When You Can Expect to Get Your COVID-19 Vaccine

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

By Lala Jackson

We now have two FDA-approved and safe COVID-19 vaccines in the US! So as a person with type 1 diabetes, you may be wondering when you can get yours.

The answer? Unclear. It’s all a bit of a logistical mess right now, but here’s what we do know – when you are able to receive your COVID-19 vaccine is dependent on your age, your specific health history (not necessarily whether or not you can check the ‘type 1 diabetes’ box on a form), the state and county in which you live, your employment type, and your healthcare provider’s recommendations.

Overall, having type 1 diabetes 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.

However, we also know that diabetes care itself is made far more complicated after contracting COVID-19 and protecting anyone with diabetes from COVID-19 is our ultimate goal. That’s why Beyond Type 1 has signed onto calls to action urging equal prioritization and is working closely with JDRF, the ADA, and other diabetes patient organizations to advocate for all people with diabetes to be included in Phase 1c of the CDC’s immunization recommendations.

Additionally, because vaccine rollout is happening on a state level, individual advocacy at a state level may be more efficient than federal action. In your community, reach out to your state representatives to let them know that people with any type of diabetes should be included in Phase 1c. Utilize JDRF’s COVID-19 Vaccine Access Toolkit for more resources.

The COVID-19 Vaccine Phased Us Rollout

In the US, the vaccine is being rolled out in phases in *most* states. Already, there are inconsistencies that make it difficult to estimate when you might get a vaccine.

Following approval of the vaccines, the CDC’s Advisory Committee on Immunization Practices created a set of rollout guidelines they recommend for states to follow. These guidelines include phased recommendations for which groups of people should be prioritized to receive the COVID-19 vaccines based on risk factors like older age, underlying health conditions, and lines of work that expose them to COVID-19.

Phase 1a is in process, having begun in December 2020 immediately following the approval of the COVID-19 vaccines in the US. It includes frontline healthcare providers and residents of nursing homes, where COVID-19 cases and deaths have been dramatically highest.

Phase 1b is happening in some states already, includes people over the age of 74, and expands to more frontline workers, including first responders, food and agricultural workers, U.S. Postal Service workers, manufacturing workers, grocery store workers, public transit workers, teachers, and child care workers.

Phase 1c is also happening in some states already, while still several months out others. This phase includes people over the age of 64, anyone else aged 16 or above with medical conditions that increase the risk for severe COVID-19*, and all other essential workers, like those in transportation and logistics, water and wastewater, food service, construction, finance, information technology and communications, energy, legal, media, public safety, and public health workers.

Note that Phase 1c is a BROAD group of people, and this is where things get a bit fuzzy. It is up to each state to control rollout. Many states are following the CDC’s recommendations quite closely, some are following them but not precisely (grouping some phases together, accelerating others), and some have created their own systems, often down to a county-by-county basis.

*What Does This Mean for People With Diabetes?

For people living with diabetes who are not otherwise prioritized because of age or employment type, Phase 1c is the one to look at carefully. As defined by the CDC, people aged 16 or over with medical conditions that increase the risk for severe COVID-19 are included in this phase. But what medical conditions are included?

Short answer – it’s in flux and it depends entirely on your state. Important to remember is that the CDC’s recommendations are just that – recommendations. They have very purposely created guidelines to inform rollout based on most recently available data on high-risk medical conditions, but their guidelines are not meant to be absolute law.

Currently included in Phase 1c recommendations are people with the following conditions: cancer, chronic kidney disease, sickle cell disease, COPD, Down Syndrome, heart conditions, weakened immune systems, obesity, pregnancy, smoking, or Type 2 diabetes.

This means that for those with type 1 or any type of diabetes other than Type 2, you are possibly, depending on your state, not included in the initial rollout and may need to wait to receive your vaccine with the general population, which is likely to be in April 2021 or later.

But don’t panic – as we’ll explain further below, you may still be able to receive the vaccine earlier, based on state or based on your specific health history.

Type 1 Diabetes + COVID-19

Type 1 diabetes itself is not likely to make you more at risk of catching coronavirus. While some have pointed toward the callout of people with immunocompromised systems being in Phase 1c, it is important to remember that having an autoimmune disease (where the immune system attacks itself) is not the same thing as being immunocompromised (where the immune system is susceptible to outside illnesses).

However, other factors associated with T1D may increase your risk of more intense symptoms and severe complications, and if you have to get hospitalized for COVID-19, diabetes care becomes dicey.

This is a piece that has been very confusing and not communicated as clearly as it could be throughout the pandemic – the factors that make a person with any type of diabetes most at risk catching coronavirus and for experiencing severe symptoms and complications of COVID-19 are systemic racism (like being denied or not believed when care is needed), healthcare access issues (like not being able to see a doctor for non-COVID care when needed, or not being able to afford medications and supplies because of job or healthcare loss), consistently elevated blood glucose levels, recent diabetes ketoacidosisjobs that increase exposure to COVID-19, etc.

Type 1 diabetes combined with these factors does create elevated risk. But well-controlled type 1 diabetes on its own does not seem to make someone more at risk of severe illness from COVID-19.

A few studies have raised concerns that outcomes for people with type 1 diabetes who get COVID-19 are far more severe than a person without diabetes, but digging into those studies provides clarity on what’s actually being shown.

  • In May 2020, the UK’s health system released numbers showing severe hospitalization and death rates for people with diabetes. It sounded scary, but what it did not clarify was that additional risk factors like heart disease were of great impact to outcomes, and that the study actually showed that people with type 1 diabetes and no other underlying risk factors like older age or other health history actually did quite well – they were not frequently hospitalized for COVID-19 and those who were had low frequencies of severe outcomes.
  • In December 2020, a similar study was released in Diabetes Care, with a headline saying that COVID-19 severity is tripled in the diabetes community. But again, what it did not immediately clarify was how much the severity was dependent on additional factors, like race (due to long-standing systemic racism), elevated HbA1c, hypertension, lack of diabetes technology, lack of health insurance, less diabetes technology use, etc.

Another study that shows these risk factors well was published in July 2020, outlining the fact that older age and other health-related risk factors were more impactful on severe outcomes than diabetes itself, particularly type 1 diabetes.

Overall, yes – anyone living with diabetes of any type needs to pay careful attention to their health amidst this pandemic. The safest thing anyone can do is practice safety measures to avoid getting COVID-19. For those who cannot – essential workers or people who otherwise have to be exposed to the virus – or those with other underlying health factors, those are the most important factors that must be taken into consideration for priority vaccination.

But just having type 1 diabetes alone, if you are otherwise healthy and not significantly exposed to the virus, should not give you reason to panic. Perhaps more important is ensuring everyone in the general public gets vaccinated as quickly as possible so that diabetes care can be safely accessed, and so hospitals and ICUs are not overwhelmed by COVID-19 patients in the event of emergency diabetes care needs.

How You Get Your Vaccine

Look up your state health department’s guidelines. 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.

Every vaccine taken decreases the risk and prevents the spread of COVID-19. While it is frustrating to watch the logistical mess, the more people who get vaccinated quickly the better, and in the meantime, continue to practice safe measures that protect you and your loved ones from COVID-19, including doing your best to keep tight control of your blood sugar levels, wearing a mask and physical distancing from anyone outside of your household, and avoiding indoor gatherings.

Source: diabetesdaily.com

Metformin May Reduce Your Risk of Death from COVID-19 Infection

This content originally appeared on diaTribe. Republished with permission.

By Eliza Skoler

The use of metformin – the most common initial medication for people with type 2 diabetes – was associated with a lower rate of mortality from COVID-19 among people with diabetes in a study in Alabama, confirming five previous studies.

