The Benefits of Working from Home with Diabetes

COVID-19 has officially changed the way the world runs. More than ever, people are staying home (whether by choice or mandate), spending more time with their families, avoiding public events, and yes, working from home. Essential employees, such as frontline healthcare workers, grocery store clerks, sanitation crews and workers rendering city services, are still having to report in person, but COVID-19 has made a third of Americans (over 100 million people) switch to home work.

This can be extremely beneficial if you live with a disability or chronic disease, and can be helpful if you live with diabetes. And while Americans still work more than anyone else in the industrialized world, working from home can help balance the stress of diabetes management. Here are some of the benefits of working from home if you live with diabetes.

No Commute

Let’s face it, commuting is not fun. The average American working full-time (8 hours a day, 5 days a week) commutes an average of 4.35 hours a week and over 200 hours (nearly nine days) per year. That is a lot of wasted time. With rising costs of living and stagnant wages, more people live farther and farther from their jobs, and have longer commutes than ever, which can cut into both one’s sleep and time for exercise. “Commuting” from your bedroom to your home-office leaves more time for quality sleep, morning exercise, and a healthy breakfast, which can set your blood sugars up for an excellent day, which can increase work productivity as well.

Not commuting will also save lots of money that would normally be spent on parking, car maintenance, tolls, and gasoline. Even if you normally take public transit to work, metro and bus tickets add up quickly! Working from home is also much better for the environment; transportation accounts for one-third of all greenhouse gases produced in the United States. Staying at home for cleaner air is an easy and simple way to help the planet.

Healthier Meals

Takeaway Chinese food or pizza at lunchtime can be a blood sugar nightmare. Working from home affords people the ability to cook easy, healthy meals in their kitchens, which is not only a healthier option, but saves money, too. It’s easy to cook lentils or beans in a slow cooker, or wash and chop up fruits and veggies for a quick grab and go snack if you get the afternoon munchies. Additionally, check out these easy, low-carb recipes that you can quickly make from the comfort of your own home!

Fewer Sick Days

People who work from home both take fewer sick days and get sick less often (no sharing germs in a communal setting or on the train en route to work!). Also, going into an office with a mild cold or flu can be miserable, but doing some work from home is almost always accessible. Plus, diabetes can mean dawn phenomenon, a kinked pump site midday, or a bad low that would previously require coming in late or leaving early- none of which would be necessary with a work from home schedule. It’s healthier for everyone!

No Judgement

Ever take a correction dose during a meeting, and get the side-eye from a nosey coworker? Ever have someone compare your diabetes to their distant relative who died of horrible complications from diabetes (when you never asked for the story?). Are people always questioning what you’re eating (or not eating), or how much you exercise (or how much you don’t)? Working from home prevents judgement and prodding questions, and you can go about your day and take the best care of yourself without intervention from others.

A Flexible Schedule

This can depend on your organization or company, but many offering work from home will grant their employees some flexibility in their schedules. If you have an endocrinologist appointment in the morning, shifting your work schedule back an hour or two can prevent the need to take personal leave for the entire day. Likewise, a flexible schedule can allow for a lunchtime run, which can counteract high blood sugars in the afternoon. Need to change your pump site or CGM midday? Working from home can let you do all that while still getting you work done. Flexibility is key to excellent diabetes management, and working from home makes it much easier.

Have you been working from home since the COVID-19 pandemic hit? How has it benefited you and your diabetes management? Is there anything that you particularly like or dislike about working from home? Share your story in the comments below; we love hearing from our readers!

Source: diabetesdaily.com

Be Prepared and Know Your Rights: Your Guide to Protesting With Diabetes

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

Editor’s Note: It is an extremely personal decision to protest, and Beyond Type 1 neither endorses nor opposes any person living with diabetes’ participation. This guide is to help those who choose to protest do so as safely as possible.

Protesting is one of many ways to create change and is a right of all Americans under the First Amendment. But if you have diabetes, there are extra things to consider, particularly amidst COVID-19.

Having diabetes – type 1 or type 2 – presents challenges in daily life already; adding a challenging environment with risk of exposure to a virus makes things more complicated. Because of that, you may choose to lend your voice to the things you care about from home, which is also impactful.

However, if you are heading out to protest, here’s what you need to know.

Be Prepared

Step 1: Make sure you are healthy enough and prepared to participate.

Consider the state of your health over the last few days and weeks. The best circumstances under which to attend a protest are when your blood sugars have been stable, you have been eating hearty and nutritious meals, you are well-hydrated, your immune system is strong, and your mental health is fortified.

Step 2: Pack a bag.

In addition to the standard items suggested for all protesters, like extra masks/face coverings, cash, your health insurance card, permanent markers, water, and snacks, there are extra things to consider if you have diabetes. Remember that you may get stuck away from home for a longer period of time than planned.

