High-Risk in the Time of Coronavirus: Protecting People with Diabetes

Person testing their glucose levels with a glucose meter.

Q&A with Gretchen Piatt

Associate Professor of Learning Health Sciences and Health Behavior and Health Education at the University of Michigan Schools of Medicine and Public Health

Chances are, you know someone with diabetes. According to the American Diabetes Association, more than 34 million Americans have diabetes—that's one out of every 10 people. During the coronavirus pandemic, people with diabetes have been listed as one of a few particularly high-risk populations, so as people with the disease try to continue to manage their condition through isolation restrictions, they have the added burden of knowing it could be much more dangerous for them to be exposed.

Gretchen Piatt is an associate professor and the associate chair for Education in the Department of Learning Health Sciences at the University of Michigan Medical School as well as an associate professor of Health Behavior and Health Education in the School of Public Health. As a chronic disease epidemiologist, she specializes in health care issues around diabetes. We spoke with her about why people with diabetes are deemed a high-risk population during the COVID-19 pandemic and the unique risks these people are facing. 

If I have diabetes, what should I do if I believe I have contracted the virus?

The first thing to do is to call your doctor. Let them know what your symptoms are even if it's just the scratchy throat, or maybe you think that it's allergies. 

Your doctor can help you determine the appropriate next steps, based on your risk factors and the symptoms you’re experiencing. Whether that’s actually going to the hospital or going to a testing site, or something else, they can tell you what’s safest for you.

Why are people with diabetes considered high-risk in the wake of this pandemic?

First I should say that, there's really not enough data right now to show that people with diabetes are more likely to get COVID-19 than the general population. The real problem is that people with diabetes face worse outcomes if they do contract the disease.

The data coming out of China has shown us that people with diabetes had much higher rates of serious complications and death than people without diabetes. In general, when people with diabetes did contract the virus the more health conditions or illnesses that they had, the higher their chances were of experiencing serious complications from COVID-19.

Unfortunately, people with diabetes usually don't just have diabetes, they tend to have a number of other chronic illnesses. It's typical for someone with diabetes to have heart disease, high blood pressure, or maybe asthma.

It's very likely that they have multiple chronic illnesses and when that is the case, your body doesn't fight infection the way a healthy body would normally fight infection. 

What is your advice for people with diabetes and their caregivers while this risk is present?

The most important thing for people with diabetes to keep in mind is that they absolutely need to monitor their blood sugars and try the best they can to keep their blood sugar under control.  The risk of getting really, really sick from coronavirus is likely to be lower if your diabetes is well-managed. If your blood sugars are constantly fluctuating, that inevitably makes your risk for diabetes complications increase.

Any viral disease, but particularly coronavirus, also increases inflammation—internal swelling within the body— which is also caused by above-target blood sugar levels. The more inflammation there is, the more blood sugar levels fluctuate, and the more severe complications present, all leading to worse outcomes from COVID-19.

My biggest advice for caregivers, especially if the caregiver is a family member or someone living in the household, would be to treat the person with diabetes like you're a significant risk to them. That means doing all of the things that the federal agencies and state agencies recommend, like making sure you wash your hands, thoroughly, before handling their food or, when giving them an insulin shot, for example.

In the event that a person with diabetes contracts the virus, they would benefit from a protected space, a dedicated room in their house where everything is disinfected and cleaned regularly. This is particularly important for people over the age of 65 with diabetes, who are at increased risk for complications from COVID-19.

Are measures for flattening the curve going to create barriers for people with diabetes to manage their care? How can they better do so during this time? 

Right now, manufacturers are reporting that COVID-19 is not impacting manufacturing, and distribution capabilities of things like insulin, blood glucose monitoring strips, and syringes. That’s a good thing—people's access to insulin and to their medications is not in danger as long as they can get to the pharmacy or the pharmacies can deliver it to the house. 

A common barrier for everyone is venturing out to grocery stores to get food and other necessities. For people with diabetes, it is especially important to eat a healthy diet to manage their blood sugar levels. However, going to a grocery store once or twice a week also puts individuals at risk for contracting COVID-19. Many non-perishable items that are easier to stock up on are not as healthy as fresh food, but going to the grocery store once or twice a week also puts individuals at risk for contracting COVID-19. One option is to use a grocery delivery service or find a friend or family member who can do grocery shopping for you, so you can maintain a healthy diet during this time.

During this time of isolation and staying at home, I would recommend trying to stick to a certain routine—like you would have if we weren't all isolated at home—and try to make thoughtful choices about your meals and snacks. As difficult as it is when you're at home, try to not have that piece of candy or leftover piece of pizza as a snack.

Are there other concerns about people with diabetes that we should be addressing during this time?

I think the layoffs that many people are facing could pose a particularly difficult issue for people with diabetes, especially because they may lead to a lack of health insurance. That can prevent people with diabetes from adequately managing their condition, as they may not be able to afford necessary medications and important supplies like testing strips. 

If you have been laid off and you're worried about your health care coverage, one option is to apply for Medicaid. 

If you still have insurance, you may want to try to stock up on your medications, syringes, and testing strips, so you have a steady supply through the duration of the isolation.

Additionally, we know from research that people with diabetes experience significant levels of diabetes-related distress. Mental health concerns in people with diabetes is a very important topic to talk about.

During this threat of COVID-19, the stress related to managing your health can be exacerbated. Not only is there concern about managing diabetes, but there's an added concern about being more at risk for COVID-19 because a person has diabetes.

We also know that a strong support network really helps people with diabetes manage the disease more effectively. However, during these stay-at-home orders, that support network becomes limited. Using video conference software like Zoom or FaceTime to connect with others is so important during this time because, for many people, their closest and most important support people are those outside of the home.