I found the following report about a young woman with Type 1 for 30 years. She contacted Covid-19 and recovered after 17 days. This is an excellent day-by-day account of what she experienced, and how she recovered. I learned much from this report!
Thanks for link, @Richard157. There are not many stories in the media specific to T1D. In fact many stories just refer to “diabetes” when they really mean T2D. I’m happy to read that younger T1Ds can survive Covid-19 but as someone from an older cohort, I’m thinking that this women’s young age gave her a closer to normal immune response. I am buoyed by the fact that she did, however, live with T1D for 30 years when she contracted the virus.
I found it interesting that she reported relatively little disturbance of her blood sugar levels, although I would consider readings “in the 200s” to be significant. I listened to a panel of doctors on the American Diabetes Association website who are familiar with the treatment of Covid-19 T1D patients and they reported a lot of diabetic ketoacidosis, something we could not treat at home well. I think it’s critical to closely monitor blood sugar levels if you’re T1D and come down with this virus. I would also check blood ketones, especially if I felt any symptoms of nausea or throwing up.
We have probably discussed this before, but how come some type 1’s don’t spill ketones when not low carbing? The only time I have been really seriously ill was when I was diagnosed 61 yrs ago. When young I had many very high readings I am sure. Hard to know with urine testing, but there were plenty of times after diagnosis when I ate what I wanted and was extremely thirsty until my glucose level fell.
I am very happy for the young woman who got through COVID-19 so successfully. I too think her young age helped her enormously even though she was dx 30 yrs ago. The fact that she had a few 200 readings didn’t bother me at all. Frankly I was surprised her readings weren’t higher from time to time since she was so very ill.
I’ll be interested to see this phenomena studied in the years to come. It makes me wonder if female hormones are protective with the Covid-19 virus. Or perhaps fewer women smoke than men. Before the emergence of this virus, it has been recognized that women live longer than men.
It’s my understanding that the human body has a few ways to deliver energy. Directly metabolizing glucose (carbs) is a preferred path. When carbs are plentiful, the body has little need to produce ketones, an alternate energy source. I think we all produce some ketones for fuel, particularly when sleeping and without a recent ingestion of carbs.
By the way, I found this Covid-19 webinar series interesting; it is produced by the American Diabetes Association and targets primarily healthcare providers. Hearing the perspective of hospital providers in a hospital Covid-19 setting regarding T1D treatment is interesting. They encourage us to bring our CGMs and all other usual diabetes supplies with us if we need to come to the hospital.
Richard have you ever dealt with ketoacidosis? I am trailing you in diabetic years since I was dx in 1959, but you have had even more experience than I have by far. I realize that you are in your 80’s now and that is so fantastic. You have done a great job!
I have never experienced ketoacidosis, and am wondering why some people have to watch for it and others seem to escape it. I had plenty of years when I was much younger when my control was quite bad.
As I understand it, and certainly for me, DKA is really more about lack of insulin, at least in a type-1. If you have poor overall control, but lets say you always take your lantus (or whatever long acting), you’re not going to slip into DKA as you have insulin on board. Your sugars may be high, but that’s not the cause in a T1.
I’ve been diabetic for ~20 years, and the only time I’ve ever felt DKA symptoms was after switching to a pump, and that pump shut itself off for several hours (medtronic CGM issue…). That’s all it took- a few hours of no insulin, and it hit me like a train.
I may have had DKA when I was diagnosed in 1945. I was in terrible shape, walking was almost impossible, I was so weak. Much weight loss, and no appetite.
In the eighth grade, age 14, I had the flu and my parents stopped giving me insulin since I could not keep anything on my stomach. We did not know anything about basal/bolus control back then. At the present time someone with the intestinal flu would be using basal insulin, but no bolus insulin. I had no insulin at all. It took several days in a hospital, with insulin, to restore my health. I had many terrible highs during my first 50 years after diagnosis.
I finally learned about basal/bolus insulins and carb counting in the mid 1990s. I have not had prolonged highs since then,
Yes, I was comatose when dx. I almost died, but I have never been without insulin since then. Just the thought scares me. So glad that you pulled through when you were 14 Richard.
From what I have read here, some type 1’s can go into ketoacidosis without terribly high glucose levels. I am sure I had prolonged very high glucose levels in my early 20’s, but escaped ketoacidosis. I have never been hospitalized for too high or too low glucose levels since dx. I am just wondering why I have been so darn fortunate.
That might be possible, but in general DKA is from high BG and no insulin.
I was only ever hospitalized on diagnosis for DKA.
But, I think I had it a 2nd time when I went camping and it rained overnight. My pump got wet and ruined. I was far from home in Wisconsin and it took me a long time to get home and fix things. I was very, very sick. I wished I was dead. I might have gone between 24 and 48 hours without insulin.
