How Community Health Workers Impact Diabetes Care

This content originally appeared on diaTribe. Republished with permission.

By Andrew Briskin

Andrew Briskin joined the diaTribe Foundation in 2021 after graduating from the University of Pennsylvania with a degree in Health and Societies. Briskin is an Editor for diaTribe Learn.

Two major factors that lead to poor outcomes for people with diabetes are food insecurity and a lack of social support. Community health workers can address these issues, connecting people with diabetes to the resources they need.

Community health workers (CHWs) play a crucial role in addressing public health, particularly in communities with lower socioeconomic status and higher rates of chronic diseases, such as heart disease or diabetes. Two of the most significant social determinants of health impacting these communities – food insecurity and social support – can have a profound effect on the ability of people with diabetes to manage their condition. CHWs can play a direct role in addressing these factors by connecting people with resources to access healthy foods, helping them advocate for themselves, providing nutrition education, and connecting with and supporting individuals on a personal and community-wide level.

CHWs are typically members of the communities they serve, who are sometimes in a paid position and other times work as volunteers. Because of how important it is for CHWs to identify and communicate with the people in their community, they typically share the same background, ethnicity, and language. CHWs work in many locations throughout the community, which can include health clinics, government facilities, churches, food banks, other community centers/events, or traveling throughout the area.

Food insecurity is an economic and social condition of limited or uncertain access to adequate food, according to the US Department of Agriculture. People who deal with food insecurity are often only able to afford low-quality foods that lack nutritional value, have access to only a limited food variety, or have disrupted eating patterns (where you aren’t able to eat multiple balanced meals each day). For people with diabetes, these eating habits can be especially harmful when trying to manage things like weight and blood sugar.

Food insecurity, which is a growing problem throughout the United States, has been further exacerbated by the COVID-19 pandemic. Estimates for 2020 indicate that over 50 million people (or one in every six people) dealt with food insecurity in the United States, an increase of 4.1% since 2018. Rates of food insecurity among people with diabetes are also higher than the national average, with estimates suggesting that one in five people with diabetes face food insecurity during any given year, even without the COVID-19 pandemic adding additional stress.

At the ADCES 2021 conference last month, Dr. Anjulyn Ballard, a research and evaluation fellow at the CDC involved in advancing work of CHWs, said, “By CHWs addressing food insecurity and social support, health disparities can decrease significantly within communities.”

Dr. Betsy Rodriguez, senior public health advisor at the CDC Division of Diabetes who trains CHWs, focusing on reaching ethnic minorities and bilingual health communities, joined Dr. Ballard in the presentation. She said of CHWs, “Their advocacy can impact many healthcare-related issues such as improving health while lowering healthcare costs, improving access to primary care, and increasing screening for major conditions such as diabetes, just to name a few.”

Together, they outlined a few of the ways CHWs play an important role in addressing food insecurity and social support in the populations they serve. These roles include:

  • Advocating for individuals and communities. This involves connecting people with helpful resources while also encouraging people to advocate on their own behalf.
  • Conducting outreach. It’s important for CHWs to establish trust through regular communication with individuals in the community.
  • Coordinating access to healthcare. This includes making referrals to healthcare providers, ensuring that people make it to their appointments, and serving as a liaison between the clinics and the individuals assuring as many people as possible get the care they need.
  • Providing coaching and general social support. CHWs should be able to inform people on where to find community forums or others in the community that can provide social support.
  • Providing culturally appropriate health education. This means helping people understand the guidance they receive from their healthcare provider (for example if there are language or education barriers) and providing advice that considers the food, language, and traditions of the specific community they serve.
  • Addressing financial hardship and environmental needs. This involves encouraging people to apply for benefits such as SNAP and assisting them in the application process.

diaTribe recently spoke with Quisha Umemba, founder of Umemba Health, an organization that recruits and trains CHWs in Texas. A certified CHW instructor and diabetes care and education specialist, Umemba discussed how CHWs can support community members in addressing food insecurity and social support.

“CHWs can help people with diabetes advocate for better nutrition and food choices in their community,” Umemba said. “Often, people don’t know they can approach store managers or owners and request a different selection of foods. They also may not know how to approach their local representation in government or how to start a community petition to address issues like food insecurity.”

CHWs can also connect people with diabetes to their local food bank or farmer’s market to get the food they need. “They can provide nutrition education as well,” Umemba added. “Sometimes clients might have access to healthier foods but they don’t always know how to cook them.”

Not sure where to start? At you can enter your zip code and be immediately connected with food assistance, help paying bills, legal aid, and other free or reduced cost programs.

Increasing CHW engagement that focuses on specific interventions can help promote health equity. Unfortunately, there is still a great need for additional funding and resources for CHWs, especially during the pandemic.

Drs. Ballard and Rodriguez said the pandemic has negatively impacted the ability of CHWs to perform their roles. COVID-19 presented the challenge of providing specific pandemic-related support to communities without the necessary funding or virtual resources, they said. Plus, the economic hardships caused by COVID-19 led to an increased number of people requesting assistance from their CHWs with food, transportation, and financial issues.

Umemba agreed. “So much of what CHWs do revolves around establishing a trusted relationship with their clients,” she said. “It was difficult at the onset of the pandemic, but I believe for the most part that CHWs now see that personal interactions don’t just have to occur ‘in-person.’”

Drs. Ballard and Rodriguez also recommended specific interventions to better combat food insecurity and social support on the community level, such as developing standardized training and increasing funding for CHWs across the board. Umemba supported these interventions, lamenting the lack of federal regulations to support standardized training.

“There is no standardized training program for CHWs at the national level, as it is mostly governed by different states,” she said. “When I think about standardized training as it relates to food insecurity, first we need to make sure that CHWs know how to screen for it as well as the other social determinants of health. Also, we need to make sure resources are provided before the patient leaves the clinic, and that appropriate follow-up takes places. CHWs can be trained to screen, assemble and provide the appropriate resources and then follow-up as needed.”

In general, getting support from a community health worker in your area can be an extremely helpful resource not only for general guidance, but to improve your health and diabetes management.

Towards the end of the conversation, Umemba discussed her start in the field, making new observations on the interactions between people with diabetes and various members of the healthcare team such as fitness trainers, dieticians, nurses, and CHWs. Noting how each of these experts was able to connect with people with diabetes, Umemba observed that “year after year, virtually every single biometric including BMI, weight, blood pressure, cholesterol, etc., was better in the group taught by CHWs.”

She concluded that “the more charismatic and identifiable the instructor was, the better the participants did. There are plenty of people taking care of a person’s medical needs but not nearly enough people taking care of a person’s social needs. That’s why I’m such a big cheerleader for CHWs.”

If you need assistance related to food, shelter, healthcare, or financial resources, visit our “Affording Diabetes” resource page. On the right sidebar, you can find a helpful tool that allows you to enter your zip code and connect with a variety of resources in your area.


We Asked an Immunologist Your Questions About COVID-19 Vaccine Safety

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

By Lala Jackson

August 2021 is starting to feel like March 2020 – the COVID-19 delta and other emerging variants are more dangerous than the original virus, but what does that mean? Cases are rising rapidly, are we safe? Do we need to wear masks or not? Vaccines work, but do they for everyone?