Do you take metformin? It’s the first-line therapy used to lower glucose levels in people with type 2 diabetes. A recent study found that metformin use was associated with a lower rate of COVID-related death among people with type 2 diabetes. Since people with diabetes are at increased risk for severe illness from COVID-19, including hospitalization and death, the relationship between metformin and COVID outcomes in this report may be of interest to many people around the world who take the medication.

Want more information like this?

The study looked at the electronic health data from 25,326 people tested for COVID at Birmingham Hospital in Alabama, including healthcare workers, between February and June of 2020. Of those tested, 604 people were positive for COVID-19 – and 239 of those who were positive had diabetes. These results showed that the odds of testing positive for COVID were significantly higher for people, particularly Black people, with certain pre-existing conditions, including diabetes. This does not mean people with diabetes are more likely to get COVID-19, only that people with diabetes were more likely to test positive at this hospital.

Importantly, the study found an association between metformin use and risk of death – the study reported that people who were on metformin before being diagnosed with COVID-19 had a significantly lower chance of dying:

  • People taking metformin had an 11% mortality (or death) rate, compared to 24% for those with type 2 diabetes not on metformin when admitted to the hospital.
  • This benefit of metformin remained even when people with type 2 diabetes and kidney disease or chronic heart failure were excluded from the calculations. This is important because people with kidney or heart disease are often advised against taking metformin. By removing this population, it helps to support the notion that metformin may be involved in this difference.
  • Body weight and A1C were not associated with mortality among people with diabetes taking metformin. This suggests that the association of metformin use with reduced COVID-related deaths was not due to the effects of the medication on weight or glucose management.

The data suggest that being a person with diabetes who takes metformin may provide some level of protection against severe COVID-19 infection among people with diabetes. Other studies have shown similar results, though it is not known whether metformin may itself reduce COVID-related deaths among people with type 2 diabetes. The authors discussed some previously reported effects of metformin beyond lowering glucose levels, such as reducing high levels of inflammation (the body’s natural way of fighting infection), which has been described as a risk factor in severe COVID infection. Severe infection with COVID-19, resulting in hospital admission, can lead to damage to the kidneys and decreased oxygen supply to the body’s tissues – and in these circumstances, serious side effects of metformin can occur.

“Given that COVID leads to higher mortality rates and more complicated hospital courses in people with diabetes, it is important to consider whether specific diabetes medications can provide some relative degree of protection against poor COVID outcomes,” said Dr. Tim Garvey, an endocrinologist at the University of Alabama at Birmingham. “This study adds to growing evidence that people with type 2 diabetes treated with metformin have better outcomes than those not receiving metformin.”

Dr. Garvey also cautioned: “Of course, these case-control studies show associations and do not rise to the level of evidence that might be found by a randomized clinical trial. For example, people with diabetes not treated with the first-line drug, metformin, may have a larger number of diabetes complications or longer duration of disease compared with people not on metformin – which could explain the more severe outcomes. In any event, we advocate for early administration of COVID-19 vaccines and other protective measures for people with diabetes.”

Professor Philip Home, a professor of diabetes medicine at Newcastle University in the UK, agreed, saying, “Multiple studies have now addressed the issue of whether metformin and insulin use are associated with better or worse outcomes in people with diabetes who contract COVID-19. In line with previous literature on other diseases, it was expected that people on metformin would do better, and people on insulin worse, than people with diabetes not using these medications. This is confirmed.”

Home continued: “It is believed to happen because people using metformin are younger and have better kidney function than those not taking the medication, while those on insulin tend to have other medical conditions. The good news is that if you have type 2 diabetes and are taking metformin, you are likely to be fitter than if you have type 2 diabetes and do not take the medication – but there is no evidence that metformin itself will make a difference to your outcome if you do get COVID-19. So, get vaccinated as soon as possible!”

To learn more about metformin, read “Everything You Always Wanted to Know About Metformin, But Were Afraid to Ask.”

Source: diabetesdaily.com

Getting the Most Out of Your Remote Healthcare Visits

This content originally appeared on Integrated Diabetes Services. Republished with permission.

By Gary Scheiner MS, CDCES

A long, long time ago, before the days of coronavirus, there was a little diabetes care practice called Integrated Diabetes Services (we’ll just call it IDS for short). IDS taught people with diabetes all the wonderful things they can do to manage their diabetes. Word got out, and people who lived far from IDS’s local hamlet (better known as Philadelphia) wanted to work with IDS. Even people IN the hamlet wanted to work with IDS but were often too busy to make the trip to the office. So IDS had an idea: “Let’s offer our services via phone and the internet so that everybody who wants to work with us can work with us!” The idea took off, and IDS grew and grew.

And virtual diabetes care was born.

Today, in response to the COVID-19 pandemic, virtual healthcare has become a virtual norm. Often referred to as “telehealth” or “telemedicine,” people with diabetes are connecting with their healthcare providers for everything from medical appointments to self-management education to coaching sessions. Some consults are conducted via phone calls, while others utilize web-based video programs (like Zoom) or simple email or text messages. Regardless of the form, virtual care can be highly effective. But it can also have its limitations. Whether you’ve been receiving virtual healthcare for months or have yet to give it a try, it pays to learn how to use it effectively. Because virtual care will certainly outlive the pandemic.

What Can… and Can’t… Be Accomplished Virtually

Most diabetes care services, including medical treatment and self-management education, can be provided effectively on a remote basis. We have managed to teach our clients everything from advanced carb counting techniques to strength training routines to self-analysis of glucose monitoring data, all while helping them fine-tune their insulin program, on a 100% virtual basis.

Some clinics and private healthcare providers have gone 100% virtual since the pandemic began, while others are using a “hybrid” approach – periodic in-person appointments with virtual care in-between. Depending on the reason you’re seeking care, a hybrid approach makes a lot of sense. While virtual visits are generally more efficient and economical (and in many cases safer) than in-person appointments, there are some things that are challenging to accomplish on a remote basis. From a diabetes standpoint, this includes:

  • Checking the skin for overused injection sites
  • Learning how to use medical devices (especially for the first time)
  • Examining the thyroid gland and lymph nodes
  • Evaluating glucose data (unless you can download and transmit data to your provider)
  • Performing a professional foot exam
  • Listening to the heart rhythm and feeling peripheral pulses
  • Checking for signs of neuropathy and retinopathy
  • Measuring vital signs (unless you have equipment for doing so at home)

The Logistics

Virtual care can be provided in a variety of ways, ranging from a phone call to an email, text message or video conference. Video can add a great deal to the quality of a consultation, as it allows you and your healthcare provider to pick up on body language and other visual cues. It also permits demonstrations (such as how to estimate a 1-cup portion of food), evaluation of your techniques (such as how to insert a pump infusion set), and use of a marker board for demonstrating complex subjects (such as injection site rotation or how certain medications work).

When using video, it is important to have access to high-speed internet. A computer is almost always better than a phone for video appointments, as the screen is larger and has better resolution. If you have the ability to download your diabetes data, do so and share access with your healthcare provider a day or two prior to the appointment. It may also be helpful to share some of your “vital” signs at the time of the appointment – a thermometer, scale, and blood pressure cuff are good to have at home.

In many cases, care provided on a remote/virtual basis is covered by health insurance at the same level as an in-person appointment. This applies to public as well as private health insurance. However, some plans require your provider to perform specific functions during the consultation (such as reviewing glucose data) in order for the appointment to qualify for coverage. Best to check with your healthcare provider when scheduling the appointment to make sure the virtual service will be covered. At our practice (which is 100% private-pay), virtual and in-person services are charged at the same rates.

