from COVID-19. Each vaccine has a slightly different rate of protection against getting the virus at all, but each guarantees protection against the worst outcomes of the disease.
  3. The Moderna vaccine trials had a slightly more diverse participant group but both leading vaccine trials included participants from across races and ethnicities, age ranges, health conditions including type 1 and type 2 diabetes, etc. No specific populations experienced any major issues with the vaccines.

Do COVID Vaccines and Diabetes Mix Well?

People with diabetes in each of the vaccine’s trials have not reported major side effects (read this T1Ds experience in the Moderna COVID-19 vaccine trial). Overall, some clinical trial participants have reported mild side effects of the vaccines, much like how some people experience injection-site soreness, mild lethargy, a low-grade fever after other vaccines. These mild reactions some people experience after vaccines are typical and not cause for alarm – they are a result of the immune system going into action as purposely triggered by the vaccine, creating the ability to fight against the actual virus were a person to be exposed to it.

In the UK, two healthcare workers who received the Pfizer/BioNTech vaccine during initial general population rollout experienced severe allergic reactions for which they administered adrenaline autoinjectors. Both individuals had a history of severe anaphylactoid reactions for which they carry adrenaline autoinjectors anyway, so if you are a person who does tend to experience severe allergic reactions, it is recommended that you not receive the Pfizer/BioNTech vaccine at this time. Other vaccines may be better indicated for your use. If you do not have a history of severe allergic reactions, there is no reason to expect you will experience one from a vaccine.

Because of the mild symptoms experienced by some, it is important to stay vigilant about blood sugar levels for the first 24 to 48 hours after receiving the vaccine. The symptoms may impact your BG, so check your levels frequently, stay hydrated, and be familiar with your sick day routine. The mild symptoms you may experience after the vaccine are significantly safer and more easily managed than potentially getting COVID-19 itself.

As we currently understand, you are not more at risk to catch the novel coronavirus if you have diabetes, but if you do catch the virus, you may be more at risk for more severe complications from COVID-19, particularly if you have been experiencing consistently elevated blood sugar levels.

If you have specific concerns or worries, make sure you speak to a healthcare provider you trust (or keep tuning into Beyond Type 1 coverage of COVID-19 to hear from the healthcare providers we trust, like Dr. Anne Peters).

Read this T1Ds experience in the Moderna COVID-19 vaccine trial

Great, When Can I Get Mine?

While the vaccines rollout in the US started as a bit of a logistical mess, the process is finally starting to get more clear! As of March 31, the CDC classified all people with diabetes as part of priority vaccination groups, updating their previous guidance that only included type 2 diabetes. And as of April 19, the Biden administration has announced that all people aged 16 and above in the US are eligible for the COVID-19 vaccines.

The COVID vaccine rollout is being handled on a state by state basis, which has made finding vaccination appointments a bit tricky. Additionally, many states are falling short in equity – many vaccine appointments are only available online, and some states have limited and hard-to-get-to vaccine locations. If you’re trying to find a vaccine appointment, here are some recommendations:

  • VaccineFinder.org is a medical-professional vetted place to find a convenient vaccination appointment.
  • You can also look up your state health department’s guidelines. Each state generally has a special COVID-19 page where they then list out COVID-19 vaccine eligibility guidelines and locations. Many states have started working with local drug stores and pharmacies; if so, they are often linked to from the state health department website.
  • If it is unclear or you are unsatisfied with what you’ve found, go ahead and reach out to your healthcare provider. Particularly if you have a healthcare provider like an endocrinologist who helps you take care of your diabetes, they may have some insider information on how their hospital or practice is planning to distribute the vaccine. Remember to be kind and patient – healthcare providers are carrying an immense amount and they may not have an answer for you immediately.

What About Kids With Type 1 Diabetes (T1D)?

The Pfizer/BioNTech vaccine is currently approved for ages 16+; they also just requested clearance from the FDA to expand eligibility to ages 12 – 15. Initial COVID-19 vaccine trials were focused on the adult population – both because adults seem more susceptible to severe outcomes from COVID-19, and because trials for those under the age of 18 require a stricter review and approval process.

Starting in 2021 and beyond, more trials are including children so that they may be safely vaccinated against COVID-19 as well. Important to note is that children do not seem to be likely to contract coronavirus or have severe outcomes from the disease. However, as we’ve seen throughout the pandemic, disparities are abundant. Native Hawaiian, Pacific Islander, American Indian, Alaskan Natives, and Hispanic children have experienced significantly higher rates of infection than their peers. Non-Hispanic Black children with T1D who contract COVID-19 are four times more likely to also experience DKA.

So while generally children are less likely to contract the coronavirus, it is important to remain vigilant and continue practicing measures to protect everyone – like wearing a mask and social distancing – to keep everyone safe until we’re all safe.

Still Have Concerns?

Individuals have expressed some hesitation to personal vaccination for COVID-19. This is an understandable feeling – vaccines do not typically make it through development and approval this quickly.

Here’s what we know:

  1. The speed with which the vaccines were developed was unprecedented. However, the clinical trials these vaccines had to go through were strict and the reporting of their safety and efficacy had to be unequivocally proven and replicated. Three phases of clinical trials, including a Phase 3 with tens of thousands of participants, had to prove safety and effectiveness of the vaccines. Phase 3 of the clinical trials were also double-blind, meaning neither the trial participants nor the company that created the vaccine knew if participants were receiving the vaccine or a placebo. Data was reviewed by the National Institutes of Health independent data review board, and final approval for the vaccines must be provided by the FDA’s Vaccines and Related Biological Products Advisory Committee, composed of scientists who have no ties to the companies by which the vaccines were produced.
  2. The Moderna COVID-19 vaccine trial focused on creating a diverse trial participant group, knowing that this is vital to ensuring the vaccine works as intended across populations. 37% of the trial’s participants were from communities of color, which is similar to the US population. The Pfizer and BioNTech trial had less representation, and many of the ongoing trials are not reporting diversity numbers at all. It is vital that each and every trial not only focus on recruiting diverse – across age, race, ethnicity, health background, and more – trial participants to prove safety and effectiveness, but also proactively communicate the effects of their vaccines across groups.
  3. Black, Native (including Pacific Islander), and Latinx communities have been hit hardest by COVID-19 because of systemic and medical racism, with Black Americans dying from COVID-19 at twice the rate of white Americans. Ensuring equitable distribution of the COVID-19 vaccines is vital to work against the deep impact of systemic and medical racism, but this must be coupled with understanding distrust due to violent medical racism throughout the US’s history.
  4. We don’t know for sure what percentage of the population needs to be vaccinated in order to achieve herd immunity, but we do know that the more people who are immune to carrying or spreading the virus, the better. Those who are willing and able to take the vaccine are helping to protect everyone in their community.
  5. If, after doing research from reputable, science-based sources (we recommend science communicators like Jessica Malaty Rivera for easy-to-digest and accurate information), you are still not comfortable taking the vaccine as it becomes available to you, continue to practice safe health measures to protect yourself and others from the novel coronavirus. Until the majority of the population is vaccinated, we cannot rely on herd immunity. We must keep those most vulnerable among us safe until we’re all safe, practicing simple actions like wearing a mask and social distancing to do so.

2020 has been hard; at many times, scary and filled with grief. Working toward getting our communities safe and healthy is important for a multitude of reasons, and will take a united effort. Ensuring you have a plan for when you will get vaccinated once you can is vital to keep yourself and those most vulnerable among us safe until we’re all safe.

Source: diabetesdaily.com

What You Should Know About COVID-19 Vaccines and Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Eliza Skoler and Dr. Francine Kaufman

Last updated: March 22, 2021

COVID-19 vaccines have been authorized for use in the United States and in many parts of the world. We’re here to answer questions for people with diabetes. Are the vaccines safe? How do the vaccines work and does it matter which one I get? What are the side effects, and how will the vaccine affect my blood sugar? What can I do after I am vaccinated?

Now that three COVID-19 vaccines have been authorized for use in the United States, and ten more around the world, many questions are circulating about the vaccines, their safety, and when to get vaccinated. While timing may differ by state and even between sites, people with type 2 diabetes or obesity will be eligible for early vaccination in the US in the coming months, though this may not be the case for millions of others – including those with type 1 diabetes and loved ones who are not currently recommended by CDC to receive the vaccine early. As states begin to distribute the vaccines, we’re here to answer your questions about COVID vaccination in the US; we’ll update this article as more information becomes available.

Click to jump down to a group of questions:

Why get the vaccine?
Why should I get the COVID vaccine?
How does the COVID-19 vaccine work?
How do mRNA vaccines work?​
How do viral vector vaccines work?