To get some clarity, we spoke with Bernard Khor, MD, PhD, of the Benaroya Research Institute at Virginia Mason in Seattle, Washington. Dr. Khor’s laboratory is trying to find new ways to treat autoimmune diseases, specifically for people living with Down Syndrome as they are more likely to develop autoimmune diseases like type 1 diabetes. Because he spends so much time researching immune responses, we published his interview on whether type 1 diabetes means a person is immunocompromised and wanted to talk with him more about COVID-19 vaccine safety for people with type 1 diabetes.

Beyond Type 1: Are people with type 1 diabetes more likely to get COVID-19?

Dr. Khor: People who have autoimmune diseases aren’t necessarily immunocompromised; instead we can think of it as having a dysregulated immune system. That’s what causes the immune system to attack its own body. It does not necessarily mean that they don’t respond appropriately against infections.

What we do know is that, if they catch it, people with type 1 diabetes are more susceptible to worse outcomes from COVID. If it were my child or loved one living with type 1 diabetes, I would do everything I could to mitigate that risk.

What about the delta variant? How did we get here?

The delta variant and other variants we’re seeing start to develop are worse for everyone. These mutations happen because the virus has had time to persist and improve itself. If we were able to completely contain it, if everyone got the vaccines right now, we could stop this pattern by giving it nowhere to hide. But if the coronavirus is hiding in 30 to 40 percent of the population, it will come back and come back worse again and again. It’s just a matter of time.

That’s the thing about a virus – it’s not a one time threat. It’s an ongoing, adaptable threat. It’s a virus that mutates. It’s trying to survive. It can change and adapt to circumstances. There’s another variant coming out from Peru that’s getting more powerful – it’s affecting younger people, it’s leading to more rapid hospitalization, it’s a worse disease.

I cannot overstate how much COVID-19 needs to be respected. The writing on the wall was very clear from the beginning. We have seen outbreaks of diseases before and we have seen pandemics before. They are all agents that need to be respected immensely.

Other forms of coronavirus – SARS, MERS – were incredibly bad. In both cases we basically escaped worse outcomes because we got lucky; transmission rates of those viruses weren’t as high as COVID. Now we have COVID. We started off unlucky, and if we don’t respect it, it will get worse. It can cause death, it can cause disability, it can cause horrible outcomes. We’ve seen nursing homes decimated, it’s devastating.

We as scientists can make the best thing we possibly can, but it doesn’t matter if no one uses it. I see this as our generation’s World War event. We’re lucky that many of us are inside, that we have Netflix and ways to work from home. But the societal impact is every bit as serious.

Are people with type 1 diabetes more likely to have a particularly bad reaction to the vaccine?

All the data points to no. You’ll rarely hear a scientist say never—1 in millions is not never—but all the studies to date say no, and we can have confidence in that because there’s been a lot of post-marketing assessment of these vaccines. We have a lot of people who have taken the vaccines already worldwide to see how it’s working.

And that’s what we look at—the remarkably low rate of adverse reactions that are reported and tracked, versus the highly measurable rates of severe illness or death, or of long-term disability from long haul COVID.

What about the fear that vaccines in general can lead to new or more autoimmune issues? Can you explain the risk?

It’s a terrible thing to come down or have your child come down with a severe life-long illness. Type 1 diabetes is so diabolically difficult, and it’ll be different for different people. It’s a slog. So of course we want to know why it happens. Especially when you’re trying to find that important of an answer, our minds are programmed to look for patterns, but when you look from a single case, you’re only able to make the pattern from the single situation. Huge studies have uniformly debunked the idea that vaccinations commonly cause autoimmune issues.

That’s the benefit of our system – it’s very transparent. When there are adverse effects, we know about them. There are rare occurrences that have been seen; an example was a batch of flu vaccines in the 1970s, where several people came down with a rare autoimmune disorder called Guillain-Barré syndrome (GBS). Even in that instance, the risk of getting GBS was ten times less than the risk of death from flu. The cost benefit ratio is not even close.

Editor’s Note: There have been 100 reports of GBS among people who received the Johnson & Johnson vaccine, from approximately 12.5 million doses administered. Each year in the United States, an estimated 3,000 to 6,000 people develop GBS. Most people fully recover from the disorder. Whenever health issues like these do arise from vaccines, the FDA requires revisions to the information provided to vaccine recipients and healthcare providers so that they know about potential risks. No similar pattern has been identified with the Moderna and Pfizer-BioNTech COVID-19 vaccines.

How can we trust vaccines that only have emergency use authorization (EUA) And are not fully approved?

Editor’s Note: Since this interview was published on August 10, 2021, the FDA has granted the Pfizer and BioNTech COVID-19 vaccine full approval for ages 16 and up, with the EUA still in effect for ages 12-15 and booster doses for immunocompromised individuals. 

I think it’s incredible that we have a vaccine ready as quickly as we did – that has been due to immense collaborative work from the entire global scientific community. That work happened because of the immense threat and impact of COVID-19.

In this case, scientists worked hard, building upon decades of existing research to make this thing work. In a sense, we also got lucky. We are so fortunate that these vaccines work as well as they do. We built this nice big shiny thing, now we have to walk on in. Because scientists can build the best possible solution and it means nothing if people don’t use it.

Lack of full approval—which we know is coming soon—is due to the fact that the FDA has a rigid and bureaucratic approval process. It’s not wrong. But it makes it very slow even once the medicine and science has been proven, as is the case with the COVID-19 vaccines we offer in the US.

But no corners have been cut—the data has been reviewed, the process has been transparent. Everyone understands the need for post-marketing surveillance, ongoing data from the vaccines as they are administered. No expense has been spared for that.

How do we know that people who take the COVID-19 vaccine won’t face health issues from it in twenty years?

I cannot think of a scientific mechanism to be worried about that. I do know that COVID is here and is a very real risk, right now. We fear the unknown; the fear of the known has become hard to remind people of. After more than a year, we’ve gotten used to the bear that’s in the house. We can get worried about how we’re dealing with the bear, or we can go ahead and get the bear out of the house.

We heard discussion a few weeks ago about the psychology of choosing to take the COVID-19 vaccine; that to humans, it’s scarier to face making a choice and something bad happening, like taking the vaccine and getting sick from it, and less scary if something bad happens to you passively, like getting COVID-19 when you are going about your daily life trying to be careful. It feels like less responsibility. What are your thoughts on this?

Choosing not to do something is as much a choice as doing something. It’s about the risk of not doing it, not taking the vaccine.

You can always be nervous about some infinitesimal risk of doing something, but there’s a true risk of not doing something in this particular case. And the risk is not just what might happen to you if you get COVID, it’s the risk of all the people you might pass COVID to, including grandparents and children.

Because it’s not a question of if you will be exposed to COVID-19, it’s a question of when.


Back to School with Diabetes Amidst the COVID-19 Variants

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

By Lala Jackson

This article was published on August 13, 2021. As of Monday, August 23, the FDA has granted the Pfizer and BioNTech COVID-19 vaccine full approval for ages 16 and up, with the Emergency Use Authorization (EUA) still in effect for ages 12-15 and for booster doses for immunocompromised individuals. Full approval for other COVID-19 vaccines currently under EUA is expected soon.