If security is of the utmost importance to you, virtual care may not be your best option. Although there are web-based programs and apps that meet HIPPA guidelines, there really is no way to guarantee who has access to your information at the other end. My advice is to weigh the many benefits of virtual care against the (minuscule) security risk that virtual care poses.

Optimizing the Virtual Experience

Just like in-person appointments, virtual care can be HIGHLY productive if you do a little bit of preparation.

  • Do yourself and your healthcare provider a favor and download your devices, including meters, pumps, CGMs, and any logging apps you may be using, prior to the appointment. If you don’t know how to download, ask your healthcare provider for instructions, or contact our office… we can set up a virtual consultation and show you how. If you have not downloaded your information before, don’t be intimidated. It is easier than you think. People in their 80s and 90s can do it. Oh, and look over the data yourself before the appointment so that you can have a productive discussion with your healthcare provider.
  • Be prepared with a list of your current medications, including doses and when you take them. Check before the appointment to see if you need refills on any of your medications or supplies. If you take insulin, have all the details available: basal doses (and timing), bolus/mealtime doses (and dosing formulas if you use insulin:carb ratios), correction formulas (for fixing highs/lows), and adjustments for physical activity.
  • Try to get your labwork done prior to virtual appointments. This will give your healthcare provider important information about how your current program is working.
  • To enhance the quality of the virtual meeting, do your best to cut down the background noise (TV off, pets in another room, etc…) and distractions (get someone to watch the kids). Use of a headset may be preferable to using the speakers/microphone on your phone or computer, especially if there is background noise or you have limited hearing.
  • Use a large screen/monitor so that it will be easy to see details and do screen-sharing. And use front lighting rather than rear lighting. When the lights or window are behind you, you may look more like a black shadow than your beautiful self. “Ring” lights are popular for providing front-lighting.
  • Provide some of your own vitals if possible – weight, temperature, blood pressure, current blood sugar. This is important information that your healthcare provider can use to enhance your care.
  • Prepare a list of topics/questions that you want to discuss. Ideally, write them on paper so that you can take notes during the appointment. If there is a great deal of detail covered, ask your healthcare provider to send you an appointment summary by mail or email.
  • Be in a private place that allows you to speak openly and show any body parts that might need to be examined – including your feet and injection/infusion sites.
  • Be a patient patient! Technical issues can sometimes happen. It is perfectly fine to switch to a basic phone call or reschedule for another time.
  • Courtesy. Be on-time for your virtual appointment. If you are delayed, call your healthcare provider’s office to let them know. And if you are not sure how to login or use the video conferencing system, call your provider beforehand for detailed instructions. This will help to avoid delays. Have your calendar handy so that a follow-up can be scheduled right away. Oh, one other thing: Try not to be eating during the appointment… it is distracting and a bit rude. However, treating a low blood sugar is always permissible!

If there is one thing we’ve learned during the pandemic, it’s that virtual care is a win-win for just about everybody. Expect it to grow in use long after the pandemic. In-person care will never go away completely, but for treating/managing a condition like diabetes, virtual care has a lot to offer… especially if you use it wisely.

Note: Gary Scheiner is Owner and Clinical Director of Integrated Diabetes Services, a private practice specializing in advanced education and intensive glucose management for insulin users. Consultations are available in-person and worldwide via phone and internet. For more information, visit Integrated Diabetes.com, email sales@integrateddiabetes.com, or call (877) 735-3648; outside North America, call + 1-610-642-6055.

Source: diabetesdaily.com

Is COVID-19 Causing a Diabetes Epidemic?

As the COVID-19 pandemic rages on into its second year, researchers have discovered a new, disturbing trend: there has been a statistically significant rise in both type 1 and type 2 diabetes diagnoses observed in patients after an experience of severe COVID-19. Even more disturbing is that nearly 14.4% of people who are hospitalized with COVID-19 go on to have either a type 1 or type 2 diabetes diagnosis, according to a November 2020 study that followed nearly 4,000 patients with severe COVID-19 infections.

It’s too early to tell if these forms of diabetes are permanent or temporary, but the correlation between severe COVID-19 cases and the development of diabetes is strong.

It’s well known that viruses can sometimes trigger diabetes. When someone contracts a virus, the immune system starts mounting a defense to fight it, mostly with T-cells. Sometimes the body will overreact, and start destroying its own pancreatic beta cells, the result being type 1 diabetes.

Scientists believe the same thing may be happening in the case of COVID-19 patients. Traditionally, COVID-19 has been an attack on the lungs, but a host of other issues and complications have come to light from sufferers of “long-haul COVID”: neurological disorders, blood clots, kidney failure, heart damage, and now many believe an epidemic of both type 1 and type 2 diabetes diagnoses may soon be added to the list.

The association between other coronaviruses and the development of diabetes has been made in the past during the SARS outbreak as well.

After the 2003 SARS pandemic, Chinese researchers tracked 39 patients who had developed high blood sugar levels characteristic of a diabetes diagnosis, within days of hospitalization with the disease. For all but six, blood sugar levels had returned to normal by their hospital discharge, and only two still had diabetes after two years.

This isn’t entirely new, either. Doctors in Wuhan, China reported a link between COVID-19 and elevated blood sugar levels back in April 2020. Italian scientists also looked into whether higher blood sugar levels could lead to a diagnosis of diabetes. That study, from May 2020, admitted more research needed to be conducted before a conclusion was reached.

Because COVID-19 is a global pandemic and the link to new diabetes cases has been observed in multiple countries, researchers globally are collecting data points about those patients in a registry called CoviDIAB.

Scientists do not know whether COVID-19 might exacerbate already developing issues or actually cause them; some believe it’s both. Many people who have had COVID-19 and have gone on to develop type 2 diabetes already have existing risk factors, such as obesity and a family history of the disease. Perhaps the increased medical attention sought out by people suffering from COVID-19 has detected the disease early, when a diagnosis was inevitable later on down the line anyway. Some medical experts believe that more people are getting medical attention than ever before, being closely monitored by experts in the field, and are unveiling underlying issues that may have been there all along.

Another theory is that elevated blood sugar levels also are common among those taking dexamethasone, a steroid that is a common treatment for COVID-19. Steroid-induced diabetes is rare, but not unheard of, and may trigger diabetes in people who have no known health risks for the disease.

“Researchers are working like crazy to see if COVID attacks the beta cells of the pancreas, which makes insulin,” pediatrician Dr. Dyan Hes said. “Some studies feel that they do, but other studies have been repeatedly saying it is not attracted to the beta-cell.”

How exactly the two conditions are connected isn’t quite clear yet, but a prominent theory is that the COVID-19 virus destroys or alters insulin-producing beta cells in the pancreas possibly by binding to ACE2 receptors, according to a short letter published in the New England Journal of Medicine.

Whatever the association is, researchers from the journal of Diabetes, Obesity, and Metabolism say a direct effect of COVID-19 on the development of diabetes, “should be considered.”

Francesco Rubino, a diabetes surgery professor at King’s College London, is convinced there is a connection between the two conditions and has been tracking and studying the phenomenon since early last year. “We really need to dig deeper, but it sounds like we do have a real problem with COVID and diabetes.”

Additionally, Rubino thinks the type of diabetes being developed as a result of COVID-19 may be a hybrid form, something of a cross between type 1 and type 2. His findings show that the symptoms in these patients have some characteristics of each form of diabetes, which he finds concerning.

Researchers are also now seeing a rise in type 2 diabetes diagnoses in children who have had asymptomatic COVID-19, which is even more troubling, as many schools are back in session, many public places do not require masks on children, and the tipping point of a diabetes epidemic may rest solely on the shoulders of our youngest, most vulnerable citizens.