Vaccine Safety
Is the vaccine safe for people with diabetes?
Does it matter which vaccine you get?
Which vaccine is best for people with diabetes?​
What are the side effects? Can the vaccine be dangerous?
How will the vaccine affect my blood sugar levels?
Do diabetes medications affect the vaccine?
Should I get vaccinated if I have diabetes and other health conditions?
What is the AstraZeneca vaccine?

Getting the Vaccine
When will people with diabetes get the vaccine?
How will I know when it’s my turn to get the vaccine?
How much does the vaccine cost?
What should I expect at my vaccine appointment?
I had COVID-19 – should I still get vaccinated?
If I have symptoms of COVID-19 now should I get the vaccine?

After Receiving the Vaccine
What happens after I get the vaccine – can I still infect people with COVID?
Can I see people now that I am vaccinated?
Is one dose of the COVID vaccine effective?
Does the vaccine protect against the new variant of COVID?
Can I get COVID from the vaccine?
Are other vaccines coming?
When can I stop wearing a mask?

Why get the vaccine?

Why should I get the COVID vaccine?

The vaccine has the ability to protect you, your loved ones, and your community. It will help your body’s immune system fight off a COVID-19 infection – this means that if you are exposed to COVID, your body can protect you and significantly reduce your chances of getting sick or experiencing severe complications from the virus. Two of the vaccines that are currently authorized in the US (from Pfizer-BioNTech and Moderna) are almost 95% effective at preventing symptoms of COVID in adults who have been exposed, and the third vaccine (Johnson & Johnson) is 85% effective at preventing severe COVID infection. In other words, if you are vaccinated with any of the three and then come into contact with someone who has COVID, you probably won’t get sick.

To stop the global spread of COVID-19, the majority of people around the world will have to become immune to the virus. The COVID vaccine – like the many vaccines that protect us from small pox, measles, the flu, and other illnesses – will play a major role in improving the health and wellbeing of people across the globe.

How does the COVID-19 vaccine work?

There are currently three vaccines that have received emergency use authorization in the US: the Pfizer-BioNTechModerna, and Johnson & Johnson vaccines. The Pfizer-BioNTech and Moderna vaccines are similar – both use messenger RNA (mRNA) to target the “spike proteins” on COVID-19 virus molecules. The Johnson & Johnson vaccine is a viral vector vaccine that also targets the spike proteins.

How do COVID mRNA vaccines work?

mRNA contains genetic instructions (like a blueprint) for making specific proteins in cells. The mRNA in COVID vaccines was developed by scientists to trigger human cells to make harmless COVID spike proteins, and after the proteins are built the vaccine mRNA is destroyed. The body’s immune system then recognizes these foreign proteins and builds antibodies against them. This means that if you are later infected with COVID-19, you’ll have antibodies that recognize the spikes on the viral molecule and can destroy it. To learn more about this process view this detailed, interactive piece from the New York Times.

mRNA vaccines are not “live” vaccines – the live virus is not injected into a person’s body. This means that you cannot get COVID from the vaccine. Similarly, the vaccine will not alter your own genes.

How do COVID viral vector vaccines work?

Similar to an mRNA vaccine, a viral vector vaccine causes the body’s cells to make harmless COVID-19 spike proteins so that it can learn to recognize the foreign proteins and build antibodies against them. Later, if you are infected with COVID-19, your body will have antibodies ready to fight off the virus.

Instead of using mRNA, a viral vector vaccine contains the DNA for a different, harmless virus. In the case of the Johnson & Johnson vaccine, it’s an adenovirus – the type of virus that normally causes a cold or a flu – that has been engineered so that it does not make you sick. Once you get the injection and the virus is inside your body, its DNA can be read by your cellular machinery to produce spike proteins. As your immune system works to fight these foreign proteins, it will learn to protect you from COVID-19. To learn more about this process view a detailed, interactive piece from the New York Times.

Vaccine Safety

Is the vaccine safe for people with diabetes?

All three currently authorized vaccines – Pfizer-BioNTechModerna, and Johnson & Johnson – appear to be safe and effective for adults with diabetes. Rigorous clinical trials tested the safety of these vaccines in adults of all ages, races, and ethnicities, as well as chronic health conditions.

  • The Pfizer-BioNtech trial included 3,150 people with diabetes (8.4% of trial participants).
  • The Moderna trial included 2,858 people with type 1, type 2, and gestational diabetes (9.4% of trial participants).
  • The Johnson & Johnson trial included 3,389 people with type 1 and type 2 diabetes (7.7% of trial participants).
  • In terms of racial and ethnic diversity, the trials each included more than 20% Hispanic or Latino participants, almost 10% African American participants, and almost 5% Asian participants.

These vaccines were advanced quickly thanks to the immense resources provided for COVID vaccine development – even with a speedy process, the vaccine manufacturers had to follow the typical safety steps and thorough checks. Read more from the CDC about how the vaccines work, potential side effects, and details from the human clinical trials.

Does it matter which vaccine you get?

No – all three of the vaccines will protect you and those around you. However, there are some differences between the vaccines that may be important to people with diabetes.

Clinical trials found both mRNA vaccines to be extremely effective in adults – with almost 95% efficacy overall, only one in 20 people that receives the vaccine would get sick from COVID. Among the trial participants with diabetes, the Pfizer-BioNtech was 95% effective and the Moderna vaccine was 100% effective, while the Johnson & Johnson vaccine was 53% effective. Participants were only followed for a few months, so we don’t yet know the long-term effectiveness of these vaccines. As more vaccines are administered there will be more data collected, and hopefully children will be enrolled in clinical trials soon.

What does it mean for these vaccines to be “effective?” If a vaccine is 50% effective it successfully protects half of the people who receive it from getting infected by COVID-19 if they are exposed. If a vaccine is 75% effective, it protects three out of four people from COVID-19 infection. More importantly, all three vaccines are highly effective at preventing severe COVID-19 infection. All three clinical trials found that in people who did get infected after vaccination, the infection was much milder – among people who had received one of the three authorized vaccines, there were almost no deaths or hospitalizations resulting from COVID-19. To learn more about how the three vaccines compare, watch this video.

During early vaccine distribution, you likely won’t have any choice in which vaccine is available to you because there will be a limited supply and the goal is to vaccinate people as quickly as possible. Both mRNA vaccines require two shots, meaning that they are not considered fully effective until you have received both doses, and your immune system has developed protection against the virus (after the second shot). You should receive two shots of the same vaccine (either Pfizer-BioNtech or Moderna). The Johnson & Johnson vaccine only requires one shot.

Which vaccine is best for people with diabetes?Which vaccine is best for people with diabetes?

Due to the distinct design of each clinical trial, it can be hard to directly compare the three vaccines that are currently authorized in the US. However, based on trial data and information from the vaccine manufacturers, here’s the best information we have on how the vaccines compare.

Vaccine data table

Image source: diaTribe

The data show that no matter which of the currently authorized vaccines you get, getting a COVID-19 vaccine is safe and important for people with diabetes. All three vaccines are highly protective against severe COVID illness and death. Click here to watch an in-depth video explaining how the vaccines compare.

What are the side effects? Can the vaccine be dangerous?

When you receive a vaccine for a particular virus, your immune system builds protection against it. Because your body is creating antibodies and learning how to fight the virus or bacteria targeted by the vaccine, you may experience normal side effects for a day or two – this is similar to getting a flu shot, and people with diabetes should monitor their blood sugar levels and have a sick day management plan ready.

According to the CDC, these are the common side effects of the COVID vaccines – they are similar for people with and without diabetes:

  • Pain, swelling, or redness in the vaccinated arm
  • Fever
  • Chills
  • Fatigue
  • Headache
  • Nausea
  • Muscle pain

These side effects are a result of your immune system preparing to combat a future viral infection – they do not mean that you have gotten sick from the vaccine itself. If your side effects don’t go away, contact your healthcare team.

Severe allergic reactions to the COVID vaccine are rare – you can learn more from the CDC here. If you have ever had an allergic reaction to any vaccine, ask your healthcare professional if you should get the COVID vaccine. If you experience a severe allergic reaction to the first dose of the COVID vaccine, do not get the second dose.

How will the vaccine affect my blood sugar levels?

Because the vaccine can cause symptoms of illness that can lead to high glucose levels, it’s important to carefully monitor your blood sugar levels for 48 hours after you receive your vaccination. Stay hydrated, and make sure to have your sick day plan ready in case you feel ill. So far, people with diabetes seem to be experiencing few side effects and minimal effect on blood sugar levels.

Do diabetes medications affect the vaccine?

At this time there is no information available on drug interactions between the authorized COVID vaccines and other medications – this has not yet been studied. However, it is not anticipated that the vaccine itself would interact with insulin or other standard diabetes medications. Note: it may be helpful to avoid injecting insulin or placing a glucose sensor or pump infusion set in your vaccine injection site for several days after vaccination.

Should I get vaccinated if I have diabetes and other health conditions?