  • Double down on water. While heavy, staying hydrated can keep your blood sugar levels more manageable and can prevent other health issues. When volunteers or street medics offer more water, accept their offer.
  • Bring a variety of snacks, with a combination of carbohydrates and protein, and glucagon (nasal or injectable kit). It is helpful to have both fast-acting glucose, like glucose tabs or gels, to raise your blood sugar quickly if you experience a low, as well as more substantial snacks to consume periodically to keep your blood sugar stable. Ensure that the people you’re going with know how to use glucagon, including what personal signs of a low blood sugar you experience that they can look out for.
  • Pack extra blood sugar monitoring supplies. Even if you have a continuous glucose monitor (CGM), it is possible for your sensor to fail or become inaccurate due to heat causing your adhesive to loosen or jostling from being in a crowd. With either your CGM or glucose monitor, make sure you are checking your levels often. If you have a closed-loop system and can utilize an ‘exercise’ setting to keep your blood sugar levels slightly higher (typically around 160 mg/dL), do so.
  • Include a back-up insulin delivery method. If you wear an insulin pump, bring insulin pens (with extra pen needles) or vials and syringes. If you utilize injections, make sure you have more supplies than you typically need. Consider packing in a small cooler system/insulated bag to keep your insulin cool.
  • Write down your medical information on index cards kept in the outer pocket of your bag. This should include your medical background information (all medical issues you live with), your medications, and the contact information for your healthcare provider and emergency contact.
  • We are still living in a pandemic, so pack extra face masks, hand sanitizer, and disinfecting wipes. If you accept water or snacks from volunteers, ensure you sanitize surfaces, like the opening of a water bottle. COVID-19 is challenging, but made more challenging by diabetes management. Minimize your risks to stay safe. 

Step 3: Wear protective articles of clothing + a medical alert item. 

Wear a mask or face covering, long pants, comfortable closed-toed shoes, a long sleeve shirt, a hat and/or sunglasses, plus a medical alert item, like a bracelet or necklace.

  • If you do not have a medical alert item, write your alerts on your arm using permanent marker. This could something like “insulin-dependent, type 1 diabetes.” Your alerts should be as clear as possible, helping a person completely unfamiliar with diabetes be more aware of your health background.
  • Protective clothing – long sleeves, sunglasses, hat, etc. – shields you from the sun, and will also provide a barrier for your skin in case tear gas is deployed. A primary component of tear gas is capsaicin, a chemical compound derived from chili peppers. As tear gas (made from fine particles) is absorbed by your skin, it can produce extensive amounts of inflammation. This can lead to health issues in anyone, but can lead to issues with blood sugar, extra pain response, and dehydration for people with diabetes.

Step 4: Have a buddy and communicate.

No one should go to a protest alone if possible, but particularly no one with an underlying health condition. Ensure you attend a protest with someone you trust, who knows you have diabetes, and can help look out for the signs of low or high blood sugar. Ask them to remind you to drink water and eat. Create a plan for where and when to meet if you get separated. Be clear about your limits and make sure you are in agreement about your boundaries. For example, if you are attending with someone who is willing to be arrested and you are not, you will no longer have your buddy system intact, which could lead to a safety issue.

Step 5: Take care of yourself when you get home.

Chances are you just walked a long distance and tensions were high. Hydrate and eat once you get back home or to a safe place. Your blood sugar may drop or rise in unexpected ways due to stress and exertion. Keep an eye on your blood sugar levels as much as possible. If you have a CGM with follow capabilities, ask a friend or family member to make sure their alerts are loud, particularly while you sleep.

Know Your Rights

Attending a protest carries the risk of being detained or arrested. Because of this, ensure you know your rights before you attend. Be aware that while everyone in the US has the same rights theoretically, being undocumented, a person of color, or belonging to any marginalized group – including living with diabetes – alters how you may need to approach interactions with members of law enforcement.

The following is summarized from the American Diabetes Association’s Inappropriate Law Enforcement Response to Individuals with Diabetes.

  1. If you get arrested, clearly and calmly state to the police officer that you have diabetes. If you are concerned about or nearing a medical episode – such as a low or high blood sugar event – while detained, communicate the circumstances to the officer. By law, if an officer has visible cues (such as clear signs of a low or high blood sugar) or has been given notice of a person’s medical condition, they must abide by the resulting rights that provides.
  2. You have a right to be able to take care of your health and receive medical assistance if and as needed. The Fourteenth Amendment grants the right of pretrial detainees (anyone who has been detained, arrested, or jailed) to adequate medical care.
  3. Under the Fourth Amendment, a police officer is not allowed to search or confiscate your belongings without a warrant or without probable cause. If a police officer believes they have probable cause, they must inform you of what they are searching, as well as what they are seizing. Consensual seizures are not prohibited by the Fourth Amendment, so you must state that you do not consent for your belongings to be seized. This all becomes more murky if the police officer can make a case that a severe crime was being committed, an immediate threat is being posed to the officer or public, or if you are resisting or otherwise evading arrest. Stay calm, be clear, and follow directions as much as possible.

Overall, if you are considering or attending a protest, safety comes first. Be prepared. Be careful. Know your rights.

Source: diabetesdaily.com

Diabetes and Blood Donations: What You Need to Know

There is currently a huge blood shortage in America, mostly due to COVID-19, according to the American Red Cross. As of this spring, over 2,700 blood drives have been canceled across the country due to social distancing protocols set in place by governors and the CDC, and people’s fears about going out in public.

This has resulted in over 86,000 fewer blood donations, and drives are the main way the Red Cross receives blood (more than 80% of all donations come from public drives at schools, workplaces, and college campuses). This is causing a catastrophe for America: this blood shortage is impacting patients who need blood transfusions, organ transplants, victims of car accidents, people suffering from cancer, and thousands facing other life-threatening emergencies.

Gail McGovern, president and chief executive officer of the American Red Cross says, “We understand why people may be hesitant to come out for a blood drive but want to reassure the public that blood donation is a safe process and that we have put additional precautions in place at our blood drives to protect the health and safety of our donors and staff.”

So, if you’re looking to donate as a person with diabetes, what are the rules? Are you allowed to? Should you stay at home? Here’s what you should know before you go:

General Requirements for Donating Blood

To donate blood, a person will need to bring a driver’s license or two other forms of identification. Individuals who are 17 years old in most states (16 with parental consent where allowed by state law), weigh at least 110 pounds and are in generally good health are eligible to donate blood.