This can also complicate a few things for people: firstly, that neither the Pfizer-BioNtech nor the Moderna COVID-19 vaccines are approved for children, and secondly, that type 1 diabetes is not being prioritized on the Centers for Disease Control and Prevention’s list for vaccine dissemination. States are able to follow their guidance or dismiss it out of hand, but federally, there is no coordination to prioritize the population.

With nearly 10% (34 million people) of the United States already affected by diabetes, and another 100 million living with prediabetes, the tidal wave of COVID-19 cases could very well send our country into catastrophe fighting two disasters at once: both uncontrolled community spread of COVID-19 along with a (COVID-triggered) explosion of new diabetes diagnoses, especially in children. This would not only send our country into panic mode but could also completely overwhelm our already fragile health care system that everyone is so heavily relying on.

Scientists are rushing to find the exact connection between severe COVID-19 cases and new diagnoses of diabetes, but between diabetes being a major risk factor for death in COVID-19 cases (nearly 40% of COVID-19 deaths have been in patients with diabetes), along with the increased risk of developing diabetes from a severe bout of COVID-19, one thing is for sure: we need to find the connection and fast and get the diabetes community and those at risk for diabetes vaccinated as quickly as possible. We don’t have time to waste.

 

Source: diabetesdaily.com

Survey Reveals the Heavy Burden of the Pandemic on People with Diabetes

The COVID-19 pandemic has now been ongoing for over a year, and even with the light finally visible at the end of the tunnel, it is undoubtable that it will have lasting effects, for years to come.

Late in 2020, we partnered with the American Diabetes Association (ADA) to conduct a survey-based analysis to assess the effects of the COVID-19 pandemic on Americans living with diabetes.

Approximately 2,600 responses were collected from the Thrivable online patient panel. People from all 50 states shared their experiences during the pandemic, describing the impacts on access to healthcare, food, outlook on receiving a COVID-19 vaccine, and more.

Key Findings: Reduced Health Care and Food Access

  • About 4 of 10 Americans with diabetes delayed seeking routine medical care, with more than 50% stating the fear of COVID-19 exposure was the primary reason.
  • About 1 in 5 Americans with diabetes have foregone or delayed getting an insulin pump or continuous glucose monitor (CGM).
  • More than 1 in 4 stated their access to healthy food was reduced, with about 1 in 5 relying on food assistance programs.
  • Almost half who receive assistance report that the food they receive negatively affects their diabetes management.
  • About 1 in 5 people who receive nutritional assistance report not having enough food to eat.

Moreover, about 1 in 5 Americans with diabetes have reported having to choose between buying food vs. affording their diabetes supplies.

The effects of the COVID-19 pandemic are widespread and span across multiple facets of people’s lives. For people with diabetes, many of whom are already struggling to afford their healthcare expenses, the financial effects of the pandemic may be particularly grim.

Perspectives on the COVID-19 Vaccine

When asked about their comfort level of receiving a COVID-19 vaccine as soon as it is made available to them, people with diabetes reported being more likely to want to receive it right away as compared to data collected from the general population.

Less than half as many people with diabetes stated that they would never want to get the vaccine as compared to data on the general population (10% vs. 21%, respectively).

It is perhaps not surprising that people with diabetes feel more strongly about receiving a COVID-19 vaccine than the general population. Currently, the Centers for Disease Control and Prevention (CDC) state that people with type 2 diabetes  “are at increased risk  of severe illness” from COVID-19, while people with type 1 diabetesmight be at an increased risk for severe illness.”

Other Insights: Barriers to Clinical Trials Participation

In addition to exploring the financial burden of the pandemic and assessing readiness to receive a COVID-19 vaccine, we also gathered information regarding previous participation or willingness to participate in a clinical trial. As per the recent press release,

“People with diabetes have participated infrequently in clinical drug trials in the past (only 11% report having done so), but the majority – 60% – say they are likely or very likely to participate in such a study in the future. Yet nearly a quarter of those who responded to the survey said they didn’t know how to participate in a drug trial if they wanted to do so.”

Check out the full press release from the ADA as well as the more data below:

New Data Alert: COVID-19 Brings Crisis of Access for Millions Living with Diabetes

Effects of the COVID-19 Pandemic on People with Diabetes

Methodology and Panel Demographics

These figures are based on Thrivable’s survey of more than 2,500 people with diabetes nationally, between December 7th and December 14th, 2020

  • A multiple-choice survey was distributed online to people with diabetes (U.S. residents) who signed up for the Thrivable Insights panel.
  • Participants were not compensated for their responses.
  • Data was analyzed using Qualtrics and Excel.
  • Details on panel breakdown include:
    • N = 2,595
    • o 47% with type 1 diabetes, 53% type 2
    • o 69% female, 31% male
    • o All 50 U.S. states are represented

Source: diabetesdaily.com

COVID-19 Vaccine: Experience and Thoughts from the Diabetes Community

We are almost one year into the COVID-19 pandemic and while it is still causing devastation, there is light at the end of the tunnel thanks to two companies, Pfizer and Moderna, now offering a vaccine.

It varies by state but healthcare workers and people over 75 years (over 65 in some states) are the first in line. After that, people with high-risk, pre-existing conditions will be next. See here to find out your exact eligibility per state.

Many people have mixed feelings about the vaccine. Some are certain they will get it, not only because they don’t believe the vaccine is at all harmful but because they want life to go back to normal as soon as possible, while also protecting their health. Others are reluctant, possibly questioning the novelty and quick turnaround of the vaccine and wondering if there may be unforeseen side effects.

We thought it would be nice to hear from people like ourselves, who also live with diabetes, and see how they feel about getting vaccinated. We also spoke to some people who have already received the vaccine and heard about their experiences with side effects.

We asked our own Diabetes Daily forum members and the diabetes online community and here is what they had to say:

My wife with type 2 diabetes also suffers from COPD, bronchitis, and asthma. Accordingly, she would have a problem surviving COVID, so we have both registered with the NJ Covid Registry and will take the vaccine as soon as it becomes available. ~ Don1942

As I see it, two of these vaccines (Pfizer and Moderna) use a completely new and untested approach called mRNA. They were tested for only a short term on young, healthy adults. Animal, medium, and long-term testing were bypassed entirely. No testing on those with various health issues, and no testing for drug interactions. They only claim to reduce the number of symptoms. Zero claims are made about keeping you from getting or transmitting the virus. Last statement verified by Fauci saying anti-social distancing, lockdowns, and masking will still apply once you have had the vaccine. Then there are the 3+% of those who are vaccinated who suffer worse side effects than the symptoms the drug is supposed to reduce, keeping in mind that in the age groups tested only 1% would ever show any symptoms at all.

Finally the manufacturers take zero fiscal responsibility for bad outcomes. If they don’t believe their drugs are safe, why should I? ~ BobCan2

I have a nephew that has a doctorate in biochemistry (currently working on gene therapy). Said “I would take any of the vaccines in a second.” His wife also an MD has had the Moderna vaccine. I have a niece that is working on her doctorate in microbiology who has had the vaccine. So yes, I will take it. ~ 1986

I’m a no. Given my recent extended exposure, I’m not concerned. I’ll gladly wait for herd immunity. ~ HaoleBoy

I am a surgeon. I got the first dose of the Moderna vaccine. Just a sore arm. I have reviewed all of the science presented to the FDA and have no concerns. Glad to have access! ~ Dr. Carrie D.

So I voted yes… I’ve stated before that I used to be in the vaccine industry and I trust the science and the process. It’s not new technology being used. ~ Jughed

I’m getting the Moderna vaccine on Monday. I am a special education teacher in WI and we are the first group identified in the school district. Blessing! ~ Melissa R.