While hopes were high that we could head back to school for the 2021 school year as though we were closer to “normal,” the development of COVID-19 variants amidst low vaccination rates has thrown a wrench in plans. But when kids need to get back to in-person schooling for quality of life, quality of learning, and socialization, how can we best keep them safe?

To help answer this and other questions about going back to school safely, JDRF—in collaboration with American Diabetes Association and Sansum Diabetes Research Institute—hosted a conversation with doctors and experts from the CDC, ADA, and the Fairfax County Health Department (Virginia).

Moderator Dr. Kristin Castorino, senior research physician at Sansum Diabetes Research Institute, kicked off the event with the most pressing question—is it even safe for students and their teachers who have diabetes to return to in person schooling, particularly for those under 12 who cannot be vaccinated yet?

“I’d change the question from ‘is it safe?’ to ‘is it appropriate?’ and I think it is,” answered Dr. Fran Kaufman, pediatric endocrinologist and chief medical officer at Senseonics. “There aren’t known answers as things change… but we need to get our kids back to school, not only for learning but for socialization.”

Dr. Kaufman stressed that the best way to make school safe is for everyone who can get vaccinated to do so. Dr. Christa-Marie Singleton, MD, MPH, senior medical advisor at the CDC later elaborated, “Vaccines protect folks against serious symptoms, hospitalization, and death. The best way to protect ourselves, our families, and our youngest people is for the adults and kids over the age of 12 around them to get vaccinated.”

“We also know about the importance of masking,” continued Dr. Kaufman. “It’s important to follow the CDC’s recommendation that all children and adults should be masked in the indoor school environment.”

What About the Legal Rights of Kids With Diabetes?

Particularly as some states ban school districts from being able to require masks in indoor learning environments, what legal protections do kids with diabetes have to stay safe in school? Crystal Woodward, MPS, director of the ADA’s Safe at School campaign, stressed “the rights of students with diabetes do not go away during a pandemic. They have legal protections under federal and state laws. Those accommodations may look a little different, but they do not go away.”

Similarly to how the Americans with Disabilities Act protects people with diabetes in the workplace, section 504 of The Rehabilitation Act protects the education of children with disabilities like diabetes. This law allows children with diabetes and their families to create what are known as 504 plans, which clearly outline agreed upon accommodations for students with disabilities at school.

While parents cannot dictate the actions of other students, they can include directives for their own children to stay safer from COVID-19 in 504 Plans, like instructions that their student must always wear a mask or will need extra physical distance in a classroom setting.

“It’s imperative that [children with diabetes] have a section 504 plan,” Crystal explained. “Everyone needs to be clear on what accommodations will be provided and by whom, like the student having the ability to take an exam at an alternate time if blood glucose levels are out of range during the scheduled test time.” Ensuring the student also knows what is in their own 504 plan can help them feel more empowered and comfortable asking for what they need.

For distance learning, 504 plans can dictate that children with diabetes can take snack or meal breaks at times best for the student, or have an agreed upon communication method with the teacher if the student needs to take a break to attend to a low or high blood sugar.

“Bottom line: the rights of students do not go away,” Crystal reiterated. “Students with diabetes and their families should work with schools and everyone needs to understand their role and responsibilities, and the plan should be updated as needed. It’s always better to get it in writing. Put the 504 plan in place while everything is going well—you never know if a principal or a nurse or a teacher is going to be there throughout the year.” Panel members stressed that families who don’t speak English, particularly in public schools, have a legal right to translators who can help establish 504 plans.

Jacqueline McManemin, RN, BSN, certified diabetes education and care specialist (CDECS) and assistant nurse manager for the health services division of Fairfax County Health Department in Virginia, spoke about what they’re continuing to do in their school district (one of the 15 largest in the nation) to keep students safe. “Parents should expect to see much of the same precautions this year that were in place last year. Particularly when students are inside, they should be masked.”

School administrators across the country can work to make schools more safe for all children, particularly those with chronic illnesses like asthma and diabetes, by putting in protective measures like establishing two different health clinics—one for people exhibiting symptoms of COVID-19 or other communicable illnesses and a separate clinic for routine care and injury treatment.  Meals can be eaten outside as weather permits and student interaction in hallways can be minimized by teachers rotating between classrooms rather than groups of students switching classrooms every period. Protocol also needs to be clearly communicated with all staff and parents about what to do if a student starts showing symptoms of COVID-19 while at school.

Getting Kids Mentally Ready for in-Person School

Back to school doesn’t just mean a change of location, it’s a change in schedules, types of interaction and stimulation, and levels of distraction that can also impact diabetes care. Psychologist Cynthia E. Muñoz, PhD, MPH, assistant professor of clinical pediatrics at the University of Southern California’s Keck School of Medicine and president of healthcare and education for the American Diabetes Association, reminded the community that the impact of the pandemic on each individual has been unique and therefore approaches to regain a sense of normalcy must be unique too.

“For parents and guardians, be aware of how you’ve been impacted. Seek support, through family, through primary care, through a therapist. Find ways to talk about your fears or concerns,” encouraged Dr. Muñoz. She went on to suggest ways to get kids mentally and physically ready for school again.

“Now that schools are starting to open, it’s time to start looking at sleep schedules, screen time, and start shifting routines and schedules to get children ready for the new routine,” she noted. “Many people watch a lot of content on social media or television—not just kids, everyone—but it’s a passive interaction with others. Shifting to a more active form of communication with others can be another way to help people ease into the change of a lot more interaction than people have had in the last year or so.”

Helping Kids Who Feel Singled Out

Kids with diabetes often deal with feelings of being the odd kid out, having to visit the school nurse, having to deal with special routines. When COVID-19 is added, kids with diabetes may feel like they’re the only ones taking special precautions, which can be additionally isolating. How can parents help children dealing with these feelings?

“I like to approach this question around the concept of support, building layers of support around the student,” Dr. Muñoz explained. “One level should be ensuring that someone at the school should know that the child has diabetes and knows what kind of support they need. Another category is who could know [the student has diabetes], but doesn’t necessarily have to, like friends. For the student with diabetes, getting support from a friend or classmate they trust could go a long way. If the student feels like they’re going to be the only one wearing a mask, they can ask a friend to wear it with them.”

“I think it’s important for adults to be sensitive to this,” Dr. Muñoz continued. “Saying “everyone has something different” might minimize how a student feels. Acknowledging their feelings and taking the time to ask them what will help goes a long way.”

To get advice from other parents and guardians or to help your student with diabetes find other kids who understand, be sure to join the Beyond Type 1 community.

Learn more about the JDRF – Beyond Type 1 Alliance here.

You Can Watch the Entire Conversation Here:


Here’s Why the CDC Updated their Mask Recommendations (Again)

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

By Lala Jackson

On Tuesday, July 26, 2021, the Centers for Disease Control (CDC) in the United States issued new masking recommendations amidst increased rates and much more dangerous variants of COVID-19 in the US. There are two big and related reasons why:

  1. Masks are the most effective way to slow the spread of COVID-19, no matter your vaccination status. This is particularly important in places with high transmission rates; you can check your county’s rate here.
  2. We are in a fourth surge of COVID-19 in the United States, with hospitalization rates surging to higher than when the pandemic began. This is due to the more contagious and more dangerous delta variant of COVID-19.

