Diabetes + COVID vaccines: what you need to know

WRITTEN BY: LALA JACKSON

Editor’s Note: We have a simple goal: tap into the power of the global diabetes community to save lives. Learn more about what you can do as a person with diabetes to keep yourself and others safe from COVID-19 until we’re all safe.

This article was last updated Monday, December 7, 2020.

Following a recent outpouring of positive clinical trial news, COVID-19 vaccines are coming soon. The upcoming vaccine roll-out has left many with questions about timing, safety, and what to expect – particularly those with diabetes or other underlying health concerns.

Here’s what you need to know about the COVID-19 vaccines on the way:

WHAT VACCINES ARE THESE?

In November, Pfizer and BioNTech announced positive results from the conclusion of their COVID vaccine clinical trials, quickly followed by Moderna. Each is in the process of receiving FDA approval in the United States, with emergency approval meetings happening for each in mid-December.

Both the Pfizer and Moderna vaccines went through the standard three phases of clinical trials – Phase 1, where it is administered to a small number of people to show initial safety, Phase 2 to hundreds of people split into groups by things like age and background to show how different types of people react to the vaccine, then Phase 3, in which it is given to tens of thousands of people, tested against a placebo. Because of the speed needed for development, both vaccines were approved to go through animal clinical trials at the same time as human Phase 1 clinical trials.

To be approved, the FDA requires the vaccine work in at least half of those who receive it. For both vaccines currently undergoing emergency FDA approval, early analysis from the National Institutes of Health independent data review board (DSMB) saw that 94-95% of those who received the vaccine in the trials became immune to the coronavirus.

Both of these frontrunner vaccines are mRNA vaccines, a type of immunization that does not use a whole virus but instead employs a piece of genetic material to create antibodies against the novel coronavirus. Each vaccine requires two doses, given three to four weeks apart.

Other vaccines – different types of immunizations made by multiple companies – are currently in clinical trials with results expected early (and throughout) 2021. 58 different vaccines are currently going through human clinical trials; in any trial where participants exhibit worrisome symptoms, the trial is paused and cannot proceed until any issues are corrected.

DO COVID VACCINES AND DIABETES MIX WELL?

Some clinical trial participants have reported mild side effects of the vaccines, much like how some people experience injection-site soreness, mild lethargy, a low-grade fever after other vaccines. Important to note – none of the vaccines undergoing approval in the US have any strain of the real coronavirus in them, so it is not possible to get COVID-19 from the vaccines themselves.

These mild reactions some people experience after vaccines are typical and not cause for alarm – they are a result of the immune system going into action as purposely triggered by the vaccine, creating the ability to fight against the actual virus were a person to be exposed to it.

Because of the mild symptoms experienced by some, it is important to stay vigilant about blood sugar levels for the first 24 to 48 hours after receiving the vaccine. The symptoms may impact your BG, so check your levels frequently, stay hydrated, and be familiar with your sick day routine. The mild symptoms you may experience after the vaccine are significantly safer and more easily managed than potentially getting the novel coronavirus itself.

As we currently understand, you are not more at risk to catch the novel coronavirus if you have diabetes, but if you do catch the virus, you may be more at risk for more severe complications from COVID-19, particularly if you have been experiencing consistently elevated blood sugar levels.

If you have specific concerns or worries, make sure you speak to a healthcare provider you trust (or keep tuning into Beyond Type 1 coverage of COVID-19 to hear from the healthcare providers we trust).

GREAT, WHEN CAN I GET MINE?

When you will get access to a COVID-19 vaccine depends on where you live, what you do for work, and your risk-level for acquiring or experiencing severe symptoms of COVID-19. People with diabetes are considered to have COVID-related health-risks. Many countries across the world will not be getting enough vaccines for their population for at least a couple years. Other countries – like the US and UK – have already invested in large amounts of vaccines, with more coming quickly over the next months and year. The FDA’s Vaccines and Related Biological Products Advisory Committee will be considering emergency approval for each of the initial vaccines in mid-December.

If you live in the US, this NY Times Calculator will provide an idea of your “place in line” to get access to the COVID-19 vaccine. As voted upon by the US Centers for Disease Control and Prevention’s Advisory Committee for Immunization Practices, healthcare workers and nursing home residents will be prioritized first, with up to 24 million likely receiving their vaccine in December 2020, followed by other essential workers, including first responders and teachers, in early 2021, dependent upon FDA approval.