People with complications of diabetes (including heart disease and kidney disease) are at much higher risk of severe illness from COVID-19. If you have other health conditions in addition to diabetes, getting the vaccine is especially important.

What is the AstraZeneca vaccine?

New results from the US clinical trial of the AstraZeneca viral vector vaccine show that the vaccine was 79% effective at preventing symptoms of COVID-19 infection, and fully prevented severe illness and hospitalization in more than 32,000 participants. The two-dose AstraZeneca vaccine is currently authorized in Europe and in other countries, but has not yet been authorized for use in the US. The latest clinical trial results show the vaccine to be both safe and effective.

In early March, several countries briefly paused giving people the AstraZeneca COVID vaccine due to concerns about possible rare side effects, including severe blood clots. However, since the data does not show that the vaccine increases the risk of blood clots, the World Health Organization determined that it is safe and that the benefits of the vaccine outweigh any risks. We look forward to updating this article if the AstraZeneca vaccine receives FDA authorized in the US.

Getting the Vaccine

When will people with diabetes get the vaccine?

In most places across the US, people with type 2 diabetes and obesity will be prioritized in the third group of early vaccination (Phase 1c) – this has already begun in some parts of the country. Type 1 diabetes is not currently considered a high-risk medical condition for this phase. Some diabetes experts believe that if you have type 1 diabetes and any evidence of kidney damageheart disease, or obesity with high insulin doses, it’s a good idea to seek vaccination as soon as possible because you may be at high risk for severe illness if you are infected with COVID-19. To learn about the CDC’s recommended stages of vaccination and where you fall in the vaccine line, read Dr. Francine Kaufman’s “When Can I Get the COVID Vaccine if I Have Diabetes?

How will I know when it’s my turn to get the vaccine?

The distribution of vaccines is the responsibility of each state, and states have different plans for vaccinating people. Most states will use networks within hospitals, healthcare offices, and pharmacies to distribute vaccines to residents. Depending on where you live, you may be asked to get on a vaccine waiting list. Click here to see the state by state report from the Kaiser Family Foundation, including who is currently eligible for vaccination in your state. To learn more about your place in the vaccination line, read Dr. Kaufman’s “When Can I Get the COVID Vaccine if I Have Diabetes?” If you have type 2 diabetes or obesity (a body mass index above 30 – check here), contact your healthcare office to ask when and how you can get vaccinated.

How much does the vaccine cost?

You will not have to pay for the COVID vaccine in the US; it will be given to all US residents for free. That said, some vaccination providers may charge an administration fee for delivering the injection. Ask your healthcare office if there will be any costs associated with your vaccination.

What should I expect at my vaccine appointment?

When you get your COVID vaccine, you’ll receive a paper card that says which vaccine you received, and when and where you received it. You’ll also get a fact sheet (paper or electronic) with more information about the vaccine, its benefits, and its side effects. After you get your injection, you’ll be asked to stay on-site for a short period of time so that healthcare professionals can monitor your body’s reaction.

I had COVID-19 – should I still get vaccinated?

Yes – though you can wait up to 90 days after initial onset of your COVID-19 infection. Researchers don’t know how long immunity against the virus can last after natural infection, though evidence suggests that you’re not likely to get sick with COVID again for the first 90 days. You should still get vaccinated for longer-term protection, and the CDC says that you can wait 90 days after the infection before getting your vaccine.

If I have symptoms of COVID-19 now, should I get the vaccine?

If you recently tested positive for COVID-19, are currently experiencing symptoms, or were exposed to someone with COVID, please stay away from other people.

  • If you test positive for COVID, wait until you’ve recovered (as early as 14 days from infection) and up to 90 days before getting the vaccine.
  • If you are experiencing symptoms of COVID, self-isolate and get tested.
  • If you were exposed to someone with COVID, quarantine for 14 days and monitor yourself for symptoms. Get a COVID test. If you do not get sick and your test is negative, get vaccinated once your quarantine period is over.

After Receiving the Vaccine

What happens after I get the vaccine – can I still infect people with COVID?

Once you have received both doses of the vaccine, it should protect you from getting sick with COVID. However, researchers don’t know whether you may be able to carry the virus (without symptoms) and pass it on to others. That’s why it’s still important to maintain safety measures even after receiving the vaccine: wear a face mask that fits you well if you’re in public, avoid contact with people not in your household, social distance from others, wash your hands, and monitor your health. Continuing to follow these measures will help you protect others and your community.

Can I see people now that I am vaccinated?

Two weeks after your final vaccine dose (one dose for Johnson & Johnson, two doses for Pfizer-BioNTech or Moderna) you are considered to be fully vaccinated and protected against severe COVID-19 infection. According to new CDC guidelines, people who are fully vaccinated:

  • Can gather indoors with others who are fully vaccinated, with no need to wear a mask.
  • Do not need to quarantine, stay away from others, or get tested if exposed to someone with COVID – unless you begin to show symptoms of illness.

The CDC also says that people who are fully vaccinated can “visit with unvaccinated people from a single household who are at low risk for severe COVID-19 disease indoors without wearing masks or physical distancing.” However, people with diabetes have a higher risk of getting severely ill from COVID-19 (though there’s no greater chance of being infected). For this reason, even if you are vaccinated, please continue to be cautious.

Is one dose of the COVID vaccine effective?

For the Johnson and Johnson vaccine, yes.

For the Pfizer-BioNTech and Moderna vaccines, not entirely. Results from the clinical trials (Pfizer-BioNTechModerna) show that one dose of the vaccine can offer some protection, but two doses of both authorized vaccines are required for full efficacy.

Does the vaccine protect against the new variant of COVID?

Probably, but not certainly. Researchers are still studying the newest variants of COVID-19 to determine how effective current vaccines are at protecting against them. So far, much of the virus structure is unchanged in the variants and the currently-authorized vaccines seem to produce antibodies that recognize variants of COVID-19. Other strains of COVID will likely develop with time (similarly to the flu), and the vaccines can then be tweaked to match the changed threat. Click here to learn more about COVID variants, how they work, and what you can do to protect yourself.

Can I get COVID from the vaccine?

No. The vaccines do not contain the live virus, so they cannot infect you with COVID-19. Side effects that appear after you receive the vaccine occur because your immune system is activating and building antibodies – they are not signs of infection.

After vaccination it takes time for your body to develop full immunity to the virus, so it is still possible to get infected with COVID in the days before or after your vaccination. This does not mean the vaccine did not work; rather, it means that your immune system did not have enough time to build full immunity from the vaccine before coming into contact with the virus.

Are other vaccines coming?

To date, 13 vaccines have been approved for full or limited use around the world. Seventy-eight vaccines are currently in different stages of human clinical trials: 55 are in the early stages and 23 are in the final stages of testing. Hopefully, some of these vaccines will be found to effectively protect against COVID, opening up more vaccination options for people around the world. To track global vaccine development, view the New York Times Coronavirus Vaccine Tracker.

When can I stop wearing a mask?

Even after you get the vaccine you should still wear a face mask whenever you are in public places. Masks will continue helping to shield you from the virus and new variants of COVID (since no vaccine is perfect), and will reduce your chances of spreading COVID-19 to people around you (if you are carrying the virus and don’t have symptoms). As more people get vaccinated, the number of people carrying the virus in your community will decrease, bringing the risk of infection down. Public health authorities will make announcements about this, which may vary from place to place and even with the season.

If you are fully vaccinated, you can begin spending time with others who are fully vaccinated without wearing face masks.

While we await further information and research on COVID vaccines, protect yourself and those around you. For more information, read “Staying Safe – And Staying Well – During a Pandemic Winter” and “COVID Variants, Double Masks, Diabetes, Oh My!

Editor’s note: This article was first published on January 8, 2021, and last updated on March 22.

Dr. Francine Kaufman is Chief Medical Officer at Senseonics, a diabetes device company and Distinguished Professor Emerita of Pediatrics and Communications at the Keck School of Medicine, University of Southern California.

Source: diabetesdaily.com

COVID-19: What Your Friends with Pre-Existing Conditions Need You to Know

This content originally appeared on Beyond Type 1. Republished with permission.

By Lala Jackson

The first few months of 2020 presented a global health crisis not seen in almost a century. When the coronavirus first emerged, wild theories abounded. We didn’t know who was most at risk to get severely ill or die. There was a mind-numbing amount of conflicting information – do we wear masks or not? Is this virus airborne or does it live on surfaces? Am I safe to go outside at all?

For those of us living with chronic diseases like diabetes, this was all exponentially more intense. Living with an invisible illness during a pandemic is a uniquely anxiety-inducing and isolating experience. Each of us has our own level of fear about our risk, but much of our ability to protect ourselves was based on pure gut feelings because no one had enough data from which to make informed decisions.