You are lucky. I go into it easily without super high bg. I was in it at diagnosis and since going on a pump have a few close calls, not from pump failure though. One landed me in hospital where I had fluids for a day and the ketones came down. Dka is from lack of or inability to use the insulin due to whatever reasons, you can have severe acidosis and not have super high bg. My bg at diagnosis was 279 and I was already in it then, 2 days later in icu, bg 360 with severe acidosis.
I can go into it from dehydration as well so I am very cautious about that.
Thanks, it sucks but I just try to live with it. The horrible lows and fluctuations I had an injections impactEd in my life more than having to worry More about DKA to be honest although it’s not like either is a good choice.
I am glad she did well and recovered. I do feel she is downplaying the seriousness of this though in that interview. She described at one point having a lot of trouble breathing, I mean at that point she should’ve gotten some help and she should have been monitoring her pulse oxygen she doesn’t say if she was doing that or not.
Also you can get very sick and die from this whether you are diabetic or not, of course we are going to have more problems if we get severe most likely and maybe more chance to. people of all ages and sexes and everything else are getting very very ill.
My advice is to get a pulse ox machine so you’ll be able to monitor yourself if you get it and you are not bad enough to be in the hospital and get essentially no treatment and treat yourself at home like I had to. Just remember though if you really start having a lot of trouble breathing go to the emergency room because pulse ox machines are not always accurate. Also some people who have had covid have had very low pulse ox but didn’t have all of the symptoms and their doctors told them on a phone call to go to the emergency room etc.
I’m also a bit confused it said that she had it for 17 days but she only isolated for 11 it doesn’t make sense. So I assume she had it for 6 days and had what she thought was bronchitis which is what happened to me and then after she felt better she stop isolating immediately. I was told you’re supposed to keep isolating until you have no more symptoms at all so I find it hard to believe considering she was pretty sick that she had no symptoms after 11 days.
As others have said, my understanding of DKA is that it relates to insulin levels more than blood sugar levels. If you eat a bunch of food and take insulin, then even though you might have super high blood sugar, your body has the insulin it needs to get energy. But if you discontinue insulin or drastically cut down on how much you’re taking, then your body doesn’t have the insulin it needs to get energy. That’s when things get out of control.
I’ve had diabetes for over 28 years and have never been in DKA. But I do develop ketones and feel horrible if my pump gets disconnected for any length of time. This happened a few days ago, I changed a set before bed, didn’t realize it was a plastic set (I typically use steel, but the plastic and steel sets for my pump look identical), which of course you’re not supposed to do before bed. The set did not go in properly. Luckily, I was already high (which is why I was changing the set), so gave myself about five units by injection at the same time as changing the set. I think taking that shot possibly saved me from a much worse situation since, although I got no basal insulin for hours, I at least had some small amount of insulin in my system for the first several hours. I woke up eight hours later with a blood sugar of 30.8 mmol/L (554 mg/dl). That’s the longest I’ve ever gone without insulin, I think. I felt surprisingly well (usually I’d be super nauseous) but checked ketones and they were high, but surprisingly not as high as I’ve had during other times of less prolonged insulin pump issues. I drank a ton of water (not hard with how thirsty I was!!) and gave myself tons of repeated corrections until I finally got down into range by mid-afternoon. That is exactly the type of situation that could have very easily ended up in a hospital visit.
The issue with being sick is that often your body needs way, way more insulin than usual. So if someone’s body suddenly needs three times the usual insulin but they don’t increase their insulin doses, that’s when DKA can happen. Or if someone needs twice their usual insulin but can’t take insulin because their blood sugar is low from throwing up and being unable to eat, that can also lead to DKA issues. Or, as in my situation, someone is on a pump and has problems but is too sick to respond aggressively as I did, that could also lead to DKA issues. Or any combination of these issues and possibly others I haven’t considered could lead to DKA. That’s why it’s so important to at least be aware of DKA and have a set of “sick day rules” and some ketone strips on hand, just in case you ever need them when you’re sick, even if you’ve never faced such a situation in the past.
Thanks for the explanation Jen. Even during all the years of just urine testing and at times more or less ignoring my diabetes, I never skipped a shot. Of course for over two decades I just took one shot a day. Lots of high glucose levels, but I always had insulin on board. As soon as home blood testing became available, it changed my life.
I have never been horribly ill except when I was dx with diabetes. I have a very strong stomach. I never test for ketones.
Once in a while I forget to give a pre meal shot, but I test often, so catch it quickly.
It wouldn’t hurt me to keep a bottle of ketone test strips around as one never knows what the future can hold.