Most People with Diabetes Can Donate

Generally, if your HbA1c levels are in range (per your doctor’s recommendations), and you are in good health (with few or no diabetes complications), you are fine to donate blood. A caveat is anyone who injected bovine insulin after 1980 is ineligible from donating, due to a very small likelihood of having and thus spreading variant CJD, also known as mad cow disease. While no oral diabetes medications will preclude one from donating, there is a deferral list of medicines that can save one time before making the trip to donate.

Does Donating Blood Make You Go Low?

Not directly, no. While some people may feel faint or nauseous from giving blood, that’s due to losing blood (in the donation process), and not low blood sugar. Donating blood does not usually make one’s blood sugar rise or fall. That being said, before you donate make sure your blood sugar is in a healthy spot, and that you have a backup low snack in case you suddenly drop.

What Would Stop Someone from Donating Blood?

Common reasons you may be turned away from donating blood are:

  • You have a cold or flu
  • You have traveled outside of the United States recently
  • You have a low iron count
  • You do not meet the weight or height requirements
  • You take certain medications

Read more about eligibility requirements here.

Is It Dangerous to Give Blood During COVID-19?

Many people are afraid to go donate blood during the pandemic, but the Red Cross wishes to reassure people that it is extremely safe to give blood, and that donations are especially needed during this time. The Red Cross has implemented new measures to ensure blood drives and donations are even safer for donors, including:

  • Checking the temperature of staff and all donors, to screen for possible COVID-19 infection
  • Providing hand sanitizer for use before and during the donation process
  • Spacing beds to follow social distancing rules between blood donors
  • Increasing disinfection of surfaces and equipment

These enhanced protocols are in addition to the safety measures that the Red Cross already takes to ensure the health and well-being of every donor, which includes:

  • Wearing gloves and changing gloves regularly (between donors)
  • Routinely wiping down communal areas
  • Using sterile collection sets for every donation
  • Using alcohol swabs on donors to clean skin surface adequately

There is no data or evidence that COVID-19 can be transmitted by blood transfusion, and there have been no reported cases of transfusion transmission for any respiratory virus including COVID-19 worldwide, so donating blood is seen as an extremely safe activity.

Safety precaution: Bring and wear a face covering when donating blood and socially distance yourself from other donors at the center. | Photo credit: Adobe Stock

Safety Precautions If You Want to Donate

If you are willing and able to donate blood, that’s great! Keep the following things in mind as you head out the door:

  • Bring and wear a face covering at all times
  • Socially distance yourself from other donors while at the center
  • Bring along hand sanitizer (for when you touch communal things, i.e. a pen to sign-in at the front desk, etc.)
  • Bring along a low snack 
  • Bring your ID
  • Thank yourself for doing this important public service!

Gail McGovern adds, “As a nation, this is a time where we must take care of one another including those most vulnerable among us in hospitals. One of the most important things people can do right now during this public health emergency is to give blood. If you are healthy and feeling well, please make an appointment to donate as soon as possible.”

Have you donated blood, in the past or recently? How was your experience? Share your experience, and any advice you have, in the comments below; we love hearing from our readers.

Source: diabetesdaily.com

COVID Phase 2: Diabetes Care During Reopening

This content originally appeared on diaTribe. Republished with permission.

By Eliza Skoler

With pandemic restrictions lifting, how can you best take care of your diabetes and your health?

As countries around the world and states across the US begin to loosen social distancing restrictions, you may have questions about how to take care of your health in this new environment. In some places, restrictions are still prevalent, while other places have almost entirely reopened. This, in combination with all the different messages and reports in the news each day, can make it hard to know how people with diabetes should approach safety during the ongoing pandemic.

Find the official reopen plan for your state here. We will continue to update this article as more information becomes available. Click here to read more of our articles on COVID-19.

Click to jump down to a section:

What is the general advice for people, whether or not they have diabetes?

Continue to wash your hands frequently and avoid touching your face. Disinfect surfaces and objects that you or people in your household touch often. Wear face coverings when in public settings. Continue to minimize contact with other people as much as possible.

If you feel sick, do not go to work or to school, and contact your healthcare professional for advice.

What is different for people with diabetes?

If you have diabetes and your blood glucose levels are often higher than your target, you may be at higher risk for more severe illness from COVID-19. Older adults and people with other underlying medical conditions are also at increased risk for severe infection.

You should take extra care and maintain social distancing as much as possible, even as things reopen.

What should I do if my area reopens?

To best protect your health, continue to social distance. Stay home as much as possible. Keep up your protective measures: as noted, wash your hands frequently and wear a face mask if you have to go out in public.

As cities and states reopen and people interact more, it’s certainly more than possible (many experts say it’s likely) that another wave of COVID-19 infection will occur. By minimizing your contact with other people, you can reduce your chances of getting sick.

What if I need to travel?

The CDC recommends avoiding all travel, if possible. This will reduce your chances of getting or spreading COVID-19. Given the uncertainty of travel restrictions, if you travel you will run the risk of not being allowed to return home.

If you do need to travel, here’s what you should do to protect yourself and others:

  • Wash your hands frequently, or use hand sanitizer.
  • Wear a cloth face mask the entire time you are in public, and avoid touching the mask.
  • Don’t touch your face if you haven’t washed your hands.
  • Avoid contact with people, staying at least six feet away from others at all times.
  • Cover your coughs and sneezes, and wash your hands.
  • Clean and disinfect surfaces on airplanes, in cars, and in hotels or rental properties.
  • Make sure your vaccines are up-to-date, including the seasonal flu shot and the measles-mumps-rubella (MMR) vaccine.