Now, we know a little bit more. Living with diabetes itself does not appear to increase our risk of contracting coronavirus, but if we do get COVID-19 and end up in the hospital, things could go south quickly. It also seems like many people who do end up in the hospital have other underlying heart or lung conditions or are older in age, so we don’t know what percentage of risk is diabetes-specific. For many of us, memories of poor diabetes care in hospital settings is a major risk to consider – COVID-19 may not kill us but a medical professional who doesn’t listen to or know how to take care of our needs might. And it may not even be their fault – in an overly taxed medical system that does not have the resources to take care of the volume of people who are sick right now, people with often-misunderstood chronic illnesses fall to the wayside.

Existing in the world with a disease like diabetes can already be already dangerous. Existing in a world currently going through a pandemic, with conflicting and limited guidance and leadership, broken healthcare systems, a taxed medical supply chain, and the medication that is our lifeline often too expensive to afford? It’s all still scary, and while we know a little bit more, we’re still flying blind and doing the best we can amidst constantly changing circumstances. Here’s some of what your friends with pre-existing conditions want you to know:

  1. This is still really scary; please give me space and time to figure out what decisions are best for me. Every person living with a pre-existing condition is different. Many of us live with multiple health hurdles we’re juggling, and even within the same disease, we each have to take care of ourselves in different ways. Some of us feel completely safe starting to return to (socially-distanced, while wearing a mask) everyday activities, while some of us feel safer continuing to stay at home. Some of us don’t have a choice — the need to earn a paycheck to support ourselves, our families, or keep our health insurance supersedes our fears. Be kind. Be patient. Don’t assume to know what we need. Ask us how you can support us.
  2. Please stop sending me articles about people with my disease dying from COVID-19. I’ve either already seen it or I’m purposely ignoring it for mental health reasons. I promise I already know all of the risks someone like me faces, and I am doing everything I can to mitigate them. It is my job to pay attention to the level my health requires, and I promise I’ve already done it.
  3. I reserve the right to change my mind at any time for any reason. In a time when we are all making decisions on the fly, there are days we’re agreeing to things because the most recent headline we saw seemed positive, or we’re having a strong mental health day. At any moment, for any reason, that may change. New studies about how COVID-19 affects people are published weekly, with studies that then directly conflict following just a week later. We’re not being flaky; we’re trying to keep ourselves alive in a constantly changing landscape.
  4. “Don’t worry, it only kills people who are old or already sick” is still a really horrible thing to hear. Knowing that there are so many people in the world who care so little about our lives is heavy. For many of us, this is simultaneously compounded by how society views our race, our culture, our social standing, our access to healthcare or a paycheck. We are being told we do not matter from multiple directions, and we are exhausted.
  5. Having a discussion about a COVID-19 vaccine isn’t productive for me. While there are many companies doing clinical trials, there is no current frontrunner. Once there is, there will be conversations about priority vaccinations. No, I don’t know if I will be able to get one. Don’t ask me about how I feel about vaccinations and what I will do once I get one or if I should get one. There are still many unanswered questions about what will happen after a vaccine becomes available and I’m just trying to stay safe until then.
  6. I still love you. But if I say I can’t visit with you yet, please respect that. I miss you immensely. I wish I could see you. Right now, I’m having to weigh the very real thought that if we visit together right now, there’s a chance I won’t be around to know you for the rest of your life. I don’t want to have to make that decision. Please don’t ask me to.
  7. Please stay home while waiting for your COVID-19 test results or if you’re feeling under the weather. This may not feel like a big deal to you. You may not feel like COVID-19 will impact you too harshly or you probably won’t end up interacting with anyone who is high risk when you go outside. But there’s no way to know who’s path you’ll cross and what impact COVID-19 could have on them or someone they are going home to. Many of us who are at higher risk do not have the option of staying inside and away from you. We have to get groceries for our families, we have to earn a paycheck, we have to see our doctor, and many of us don’t look sick. You won’t know when you cross paths with a high-risk person. Please don’t make those choices potentially deadly for us.

To learn more about the precautions everyone impacted by diabetes should take throughout the COVID-19 pandemic, visit coronavirusdiabetes.org.

Source: diabetesdaily.com

The Latest on COVID: Staying Safe as The Pandemic Surges

This content originally appeared on diaTribe. Republished with permission.

By Eliza Skoler

As COVID restrictions and recommendations shift, what do we know about staying safe with diabetes? How can we protect others and make careful decisions about risk?

As the pandemic continues to unfold, states and countries are leading their own initiatives to reduce infection rates and keep people safe. This means that people around the world are experiencing different stages of caution, risk, and safety. As we navigate the uncertainty of conflicting messages and daily updates to guidelines and recommendations, everyone – with or without diabetes – can do some things to keep themselves and others as safe as possible. In this article, we’ll look at the latest scientific recommendations to discuss what we know about preventing serious COVID-19 infections.

View our new COVID and diabetes infographic here. Click to read our first COVID reopening article, “COVID Phase 2: Diabetes Care During Reopening,” or check out more of our articles on COVID-19. You can also find the official reopening plan for your US state here.

On July 17, the CDC updated its recommendations for people who are at higher risk for severe coronavirus infection. People with type 2 diabetes have increased risk for severe illness, while people with type 1 diabetes may have increased risk. If you have diabetes, the best thing you can do to prevent severe COVID infection is avoid contact with other people as much as possible.

Click to jump down to a section:

diabetes and COVID

Image source: diaTribe

Stay at home as much as possible to avoid contact with other people

Coronavirus is spread through contact with infected people. This means that by avoiding public spaces and people who do not live with you, you can dramatically reduce your chances of infection. We know that not everyone is able to stay home – if you are an essential worker, thank you for the work you are doing. Please be as careful as possible and see below for information on protecting yourself outside the home.

COVID-19 is primarily spread through the droplets that come out of an infected person’s mouth or nose when they talk, breath, cough, sneeze, laugh, or holler. The virus is carried through these small droplets. Anyone close by can be infected by the virus if the droplets enter their mouth, nose, or eyes.

  • Droplets can also land on surfaces (like door handles or food at the grocery store) and infect someone who touches a contaminated surface and then touches their face.
  • The World Health Organization acknowledged in July that COVID-19 may be spread invisibly through the air. Many scientists agree that tiny droplets can stay in the air for an extended period of time after they are released, which means COVID-19 could be considered an airborne virus, increasing its danger. This provides even more reason to stay home.

Protect yourself if you are outside your home

  • Social distance by staying at least six feet away from other people.
  • Wear a cloth face covering when around other people in public. Your mask should full cover your mouth and nose and fit snugly against your face. See below for more tips on wearing and cleaning your face mask.
  • Wash your hands often with soap and water for at least 20 seconds; use a hand sanitizer with at least 60% alcohol when you don’t have access to soap and water.
  • Avoid touching your eyes, nose, and mouth.
  • Avoid close contact with people who are sick, even in your home.
  • Cover coughs and sneezes. Do not remove your mask to cough, sneeze, or talk to others.
Mask

Image source: CDC

Many people with coronavirus may not show symptoms or know that they are carrying the virus; however, even those without symptoms can still spread it to other people. Cloth face masks are meant to protect people around you if you are already infected (as shown in the image on the right; source: CDC). Studies show that masks are extremely effective: the more people wear masks in public, the less the virus is passed.

Here are some resources on cloth face masks:

As things reopen, make careful decisions

For many people, the hardest part about removing or lessening restrictions is that it can feel “safe” to go back to our pre-pandemic activities. To make the problem even more challenging, even though it’s not completely safe yet, many people are tired of social distancing and staying at home, and the social isolation has taken its toll on many.

According to the CDC, “the more people you interact with, the more closely you interact with them, and the longer that interaction, the higher the risk of COVID-19 spread.” While the pandemic is still raging, here are some ways to be careful if you will be seeing people.

  1. See people outside, rather than inside

Because COVID-19 is spread through the air, it is much easier to spread the virus indoors than outdoors given that wind circulation and open space outside are far greater. This means that closed, small, indoor spaces are the most dangerous places to interact with other people. If you or someone you live with has diabetes, avoid seeing others indoors. Instead, consider seeing people outside, where you have more space to remain distant and the breeze complicates the transmission of droplets.

  • If you must see family or friends indoors, open windows or doors to create air flow. Find an indoor space that is large, so that you can stay far apart.
  • Wear cloth face coverings, even at socially distant gatherings.
  • Wash your hands often (or use hand sanitizer) and don’t touch shared surfaces.
  • Read more about the safety of outdoor gatherings from the New York Times.
  1. Avoid travel

The CDC continues to recommend that people avoid travel, if possible, because traveling exposes you to many other people who may be infected. This is especially important for people with increased risk; if you have diabetes, or you are considering visiting someone with diabetes, travel can pose a high risk for serious coronavirus infection.