I think most people of my age remember friends getting polio, and I also remember giving my father chickenpox, which made him very, very ill; so having seen the miracles these vaccines did for quality of life, and preventing unnecessary deaths, I know I am very much pro-vaccination. My name will go down for a vaccine when it finally arrives here, hopefully, next month. I’m eligible for priority vaccination because of my age and a couple of chronic conditions.

I am 81 years old and a type 1 diabetic for 75 years. I am very high risk if I have the COVID virus. I am scheduled for the vaccine on Wed, Jan 21. My only hesitance is that the vaccine is being given in the gym complex at the local high school. I will probably encounter several individuals in the parking lot, while entering the building, inside the building, etc. In some states, people are receiving the vaccine without getting out of their cars. I wish it was done that way here where I live. ~ Richard `57

I am getting mine next weekend. I am 100% behind the science and haven’t given it a negative thought. Bring it on! ~ Susan K.

I’ll have it as soon as it’s offered. I am just recovering from COVID and it is awful. Sugars were terrible. I never want it again if I can help it. ~ Michelle R.

I will not be getting one. Mostly because I can’t help but think childhood vaccines play a major role in type 1 diabetes in the first place as vaccines are designed to trigger the immune system. ~ Fabian B.

I plan on getting the J&J one once it’s approved. I’m uncomfortable with the speed of the first two on the market, despite all I know everyone is saying. I feel better about the slow poke even if it’s irrational. ~ Caroline L.

Nope, nope and nope again. ~Kristin R.

I won’t be giving it to my son or myself. ~ Julie P.

I plan on getting one. In Nebraska, people living with diabetes are now eligible. ~ Wendy G.

My daughter is type 1 but it is not approved for children yet but she will not receive one and will remain not vaccinated as she always has been. ~ Stefanie R.

Here is what the people who have already received the vaccine had to say:

I had both doses. I’m 10 days out and still feel very run down. I was COVID-tested yesterday because it felt like a mild case but was negative. I received the vaccine 2 weeks ago and no side effects. Type 1 for 55 years. ~ Cindi H.

Tolerated both injections. Side effects were mild, with some deep muscle soreness, at least for me. I did note some insulin resistance post injections. ~ Chris A.

I got my first dose a couple of weeks ago and will get my next one in two weeks. I just had a sore arm and a little fatigued the next day. By the third day, I felt pretty normal. I didn’t notice any changes to my insulin sensitivity or blood sugar levels. ~ Karissa G.

I received both doses. My only issues were headache, fatigue, and chills.

COVID vaccine update #2: 24 hours later, I don’t feel horrible, but definitely off. Some body aches, headache and overall sluggishness. I went to bed at about 8:30 and “slept” till 10:30. (with my saul dog interruptions and the baby kicking my bladder, etc.)” ~ Nicole M.

I had mine because I work for the National Health Service and I had no side effects at all. ~ Kate B.

I was nauseous after my first dose for about 12 hours. I took a Zofran and was fine. ~ Jamie B.

I did have side effects (pain, mild fever) but I won’t hesitate to go for the second shot.

I have completed the series and just had a sore arm for a couple of days each time.

No side effects beyond a sore arm. I like the peace of mind and I did extensive research before getting it to fully understand what I was getting into. ~ Sarah R.

My 82-year old identical twin sisters each received the first dose. One got the Pfizer and the other the Moderna. No adverse reactions thus far. The one that got the Pfizer has allergies so was a bit concerned but had no reaction. ~ Auburn75

It should be mandatory that vaccines like this are taken. It’s not a conspiracy theory. There aren’t robots in the vaccine. This whole virus story isn’t a hoax, and this hasn’t been started because some people are simply trying to make some money. The sheer lunacy I’ve seen out there is beyond description. Some people think the world is flat. I’ve gotten both doses and have had zero side effects. ~ Sheralyn B.

I received my first vaccine on Jan 8 with minimal side effects being a sore arm and mild low blood sugars. On Jan 27 I received my second vaccine. Initially only had a sore arm and headache but after 36 hours, developed mild fever of 99.7, body aches, headache, continued low blood sugars, and a grape side swollen lymph node in my armpit, the arm I received my vaccine in. Fever and swollen lymph node improved with Tylenol and Ibuprofen! ~ Carlie W.

Will you be getting the vaccine once it is available to you? Have you had one or both doses and experienced side effects? Share and comment below!

Source: diabetesdaily.com

COVID-19 Vaccine for People with Diabetes: What’s Going On?

The COVID-19 vaccine is here, and like most things dealing with the pandemic, the rollout of both the Pfizer-BioNtech and the Moderna vaccines has been a nightmare. The Trump administration’s Centers for Disease Control and Prevention (CDC) Advisory Committee for Immunization Practices (ACIP) released loose guidelines for states to follow in determining how to disseminate the vaccine but has largely left most of the decisions up to the states. Most people don’t yet know when they’ll receive the vaccine, and on the whole, most states are still in phase 1a, disseminating shots to frontline healthcare workers and those living in long-term care facilities.

In their initial recommendations, people with type 1 diabetes would receive the vaccine further down on the priority list, along with healthy individuals under 65 years old. People with type 2 diabetes are classified as, “at increased risk for severe COVID-19–associated illness”, and are thus to be given priority access in phase 1c, along with people who suffer from other conditions, such as cancer, heart failure, sickle cell disease, chronic obstructive pulmonary disease (COPD), and smoking. Type 1 diabetes is classified as, “might be at increased risk for severe COVID-19-associated illness”, to be given access in phase 2, with other conditions such as being overweight (BMI >25), and suffering from neurologic conditions.

This would put people with type 1 diabetes in the general population rollout, months after not only people with type 2 diabetes have gotten their shots, but behind many other chronic conditions, too. This is a harsh slap in the face for a community that could face so many negative consequences should they contract the virus (not to mention people with diabetes make up 40% of all COVID-19 deaths).

But recent data has come out that people with type 1 diabetes suffer from mortality from COVID-19 at similar rates as people with type 2 diabetes, and a study conducted by Vanderbilt University said people with either type 1 or type 2 diabetes who have COVID-19 have three to four times higher risk of severe complications and hospitalization as compared to people without diabetes.

Several more studies show that having type 1 diabetes is potentially even more dangerous if you contract COVID-19  than having type 2: A Lancet Diabetes & Endocrinology study published last year looked at medical records from the National Health Service in England to conclude that the risk of dying from Covid-19 was almost three times higher for people with type 1 diabetes and almost twice as high for type 2 than for those without diabetes.

In Scotland, another Lancet study said being admitted to an ICU or dying was more than twice as likely for type 1 diabetes patients and nearly 1.5 times more likely for type 2 diabetes patients than for people without diabetes.

People with type 1 diabetes have been told that they live with a disability the entire time they’ve lived with this incurable illness. We’ve sat on the sidelines while going low, been discriminated against in the school and workplace, shut out from certain industries and employers, and know the unique and awful feeling of our skin tightening from a hyperglycemic event after our pump failed for the umpteenth time in our sleep. We require special accommodations, a militant watch on our medication, exercise, insulin, and food intake, and are never offered a break, a day off, or even a hint of affordable insulin.

We live in the unique situation of a dual-reality: having a chronic condition, yet feeling its invisibility every day. We’re never quite “sick enough”; we never “look” diabetic; sometimes, we feel like we don’t even “deserve” the meager accommodations that we get (always pre-board flights, because you’re allowed to!). We live every day with the knowledge that our life expectancy is likely shorter, our days are harder, and especially during this pandemic, many of us have lived in fear of a serious complication should we contract COVID-19 and the bleak consequences we could face. Many of us have stayed home, shut-in, and waited this out, while watching some of our able-bodied peers continue to ignore public health protocols and guidelines.