Different types of travel (airplane, bus, car) all come with different risks – make sure you think through what risks you will face in transit, and how you can reduce the spread of germs.

If you return home from international travel, be prepared to self-quarantine in your home for 14 days to monitor any signs of illness.

Should I go to in-person diabetes medical appointments?

Talk to your healthcare professional to see if virtual visits are an option for you – many healthcare teams are offering telemedicine appointments, so that you can discuss your diabetes management without coming into contact with other people. Click to read about preparing for telemedicine appointments or watch our video on telemedicine during COVID-19.

As your healthcare team whether it is safe and important for you to visit the clinic for regular diabetes management. For emergencies, contact your healthcare team immediately, to see if you should visit the emergency room.

What is an antibody test? Should I get one?

An antibody test is used to evaluate whether you were already infected by COVID-19. If your body was exposed to COVID-19, fought off the virus (whether or not you had symptoms), and recovered, you will have special proteins in your blood that remember the virus and help you fight it; these are called antibodies. Antibodies against COVID-19 mean that your body is better prepared to fight the virus. However, scientists do not yet know whether antibodies will protect you from getting COVID-19 again, if you already had it.

If you think you were exposed to COVID-19 and are wondering whether your body already fought the infection, you can talk to your healthcare team to see if an antibody test is an option.

  • If you test “positive” with an antibody test, it means that you’ve likely already had COVID-19 and have some protection against getting it again. If you have no coronavirus symptoms when you get the antibody test you probably are not still sick or contagious.
  • If you test “negative” with an antibody test, it shows that your body has not previously recovered from a COVID-19 infection. This could mean two things: 1) you have never been infected with the virus and could still get it, or 2) you have a current infection and could be contagious. If you have symptoms of coronavirus you should get tested for the virus.

For many people, a positive antibody test would be a reason to go back to their “normal” lives, pre-COVID, without fear of infection with the virus. Antibody tests are also used to track the spread of the virus.

When will it be safe to visit people?

For the time being, the CDC continues to recommend social distancing, meaning that you should avoid coming into contact with other people. In the future, once broader testing and virus tracking is in place, it will be less risky to visit others.

We will continue to update this article as more information becomes available. Click here to read more of our articles on COVID-19.

Source: diabetesdaily.com

What to Expect in a Telehealth Appointment for Mental Health

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

By Mark Heyman, PhD, CDE

Due to the confusion and isolation the world is undergoing as a result of COVID-19, countless people are now in need of virtual appointments with mental health providers. And as mental health providers transition to working with clients virtually, many people remain unsure about how conducive remote therapy sessions will be for them. Dr. Mark Heyman addressed some of the concerns regarding telehealth and the potential for impact on mental health.

A lot of people are seeking mental health treatment for the first time – what tips do you have for someone seeking mental health support for the first time now that we’re primarily doing so online? 

Seeking online mental health treatment for the first time may seem a little scary. After all, you are meeting a therapist – who is a complete stranger – over video. Here are a couple of tips to make your first video appointment more comfortable:

  • Fill out and return any paperwork to your therapist before your appointment.
  • Make sure you have a private, quiet place where you will not be interrupted or distracted.
  • Turn off notifications on your computer, or if you are using your phone, put it on ‘Do Not Disturb’
  • Be prepared for the video technology to not work perfectly – even the best systems don’t always work as planned.
  • Write down the reasons why you are seeking therapy at this time; common reasons are that you are having symptoms (e.g., anxiety, depressed mood), something has happened that you want to talk about (e.g., you lost your job or ended a relationship), or you are having a hard time doing things in life that are important to you (e.g., managing diabetes, working, going to school).
  • Write down any questions that you have for your therapist. For example, you may want to ask them what treatment will involve, how long it might last, what kind of experience do they have working with people with issues similar to yours, and what do they know about diabetes. Ask whatever is on your mind – no question should be off the table.
  • Expect the first part of the session to be a little bit awkward, but know that after a few minutes, it will become more comfortable.

How do you (or any mental health provider) approach telehealth visits with new clients? What does the first conversation look like? 

The first session with a new telehealth client is really no different than the first session with someone I am seeing in my office. It is about getting to know them and why they are seeking treatment. I have a series of questions that I use to guide the discussion. For example, I start out by asking about what brings them to therapy at this time. Because I only see people with diabetes, I also ask about their history with diabetes and how things are going with diabetes right now. I want to know about their relationships with family and friends, how they spend their time and what they do for fun. I also always ask about their goals for therapy. What do they hope will be different when they are done? After I learn about the person, I will tell them about how I work and the things I think I can do to help them. Also, if I do not have the expertise to help them, I will let the person know and help them find someone who does. Throughout the session, I am always open to answer any questions the person has.

What about clients who are moving to telehealth from in-person? How does that change the dynamic? 

Though I’ve been doing telehealth for five years, over the past month, I have moved my entire practice online. Honestly, it has not changed the dynamic much at all. I think for most people, seeing me over video instead of in-person does take a little bit of getting used to, but once that happens, treatment continues without missing a beat. The only difference is that I get to see people in their homes and get a window into their natural environment.

One group where the dynamic is a bit different in-person vs. online is teenagers. I find that it is harder for teens to stay engaged online than it is when they are sitting in my office.

In your view, what are some pros and cons of remote therapy?