Who Needs to Be Wearing a Mask and When?

Everyone, particularly when you’re in indoor public spaces (because you’re breathing in other people’s air, and they’re breathing in yours).

If you’re vaccinated, this is primarily to do your part to protect others. Breakthrough cases, (where a vaccinated person gets the COVID-19 disease) are rare, but vaccinated people can still carry the coronavirus to others without having any symptoms. Luckily, vaccinations still make a massive difference – people who are vaccinated are less likely to carry coronavirus and are extremely unlikely to experience any severe symptoms from the disease.

If you’re not vaccinated, this is to protect yourself and others, as you can carry high levels of COVID-19 to others even if you don’t get sick yourself. However, even if you’re an otherwise healthy person, it’s important to keep in mind just how much more dangerous the new variants of COVID-19 are.

These variants will continue to develop rapidly until almost everyone is vaccinated—because they have so many hosts in which to thrive—and they are more contagious than the original COVID-19 variant. This is due to how viruses mutate (all viruses do this; it’s why we have new flu vaccines every year to address new variants of the flu). And because so many people are still unvaccinated, the virus has lots of places to thrive and change, making it more contagious and more dangerous.

Why Do Vaccinated People Need to Wear a Mask in Indoor Public Spaces?

The delta variant can live in small amounts in people who are vaccinated, so even with no symptoms of COVID-19 ourselves, vaccinated folks can still pass the virus to other people.

This is particularly dangerous for the elderly or ill who have already been vaccinated but cannot afford to take on the high viral load of the delta variant and for children who are not yet eligible to be vaccinated.

To combat high transmission rates, several cities have already instituted mask mandates again, like Washington, D.C., Savannah, GA, and St. Louis, MO.

What Can We Do to Protect Ourselves and Others From the New Variants?

Getting vaccinated against COVID-19 and continuing to wear masks in indoor public spaces are the most impactful things we can each do to protect ourselves and others. Doing so right now matters, as we do not want to give the novel coronavirus more time to continue mutating beyond what we know how to prevent and treat. We have the tools to stop the current COVID-19 variations but they mean nothing unless we all use them now.

What if I’m Too Healthy to Get COVID-19?

Particularly if you have diabetes, you pay so much attention to your health, and you already do so much to make sure your system is healthy and strong. But think about this – hospitals are getting overwhelmed by COVID patients again, which means they cannot provide care for anyone else who needs it. Check out this statement from the Chief Medical Officer of Our Lady of the Lake Hospital in Louisiana.

Even if you don’t get COVID-19, can you absolutely guarantee that you won’t have a diabetes issue that needs medical help? That you won’t get in an accident where you need the emergency room? What if you just get the normal flu and you need IV-fluids, but there aren’t enough medical professionals to help you because they’re all dealing with COVID patients?

COVID-19 is a disruptor to our entire medical system. Protecting yourselves and others against it by getting the vaccine is the best way to ensure that you and your loved ones will be able to get the care they need, when they need it.

When Will This End?

When the vast majority of people are vaccinated against COVID-19, giving the virus no more places to hide and mutate into stronger and more dangerous versions.

Do your part. Get vaccinated. If you’re hesitant about them or want to learn more about their safety, read this piece clarifying a few myths about the vaccines, or this piece explaining how mRNA vaccines work.

For more information on the COVID-19 vaccines for kids, read this.


Diabetes Community Survey Shows Drug Costs Still Ranks Highest Access Concern

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

By Beyond Type 1 Team

In early 2021, Beyond Type 1’s advocacy division surveyed almost two thousand people living with or caring for someone with diabetes to determine key healthcare access issues faced by members of the Beyond Type 1 community throughout 2020. While other surveys on access have been conducted within the diabetes community, it was important to Beyond Type 1 to hear directly from the community they serve on issues faced, both throughout the COVID-19 pandemic and generally.

The survey follows ongoing advocacy work from Beyond Type 1 addressing the rising cost of insulin and other healthcare access issues such as implicit bias and equitable technology access, Medicare and Medicaid access, drug pricing and rebate reform, and more.

The survey ran in English and Spanish, was anonymous, and included survey respondents both within and outside of the United States. The survey was run independently by Beyond Type 1 and specific methodology can be found at the bottom of this article.

Key Learnings

Access + Cost

A majority of respondents (56%) ranked access to affordable insulin and diabetes drugs as their most important access issue. This aligns with data reported from studies such as the 2018 Yale report showing that one in four insulin-dependent people ration insulin due to cost, while also nodding toward the high cost of other diabetes medications like SGLT2 inhibitors and GLP-1 receptor agonists.

Almost half of respondents (40%) ranked access to diabetes supplies as the second most important access issue (8.5% of respondents ranked access to supplies as their most important access issue), while nearly the same amount of respondents (36%) ranked access to affordable healthcare coverage as their third most important access issue. Just 6% of respondents ranked access to new therapies that cure, treat, or prevent diabetes as their top access issue (75% of respondents ranked it as their least important access issue).

Health Insurance

In the United States, 66.4% of respondents indicated they used employer-based health insurance to access healthcare in 2020. This is slightly higher than the 2019 U.S. population health insurance coverage data provided by the Current Population Survey Annual and Social Economic Supplement (CPS ASEC) and the American Community Survey (ACS), which calculated 55.4%.

Of the remaining third of respondents:

  • 8.1% received 2020 health coverage through Medicaid
  • 7.7% through / State Marketplace
  • 5.8% through Medicare
  • 5% reported no insurance coverage in 2020,
  • and 4.6% indicated ‘other’, which could include either a combination of coverage options, catastrophic care plans, COBRA, and/or other temporary plans

While two-thirds of respondents reporting employer-based health insurance could be seen as a positive—that access to healthcare is the norm rather than the exception—40.4% of respondents indicated they incur a deductible of more than $1500 per person for their insurance coverage. This indicates that over a third of respondents are covered by High-Deductible Healthcare Plans (HDHPs), a rising trend across American healthcare that, for those with chronic health needs, creates excessive financial burden.

HDHPs create a scenario in which a person often must pay full price for medications or supplies until the healthcare plan’s deductible is met, creating a significant out-of-pocket cost at the start of every calendar year. For people living with chronic conditions such as diabetes, this economic burden can create avoidance of healthcare treatment, unaffordability of life-essential medications, and inability to purchase or utilize supplies needed.

Out of Pocket Costs

Survey respondents reported excessive out of pocket expenses not only for medications, but for diabetes supplies (such as insulin pump or glucose monitoring supplies).

  • 55% of respondents stated they have paid more than $100 out-of-pocket in any month for any diabetes medication
  • 64% of respondents paid more than $100 out-of-pocket in any month for diabetes supplies

Global Issues

While the American healthcare system often creates an undue financial burden for people living with diabetes, access abroad remains a major issue as well.

