Next in our series about medical conditions that put patients at a higher risk for poor COVID-19 outcomes, we spoke with adult endocrinologist Maria Justina Villano, M.D., FACE about type 1 and type 2 diabetes.
Q: What is the difference between type 1 and type 2 diabetes?
Dr. Villano: Diabetes mellitus (DM) refers to a group of conditions marked by high blood sugar levels. There are several causes but the more familiar ones are referred to as type 2 and type 1 DM. Type 2 DM is the most common cause of diabetes, typically seen in older adults, usually associated with an increased body weight and related to insulin resistance. Type 1 DM is the most common cause of childhood diabetes and is related to an insulin deficiency caused by the loss of the beta cells (insulin producing cells) in the pancreas. Type 1 DM must be treated with insulin injections while type 2 DM can be treated with oral medications.
Q: With regard to risk for COVID-19, are there different concerns for the two different types of diabetes diagnoses?
Dr. Villano: No, for people with both of types of diabetes, having good blood sugar control is important in every situation. And this is not a situation where only people with serious medical conditions, like diabetes, need to be vigilant.
People of all ages are at risk of developing COVID-19, and an infected person can have no symptoms and still spread the disease. We ALL have to follow the stay-at-home guidelines, social distancing rules and good personal hygiene habits to keep the entire community as safe as possible.
Q: Why does a person with diabetes need to be concerned about COVID-19?
Dr. Villano: Infections, like influenza and pneumonia, can be more serious among patients with diabetes. The same is true for COVID-19. The Centers for Disease Control and Prevention (CDC) has identified persons with diabetes as a group that is at higher risk of developing serious illness. While there is not enough data to suggest that people with diabetes are more likely to get COVID-19, they are more likely to suffer from a worse outcome from the infection.
Additionally, many patients with diabetes have other related chronic medical conditions, like heart disease or kidney disease, that also increase the odds of a worse outcome. These outcomes may include hospitalization in the intensive care unit, the need for mechanical ventilation and potentially death.
Q: Are there different concerns if you have your diabetes under control with lifestyle or with medication? (Is there an A1c number associated with “under control?”)
Dr. Villano: As I mentioned, having good blood sugar control is important in any situation, regardless of how that is achieved. Ideally, we would like all patients to have a hemoglobin A1c (HbA1c, a measure of blood sugar control) as close to or below 7 percent. In patients with normal kidney function, this represents an average blood sugar of about 150 mg/dL; which in multiple studies has been shown to be a level where the likelihood of complications related to diabetes is limited or controlled. For certain individuals, usually our older patients with other medical conditions, the goal HbA1c may be slightly higher due to concerns with hypoglycemia (low blood sugars).
Achieving blood sugar control can be extremely difficult for persons with diabetes during this pandemic. Even under the best circumstances, maintaining a healthy and low-carbohydrate diet as well as regular exercise can be challenging. One way I encourage my patients is to point out that their lifestyle choices (including adherence to medication) are one thing they can control during a time of so much uncertainty.
Q: Are there any additional precautions or suggestions you have for persons with diabetes (aside from hand-washing, social distancing, etc.)?
Dr. Villano: I like to think about actions to promote health, especially at this time, based on three different levels.
On an individual level, persons with diabetes have to continue to work towards improving and maintaining good blood sugar control. Close attention to proper eating habits as well as regular exercise (ideally 30 minutes of moderate exercise daily) are key. Check blood sugar levels regularly (according to your physician’s orders) to monitor for any wide swings.
Continue taking all medications for diabetes (and other medical conditions) at the prescribed doses and intervals.
At the family or home level, household members have to understand that people with diabetes are at higher risk of serious illness with COVID-19 and should be cared for with extra precautions. For example, the CDC recommends household members wash their hands before feeding or providing extra assistance. Also, all utensils and household surfaces should be cleaned regularly. If possible, high risk individuals should be given a protected space inside the home.
Lastly, at the community level, persons with diabetes should not hesitate to access support from their physicians and other healthcare providers. They should have an open line of communication to address concerns as soon as they arise, including guidance for sick day plans. The NCH Medical Group continues to care for patients and in many cases can provide virtual visits that offer evaluation and treatment remotely. In this era of social distancing, many of my patients appreciate the continuity of care this service provides. And if the need arises, our offices remain open for in-person visits as well.
Q: If a patient with diabetes thinks he or she has been exposed to COVID-19, should they call their endocrinologist or primary care physician?
Dr. Villano: First and foremost, any patients with life-threatening symptoms should call 911. For any COVID-19 related symptoms, it is best for all patients, whether they have diabetes or not, to contact their primary care physician for a referral to a COVID clinic. To minimize exposure, the NCH Medical Group has established a dedicated clinic that provides care for those with symptoms consistent with COVID-19, including provider visits, imaging and lab tests, and to facilitate hospital admissions as needed. There is also a COVID Hotline at Northwest Community Hospital at 847-618-1000, opt. 9.
If there are specific questions about blood sugar levels or about dosing changes for diabetes medications, patients with diabetes should contact their endocrinologist.
Q: Do you have any additional advice for diabetics and their caregivers during this stay-at-home order?
Dr. Villano: I would like to mention the need for a “sick day plan” for people with diabetes. I recommend working with your endocrinologist to develop an action plan in case of acute illness. While each plan should be individualized, the American Diabetes Association recommends reviewing the following points:
- When to call your doctor (in most cases if you are vomiting or have diarrhea more than three times over 24 hours or have had a fever over 101F for 24 hours).
- How often to check your blood glucose.
- What foods and fluids to take during your illness.
- How to adjust your insulin or oral medication, if you need to.
- If and when you need to check for ketones (this is more important in type 1 DM).
- Discuss what over-the-counter medications you should use for colds, flu, etc. Some can raise your blood glucose or affect your usual medications.
Lastly, if possible, keep at least a 30-day supply of medications to limit trips outside the home. For people with diabetes, this includes the supplies they need to check blood sugars (i.e., glucose meter, batteries, strips and lancets) and to administer insulin if they need to (i.e., pen needles, alcohol swabs, back-up insulin vials and syringes).