Pros:

  • No need to commute to a therapist’s office
  • More flexible scheduling
  • The ability to find a therapist that has experience with what you are struggling with (e.g., diabetes) if there are none in your area

Cons: 

  • For some people, the act of leaving their house and going to a therapist’s office is an important part of treatment (e.g., someone who is depressed)
  • It is easier to avoid engaging in therapy online
  • It is more difficult to see non-verbal cues
  • Insurance does not always cover telehealth (though since COVID-19, that is changing fast)
  • State laws require that the therapist be licensed in the state where the client is physically located

What services or online services do you recommend, if any? 

Right now, almost all therapists have moved their practices online, so looking for telehealth services is no different than looking for a therapist in-person. You want to make sure the therapist you are seeing has experience with the issue you are seeking therapy for. Some great resources for seeing therapists are Psychology Today or if you are looking for a provider who specializes in diabetes, the ADA/APA Mental Health Provider Directory is a great resource. I also wrote an article awhile back on telemental health that is diabetes-specific.

Source: diabetesdaily.com

UK Study Under Review Finds People With Type 1 Diabetes More at Risk to Die of COVID-19 Than People With Type 2 Diabetes

There’s a large UK study (2 million people) under peer review that’s gaining traction on social media. Why? Because it defies our – already overtaxed mental states – of what’s possible.

Covid-19: people with type 1 diabetes more likely to die than those with type 2.” This is how The Guardian, among other publications, headlined it.

NHS (United Kingdom National Health Service) research reports that people with type 1 diabetes are at 3.5x higher risk for death if they get COVID-19 than people without diabetes. In contrast, people with type 2 diabetes are twice as likely to die as people without diabetes.

Surprised? I was. And even though the research is currently being reviewed, and nothing’s yet been proven, the data has a strong statistical basis.

If you’re curious what all this means, I can share with you information I’m privileged to have access to. I am part of a team of global diabetes experts – MDs, researchers, scientists, heads of the university, and hospital departments. The group was formed a few months ago under the leadership of Professor Itamar Raz, diabetologist and former head of Israel’s national diabetes health policies and Guang Ning, Head of Shanghai Clinical Center for Endocrine and Metabolic Disease.

The team is digesting a barrage of information, sharing their expertise and experiences and brainstorming prevention and treatment guidelines that they can safely, and quickly, recommend to health professionals and the public.

Unnerved by The Guardian article, I reached out to the group immediately. Philip Home, Emeritus Professor at Newcastle University, UK responded within an hour. It was 10:30 PM in the UK.

Here’s what I can tell you with the proviso, as Home emphasizes, that currently this research presents an interpretation of the data, which is dependent on a rapidly changing situation in the UK. This means its application to other people, in other circumstances, is not easy – medicine is as much art as it is science. And, it’s hard to know whether there have been any population and/or calculation errors. For instance, some people with type 2 diabetes on insulin may have been incorrectly counted as type 1s.

Below (in italics) is a summary from my email exchange with Professor Home.

Those Not Necessarily at Higher Risk:

This comment is currently a hypothesis, but we do think people who have no evidence of vascular damage, no retinopathy, no albuminuria (including microalbuminuria) and no cardiovascular disease, are likely not at greater risk to be hospitalized or die if they get COVID-19 than people without diabetes.

Further, if one’s blood sugar is also well managed, A1c under 7.5%, they are probably at no greater risk of getting COVID-19 in the first place than someone without diabetes.

Those at Higher Risk for Poorer Outcomes:

People who have type 1 diabetes who show evidence of vascular damage, should they get COVID-19, would be at higher risk of severe outcomes including hospitalization and death. The risk for vascular damage is higher the longer you’ve had diabetes, particularly if glucose levels have been high.

Further, if you have poor glucose management you may be at greater risk to contract the virus.

People can check with their health professionals whether their markers that indicate vascular damage are in range, that includes CRP, HDL cholesterol, triglycerides, and liver enzymes (ALT). They can also check if they have any albumin leakage through the kidney. Also, they can check with their eye professional whether they have any retinal damage.

Understanding that this is a vascular issue and that vascular damage increases risk for comorbidities such as cardiovascular disease, I better understand why it’s possible someone with longer duration type 1 diabetes, who gets COVID-19, may be at higher risk for worse outcomes than someone with type 2 diabetes.

What else can you do now to protect yourself should you get COVID-19? First, don’t panic. As Home says, the data is not yet in. Second, use this time to build your nutritional and metabolic health. In other words, follow the common recommendations:

  1. Do your best to keep your blood sugar in target range
  2. Eat as healthily as you can – vegetables, whole, not processed foods, some fruit, dairy if you can tolerate it, beans, seeds, nuts, healthy fats
  3. Be active, even if you’re in lockdown

Like everyone, diabetes or no diabetes, wear a mask when out in public, stay six feet away from others and wash, wash, wash your hands. My personal prescription includes using those clean hands to then pour a glass of antioxidant-rich red wine.

Note: I wish to gratefully acknowledge Professor Home who responded to my query immediately, answered my questions, lowered my stress level and helped me interpret the medical data.

Source: diabetesdaily.com

The Impact of COVID-19 on African Americans

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

By T’ara Smith

Think the coronavirus is the “great equalizer”? Think again. New data on the deaths from coronavirus shows the pandemic is impacting communities of color, specifically African-Americans, at disproportionate rates. African-Americans and other minorities are more likely to have underlying conditions such as diabetes, hypertension, heart disease, and asthma, which contribute to the mortality rate of COVID-19. These underlying conditions stem from health inequalities that range from food accessibility to barriers to healthcare.

African American

Image source: Beyond Type 1

Compared to non-Hispanic whites, Black/African-Americans are 60 percent more likely to have diabetes according to the Office of Minority Health. However, this doesn’t mean minorities are more susceptible to being infected by COVID-19, but that when they are infected they are more likely to die from it.