The end result of the CDC’s recommendations burns and is tangible: states, including Iowa, Illinois, and Virginia, are prioritizing dissemination of the vaccination to people living with type 2 diabetes before people living with type 1 diabetes. Simply put: we’ve been told to stay in, shut up, and wait it out for the vaccine, due to our fragile health condition, and now that the vaccine is here, our disability is yet again being ignored.

Yes, type 2 diabetes is being prioritized and that is right, good, and important, but type 1 diabetes needs to be prioritized, too. They’re not mutually exclusive. Currently, the United Kingdom is not differentiating between type 1 and type 2 diabetes; they are prioritizing people who have either type. Other countries are following suit.

On Tuesday, the Trump administration reversed course, adopting part of president-elect Joe Biden’s distribution plan, advising states to prioritize everyone over the age of 65 and any person with a chronic condition to get the vaccine as soon as possible; states have yet to officially adopt these plans on a wide scale.

Recently, several letters were sent from various diabetes advocacy organizations to the CDC urging them to reconsider their guidelines. Organizations such as T1International, Mutual Aid Diabetes, The American Diabetes Association, JDRF, Beyond Type 1, Children with Diabetes, The diaTribe Foundation, DiabetesSisters, and T1D Exchange have lent their voices to make the needs of the 1.6 million people living with type 1 diabetes in America known.

The bottom line is that we need to curb the tide of this pandemic. Almost 400,000 Americans are dead, with a holiday-related surge in cases, hospitalizations, and death on the way. We need to get shots into as many arms as quickly as possible and stop telling some of our most vulnerable populations that, yet again, they aren’t sick enough to qualify, and that they can wait. We can’t.

Source: diabetesdaily.com

Type 1 Nuclear Pharmacist on Getting a COVID Vaccine

Ann is a nuclear pharmacist who also lives with type 1 diabetes. We chatted with her about her recent experience with the Pfizer COVID-19 vaccine.

Hi Ann! Thank you so much for taking the time to speak to me. I know many people living with diabetes have had a challenging year whether trying to avoid COVID-19 or dealing with the virus itself. Now that a vaccine is available, I know many are wondering if it is right for them.

How long have you been living with type one diabetes?

I was diagnosed in March 1992, a few days before my 7th birthday.

Did having type 1 diabetes impact your decision on what you wanted to do career-wise?

Kind of. I would have loved to try to go to medical school, but I was worried about the difficulty of managing my diabetes throughout such a demanding program.

I understand you are a pharmacist, congrats! I know that takes many years of education and hard work and dedication! At what point did you know that was what you wanted to do?

I started working as a pharmacy cashier when I was in high school. That got me interested in the field of pharmacy.

Where do you work?

I’m a nuclear pharmacist for the University of Oklahoma.

I understand you have a very important role now that the vaccines have arrived at your University. What is your role? And why is it so important that you are all vaccinated?

My pharmacy is preparing all of the vaccine doses for the health sciences campus that we’re a part of. We prepared about 3,700 doses for this initial round. Besides preparing the vaccine, my pharmacy also delivers nuclear medicine doses to hospitals and clinics all around central Oklahoma. Our staff is potentially exposed to COVID during every delivery we make. It would be a devastating loss if multiple staff became infected and we were unable to operate at full capacity.

When you found out you were going to receive the vaccine, what were your initial thoughts?

I was thrilled! I had already made the decision that I would get vaccinated as soon as I had the opportunity.

Ann Kirkpatrick

Photo credit: Ann Kirkpatrick

Did you find most of your colleagues were willing to take it without hesitation? If they were reluctant, what was their reason?

So far, nearly all of our staff has received the vaccine. There are a couple who have had COVID recently, so they will not be getting vaccinated yet.

I understand the vaccine comes in two doses. When will you receive the next one?

I got the Pfizer vaccine. My next dose will be 21 days after my first dose. The Moderna vaccine doses are given 28 days apart.

Have you ever had COVID before?

I’ve never had COVID. People who have had it can still receive the vaccine. One of the current thoughts is that if you still have antibodies, you should wait to get the vaccine, so that others without antibodies may be vaccinated first.

What happens if you are exposed to COVID-19 in the interim before you receive your second dose?

The CDC recommends deferring vaccination until after the quarantine period following a known exposure. It’s best to receive the second dose as close as possible to the 21-day mark (or 28 days for the Moderna vaccine). However, there is no maximum time period between doses.

Did you notice any side effects after receiving the shot? Many are concerned that the shot will elevate their blood sugars. Did you notice any impact on your numbers?

The only effect I noticed was some soreness around the injection site. For me, it was mild and only lasted a couple of days. I did not notice any effect on my blood sugar!

Thank you so much Ann, for answering my questions. I will be sure to check back in with you but thank you so much for doing your part to rid this world of this devastating virus!

Source: diabetesdaily.com

More Control Than We Think – Pandemic Strategies for Healthy Eating

This content originally appeared on diaTribe. Republished with permission.

By Katie Bacon

As you look toward staying healthy in the new year, meaningful changes to your diet may help you manage glucose levels and maximize health in the face of COVID-19. Four experts – Whole Cities Foundation’s Dr. Akua Woolbright, low-carb guru Dr. Mariela Glandt, San Francisco General’s Dr. Rita Nguyen, and Harvard’s Dr. Lee Kaplan – shared insights for eating well, finding affordable food, and keeping your body’s immune system strong.

As we’ve learned more about COVID-19, it’s become clear that the virus presents a particular threat to people who have diabetes or other metabolic conditions, including obesity. With that in mind, I spoke with a range of experts who had specific, actionable tips on how to make nutrition and lifestyle changes during the pandemic, with an eye toward improving glucose management and metabolic health – even at a time when increased stress may make that more difficult. Though their perspectives and advice differed, each expert agreed that the disruption caused by COVID is a good time to make changes. Many of their suggestions offer ways to improve health – and not just during COVID. Others offer ways to make your money stretch further at a time when many people are economically on the edge (especially in the diabetes community), yet are also looking for healthier ways to eat. Though many of us feel helpless right now, we actually have more control than we may think, and the small decisions we make about food each meal can lead to positive changes.

All of the interviews have been condensed and edited for clarity. For more nutrition information for people with diabetes, click here.

  • Dr. Mariela Glandt is the founder and director of the Glandt Center for Diabetes Care in Tel Aviv, Israel, which specializes in treating diabetes through very low carbohydrate diets. She is also the author of How to Eat in the Time of Covid-19.
  • Dr. Lee Kaplan is an internist and gastroenterologist, a leading researcher, and the director of the Weight Center at Massachusetts General Hospital.
  • Dr. Rita Nguyen specializes in internal medicine and has served as the Director of Chronic Disease Prevention for the San Francisco Department of Public Health, where she founded and directed the city’s Food As Medicine Collaborative. Currently, she is leading the department’s efforts to write COVID-19 guidance for all city sectors.
  • Dr. Akua Woolbright is the National Nutrition Program Director at the Whole Cities Foundation, an independent nonprofit foundation started by Whole Foods Market with the goal of increasing access to fresh, healthy foods and quality nutrition education.

What advice are you giving people during COVID, particularly in terms of nutrition?

Akua Woolbright: I have a mantra that I recommend: whole foods, plant based. Eat from the Earth, things that your great, great, great, great, great, great, great grandmother would have found in her outdoor environment. Another way I like to say that is food made by nature, not by people.