  • 55% of respondents could not get supplies
  • 18.3% of respondents had run out of medications or rationed due to cost
  • 23% of respondents made a decision between bills and diabetes supplies

The Impact of COVID-19

Of course, the COVID-19 pandemic exacerbated healthcare issues across the globe. For those living with diabetes or caring for individuals with diabetes,

  • 30.7% of respondents did not see a healthcare professional or have lab work completed in 2020 due to fear of contracting COVID-19
  • 38.4% of respondents experienced mental health issues related to the COVID-19 pandemic
  • 7.8% of respondents experienced employment discrimination due to COVID-19 in relation to diabetes during 2020

The Bottom Line

Living with diabetes creates a major financial burden for many—the added medical cost of living with diabetes in the United States has been estimated at an average of $9,071 annually per individual—and the financial decisions that many are forced into making create short- and long-term consequences. Among survey respondents:

  • 21.6% ran out of medications or rationed due to cost
  • 15.0% skipped specialist visits or other healthcare to pay for diabetes care or supplies
  • 16.8% did not see a medical professional due to cost
  • 14.1% “borrowed” insulin or other diabetes supplies because of cost
  • 20.1% utilized a copay card for any diabetes medication
  • 22.8% made a decision between bills and diabetes supplies

These survey responses will continue to shape ongoing work being done by Beyond Type 1 ensuring everyone impacted by diabetes — type 1, type 2, and beyond — has a right to the best care possible for their unique situation. To learn more about Beyond Type 1’s advocacy work and to lend your voice to legislative actions, click here.

Details on Methodology

The Beyond Type 1 Diabetes Experiences Survey was created on Formsite, a secure platform for processing and hosting sensitive survey data in both English and Spanish versions. Both versions were identical in ranking questions, response offers, and language. The survey was logic mapped to offer additional questions for those who identified as individuals living outside the United States.

Questions were created by employees of Beyond Type 1 living with diabetes, with careful attention paid to plain, inclusive language in demographic self-identification inquiries.

The Beyond Type 1 Diabetes Experiences Survey was shared online through different avenues from mid-January to mid-February in English and mid-January to mid-March in Spanish through the Beyond Type 1 website (English and Spanish), the Beyond Type 2 website (English and Spanish), a targeted email from Beyond Type 1, and both organic and paid posts on Twitter, Facebook, and Instagram. There was no paper version available to print out; it was online responses only.

Respondents self-identified as people living with diabetes or caring for an individual living with diabetes.

The survey was completely voluntary; no one was paid to provide responses. All responses were mandatory for a survey to be deemed complete. If an individual did not click submit at the bottom of the survey, no results were recorded. A statement before the beginning explained that the survey results were anonymized, and only aggregate data and key learnings would be shared publicly.

1924 individuals fully completed the survey, with 1850 identifying as living in the United States.

Noted Limitations

The sample size of 1924 individuals is a small section of the global diabetes population, although larger than many similar surveys in the space. Additionally, respondents cannot be assumed as indicative of all people living with diabetes – 93% of respondents lived with or were caretakers of someone with type 1 diabetes, 91% lived in the United States, 85% were white, and 83% were female. Just 3.2% were 65+. All respondents had access to the internet and were either already following or in some way connected to Beyond Type 1 channels.


COVID-19 Vaccines and Diabetes: Vaccine Access Issues for People of Color

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

By Kayla Hui, MPH

On April 21, 2021, the Kaiser Family Foundation released updated data that found that Black and Hispanic people received a smaller share of COVID-19 vaccinations when compared to their share of coronavirus cases and deaths. Throughout the pandemic, communities of color have borne the disproportionate burden of COVID-19, highlighting the importance of equitable vaccine access. Vaccine access is not only crucial for people of color, but for those with underlying medical conditions such as diabetes. When overlaid with disparities such as implicit bias, it creates a compounded healthcare issue for communities of color with diabetes.

Unfortunately, vaccine access for communities of color has been all but fair. In Arizona, Hispanic people have only received 14 percent of vaccines despite accounting for 40 percent of COVID cases and 31 percent of deaths. And in Michigan, Black people only received eight percent of vaccines despite comprising 23 percent of deaths.

“Because of long standing economic discrimination, communities of color are much more likely to find themselves in jobs where they can’t take off work without docking their pay. They have to work certain hours and aren’t able to get away for a vaccine appointment,” Michelle Andrasik, PhD, clinical health psychologist and affiliate assistant professor of Global Health at the University of Washington, tells Beyond Type 1.

Communities of color have an increased burden of COVID-19 for a variety of reasons including required exposure during work. For Black and Hispanic people, 24 percent were employed by service industries compared to 16 percent of whites. These industries include restaurant, hospitality, and retail work, all of which require people-facing interactions.

People of color are also more likely to live in multigenerational households and in densely populated urban areas and housing situations, further exacerbating coronavirus transmission. In urban counties across the U.S., people of color comprised 56 percent of the population. Additionally, data showed that four in ten Black people (41 percent), Hispanics (38 percent), and Asians (38 percent) lived in areas surrounded by multi unit residential buildings compared to 23 percent of whites.

Another driver of inequitable vaccine access is vaccine hesitancy due to broken trust in healthcare providers among communities of color. Mila Clarke Buckley, a diabetes and food blogger who created the Hangry Woman, was diagnosed in 2016 with type 2 diabetes–a condition where the body cannot properly use insulin. However, after months of failed medications and skyrocketing blood sugar levels, Clarke Buckley discovered—after taking an antibody test with an endocrinologist—she had type 1 diabetes. “I was misdiagnosed with type 2 diabetes which has given me a little bit of distrust in the healthcare system,” Clarke Buckley says.

Clarke Buckley is not alone in her experience. Phyllisa Deroze, a global diabetes patient advocate and blogger, shares that she wanted to get vaccinated, but did not want to be the first due to the legacy of the nation’s medical racism. “The field of gynecology in America was created on the wounds of Black women who were enslaved. And so there’s just really a long history in America of just not treating Black people like human beings and using them as experiments,” Deroze says.

Deroze was told by one healthcare provider that her electrolytes were off, which prompted her to ask her provider for an antibody test. But that provider was offended when Deroze asked to be tested for antibodies. “I was once again denied antibody testing. It was clear that the endocrinologist was offended by me even asking,” Deroze says.

Deroze was misdiagnosed twice for type 2 diabetes, once in 2011 and another time in 2018, albeit having type 1 diabetes. Her misdiagnosis led her to experience diabetic ketoacidosis. “My life was on the line. And that shouldn’t happen,” Deroze says. “If a person is diagnosed with type 2 diabetes, what is the harm in testing for antibodies just to make sure you’re treating the right condition?” It wasn’t until 2019 when Deroze was properly diagnosed with type 1 diabetes by her gynecologist

Clarke Buckley also recalls suggesting antibody testing on numerous occasions to medical providers. However, her idea kept getting shut down, putting her at risk for long-term complications as a result of untreated type 1 diabetes. These complications include: foot problems, urinary tract infections, eye disease, skin infections, heart disease, kidney disease, and even death. “It’s communities of color that are subjected to the system that essentially puts us at additional risk,” Clarke Buckley says.