  • While traveling in personal vehicles carries the least risk of COVID-19 infection, activities such as road trips can still expose you to the virus at rest stops, gas stations, and other places where you may stop.
  • Learn more about travel considerations from diaTribe and from the CDC.
  • Given the uncertainty of travel restrictions, if you travel you may run the risk of not being allowed to return home.
  1. If you haven’t already, ask your healthcare team if you can try telehealth appointments

Going to a clinic, medical office, or hospital can expose you to people who have COVID-19. Many healthcare teams offer telemedicine appointments so that you can discuss your diabetes management without coming into contact with other people. Ask your healthcare team whether it is safe and important for you to visit the clinic for regular diabetes management.

  1. Stay as healthy as possible

For people with diabetes, it is more important than ever to carefully manage your blood glucose levels. Keeping your blood glucose levels stable will keep your body healthy and ready to fight off an infection.

If you show symptoms or begin to feel unwell, get tested for COVID-19

Symptoms of COVID-19 can appear up to 14 days after you have been infected with the virus. According to the CDC, these are the symptoms to watch out for:

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Tiredness
  • Muscle ache, headache, or body aches
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

If you have any of these symptoms or are not feeling well, stay away from others, contact your healthcare professional, and get tested for COVID-19. Find free testing sites in your state here. It is important to note that you may experience other symptoms of COVID-19 that are not listed above, or even no symptoms at all.

We know that people with diabetes face more serious outcomes of COVID-19 infection. If you, or someone close to you, has diabetes, it’s even more important to be careful in this pandemic. The best thing you can do to protect yourself and those around you is stay home as much as possible and wear a face mask (appropriately!) when you’re out in public.

Source: diabetesdaily.com

Emergency Changes to SNAP and WIC (Food Stamps) Adjust to Thousands of New Applicants During COVID-19

This content originally appeared on diaTribe. Republished with permission.

By Karena Yan

SNAP and WIC help connect millions of individuals and families to affordable, nutritious foods. Here are how these programs are evolving

Healthy food and nutrition are important not only for managing diabetes but also for the proper function of your immune system. The World Health Organization (WHO) recommends that people maintain a nutritious diet and limit their alcohol and sugary drink consumption to improve our bodies’ ability to fight off viruses like COVID-19.

At the Tufts’ Food and Nutrition Innovation Council (FNIC) Summit on April 16, experts in nutrition, healthcare, and policy gathered to discuss the implications of coronavirus on the affordability, accessibility, and sustainability of healthy food in our country. In addition to discussing the changes brought about by the pandemic, council members made food policy recommendations for the post-COVID future.

While coronavirus poses a challenge for the smooth operation of programs like the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), the USDA’S Food and Nutrition Service has implemented emergency changes to these programs to ensure access to healthy food for program recipients.

What are SNAP and WIC?

SNAP, previously referred to as food stamps, is a federal program that provides nutrition benefits for eligible, low-income individuals and families to support their ability to purchase healthy foods. These benefits are provided via an Electronic Benefits Transfer (EBT) card, which acts as a debit card at authorized retail food stores.

Similarly, WIC provides federal grants to low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk. WIC serves about half of all infants in the United States, and these grants supplement the purchase of foods, health care referrals, and nutrition education.

How has coronavirus impacted SNAP and WIC?

As unemployment has reached nearly unprecedented levels , enrollment for SNAP and WIC has seen a marked increase. In California, application volume to receive CalFresh, the state’s version of SNAP, has seen a 350 percent increase since the crisis began. More than 57 percent of these applicants reported that they lost a job within the previous 30 days, compared to 16 percent in January.

Graphs

Image source: diaTribe

Moreover, panic buying and stockpiling during the epidemic have made the availability of SNAP- and WIC-eligible products scarcer. This is particularly true for WIC recipients, who may only use their funds on a limited list of products that have been selected as low-cost and nutritious. For those who do not receive WIC benefits, the National WIC Association asks shoppers that if they are choosing between two items, one of which is WIC-eligible, to avoid buying or hoarding WIC-eligible products, including infant formula.

What emergency changes have been implemented to support SNAP and WIC?

The USDA has implemented a 40 percent increase in overall SNAP benefits, which amounts to a $2 billion monthly allotment in addition to the usual $4.5 billion that goes toward monthly SNAP benefits. WIC has also received $500 million in additional funding to cover increases in program participation.

Additionally, while SNAP and WIC have some requirements that are challenging to meet during COVID-19, such as mandatory in-person visits to enroll or re-enroll in the programs, the USDA has offered many accommodations to these requirements. However, the USDA’s Food and Nutrition Service has offered many accommodations to these requirements, in addition to providing extra funding to both programs. Several of these program changes are highlighted below. To see the full list of changes, please see here.

SNAP:

  • Application Processing: State agencies can extend certification periods and temporarily waive periodic report form submissions for enrolled households. Additionally, in lieu of face-to-face interviews for enrollment, states are waiving the interview requirement or conducting interviews via telephone.
  • Pandemic EBT (P-EBT): States are now allowed to provide benefits (similar to SNAP or “food stamps”) to children who normally receive free or reduced-price school meals.
  • Able-bodied Adults without Dependents (ABAWDs) Time Limit Suspension: States may temporarily suspend the time limit associated with ABAWD work requirements, which ordinarily terminate an ABAWD’s SNAP benefits after three months of unemployment.

WIC:

What happens after COVID-19 is over?

At the Tufts’ FNIC Summit, council members discussed the importance of maintaining some, or all, of these measures after the crisis. Requirements such as in-person visits and lengthy renewal processes pose barriers for SNAP/WIC recipients and risk delaying or inhibiting people’s ability to access these services, regardless of the circumstances. Moreover, given the sharp uptick in SNAP/WIC enrollments, the increased efficiency and accessibility of these programs will greatly benefit recipients long after the “end” of the coronavirus crisis.

Furthermore, council members hope even further adjustments to SNAP/WIC are made in the future. While these programs have been relatively effective in facilitating access to healthy foods for low-income individuals and families, the FNIC calls for greater emphasis on nutrition within the programs, such as by providing a subsidy for fruit and vegetable purchases or removing sugar-sweetened beverages from the list of eligible purchases.

Such incentives can provide vast benefits for both individual health and healthcare costs. For example, a 30 percent fruit and vegetable incentive for SNAP participants is estimated to save $6.77 billion in healthcare costs over a lifetime. Thus, while some headway has been made to these SNAP/WIC programs, advocates must pursue not only the permanence of these adjustments but also additional changes to the programs’ health and nutrition standards and practices.

Source: diabetesdaily.com

Embracing Community in Times of Crisis

This content originally appeared on Beyond Type 1. Republished with permission.

By Erin McShay

Sometimes in life, it takes something bad to happen for us to pause and appreciate how good things once were. I used to think of our lives as before and after our Sam was diagnosed with type 1 diabetes. Fast forward twelve years: he’s a senior in high school and the Corona virus is sweeping the country. The cacophony of chaos in the world is now pulling our attention into dark territory, channeling voices of fear and uncertainty. It’s almost as if time has slowed down to a crawling pace; giving us the chance to inhale and catch our second wind.

Community

Image source: Beyond Type 1

Always a Battle

Dealing with any chronic illness is an arduous job packed with hundreds of additional decisions to make a day. Ordering supplies, planning and packing become essential, life-saving chores. We take the burden in stride, but then become our harshest critic when thing go wrong. From personal experiences, I’ve learned that dwelling on our missteps serves no one. Remember that Billy Joel song? “We’re only human, we’re supposed to make mistakes.”

Just last year I made a doozy when we sent our two teenagers to Houston to visit family – I forgot to pack additional insulin pump cartridges for our son. Halfway into the trip, Sam called to say he ran out of cartridges. We’ve taken dozens of trips throughout the years, driven and flown across the country, camped in remote areas, and I’ve never forgotten anything. I told him to check again. We went over the list together; extra insulin, needles, blood sugar meter, back up meters, test strips, infusion sets, ketone strips but no cartridges. In a cupboard, I found the sandwich baggie of them that somehow got left behind. Anyone who’s ordered these types of supplies knows that you can’t just walk into a pharmacy to get more; in fact, you only have a few options and they all take twenty-four hours to ship. It didn’t matter how many times my son and husband told me it was okay: two thousand miles away, I spent the entire night consumed with guilt and worry, crying on my husband’s shoulder. Sam spent the night waking up every two hours to do blood sugar checks and give himself shots. He learned a hard lesson and so did I, but meanwhile we still had to find cartridges.