“It’s not that they’re getting infected more often. It’s that when they do get infected, their underlying medical conditions wind them up in the ICU and ultimately give them a higher death rate. We really do need to address the health disparities that exist in the U.S,” said Dr. Anthony Fauci, National Institute of Allergy and Infectious Disease (NIAID) director and leading expert on the coronavirus pandemic, at a White House briefing on Tuesday.

Recent data reported from cities and states magnifies how dire the pandemic situation has become for African-Americans. In Michigan, African-Americans made up 35 percent of COVID-19 cases and 41 percent of deaths — African-Americans consist of 14 percent of Michigan’s population. Specifically, Detroit, a city with predominantly Black residents, is a hot spot for coronavirus cases. In Chicago, 72 percent of COVID-19-related deaths were Black, who only make up 29 percent of the city’s population. Louisiana has shown a trend nearly identical to Chicago’s.

Evidence shows African-Americans are also having more difficulty getting tested for coronavirus. In early April, Syracuse University reported that while COVID-19 testing is far too low in the United States in general, the testing rates are lower in states with higher percent black populations and poverty rates.

Coronavirus Further Exposes Long-Existing Health and Economic Disparities

The prevalence of chronic health conditions in minorities such as diabetes can be attributed to long-existing barriers to quality of life essentials such as food, health care, and sustainable income. Food deserts, or areas where there is no access to food or quality healthy food, are more abundant in minority neighborhoods. African-Americans are more likely to be uninsured, rely on government insurance, and are less likely to have private insurance compared to their white counterparts, according to the Office of Minority Health. They’re also more likely to have a lower median income. Recent data also shows the wave of millions of job losses is disproportionately affecting minorities.

“It’s jarring to me to hear that African-Americans are disproportionately affected by COVID-19,” said Mila Clarke Buckley, Beyond Type 2 Leadership Council member and owner of the Houston-based Hangry Woman website, who has been living with type 2 diabetes since 2016. “We do have to recognize the systemic factors that play a role in this. Even though I have privilege and resources, I don’t feel safe. It has highlighted the importance to me of practicing social distancing, and staying in as much as possible. I don’t want to be in a position where I can’t get the care I need if I were to get the virus.”

Current CDC recommendations to decrease the risks of contracting coronavirus are to stay home and practice social distancing. However, not everyone has the privilege to abide by those guidelines. A report by the Economic Policy Institute based on federal labor data shows Black and Hispanic workers are less likely to be able to work from home.

“Taking public transportation to get to jobs as essential workers because they can’t afford to not work, living in food deserts and having to travel to get groceries, and other issues that have been reported on,” said Dr. Fauci at a press conference.

Constance Brown-Riggs, MsEd, RD, DCES, CDN, discussed another layer to the public health crisis’ impact on minorities: the lack of trust in the healthcare system itself.

African American

Image source: Beyond Type 1

“There are many factors that contribute to health disparities in people of color. One factor is the mistrust of the medical community. Additionally, numerous studies show that health care provider bias also contributes to health care disparities,” said Brown-Riggs. A New York Times article published in January summarized the generations of institutional racism and discrimination towards African-Americans.

“One of the most troubling explanations for mistrust is the Tuskegee experiment, in which poor black men were unknowingly infected with syphilis and allowed to live with the deadly infection so doctors could track the life history of the disease. Black Americans who know of the study report a greater mistrust of medicine and research,” said Brown-Riggs.

Global patient diabetes advocate of Black Diabetic Info and Beyond Type 2 Leadership Council member, Phyllisa Deroze, also echoes a similar sentiment about bias within the healthcare system.

“I’m not surprised that African-Americans are impacted more,” said Deroze, who lives with LADA diabetes. “I have long since said that the coronavirus might not discriminate, but the American Healthcare system has a long history of being biased. Just look at the maternal mortality rate – black women are 3-4 times more likely to die than white women [in childbirth].”

African-Americans and other minorities have also reported experiencing racial discrimination at medical appointments. Among professionals who work with minorities with diabetes, Brown-Riggs says the lack of diversity plays is a factor as well.

Studies show that most health care providers have an implicit bias in terms of positive attitudes toward whites and negative attitudes toward people of color,” says Brown-Riggs. “This bias is particularly worrisome when the majority of people with type 2 diabetes are African American or Hispanic American and the majority of diabetes care and education specialists and nutrition professionals are white.”

Pressing Forward Despite Systemic Barriers

African American

Image source: Beyond Type 1

Still, African-Americans and other minorities with diabetes are taking the steps to lower their risks of getting the novel coronavirus. Paul Ellis, a person with type 2 diabetes living in Cerritos, California, says despite the issues within the healthcare system, he’s going to do what’s necessary to decrease his chances of contracting it. “I try not to let [the health disparities] get to me,” said Ellis. “I’m determined to manage the disease the best I can and have made a lot of progress since I was diagnosed. I lost a lot of weight, and between that, exercise, diet, and meds, I am doing pretty well. I even did a virtual 5k for the first time a couple of weekends ago and even though I was as slow as molasses, I did it to show myself I won’t be beaten.”

Likewise, Deroze is not taking any chances with COVID-19 and says she’s taking the guidelines seriously. However, the stress and anxiety from the COVID-19 have impacted her glucose levels.

“I’m staying indoors and am only leaving the house for an hour walk in the morning,” said Deroze. “After going to the grocery store a week ago, I decided I didn’t want to be around many people. I started to see an increase [in my blood sugar] the second week of quarantine. The lack of my usual exercise routine and the abundance of food in the house contributes to that. I know this is partly due to environmental stress, but this is a lot to deal with at once.” 