Misdiagnosis of diabetes among people of color is not uncommon and is just one example of the bias of the medical system. Research shows that glycated hemoglobin (HbA1c)—a measure of average blood sugar over three months that can show evidence of diabetes—is not an adequate health measurement for all genetic ancestry groups. Particularly for African ancestry groups, additional screening may be necessary to diagnose diabetes. This leaves hundreds of thousands of African Americans with type 2 diabetes undiagnosed. Additionally, a high HbA1c measurement alone does not prove that a person has type 2 diabetes. It only proves that glucose levels are consistently high. Therefore, an autoimmune antibody test must be done to confirm or rule out type 1 diabetes. Because type 1 diabetes differs heavily from type 2 diabetes in that type 1 always requires insulin treatment, a misdiagnosis could be fatal and lead a person without insulin into diabetic ketoacidosis (DKA), a complication that occurs when the body does not receive enough insulin to break down glucose. DKA can lead to coma and even death.

Some states have made efforts to curb the unequal distribution of vaccines. For example, in Vermont, Black adults and other people of color were given priority status for vaccines. But despite these intentions, many state efforts have fallen short.

Kia Skrine Jeffers, PhD, RN, PHN, assistant professor at the University of California Los Angeles School of Nursing tells Beyond Type 1 that in California, the state distributed vaccine access codes to improve COVID-19 vaccine availability and access for hard-hit Black and Latino communities. “The special code that people of color could use to register to get the vaccine was being distributed among people who were not people of color,” Jeffers says. Instead, wealthier populations who work from home were misusing the system, the Los Angeles Times originally reported.

Anna Lopes, MD, family physician based in Southern California, explains that the underlying culprit of vaccine inequity is systemic racism. Lopes references the Tuskegee Syphilis Study, an ethically abusive study that failed to treat and inform Black men of syphilis in the 1930s and the forced sterilization of Puerto Rican women. “There was significant hesitancy in the Black community, and other communities of color, specifically because of institutional racism,” Lopes says.

Achieving Vaccine Equity

Jeffers suggests that to achieve health equity, health leadership must reflect and have representation from the communities they serve. “If you don’t have community stakeholders involved in the planning, then community perspective is often overlooked or underappreciated,” Jeffers explains.

In addition to having representation in health leadership, Jeffers and Andrasik add that equity involves recognizing and rectifying historical injustices and distributing resources like vaccines to populations that need it the most.

“What we have found in terms of access is that you really have to take the vaccine where people are. We have partnered with Black churches, community centers, and community organizations to open up vaccination sites,” Andrasik explains. “In doing that partnering, the vaccination sites then reach out to their local communities they have long standing relationships with.”

Still, people of color are struggling to access vaccines due to transportation, financial, language, and nebulous registration barriers. To achieve equity, Andrasik, Jeffers, and Lopes stress that states need to be more intentional with their vaccine rollout process to make equity intentional. “All of these access issues really create barriers that are easily mitigated when we really think outside the box and think about how we can do things differently, and in partnership with communities,” Andrasik says. Vaccine access for people of color with diabetes is just the first step toward equity.


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:

  • 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.


Mental Health Check In: Identifying and Processing Trauma

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

By Beyond Type 1 Editorial Team

Over the past year, we’ve collectively faced an intense and stress-inducing time due to COVID-19. Even with some light at the end of the tunnel approaching due to vaccines, we will each be dealing with and processing the ramifications of this past year for some time, and nowhere is that more true than the year’s impact on our mental health. So we spoke with diabetes psychologist Dr. Mark Heyman about how to identify stress versus trauma, when and how to get help, and how often similar issues come up when we’re dealing with diabetes, from diagnosis to low blood sugars and more.

For more mental health + diabetes content, check out Dr. Heyman’s podcast at

Watch the Entire Roundtable Discussion in Full:

The following transcript has been edited for content and clarity.

Lala: Today, we’re going to be talking about trauma – how to identify it, some of the tools and resources to help us through it. Dr. Heyman, can you start to give us a little bit of an overview of what trauma is?

Dr. Heyman: The definition of trauma is real or perceived danger and threat of death or serious injury. So if you are in a car accident, if you experience a sexual assault, if you have been diagnosed with diabetes, that is the definition of a trauma. Also, if you have a close friend or family member who has experienced that and you have a belief or an actuality that you’re going to lose them and they’re going to be seriously injured or die in a situation, that’s considered a trauma.

I think that often times trauma is thrown around as a buzzword and as a substitute for stressful situations. And not that stressful situations are not challenging for all of us to deal with, and also I think that there’s a lot of similarities in ongoing stress like COVID, and in quarantine and being in this situation for a long time. But that is not the definition of trauma. The definition of trauma is having an event or sometimes a series of events where you are in danger of dying, or you perceive that you are in danger of serious injury or death.

Lala: What are some of the ways that someone might be able to recognize that they did in fact go through something that their minds and body are processing as a trauma?

When somebody experiences trauma, and I’ll use the example of a car accident as an example here, generally speaking, what happens is your anxiety level increases and that’s a natural thing. We would hope that would happen because it’s your body’s way and your mind’s way of keeping you safe. And what happens is you have a couple of symptoms, oftentimes you have what we call re-experiencing, and so you have either intrusive thoughts, or you have nightmares around that event.

You also have what’s called hypervigilance, which means that for example, the car accident, you may be nervous to see a car or nervous that’s the first time you drive after a car after your car accident. So you’re going to be vigilant and kind of be on guard.

And then the third symptom that we see is what’s called avoidance. And that’s exactly what it sounds like – you avoid situations, people, things that remind you of that trauma. But when those happen, those aren’t problematic in and of themselves, those are actually a really natural response.

What the challenge with trauma is, is when those symptoms of re-experiencing, avoidance, and hypervigilance stay with you and they don’t resolve—because naturally they should resolve—but when you get stuck in those symptoms and you stay there in that hypervigilance, avoiding, re-experiencing state, that’s where it becomes really problematic for us, because the context is different in your life, because you’re not in danger anymore, but your body and your mind is telling you that you are still in danger. And that can cause all kinds of challenges in our functioning and our ability to live in the world in a really effective way.

Lala: I want to go through some of the things that I’ve heard on the internet to debunk and maybe verify some things. One of the phrases that I’ve heard is that you can’t process trauma while you’re in it. Can you clarify that statement?

I think that’s probably a fairly accurate way of putting it, because when you’re in a traumatic event or you’re experiencing a traumatic event, or you’re experiencing ongoing stress, your goal is to keep yourself safe.

And so if you’re on guard because there is a danger coming at you, either perceived or real, and you want to stay alive and your mind is telling you to stay alive, your mind doesn’t have the capacity to process that. Your goal is to stay alive.

It’s kind of like having a low blood sugar – when you’re low, all you want to do is eat and get your blood sugar up, because your body knows that if you don’t do that, you can get yourself into some really big danger and really big trouble there.

And so, not that trauma and low blood sugar are in any way equated, but it’s the same concept your body is telling you, “I need food.” Your body’s telling you, or your mind’s telling you, “I need to get out of this situation.”