Community

Image source: Beyond Type 1

Somehow, on a hunch and a prayer I managed to look up a Facebook/Beyond Type 1 friend whom I’ve never met – and asked for help. It was a miracle really. I was a complete stranger to her, she could have said, ‘Sorry,’ but instead this angel went to extraordinary measures for us by reaching out to her community to find me the specific cartridges I needed for Sam’s pump. Her son had a different pump, but a friend of her’s (another angel) met Sam and my sister-in-law to give them an exceeding amount, beyond what he needed. I paid her back when I got her address, but at the time I don’t think they knew the depth of my gratitude. Not to mention the many thanks to my sister-in-law for driving Sam to another county, and our family in Houston for taking such good care of him.

When You Need Help, Ask

The chances are in your favor in the type 1 community with a million out-stretched hands, and general well-wishers ready and willing to offer not only advice, but whatever you need to help you get by.

I’m embarrassed to say I ran out of supplies once before the Houston trip. Not long after Sam was diagnosed, we depleted our infusion sets before our new order arrived. Luckily a neighbor, whom I met through a friend, had the same insulin pump as Sam, and gave us a few loaners. Another neighbor, a type 1 diabetes (T1D) dad who lived around the corner from us, went out of his way to offer advice and help us when Sam was first diagnosed. We were so scared in those early years and his helpful words still bring me comfort years later.

Get to Know Your Neighbors

Once, I bonded with a fellow writer at a conference, where I divulged that I had a son with type 1 diabetes. We became fast friends after she told me she had developed late adult onset T1D. One night, when my son’s pump stopped working, I called her in tears. My husband was out of town and I couldn’t get Sam’s pump to prime. She drove over to my house at ten at night – because these problems never happen in the middle of the day – and got the pump working again.

I wouldn’t have known these angels to receive help from them, had I not been as forthcoming about Sam’s disease. Nor would I have met them if I wasn’t on Facebook or involved with my community. You don’t realize these tiny miracles for what they are, until after the fact. If not for their help, I would probably be in a strait-jacket staring at a cement wall somewhere. Instead, I am now willing and able to pay it forward anyway I can.

Sibling

Image source: Beyond Type 1

As a writer and avid reader, I peruse tons of articles and social media sites a day, and if there is one thing I’ve learned, it’s to think before you say or post something. Negativity helps no one. I’ve found that depressing, bleak posts can linger in your psyche long after you’ve read them. Your views can really impact others. On the other hand, knowing how meaningful certain tweets can be, spreading love and encouragement, cannot only change a person’s day but has the power to alter their lives.

One kind word can mean the world to someone. Life is hard, especially with a chronic illness and there is no question diabetes stinks, but what a wonderful support system we have in place within the T1D community! People can be quite beautiful, and they have a wealth of knowledge on a much deeper level sometimes than our medical professionals.

Pay It Forward

I heard once that Jackie Kennedy Onassis said that motherhood was the most important job on earth and if you mess that up, whatever else you do doesn’t matter very much. My son and daughter are edging their way to adulthood now, and I hope that they’ve learned from my mistakes and watched how I forgive myself. I hope they’ve learned from the tiny mercies shown to us, and that when someone’s in need, you offer a helping hand or an encouraging word without blinking. I hope they stand up to injustice when they see it, and become advocates for the less fortunate, like those struggling to afford insulin.

As I reflect in this trying time, I see that through Sam’s diagnosis, we’ve learned and grown so much because of it. It’s made us who we are – all of us. And though this is a flawed, imperfect world, we truly have a family beyond our own. No amount of social distancing can diminish how interconnected we truly are. The silver lining through this all is that we have each other.

Source: diabetesdaily.com

Front Line Nurse with Type 1 Contracts COVID-19

Sarah Hannigan is a fellow member of the diabetes online community. When I saw she was also a fellow New Yorker, who was putting her own life at risk for us, I just had to reach out and thank her. Sarah tells us about her recent experiences with becoming infected with COVID-19 during the ongoing pandemic. Thank you, Sarah, for everything you do and for taking the time to share your experiences with us!

How long have you been type 1?

I am Sarah, a nurse practitioner in a New York City hospital. I have practiced in a hospital for over 14 years as a nurse, ICU nurse and now nurse practitioner for the last five years. I am married, live in NJ and have two young boys. Some of my hobbies include traveling, weightlifting, Zumba, and yoga.

I have had type 1 diabetes for 20 years now. I have been on an insulin pump for 16+ years and have been using a continuous glucose sensor for about nine years. When I was pregnant, I kept my A1cs in the 5.3-5.7% range, but my normal control is typically 6.4-6.7% for the past decade. Prior to that, I spent some years in the low to mid 7s.

Did that play into your decision to become a nurse practitioner? 

Yes, I would say that being a person with diabetes played a role in me going into the medical field. Considering various careers, having a chronic disease makes it very important to have stable employment with good health insurance. I also got to see what nurses can do. No one in my family was a nurse and I didn’t really know how autonomous you can be. I also researched being a nurse practitioner and that seemed to be like a great combination of having a nurse background, but being able to diagnose, prescribe medications and radiographic studies, and do important disease prevention education. It seemed like a good way to connect with people and be able to prevent and treat diseases.

Photo credit: Sarah

When you heard about COVID-19 heading our way, were you nervous? For your family? And for your work as a nurse practitioner during this pandemic? Did you feel your hospital was prepared for the outbreak?

At first, like many people, I didn’t know what to think. My hospital, as with many places (in my opinion, because of our country’s poor leadership and lack of proper prevention strategies) kept functioning as usual business until mid-March when we started decreasing visitors significantly, stopping nursing and medical students, decreasing nonessential staff in the hospital. We were still doing elective surgeries. It seemed like it could help, but truthfully the virus was already in NYC; it was just that it was extremely difficult to get tested. This was evident by the skyrocketing numbers we saw when testing was more prevalent. As health care providers, we were actually beginning to wonder who had had it in the previous month.

I didn’t know what to think at that point; I knew my job was going to change, but it was unclear when and how. Since then, we have had to adapt to multiple changes since this is something we have never been exposed to at all. Resources, including doctors and nurses, have been redistributed to better manage the influx and we are constantly adjusting. We have stopped doing elective surgeries and the ways we diagnose and progress patients have drastically changed.

I was the most nervous for me in my house since I am the immunocompromised one who is working in a hospital. Children seem to do well with this disease and my children are very healthy. They don’t have any asthma or other respiratory illnesses. My husband is also healthy. I do know that anyone can get very sick as I have seen many scenarios as a provider for other diseases, but excessive worry is also not good for the immune system, so I have tried not to worry.

Most people were going out and buying hand sanitizer and disinfecting wipes, but I was just trying to prep my immune system as much as possible. I increased my fruit and vegetable consumption, eating smoothies and salads every day, and was more careful with blood sugar control. I did have my husband buy some frozen food and supplies in case we are unable to leave the house for a few weeks, but I didn’t do any excessive buying.

Photo credit: Sarah

At what point did you find out that you have COVID-19? Do you know how you contracted it?

It was either a co-worker or a patient who I contracted it from. I was in the room for the patient for 30 minutes. I worked closely with the co-worker for two shifts and then he left for the day with a high fever. I wasn’t going crazy at this point because I thought he could have something else, but I put it on my radar.

It took five days after I was in close contact with the patient for her to come back positive. It was seven days before I knew the co-worker had it. Testing took a long time to result. Before I knew they had it, I started feeling a little sick. I had a sore throat and felt like I was getting a sinus infection, but I didn’t immediately go to COVID since I didn’t have a cough or fever.

At the same time, my husband was feeling like he had a fever. He tried to get tested, but since he had no known contacts and wasn’t sick enough to require a hospital, they wouldn’t test him. Since my youngest had had a cold for over two weeks, I thought he could have given us something.

Once I heard the patient tested positive, though, I started being suspicious. I talked to my supervisor and she told me to do a telehealth visit to see if they would test me. I didn’t have classic symptoms; I had lost my sense of smell and taste, was very fatigued, and had mild body aches. I didn’t have a cough or fever. Being a person with diabetes, I also had the clue of needing more insulin. My basal was up 20-30% and I need more with mealtime insulin also. This was suspicious to me because normal colds don’t require more insulin.

I did the telehealth visit and the doctor placed an order for me to get the test, but the first appointment was five days away. By the time I was to get tested, I had symptoms for ten days. In the meantime, I took my younger child to the pediatrician since his cough had gotten severe; he was having trouble sleeping at night. Like my husband, they were only willing to test my son if I had tested positive.

It wasn’t good enough for me to say that I had been closely exposed to two people [who have tested positive]. This was frustrating to me because my testing was so delayed and by now I could have given it to my whole family and frankly, no one seemed to care. This, I believe, is how COVID-19 got so widely spread so quickly. It was so rare to get tested, so we, as a society couldn’t know who had it or didn’t. Even though I was social distancing, I still went to the grocery store and drugstore, thinking I was trying to protect myself from other people, not knowing it was the opposite.

Finally, I was tested at work; the test resulted quickly, and was positive. It was quite a turn around to go from having a hard time getting anyone in my house tested to my local public health department calling me and asking every place I had gone for the past two weeks, who I had seen, and the transportation I took to get there.

