We are living in unprecedented challenging times, facing an unexpected health crisis that we have never experienced before. In just a short span, an unknown virus has changed the way we live, and the way the world has functioned so far. Initial data analysis from China, Italy and the US suggest that patients with diabetes are at a higher risk of severe COVID-19 disease. Preliminary data from India also indicate that diabetes is a common comorbidity amongst those who have succumbed to the infection. Understandably, people with underlying chronic diseases such as diabetes are even more concerned about the spread of the coronavirus and how it could affect them. In light of this, it is important for people with diabetes to know why their risk could be higher and what they can do to protect themselves.
Getting COVID-19 vs. Complications from COVID-19
According to the American Diabetes Association there is insufficient evidence to conclusively show that people with diabetes are more likely to get COVID-19 as compared to people without diabetes. However, from what we know so far, if they do get the infection, they tend to have worse outcomes.
Reasons why patients with diabetes are at a higher risk
Patients with diabetes have a compromised immune system which makes it harder for them to fight off the infection. Also, it is possible that the virus may ‘thrive’ in a high sugar environment, which would increase the risk for those with elevated blood sugariv indicating that their diabetes is not under control. Moreover, many patients with diabetes also have hypertension (high blood pressure) and are treated with a type of medication called “ACE inhibitors” and “angiotensin II type-I receptor blockers (ARBs)” which appear to make it easier for the virus to affect the cells. However, this in no way implies that patients should stop taking their prescribed ACE inhibitors and ARB medication. These medications are important for them to stay healthy. Instead, patients should do what they can to prevent the infection. How to stay protected from the infection
Some of the recommendations given below to reduce the likelihood of getting an infection are common to all people to follow, while others are particularly important for those with diabetes:iv,
• Wash your hands for at least 20 seconds with soap and water, or with a sanitizer that has at least 60% of alcohol. Take special care if you have been in a public place, or if you been coughing or sneezing.
• Avoid touching your face unless you have washed your hands.
• Avoid any unnecessary travel or crowded areas.
• If you are out in a public place, do not touch surfaces that are used frequently by a number of people such as door handles, handrails on stairs, lift buttons, lift doors. Use a tissue or a handkerchief to touch these surfaces and then throw away the tissue and wash the handkerchief.
• Avoid sharing cutlery, towels, tools with others.
• Avoid contact with people who have any respiratory symptoms.
Most importantly, people with diabetes must ensure that their blood sugar levels are optimal and as advised by their doctor. This becomes even more critical at this time. Moreover, they should not give up on their daily exercise routine. Since outdoor activity and exercise are restricted, they should look for creative ways to exercise indoors – exercising to upbeat music or using an app for exercise tutorials are some ways to do this.
While patients must do everything they can to prevent an infection, they should at the same time stay prepared to manage the situation in case they do fall ill. First of all, they should make an easy-to-access list of the contact details of their doctor(s), a COVID-19 testing centre and a pharmacy, as well as a list of all the medication they have been prescribed.
If they live alone, they should stay in touch with a family member or friend in the neighbourhood who can bring them emergency medical and other essential supplies and accompany them to a doctor, if the need arises. They must ensure that their medication stock is not depleted, because it may be more difficult to get immediate pharmacy supplies at this time.
Finally, while patients do all they can to stay physically protected and safe, it is just as important for them to pay heed to their mental health. There is a great deal of information floating around these days and not all of it is accurate. Moreover, the constant barrage of such information can exacerbate our fear and concern for our health and increase our sense of helplessness and despair. My advice is to stay informed but avoid listening to COVID-19 news all day long. Instead, watch an old favourite movie, play a game of cards with your loved ones, try a new indoor hobby, or even rest for an additional hour or two. Patients should find their own way to relax – and most importantly, they must continue to hold on to hope!
The article has been authored by Dr. Rajiv Kovil M.B.B.S (Bom), D. Diabetology (Bom), FRCP (Edin)
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