And you cannot process something while you are in it, because those symptoms that we just talked about are actually really helpful for you. They’re keeping you safe in that place.

When you’re outside of that situation and those symptoms continue in the long-term, that’s where things get challenging, that’s where the processing really needs to happen.

Lala: If I think I may have been through something, what are some tools I can use to just kind of assess where I’m at? I think in this day and age, we’re often taught to just kind of push through it, and if you just keep going, the bad stuff will go away. But how can someone really look at themselves and figure out if this is something that they might need some help processing?

The simple answer is looking at your behavior and how you are right now and how that’s impacting your ability to live in the world.

Is it impacting your work? Is it impacting your relationships? Is it impacting your sleep? And if you’re having trouble in your relationships because of a diagnosis with diabetes, or because of some other trauma, that’s really making you stay away from relationships or be overdependent on relationships, if you’re having trouble sleeping and you’re having nightmares on a regular basis, and that’s impacting your ability to work, because you’re so tired, if you’re not able to focus on your work, those are some really good signs that you might need help because the trauma is not resolving on its own.

Again, I look back to using the example of a car accident. So imagine that you get in a car accident today, God forbid. And so you get your car towed, you get it fixed, and it comes back to you, and so you go and you get in your car and you drive it for the first time, maybe next week after it’s all fixed up. You’re probably going to be a little bit nervous and that’s normal. You’ve just experienced something pretty traumatic and now you are trying to kind of process that and move through it and show yourself that driving is generally a safe thing, although the thing that happened to you that one time is a one-off, but you’re going to be nervous.

And so you do it, but the more you’re able to drive and see that you’re a safe driving, then the easier it gets. But if the same situation happens and you go to get in the car and you cannot get yourself to open the door, or you can’t get in the car without taking three Xanax. And so you’re avoiding that anxiety in that way, that shows you that you’re not able to function at a high level like you want to. And the trauma is the reason why, and that’s a good sign that you may need some help.

T’ara: While you were talking, I was thinking, this is probably the best example of collective trauma that we’ve been through in our lifetimes with COVID. And I feel like we’re still in that state of hypervigilance and sensing danger, and I think as people with diabetes, we know that our risks of severe complications or even death from COVID are very real. But we are starting to see that sort of light at the end of the tunnel, people are getting vaccinated, but I don’t think that means that the trauma is going to just go away. So what are some ways that we can start to process our traumatic experiences, especially as people with diabetes going forward? What are some tools that we can use?

I think, community is really number one, both using the resource of the community that we have, but also talking about it and just being open about how this experience has impacted all of us, and it impacted us individually and impacted us as a society. I think that’s number one.

I think that the number two thing is really using the data to drive our behavior. I’ve talked to a lot of my patients recently about this, many people who have been very, very isolated because of COVID, both because there’s nothing to do, but also because they have fears about it. And talking about what’s going to happen next, once they get vaccinated or once the world opens up, and there’s a lot of people who are really saying, “I’m not sure I’m going to be going out until 2023.”

And that’s a really kind of scary and a really kind of a hopeless place to be. And my response to that is, up until now and even right now, not going to restaurants, wearing a mask, all of those things, those are really important things. Those are really functional. And those things are keeping us safe.

But there’s going to be a time in the future, hopefully sooner rather than later, when those things are not going to be necessary anymore. And they’re not going to be helpful anymore. And not socializing is not going to be helpful anymore. But if we continue in the belief that we are in danger there, and that goes against what the evidence is showing us, the case rates are down, you’re vaccinated, then you get stuck in this traumatic cycle of not being able to process, not being able to move forward.

And so what I would suggest that people do is of course follow the public health guidelines, do not disregard them. But when the public health guidelines say, “It’s okay to go to the grocery store and not wear a mask,” or, “It’s okay to go to a restaurant and eat inside.” And you may feel a little bit uncomfortable doing that, I would really encourage you to push yourself to do that, because that continued avoidance is going to keep you stuck.

Trauma and traumatic events are very contextual. And when you’re experiencing the trauma, or when you’re in danger, those types of behaviors are keeping you alive. But when the context is different those types of behaviors are keeping you stuck, and it’s important to recognize that context.

And if you’re having trouble recognizing that or having trouble taking those steps when it’s safe, and when it’s objectively safe, that may be a time where you need some professional help, because trauma and PTSD—post traumatic stress, which is that stuck place after a trauma—those things generally don’t resolve on their own. Those are things that really require some help in getting you to a place where you can be more flexible in the world.

T’ara: I’ll even say there is no shame in getting extra help or professional help. I know for me, I started therapy in COVID just because of how scary it is… But even then, we know that this isolation that we’ve been in for a year can definitely take a toll, especially how we interact with one another. How do we make sure that our personal traumas are not impacting others? How do we make sure that we’re not lashing out and taking out our anger and fear on other people?

Each one of us has to do some introspection in, and really make sure that that’s not happening. I think that the first piece of advice is to do that introspection and say, “I’m angry right now, or I’m feeling stressed right now. And I’m lashing out at my friends and family, what’s causing that? Is it them or is it me?”

And maybe it’s them, but most likely, or more likely than not, it may be you, especially kind of given the stress you’ve gone through. And so if you’re able to see that and you’re able to use that introspection and be able to look at yourself from the outside and make change, then that’s really helpful. Also, it can be really helpful when you notice yourself getting that anger or that lashing out, that impulse to lash out is to take a deep breath and just give yourself a beat and see if you can make a choice not to.

If you’re having trouble making that choice, if you’re having trouble being able to choose whether or not you lash out or not, you may need some professional help. But if you’re able to do that on your own, and you’re able to calm yourself down and be intentional about how you respond, you have the ability to do this on your own.

But again as you said, there’s no shame in getting help, because staying in that stuck place, it generally becomes even more stuck and more stuck the longer it happens.

T’ara: Someone close to me went on vacation. They got on a plane travel because they were like, “I am tired. I need a break.” And instead of asking them, “Well, what’s going on? How can I help?” I went straight to, “you shouldn’t be doing this. You shouldn’t be doing that. You’re going to kill yourself. You’re going to kill someone else.” Like just completely lashing out and not recognizing that I was projecting my fear onto that person. 

I think that COVID – I think that in some instances it’s this trauma, but in some instances it’s ongoing stress. And in some ways that can be actually even more challenging to deal with because it’s day-to-day, every day is Groundhog day, same thing over and over again.

And that’s stressful for all of us. And so we feel very boxed in and have a difficulty just being in the world because it’s hard to right now. And so, that sort of stress builds up and then we take it out on other people. I certainly been guilty of that as well.

T’ara: I think what you said about introspection is right. I think, especially as the world kind of starts to open up more people are getting vaccinated. So more people are itching just to get out there. If you’re feeling super strong feelings I would probably say to journal it out, write it down and really analyze where those deep feelings are coming from.

I want to say, when we’re talking about trauma, and if you are looking for professional help around trauma, I would really encourage you to make sure that you find a therapist who knows what they’re doing with trauma. And there’s a couple of reasons I say this.