Photo credit: Sarah

Did anyone else in your family get it? If so, what were their symptoms?

I am pretty sure that everyone in my family had it, but it is unclear. When I called the pediatrician back, they were not interested in testing G since he was doing better. My husband got better much quicker than me and then wasn’t interested in getting tested since I told him how painful the test is.

How long were you (and any family members) sick for?

T, my husband was sick for five days. He had mild shortness of breath, moderate muscle aches, and significant fatigue. He said he felt like he did when he had the flu. (I have never had the flu so I can’t compare it to that). My young son had a bad cough. My older son had cold symptoms including a cough and runny nose. I am assuming they had it, but I won’t be able to know unless they get tested for antibodies.

Everyone was exposed because I really didn’t think I had it well into me being contagious. We are a very cuddly family, so we are always snuggling and hugging. Despite trying, I couldn’t get them tested. I didn’t self-quarantine because I honestly felt like I had exposed them all already and I assumed T and I had it and someone needed to take care of them.

Photo credit: Sarah

What is the main concern you have as a nurse practitioner and someone that has had COVID-19?

The biggest concern after having it myself is that so many people are walking around with it and we have no idea. I didn’t have the classic symptoms and it was so hard to get anyone in my house tested. I feel like it is so widespread and we have no way of knowing how far it extends.

As someone with type 1 who gets diagnosed with COVID-19, what was the first thing you did in order to prepare for your illness?

I just was trying to be extra health focused. A chronic illness makes you more susceptible because no matter how well controlled you are, you are not about to fully mimic your pancreas. I have exercised on some level which helps me keep up my energy. Only on the days of my worst fatigue did I take a break from working out. I think that helps me keep my immune system operating at a higher level.

Is there anything to have on hand that you would recommend to other people living with diabetes?

Keeping a healthy lifestyle! I would try to have other people go to the store for you as much as possible, washing fruits/vegetables well and quarantine other foods for a few days before you bring them into your house (COVID can be on the package).

I can’t imagine how stressful this time has been for you. How have you been able to rest, take care of your family and your patients?

My husband is very good at letting me take naps and workout when I need. I try to get one or two things accomplished before I let myself rest and veg out. When I am at a high energy time, I try to go with it and make dinner if need be. It can be reheated later.

Self-care is so important, how has working on the front lines affected your mental and emotional health right now? What are you doing to make sure you take care of yourself?

My goal for this week is to find a mental health professional to talk to on a video chat. I know there is help out there and I (and I think most medical professionals) could use some help right now. Our jobs are so different and the stress is challenging. I have been trying to listen to my body; I try to take a break from everything COVID every few days because it is making me anxious to be immersed in it all the time. I am working out or doing yoga every day because it makes me feel better.

Photo credit: Sarah

Were you able to take off from work once you find out you were diagnosed? At what point did you go back?

Ironically I was on vacation for the first ten days of my symptoms. NYSDOH and my job recommend healthcare providers stay home for the first seven days after symptoms, so I haven’t had to miss work. I want to take care of the COVID patients since I have had it. I would hate to see any of my coworkers getting very sick from it.

Being on the front lines, what is the most concerning thing you have seen from the COVID-19 patients?

The lack of knowledge and resources has been difficult to deal with. Hospitals are functioning for lack of a better term like war zones. No visitors are allowed. We have to function with what we have. There is no bed. We have to figure out how to manage the patient until they do. There are a lot of different precautions we need to follow to keep staff and patients safe.

What do the symptoms you see range from?

I am in the hospital so patients have to be pretty sick to get admitted. Mild COVID-19 patients, I do not get exposure to. In hospitalized patients, we are watching their oxygenation. They usually require oxygen supplementation in varying degrees. When the oxygenation gets low enough despite non-invasive measures, they have to be intubated and go on a ventilator. Frequently patients have fevers, nausea, and low appetite. It would be unlikely for me to see only mild symptoms because we would have them manage at home since hospital beds are a limited resource.

People are very afraid, being that you have type 1 diabetes and now have survived COVID-19, what would you like to tell our readers? Any words of wisdom on how to feel about this whole terrible situation?

Be vigilant about social isolation, hand hygiene, and good infection control, but try not to be scared. There is only so much you can do and being afraid isn’t good for your immune system. The biggest advice I have is controlling your blood sugars. Good diabetes management when you are sick cannot be overstated. Refilling prescriptions and obtaining your testing/pump supplies as much as you can is good prep as well.

Diabetes doesn’t mean that you are going to be worse off if you get COVID-19. Healthy people are dying from it. Alternately, diabetes doesn’t make COVID-19 a death sentence. I have diabetes and was less sick than my co-worker who is healthy. It is hard to predict, so take care of yourself!

Thanks so much for taking the time to talk to me! I am so glad you are okay and feeling better. And from all of us here at Diabetes Daily, thank you for all you do! 

Source: diabetesdaily.com

Supporting Older Adults with Diabetes During COVID-19

This content originally appeared on Beyond Type 1. Republished with permission.

By T’ara Smith

With COVID-19 spreading around the world, it’s important to be prepared, not panic, and practice social distancing, especially for people with underlying conditions such as asthma, diabetes, and heart disease. Though people of all ages are susceptible to contracting COVID-19, older adults appear to be more vulnerable. The Centers for Disease Control and Prevention has labeled adults aged 65 and older as a high-risk group for severe illness from COVID-19. It’s also important to note diabetes impacts many older adults — an estimated 33 percent aged 65 and over have diabetes and are at risk of complications like low blood sugar, kidney failure, and heart disease.

At a time like this, it’s important to think about how the COVID-19 public health crisis impacts our elders with diabetes, whether they be our grandparents, friends, or neighbors. Here are some tips on supporting older adults with diabetes during COVID-19:

Help Ensure Medications and Food Are Stocked

Help older adults obtain at least a month’s supply or more of diabetes medications and supplies. If available, have them delivered by the pharmacy. Note that insulin can’t be delivered, so consider picking it up from the pharmacy for them. Health plans are also waiving early refill restrictions and allowing 90-day supplies. America’s Health Insurance Plans has a list of health insurance companies and the steps they’re taking to address the pandemic.

In regards to food, insist on helping older adults set up a grocery delivery service. If those services are unavailable, offer to pick up groceries for them. If your loved one is insisting they shop on their own, many grocery stores have set up a system where the first hour the store is open is reserved for older and immuno-compromised shoppers only. Everything is freshly cleaned and the crowds are smaller.

Stay Informed About COVID-19

We’re learning new information about the coronavirus, which leads to the viral disease COVID-19, every day. Keep up-to-date with changing guidelines and new research by the WHO and CDC. As we learn more about the coronavirus, we’ll be updating the information here. In the meantime, continue to follow WHO and CDC guidelines such as hand-washing, disinfecting high-touch surfaces, avoiding touching your face, coughing into your elbow, and more.

Implement Household Changes

If you live in a multi-generational household, there are varying levels of COVID-19 risks. In this case, it’s important to consider how likely each member is to be carrying the virus, especially if some members are essential workers. Consider implementing household rules such as not sharing personal items like cups, utensils, food, and water. If you have space, designate a bedroom and bathroom for potentially exposed or sick family members. Also, consider limiting or forbidding visitors. People may be carrying the disease without displaying symptoms.

Communicate With Their Healthcare Team

You can support older adults with diabetes during COVID-19 by helping them communicate with their healthcare team. Non-essential doctor’s visits can be held online and these services are offered by health plans. Assist older adults who may not be technologically savvy by setting up virtual doctor’s appointments.

If your loved one is in a nursing or retirement home, contact the facility to learn what measures are in place to handle the public health crisis. Ask what adjustments are going to be made to your loved one’s routine, particularly with blood glucose management.

Know that visitation may not be recommended at this time, as assisted-living and long-term care facilities have to consider that visitors may be carrying the disease. Advocates are also urging family members to not panic and do not recommend bringing home loved ones to avoid infection. However, if you’re interested in becoming a caregiver, learn what the caregiver laws are in your state and what health decisions you can legally make on their behalf.

Stay Connected to Prevent Isolation

In the midst of social distancing, feeling isolated can become a real problem. Older adults may be feeling more anxious and overwhelmed than usual. Use things like FaceTime, Google Hangouts, Facebook Messenger, and more to stay connected. Talk about things that aren’t related to COVID-19. However, if they want to discuss the virus and simply need someone to listen, be that person. If you notice COVID-19 is taking a deeper toll than you can handle, recommend professional online therapy services. Some are covered by insurance or have a co-pay. There are other online therapy services like Talkspace and BetterHealth where you can be connected to a counselor.

Source: diabetesdaily.com

The Problem with How COVID-19 Risk Is Being Discussed

This content originally appeared here. Republished with permission.