Fortunately, the push for telehealth may yield its benefits for those who need to seek care without leaving their homes. Brown-Riggs suggests inquiring about telehealth with healthcare professionals.

“During this COVID-19 pandemic, it’s extremely important for African Americans and other minorities with diabetes to stay in contact with their diabetes treatment team. Under the recently enacted Coronavirus Preparedness and Response Supplemental Appropriations Act, physicians, nurse practitioner (NPs), physician assistants (PAs), nurse-midwives, clinical nurse specialists (CNSs), and registered dietitians (RDs) or nutrition professionals (RDNs) are permitted to provide telehealth services,” said Brown-Riggs.

She also emphasizes that it’s important to continue with regular self-care behaviors such as eating healthy, being active, and getting regular sleep. For people who are food insecure, check out local food assistance programs and banks. Brown-Riggs warns against scams and misinformation from people looking to capitalize on those most vulnerable to COVID-19.

There are other steps being taken to address this issue from an institutional level. Chicago Mayor Lori Lightfoot said in a news conference that an urgent public-health education and outreach campaign will be launched in minority neighborhoods worst-impacted by the coronavirus.

In early April, California released partial race-based data that did not show a disproportionate impact of COVID-19 on racial minorities — but the bottom line is that we need more data. “Based upon the 37% of the data that’s in, we are not seeing [race and ethnic disparities],” said California Governor Gavin Newsom. “But I caution you, the data is limited. Nothing is more frustrating than the disparities that manifest in relationship to public health. Those issues preceded this crisis and they persist in this crisis.”

The coronavirus crisis is a global pandemic, but its impact will follow the same patterns of health inequality built into systems, institutions, and culture. It’s important to remember that minority communities are already facing disproportionate impacts of COVID-19, with additional barriers to the resources and care needed to mitigate damage caused by the virus.

Source: diabetesdaily.com

Big Changes! Centers for Medicare & Medicaid Services (CMS) Loosen Requirements for Obtaining a Continuous Glucose Monitor (CGM) During COVID-19

This content originally appeared on diaTribe. Republished with permission.

By Karena Yan and Kelly Close

In-person visits, lab tests, and finger stick documentation are no longer required at present to get a CGM

Editor’s note: This article was updated on May 21, 2020 to reflect that lab testing is still required for an insulin pump and pump supplies.

High blood sugar levels leave the body vulnerable to infections, meaning those individuals with poorly controlled diabetes are at greater risk of contracting COVID-19. To properly monitor and respond to glucose levels and to strengthen the immune system to fight off infections, a continuous glucose monitor (CGM) can be very helpful.

If you are on Medicare, obtaining a CGM through your healthcare professional is a relatively involved process, requiring an in-person clinic visit, lab tests, documentation of frequent finger sticks (four or more times a day), and a lot of paperwork. At present, only those on insulin have an opportunity for approval. However, due to COVID-19 and the increased risks it poses for people with diabetes, the Centers for Medicare & Medicaid Services (CMS) announced that it will not enforce the following criteria for receiving a CGM:

  • In-person clinic visits
  • “Clinical criteria,” including lab tests for C-peptide or auto-antibodies, or demonstration of frequent finger sticks

This means that people with diabetes do not have to go to the doctor’s office or undergo lab tests to receive a CGM. Importantly, these loosened restrictions also reduce the amount of paperwork and bureaucracy for healthcare providers and give them greater flexibility in providing CGMs. Lab testing is still required for insulin pumps and pump supplies.

This increased access to CGMs is a huge win for the many people with diabetes on insulin who would not otherwise be able to get a CGM. Because CGMs provide real-time data for blood sugar levels, users are able to monitor their glucose and proactively adjust their insulin doses. Not only do CGMs help increase time in range, and thus have the opportunity to increase productivity and quality of life, but they can also improve overall diabetes management and can help keep patients out of the hospital.

We hope that in the future, at least those on SFUs will be able to get CGM, as SFUs can prompt hypoglycemia, which is especially dangerous right now, given the importance of staying out of the hospital.

Every person with diabetes can benefit from either a professional CGM used regularly (at least yearly) or a 24/7 CGM. While these new CMS guidelines are temporary in response to COVID-19, we are hoping and advocating for making the changes permanent. With the rise of the Beyond A1C movement and increased awareness of time in range, CGM (24/7 or professional) is an essential tool for people with diabetes to live happy and healthy lives, both during and after COVID-19.

This article is part of a series on time in range maybe possible by support from the Time in Range Coalition. The diaTribe Foundation retains strict editorial independence for all content.

Source: diabetesdaily.com

Build Your COVID-19 Diabetes Go Bag

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

By Jordan Dakin

When it comes to being hospitalized in the midst of the COVID-19 pandemic, it’s natural to worry about that possibility and while we hope we can stay home at all costs, being prepared for any scenario is the best course of action. As a result, packing a go bag in the case of a hospital visit during this time is crucial.

Most important? Pack your bag with 15 days of supplies to be on the safe side. The CDC recommends up to 14 days of quarantine in some cases for those who have been exposed or infected depending on the time it takes for symptoms to develop, so being prepared for a lengthy hospital stay just in case is advised.

The nature of COVID-19 is tricky because it requires isolation and even if you’re hospitalized for something diabetes-related, you run the risk of being exposed to COVID-19 in a hospital setting. Make sure you have all you need as it will be difficult for loved ones to get items to you if you are in isolation during a hospital stay.