When I say plant-based, I don’t mean that everyone should necessarily be vegan or vegetarian, but that by building our meals around green and colorful vegetables, colorful fruit, whole grains, legumes, a few nuts, and seeds, our food starts to become micronutrient dense. We’re naturally getting less of what we don’t need (excess calories, saturated fat, and cholesterol) and more of what our bodies use for fuel and energy – vitamins, minerals, antioxidants, and phytonutrients.

Instead of looking at one diet for weight loss and something else for high blood pressure and then doing something else for cancer prevention and then thinking about diabetes, I try to construct a diet that will be beneficial to all of our systems, organs, cells, and DNA. Here are some of my strategies:

  • That mantra “whole foods, plant based” can be used as a touchstone when you’re walking through the grocery store, when you’re going to restaurants, and preparing meals in your home. Try to avoid those packaged food products.
  • For someone who has diabetes, lean more on the green and colorful non-starchy vegetables. Go more towards the tart fruit like berries, and avoid starchy produce.
  • To start, think about changing breakfast. Breakfast in America tends to be pancakes, cereals, all of that stuff. And so instead, perhaps eat some beans for breakfast. That sounds crazy to people, but we know that beans with resistant starch can help regulate blood sugar for the rest of the day. Beans are simple, they’re affordable, and you can mix them up so many different ways – pinto beans with chili powder, curried black beans – I try to get people to be creative.
  • Start lunch and dinner with a large salad or a vegetable soup. This will give you a lot of micronutrients and fill you up with some bulk in fiber so you’re better able to manage your blood sugar and your cravings.
  • Drinking plenty of water is important. Some of your water can come from eating watery fruits and vegetables and drinking herbal teas. Herbal teas are great because they’re high in antioxidants and vital nutrients. And by getting proper hydration, you can remove toxins from your body and curb hunger.

I try to have some urgency around the changes we need to make to lead healthier lives – we can do so much more to support our own health.

Mariela GlandtMy message is that now, more than ever, is the time to pay attention to our metabolic health. And the best way I know of to do that is to reduce how much insulin your body needs, by changing the way you eat. I argue that when you lower insulin levels, it can be possible to correct metabolic issues, like heart diseasehigh blood pressure, high cholesterol, obesity, and type 2 diabetes. There is a much greater chance of getting severely ill if you have a complicated metabolic condition.

So how can you improve metabolic health? By avoiding the foods that demand insulin, which are carbohydrates and sugar. For the people I work with who have type 2 diabetes, I recommend a ketogenic diet (high in fat, low in carbohydrates). Type 2 diabetes is the body telling you, “Please, don’t bring in any more sugar; I don’t have anywhere to put it.”

As far as bang for your buck, you can see many more effects from changes to diet than from exercise or other aspects of lifestyle. It’s really worth paying attention to what you put in your mouth. Here are some tips to help you:

  • Go as “real” as possible – the least amount of store-bought and processed food. Stick to the outer aisles of the grocery store for the fresh food. Try to make things at home. Chicken, fish, eggs, and vegetables. That in itself brings you a lot closer to health.
  • Drop that bowl of cereal in the morning and have two eggs instead.
  • I’m against snacking. I think we should eat enough fat and protein to feel full without snacking. Aiming to eat no more than three meals a day can help to decrease insulin levels throughout the day.
  • Eat dinner as early as possible, because humans are not meant to be eating during the night time. That one change of eating earlier can be really helpful in terms of reducing insulin levels.

Rita Nguyen: The people I typically see are at our county hospital, so they tend to be economically and socially disadvantaged. Now, with the economic stress brought on by COVID-19, more people are facing similar economic situations to my patients. When you have plenty of money and access to food, it’s much, much easier to comply with dietary recommendations for diabetes. In the setting of restricted resources, I tell my patients that portion control becomes more important because you’re not able to always pick the healthier items, and oftentimes you may be only able to purchase or access shelf-stable foods.

For people facing financial constraints, here’s what I suggest:

  • You may end up eating more carbs to keep yourself full, but you should be particularly mindful to seek out complex carbs rather than simple carbs, and whole grains whenever you can (although some of the nicer whole grains are more expensive).
  • Try to cook from scratch as much as possible.
  • Protein is meant to keep people full longer and has less of an effect on your blood sugar.

People can do these things anytime, but these strategies become even more important when you’re facing real limitations in what you can purchase.

The final piece of advice I give is to quit smoking. The leading cause of death among people with diabetes is heart disease, and smoking contributes greatly to heart disease. Plus, cigarettes are expensive. If you smoke a pack a day, that costs over $2,000 a year. I totally understand that increases in smoking and drinking happen when there’s increased economic stress. But for some people, if you point out the economic and health costs, it can help them quit.

Lee Kaplan: Because we’re all eating at home to a much greater extent during COVID, we have the opportunity to learn how to cook and eat less processed foods than we did previously. This disruption provides a good time to make long-term lifestyle changes – whether it’s reducing stress or getting better sleep or eating healthier food. That’s the silver lining of all this. You can build new patterns with a keen eye toward where you eat, when you eat, how you eat, and what you eat, which all become part of a healthier dietary lifestyle.

To decrease the risk of developing diabetes, other metabolic diseases, cancer, and heart and vascular disease, you want to eat the diets that have been shown to improve specific risks [read about the American Diabetes Association’s dietary guidelines for diabetes here] – for instance, you want to follow diets that have iron, Omega-3s and Omega-6s, and are low in saturated fats, have no trans fats, and are low in concentrated carbohydrates. But none of those recommendations, in my view, has been demonstrated to cause substantial or durable weight loss. So, you should follow these diets for their health benefits, not because they will necessarily cause weight loss.

To the greatest degree possible during this time, you should also:

  • Decrease stress.
  • Have physical activity in your life.
  • Get healthy sleep.
  • Normalize your body’s internal rhythms through regular patterns of eating and sleeping, and accommodating third shift work or travel as needed.

Do you have specific recommendations around trying to boost the immune system during COVID?

Akua Woolbright: I like to make sure that we’re getting a variety of colorful produce at every meal. Every color corresponds to a different set of nutrients that feed different parts of the body. By eating a variety of colorful produce – purple foods, red, orange, yellow, green, brown, white – you are feeding different systems and organs, and really drilling down into your cells with nourishment and the ability to heal and rejuvenate the body.

When we’re looking for immunity, the three colors that stand out are orange, yellow, and green foods. This includes things like citrus, yellow or orange peppers, squashes, even some sweet potatoes, dark green leafy vegetables, broccoli, and cabbage. They’re all effective in strengthening immunity, and those green foods give an added boost by removing toxins from the body.

I also like to talk about high-quality protein and making sure that people with diabetes and those who are trying to build a healthy immune system are careful to get enough protein throughout the day. Aim for at least 10 grams of protein, up to 20, spread throughout the day at breakfast, lunch, and dinner. Why is protein so important for blood sugar and maybe even weight loss? It helps to stabilize cravings and blood sugar and makes you feel more even and balanced, allowing you to make active choices.

The quality of protein throughout the day is also important because our immune antibodies are made from protein. So we’re looking at lean meat: salmon is particularly great for immune boosting. When I’m looking for a plant-based protein powder, I’m looking for something clean, made with few ingredients, and with the protein coming from hemp, brown rice, or green peas.

With the pandemic economy, many people have even less ability than they did before to buy certain foods. How do you talk to people about healthy food choices at a time when so many are so economically stretched?

Rita Nguyen: Right now, it’s all about connecting people to resources through things like food pantries and food pharmacies, because you can only go so far with advice.