By Caroline Levens

There are 24 confirmed cases of COVID-19 in my county, and I’ll admit it: I’m very worried about the outbreak. Call me crazy as I sit in my apartment with mountains of supplies and food that could easily get me through June, but I’m part of the group largely dismissed by mainstream media. I’m immunocompromised and have underlying chronic health conditions.

Article after article says something along the lines of “most COVID-19 illness is mild, only those over the age of 70 or who are immunocompromised or have existing health conditions, such as diabetes, asthma and heart disease, are likely to experience serious illness.” They then go on to say that most people with mild conditions will recover, so people just need to stay calm and wash their hands. Aside from that sole line, the high-risk group has no other mention in the article.

If you’re in the majority group and are indeed at lower risk, I’m glad COVID-19 may not be as threatening to you. But here’s the thing: you likely have parents, grandparents, friends, colleagues and maybe even children who read the exact same statement from the other side. In fact, according to a Department of Health and Human Services analysis, over 50 million non-elderly Americans have some type of pre-existing health condition.

Facts are facts, and believe me, I want the facts. So what’s wrong with saying those groups are at a greater risk? Absolutely nothing – what’s wrong is the insensitive tone they come across with when they give the fact a quick nod and devote the remainder of the article to the people who don’t need to worry, and that saying ‘only’ the “the elderly, immunocompromised and unhealthy” belittles the value of this group. Comparing the average low-risk American to the high-risk group to help reassure them that at least their personal odds are better than some is in poor taste.

Sure, they’re writing towards mass America. But “the elderly, immunocompromised and unhealthy” is no small group, and the people in this group deserve better. While at a bare minimum an emphatic tone would be appreciated, the articles could share what precautions low risk individuals could take to protect those who are at higher risk. Their “mild” case could be life-threatening to someone else who contracts it from them, and it’s important they’re aware of that and how to minimize spread. Current articles make little sense: they focus on reassuring the people at lowest risk and exclude the high-risk group who needs it most. And it’s not just the high-risk group this matters for: it’s their children, grandchildren, parents and caretakers, among others.

The truth is, you have no idea who might be in this high-risk group, or who has loved ones that are in this high-risk group. Just the other day I was told I was taking excessive precautions and I’d be fine because I’m in my late-20s and look healthy (that’s exactly what invisible illness is!). And if you’re fortunate enough to be low-risk, let me tell you, it doesn’t feel great seeing the mortality rate for your condition five times higher than the average American, based on the limited data available from the Chinese Center for Disease Control & Prevention. I should also add the concern isn’t just about getting COVID-19; it’s about COVID-19 putting such a strain on the health system that individuals with chronic health conditions may not have access to the physicians, medications and treatments they need.

So all in all: please consider how you’re coming across when you talk about COVID-19. If you’re able to go about your day-to-day life unaffected, I’m glad you’re in good health and feeling little disruption. But there is nothing wrong with preparedness or being overly cautious. Life is precious, and I’ll happily work, eat and hang at home to reduce my risk and the anxiety stemming from the staggering fatality figures.

Source: diabetesdaily.com

COVID-19: Perspective of a Type 1 Healthcare Worker

Kelly Pearson is a family nurse practitioner who works at a busy urgent care center, and also lives with type 1 diabetes. Kelly took the time to answer some of our most pressing questions concerning the Coronavirus outbreak. Thank you, Kelly, for your time, and for being on the front lines during such an uncertain time, putting yourself at risk to help others.

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I understand you work for Fairview Health Services, one of the largest Urgent Care in our country, in suburban St. Paul, MN. At what point did your organization start preparing for the COVID-19 breakout? 

I’m not sure, but we started testing for COVID-19 via drive up cars at my urgent care 8 days ago [around March 10th].

As a family nurse practitioner who is on the front lines, seeing how medical professionals are preparing, do you think we as a country will be able to handle the outbreak and treat all necessary patients?

I have friends that work as ER docs at Hennepin County Medical Center, a large teaching hospital in downtown Minneapolis, and their ultimate plan is to hand out flyers at the door stating that there is no medicine and no testing available for COVID and that the recommendation is to go home and get people to voluntarily sign out. Sadly, they are legally required to see all patients that want to be seen, which will overwhelm the healthcare system quickly if people refuse to go home, and you simply can’t keep them from infecting others in a crowded waiting room. That may simply include a vital sign and lung check and discharge home. I don’t know anything about the ICU capacity and how that’s going, but if regular hospitals are full, we can access the VA.

I don’t know how this will go. I think there will be harder hit areas and nurses from one state may need to up and leave to help as travelers. I hope they will suspend lengthy state-to-state nursing and physician license issues for this.

I read that people with diabetes are not more susceptible to contracting the virus, but the concern is what happens once we get it. What are the main concerns specific to people with diabetes? And, is the risk different for those who have type 1 vs.type 2 diabetes?

I would read this to answer this question. The key message is that well-controlled diabetics seem to do as well as other people their age, assuming they have no additional comorbid conditions, such as heart disease.

Being around patients who have the virus, what do you see as the most challenging aspect of the illness. What should people be most concerned about?

In Urgent Care, the most difficult thing is keeping people out of Urgent Care. We have had patients ignore signs telling them to go back to their car and call-in number for further advice and contaminate the whole clinic, for instance. People need to know that we are not able to help you at all, at least in Minnesota, unless you are severely ill and can’t breathe and then you need to go to the hospital. We are not even allowed to give a nebulizer to an asthmatic with likely Coronavirus because it will cause the virus to live in the air for several hours. You want to help, but you can’t. It sucks.

COVID-19 Perspective of a Type 1 Healthcare Worker 2

Kelly at work with her coworker in the Urgent Care, Jason Kimmel, PA

Having type 1 diabetes yourself, how are you staying healthy so that you don’t contract it? I’m sure you are stressed, tired and overworked?

Unfortunately, my gym closed until further notice today. The gym owners are putting up home workouts and actually let us borrow equipment to take home. Today, I did a bodyweight workout that actually kicked my butt.

I’m tired AF.

Something I didn’t think about was how tiring it is to always be aware of what you’re touching, including your face and surfaces. At work, I go by the presumption that all surfaces that come into contact with patients are at least intermittently contaminated with the virus. Information also changes by the hour, and we have to learn something and then unlearn it an hour or two later.

The thing that has stressed me out the most this week was the announcement this morning that no patients will receive COVID-19 testing unless they are healthcare workers or hospitalized. Minnesota only had the capacity to do testing for those with fevers, coughs with international travel or known exposures for 7 days. Basically, the only thing we’re tracking now is hospitalizations.

Do you feel comfortable being around loved ones knowing that you’ve been in such close contact, despite the hospitals taking all protective measures?

Good question. I think people are more scared of me because I work in a testing site.  I think my boyfriend is starting to get scared of me, but he’s still being supportive anyway. To make things worse, I get seasonal allergies right around now, so I’ve been aggressively treating those. I otherwise live alone.

As someone who has seen the symptoms and complications associated with this disease, as a person with diabetes, are you worried about your own health if you should contract COVID-19? I’ve read that vitamin D might help?

Yes, I’m worried about my health. I hope that being a lifelong athlete will do something. I think vitamin D helps all infections, but I don’t know of any statistic off the top of my head.

Many people are taking this very seriously, but some are not, including some millennials and the elderly. What would your message be to them?

As a Christian, we are supposed to work together, love your neighbor as yourself, not be selfish. I’ve seen a lot of instances of this so far. I think folks are coming around overall, but we’ve shut everything down to prove our point, too.

As this was so far an international travel and cruise ship issue for the most part (the overwhelming majority of patients are white and upper-middle-class), I’m mostly worried about when it hits our refugee and the immigrant population, who cannot readily access written information and may not trust information from the government. I have not seen information posted in other languages in the community. Hopefully, it’s getting there and accurate.

Overall, leaving politics out of it (albeit challenging), some people think we may be overreacting or that the media is hyping this up. How serious do you think this virus is and how serious should people take the instructions coming from ours/their government? 

Computer models show we’re about 11 days behind Italy. We’re really only a week into this here. During H1N1, we ran out of ventilators at our hospital in downtown Saint Paul, and I (ER nurse at the time) hand-ventilated a lady who needed a ventilator for two hours while the respiratory therapist called all over the Twin Cities at 3 am begging other hospitals to loan us ventilators. We were able to find one total. I think this is the best case scenario. Coronavirus is much more deadly than H1N1. Listen and stay home, wash your hands like your neurotic cousin. Assume any temp over 99.5 with even a minimal cough is corona, and don’t you dare leave.  Have an agreement with someone who will pick up your food and medications for you and you for them.

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Thank you again, Kelly for taking the time to talk to us today. Stay safe and thank you for everything you do.

Source: diabetesdaily.com

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