One is that trauma therapy is hard. It’s hard for the therapist. It’s hard for the person getting the therapy, but it’s also hard for the therapist because the therapist’s job here is really to push the person out of their comfort zone. It’s certainly with compassion. But if someone comes to me who’s experienced trauma and they say, “I’m really worried about leaving my house, because I’m worried that I’m going to have a low blood sugar when I leave my house.” Okay. Fair enough.

If I said, “Well, then, I think what you should do is just stay home. I think we should, in order to keep you calm in order to keep you not stressed, I want you to stay home. And that’s probably a good thing for you.” That’s actually doing the exact opposite of what needs to happen.

What needs to happen is for us to assess the risk. And then if the risk is at an acceptable level, objectively push the person to become uncomfortable. And that’s hard to do. And if you’re not trained to do that well, it’s easy to get trapped in this way of like, “Oh, it’s going to be okay, stay home.” And so finding a therapist who is trained in trauma therapy is important.

T’ara: Can you give some tips on how people can find or at least interview with therapists and make sure that that therapist is actually trained in that? Or if that therapist will be for them? What are some common things that you should ask a potential therapist?

There are a couple of evidence-based treatments for PTSD and for people who’ve experienced trauma. I would say that there are three big ones. One is called prolonged exposure. It’s a therapy where the person is asked to recount the trauma out loud, as a way of processing it, as a way of kind of making sense of it. So making the list of things that are scaring you that you’re not doing, and going and doing them on a greater level.

The other one’s called cognitive processing therapy, which is a cognitive therapy, which really focuses on a couple of different areas, including safety, trust, intimacy, and seeing how the trauma has impacted those areas and really finding ways to reframe your thoughts and then moving your behavior forward in those areas.

And the other one is called EMDR, which is a therapy where it includes bilateral stimulation. So, you know, tapping – it’s evidence-based because it helps the brain to process it, as well as to have those exposures.

So asking a therapist how they treat trauma, and what evidence is in place to support the treatments that they use. If they’re unable to answer that question, they’re not the right therapist for the person who’s experienced trauma. Because therapists who are going to help you dealing with stress with your relationships may not be the right therapist to help you if you’ve experienced a traumatic event like a diabetes diagnosis, like a car accident, a sexual assault or having COVID or having a family member who’s had COVID.

Just like you wouldn’t go see your dermatologist for your diabetes, you don’t want to go see a relationship therapist for a trauma-related issue.

T’ara: Thank you for answering, Dr. Heyman. Those are really good tips. 

Lala: I think my last question, Dr. Heyman – if you have a loved one, that you can see has clearly gone through, or is going through a trauma, but is maybe reticent to recognize that or reticent to get help, what’s the best way that we can lend support to those loved ones who are going through something?

I think the best way is really being transparent about what your observations are about what’s happened to that person, how it has impacted them, and also how that’s impacting you. For example, let’s say that your mom is this person that you’re seeing is having a lot of trouble because of a trauma because of COVID. And that’s impacting her ability to come over to your house for dinner, or to talk to you on the phone for that matter.

So saying, “Mom, I’m really concerned about you because it used to be, we talked on the phone every three days, and now I talk to you on the phone once a month – you seem like you’re having a really hard time. And I really want to regain that relationship. And I want to do whatever I can to do that as well, but I want to let you know that what’s happening for you, seems to be impacting you a lot, but it’s also impacting me. And so what can I do to support you in helping us to get back what we had before?”

And so I think that kind of, that sort of transparency – letting somebody see how what’s happening is impacting them, which they may not be aware of, but also how it’s impacting you. You can give them both sides and hopefully give them the courage and motivation they need to get help if they do need that.

Thank you so much, Dr. Heyman, any closing thoughts on trauma and what we’re all going through?

We’ve all experienced stress over the past year, and it’s been significant. And I think it’s going to be a little bit of a road getting out of this situation. When things get back to ‘normal’ I think it’s going to be hard for all of us to do that, because we’re just so used to being in this place of not doing things and it’s going to be really weird to have people in your house again, or go to a restaurant again.

Be patient with yourself and just give yourself some grace, but also when it’s safe and when the public health officials are letting us know that it’s safe, push yourself to be uncomfortable in those situations. Because the last thing we want to do is continue to get stuck and kind of have this collective trauma impacting our lives in the future.

The more we can push ourselves to get back into a routine that may not feel comfortable right away, just like things didn’t feel comfortable when we started this whole process, we didn’t know what was going on, the same thing is going to be the process for getting out of it.

Because now we’re so used to it. And we’re used to, even though it’s not comfortable at all, we’re used to the discomfort. And so we’re going to have to kind of get back into that. And it’s clearly a process.

So patience and grace, a willingness to seek out support, if you need it, whether it’s friends and family, the diabetes community, or a professional.


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.


New Study Shows Greater Risk for Severe COVID-19 Among People with Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Eliza Skoler

New results from the CORONADO study reveal that one in five people with COVID-19 and diabetes die within 28 days of hospital admission. The main predictors of severe illness are older age and diabetes complications. 

In May, the CORONADO study revealed that one in ten people with COVID-19 and diabetes died within seven days of hospital admission. Read our early article on the study here.  New findings from the same study show that one in five people with COVID-19 and diabetes died within 28 days of hospital admission.

In the spring of 2020, the study followed 2,796 people with diabetes in France for 28 days after being admitted to the hospital for COVID-19. The analysis looked at rates of death and rates of discharge from the hospital during the 28-day period. The results revealed that after 28 days, 50% of individuals had been discharged and 21% of individuals had died (29% were still hospitalized). The analysis also looked at other factors in the study population:

  • Average age was 70 years old
  • About 40% had long-term microvascular (such as eye or kidney) or macrovascular (such as heart or leg) complications; 11% had heart failure
  • 78% had high blood pressure
  • Almost two thirds were men
  • 88% had type 2 diabetes, and 12% had type 1 diabetes

Older age, diabetes complications (especially heart disease and high blood pressure), difficulty breathing, use of anticoagulant (blood thinning) medication, and biological markers of inflammation were associated with a lower chance of hospital discharge. Similarly, older age, longer duration of diabetes, and a history of microvascular complications were associated with severe illness and poor outcomes from COVID-19 infection. On the other hand, younger age and metformin use were associated with leaving the hospital by the end of 28 days. As discussed in a previous article, while metformin use was associated with a more favorable health outcome, it was not shown to cause better health. Overall, the factors associated with death were the mirror-opposite of those associated with hospital discharge.

Long-term blood sugar management (measured by A1C) was not found to affect COVID-19 outcomes, though high plasma glucose levels at the time of hospitalization were strongly associated with death. Because glucose levels may be tied to COVID-19 outcomes, careful diabetes management remains important for preventing severe illness.

People with diabetes do not have a higher risk of getting COVID; rather, they are more likely to experience severe illness and worse outcomes if infected with COVID-19. It remains important for people with diabetes, as well as their contacts and loved ones, to do everything possible to stay healthy and safe: get vaccinated as soon as you can, continue to social distance, and wear one (or two!) masks in public. To learn more, read “What You Should Know About COVID-19 Vaccines and Diabetes” and “COVID Variants, Double Masks, Diabetes, Oh My!


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