Healthcare can’t ignore the fact that you have to address food insecurity. You can’t assume that the person sitting in front of you has been employed the last nine months and has enough to eat. For people with diabetes facing food insecurity, if you maintain the dose of insulin or other medications, you either risk hypoglycemia because they’re not eating consistently, or maybe you’re under-treating them because their eating habits have changed. So for any diabetes healthcare professional, I think screening for food insecurity should be part of the standard of care at least during the pandemic.

Mariela Glandt: It’s a matter of prioritizing and looking for the sales. You can get meats that are on sale. Eggs also provide a huge amount of nutrition, they’re amazing, and they’re much cheaper than meat.

Akua Woolbright: I kind of treat this like church, where I give you all of the Ten Commandments, all the dos and don’ts. But then I tell people, “You’re going to start where you are and do what you can. If you can only go buy the fresh produce or dried beans, do that. If you can buy one new item, figure out which one you like and start there.”

Some of the recommendations I help people think through are logistical. If there’s one person in your neighborhood or your family who has a car, maybe you come together and drive further out to a grocery store that’s more affordable. Maybe you find hardy produce on sale, like cabbage, carrots, or squash, that will last for two to four weeks. Or look for fresh produce on sale. You purchase it and freeze it for later.

I talk to people about being creative in how you use frozen foods and canned and dried beans to stretch what you have so you can go to the grocery store less frequently. In the face of the coronavirus, we don’t want to be out in the grocery store every day anyway.

I eat very simply, and that’s how I encourage others to eat too. I make this wonderful curried chickpea dish with canned chickpeas. It’s a little bit of curry powder, turmeric, salt, garlic in the skillet with some oil. Add the chickpeas, stir them all up until they start turning yellow from the curry and the turmeric and then let them just simmer for a minute. Then I top that with whatever greens I have, and then maybe some chunks of tomato. I put that on top of some brown rice, and I am happy. And chickpeas are inexpensive.

Any other tips you are giving your patients now, specifically in terms of COVID?

Lee Kaplan: COVID is creating all kinds of stress, including a lot of economic stress for people. Be aware of that and pay attention. Stress is a huge negative factor in all the health conditions we’re talking about, whether it is obesity, diabetes, or liver disease. I think it’s very important to try to find new ways of relieving the stress, if possible. Whether through walks, time for solitude, or whatever activities help you relax.

Mariela Glandt: The virus is going to go around. It matters where it lands. It matters if it lands on fertile soil or not; I think that how metabolically healthy you are plays a really big role here. So in this regard, we have more control than we think. I’m not saying we have all the control, definitely not, but at a time when we can feel helpless, there’s a lot we can do to try to be healthy – and we can start by deciding what to eat.

Click here to read more about nutrition and diabetes.

About Katie

Katie Bacon is a writer and editor based in Boston. Her daughter, Bisi, was diagnosed with type 1 diabetes in August, 2012, when she was six. Katie’s writing about diabetes has appeared on TheAtlantic.com and ASweetLife. Katie has also written for The New York Times, The Boston Globe, and other publications.

Source: diabetesdaily.com

Person with Type 1 Diabetes in the Moderna COVID-19 Vaccine Trial

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

By Zoe Cook

Here’s the quick version for all of those who don’t have time to read my full experience below — I trialed the Moderna COVID-19 vaccine and *spoiler alert* had a great experience.

If you had asked me ten months ago where I thought life would be now, it would be anywhere but here. I was preparing to graduate from UT Austin, finalizing my application to medical school, and planning my gap year. I had planned to spend the year traveling, working as an EMT, and living life to the fullest before I commit myself to my career for good. It was only a few weeks after the news first broke of COVID-19 that I was emailing my professors and voluntarily studying from home. Quickly realizing that our entire family is high-risk, we decided to air on the side of caution. The first week of March we decided to lock down and we’ve barely left since.

Why I Participated

In early August, I found out that a local research center was conducting a trial for the Moderna COVID-19 vaccine and that they were looking for high-risk frontline workers to participate (at the time, I was working at a children’s hospital). Many people questioned my choice to participate, but here’s why I decided it was right for me:

  1. My entire family is high-risk and not only was I the only one leaving the house, but I was leaving to work at a hospital.
  2. Thanks to my pre-med studies, I understand mRNA technology and the FDA clinical trial safety measures enough to feel comfortable in making an educated decision.
  3. I participated in the blinded Teplizumab trial when I was first diagnosed at the age of ten, so I am no stranger to the clinical trial process.
  4. I wanted to be a part of the solution. My nature is to help others in any way that I can; someone has to trial it for other type 1s, why not me?

Sure, my hands were shaking and I was sweating as I signed the final consent form, but it was something I felt I just needed to do.

The Doses

I went in for my first dose in mid-August. It was a long first appointment filled with lots of signatures, tests, and questions. I received my first dose that same day, with a 50/50 chance that I had the vaccine or placebo. The next day I had some arm soreness, but nothing else. I was secretly hoping for at least a little chill or body ache to try and confirm that I received the vaccine, but nothing. I was disappointed with the uncertainty, but also knew that symptoms were expected to be worse after the second dose and that I had a slightly swollen lymph node in my neck. A month later in mid-September, I had a second dose, which again resulted in no immediate side effects and didn’t even make the lymph node swell up again. Interestingly, after both doses, my insulin needs dropped slightly over four days, with the fourth day needing ~30% less insulin. I also developed eczema on my face, which is something I likely would have developed at some point in my life since we have a family history of many skin issues.

In October, I got my antibodies tested and was surprised to find out that I did indeed have antibodies. I can’t say for sure yet whether I had the vaccine, but based on the lymph nodes, sore arm, and antibody tests, it seems fairly certain. As I’m isolated and no one I know has had COVID symptoms, it would be highly unlikely that I got antibodies from anywhere else.

Editor’s Note: According to interim guidance from the CDC, COVID-19 antibody tests are not 100% accurate can result in both false negatives and false positives.

Even though I have antibodies and could assume I had the vaccine, I didn’t know how truly effective the vaccine was. I decided to still treat myself as though I was unvaccinated and not take any chances. Now that it’s been announced that the vaccine is 95% effective, I can feel more comfortable returning back to some form of normal-ish life. Even then, it’s been hard to undo the anxiety and fear that seem to have become a part of daily life over the past ten months. I still get uncomfortable when I see someone without a mask, don’t even begin to consider large gatherings, and stay home as much as possible. The changes for me have been small — being able to go to the grocery store, have a cup of coffee with a close friend, and start looking for jobs again. For our family, it was just the simplicity of going to bed with peace of mind that is priceless.

What’s Next

Within the next few days, trial participants should find out about the process of being unblinded if we are offered a vaccine elsewhere. I will most likely choose to stay blinded to keep the study valid. As long as I continue to test positive for antibodies, I personally don’t feel a need to be officially unblinded, as I imagine this means we will have to be removed from the trial.

For privacy reasons, I won’t say which trial center I participated with, but I can say that they were amazing. The staff and study coordinators made the expectations of me as a participant crystal clear and were responsive to any (and all) questions and concerns. I am very grateful that I had the opportunity to receive a vaccine early on and that I was able to potentially help others in the process. I cannot thank Moderna, their scientists, or their research teams enough for the peace of mind and protection they have provided both me and my family.

Originally I thought 2020 was going to be my year — the year I graduated, did an IronMan, traveled, lived life, worked hard, and visited my dream medical schools. Now, 2020 has been the year that reminded me to be grateful for all of the things I already had. I still got to wear a cap and gown, even if it was at home. I found a different way to work, a different way to interview at schools, and planned my own triathlon. Life being “paused” has reminded me how precious quality time with family is, the enjoyment of a good book, and how easy it is to take things for granted.

Source: diabetesdaily.com

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