Antiemetic or Anti-Nausea Medication

Zofran or any other antiemetic medicine is helpful to have on hand in case you do contract a mild form of COVID-19 to keep yourself from throwing up, as this can be dangerous and lead to DKA (diabetic ketoacidosis).

Carbs and/or Glucose Tabs

This may seem obvious, but it is so important. Be sure to pack some hard candy, fruit snacks, fruit juice, glucose tabs and gels, and any other preferred fast-acting carbohydrates.

Beverage(s) to Prevent Dehydration

This could include sports drinks, water, or a mix-in hydration powder with little to no carbs.

Ketone Strips and Glucagon

If you are sick, BGs are harder to manage and DKA can be a dangerous reality if you’re needing more insulin than normal while having trouble keeping carbs or fluids down. As a result, you should test for ketones more frequently when you are sick.

Insulin, Syringes, Pen Needles and Pump Supplies

Having backup methods to administer insulin is important in the event of a pump malfunction.

Testing Supplies Like a Blood Glucose Meter, Lancing Device, Lancet and Test Strips, Plus Sensors If Using Continuous Glucose Monitoring (CGM)

In some hospitals, it’s been difficult for patients to have their glucose levels checked hourly because healthcare workers don’t have enough personal protective equipment (masks, gloves, etc) to go in and out of patient rooms that often. Because of this, people with diabetes should be prepared to do their own testing and monitoring of blood glucose (BG). Bringing a backup method for testing aside from your CGM is also recommended in case sensors fail or other malfunctions occur.

Alcohol Swabs, Hand Sanitizer, Bandaids and Medical Tape

Disinfecting and keeping things clean and protected during this time is especially important.

Any Necessary Medications and Other Important Medical Details

This includes an itemized list of medications you’re currently taking, allergies to medications you might have, your physician’s information and emergency contact information.

Personal Protective Equipment

Pack your own gloves and masks or face coverings just in case. If possible, it might also be good to remember to wear PPE when entering the hospital to prevent excessive exposure to COVID-19.

Other Necessary Electronics and Chargers

Be prepared and bring any necessary cables to keep phones and tablets charged, especially if you’re using any kind of smart device to help monitor BGs.

A hospital stay during this time might sound scary, but it is important to take care of yourself and be prepared. If you are sick and have gone into DKA as a result and can’t keep down fluids, hospitalization becomes necessary and waiting only makes DKA more severe and life-threatening.

Source: diabetesdaily.com

Your Eye Health During COVID-19 — What You Should Know

This content originally appeared on diaTribe. Republished with permission.

By Kira Wang

While the global pandemic has interrupted many healthcare services, eye care is still essential and available under certain circumstances

Diabetes can lead to changes or problems in your vision, making annual eye appointments a necessity for every person with diabetes. One can prevent complications with vision for many years, even many decades, with some luck – it’s about glucose management as well as genes. For people who already have eye complications, treatment may be required as often as every few months in order to keep eyesight as strong as possible. But COVID-19 has disrupted many aspects of our daily lives, including the ability to visit eye care professionals for regular appointments. Although providers may not be able to see you in person at this time, there are still ways for you to access the care you need and keep your eyes as healthy as possible.

Can I still see my eye care provider in person?

We reached out to diaTribe’s network of healthcare professionals and learned that eye care providers are still treating emergencies and people with advanced cases of diabetes-related retinopathy and diabetes-related macular edema. Emergencies might include cases of trauma, infection, or sudden changes in vision (e.g., flashing lights, floaters, blurriness) – if you have experienced any of these situations, talk to your healthcare team right away.

If you have been diagnosed with diabetes-related retinopathy or diabetes-related macular edema, delaying treatment can risk worsening vision, and you may need to receive in-person care. If your treatment has been rescheduled, double-check with your healthcare team to make sure your vision is not at risk. For more mild cases of diabetes-related retinopathy or diabetes-related macular edema, your healthcare professional may consider the risks of exposure to COVID-19 versus how your vision will be affected without scheduled treatment.

Planning ahead is important, and every person is different – ask your doctor in advance about what specific plan works for you. If you do visit your eye care provider in person, remember to wear a face covering—this will help keep you and your healthcare team safe!

Telemedicine and eye care: when can I talk to my healthcare professional virtually? 

For problems with the outside of your eye, video visits can help you connect with your provider right from your home. Issues outside your eye might include redness, discharge, or swollenness. Explaining your symptoms to your provider over video can help them determine whether you’ll need to be seen in person.

What should I know about scheduling eye appointments in the midst of COVID-19?

For those who already have regularly scheduled eye appointments, your check-ups may be delayed during these times. If your visit is delayed, you should still pay attention to any changes in your vision. You can do this by giving yourself an at-home eye test.  If you don’t already have annual visits with an eye care professional, try to set up an appointment as soon as eye care clinics are back up and running.

Remember: keeping your blood sugar levels in range is central to maintaining healthy eyes.

In these challenging times, we are impressed by the use of telemedicine, for eye care and beyond. For more information on telemedicine during COVID-19, check out these nine tips by longtime diaTribe advisor Dr. Francine Kaufman. To the many healthcare professionals out there, we are grateful for your service and support. Mark your calendars—July is Healthy Vision Month, and we’ll have more articles on eyes coming your way soon!

About Kira

Kira Wang graduated from Duke University summa cum laude with a degree in psychology and minors in biology and chemistry. She wrote a senior thesis on the transactional coping strategies of parents and youths with chronic illness and spent time researching eye imaging techniques in the Duke Eye Center.

Source: diabetesdaily.com

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