People who are not essential workers but live with COVID-related health risks – like those over the age of 65 and/or with heart disease, cancer, diabetes, obesity or other immunocompromising conditions – may be able to receive the vaccine in early to late spring. All others – those who are otherwise healthy and children (as clinical trials for the COVID-19 vaccine in children are just starting) – will likely need to wait until late spring, summer, or into the fall.

In the US, vaccines will be free, with the federal government paying the vaccine developers directly. They will likely be available in many of the places flu shots are typically distributed – drug store and grocery pharmacies, medical offices, and possibly school clinics. The timeline for each of the vaccines is dependent on FDA approvals, followed by funding for distribution and logistics set up in each state.

STILL HAVE CONCERNS?

Individuals have expressed some hesitation to personal vaccination for COVID-19. This is an understandable feeling – vaccines do not typically make it through development and approval this quickly. Particularly for Black, brown, and indigenous people in the United States and across many places in the world, deep-rooted medical racism and exploitative medical experimentation, including with past vaccines like the Tuskegee syphilis experiments, has led to understandable distrust in vaccine administration and the healthcare system at large.

Here’s what we know:

  1. The speed with which the vaccines were developed was unprecedented. However, the clinical trials these vaccines had to go through were strict and the reporting of their safety and efficacy had to be unequivocally proven and replicated. Three phases of clinical trials, including a Phase 3 with tens of thousands of participants, had to prove safety and effectiveness of the vaccines. Phase 3 of the clinical trials were also double-blind, meaning neither the trial participants nor the company that created the vaccine knew if participants were receiving the vaccine or a placebo. Data was reviewed by the National Institutes of Health independent data review board, and final approval for the vaccines must be provided by the FDA’s Vaccines and Related Biological Products Advisory Committee, composed of scientists who have no ties to the companies by which the vaccines were produced.

  2. Black, Native, and Latinx communities have been hit hardest by COVID-19 because of systemic and medical racism, with Black Americans dying from COVID-19 at twice the rate of white Americans. Ensuring equitable distribution of the COVID-19 vaccines is vital to work against the deep impact of systemic and medical racism, but this must be coupled with understanding distrust due to violent medical racism throughout the US’s history.

  3. We don’t know for sure what percentage of the population needs to be vaccinated in order to achieve herd immunity, but we do know that the more people who are immune to carrying or spreading the virus, the better. Those who are willing and able to take the vaccine are helping to protect everyone in their community.

  4. If, after doing research from reputable, science-based sources (we recommend science communicators like Jessica Malty Rivera for easy-to-digest and accurate information), you are still not comfortable taking the vaccine as it becomes available to you, continue to practice safe health measures to protect yourself and others from the novel coronavirus. Until the majority of the population is vaccinated, we cannot rely on herd immunity. We must keep those most vulnerable among us safe until we’re all safe, practicing simple actions like wearing a mask and social distancing to do so.

2020 has been hard; at many times, scary and filled with grief. Working toward getting our communities safe and healthy is important for a multitude of reasons, and will take a united effort. Ensuring you have a plan for when you will get vaccinated once you can is vital to keep yourself and those most vulnerable among us safe until we’re all safe.

1 Like

I’d like to toss a few concerns out there which have not been publicized. First of all, if your state follows the CDC guidelines, Type 2 diabetes will put you in line ahead of the generally healthy people. Type 1 diabetes will not, you will not have priority for the vaccine, unless you have other conditions. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

Second of all, I have not found any clarification about the age cutoff of 65 for priority. All through the pandemic we were shown statistics indicating a higher risk of hospitalization starting at age 60, not 65.

Thirdly, many states have expanded the list of “essential workers” to include tech workers, bankers, real estate etc. As I understand the vaccine prioritization here in WA (based on their draft policy) a 64 year old Type 1 diabetic will be in line with 29 year old bankers and tech workers (who are working from home), probably late spring 2021.

Does that seem right to anybody?

It’s odd that it specifically list type 2.

Also “essential workers” it seems like half the country is essential.

A couple months ago we had a lock down in my county. Almost everything was still open.

I was consider an essential worker and I’m a programer. In my case I can work from home but I was technically allowed to go into work being “essential”.

When it comes to vaccines while I want one asap, I hope someone like me isn’t really consider as “essential worker” as hospital workers, paramedics, teachers etc…

It’s going to be tough to get all these vaccines out as fast as possible. The most important thing is to get it in as many people as possible, that will eventually start slowing the spread and make us all safer.

Better to be quick getting people vacated then spend more time figuring out what is more fare/optimal.

They did have 10ish months to think about and plan for that though.

The T1 thing makes sense (said as a T1 diabetic). Type 2s are clearly at increased risk—at this point, the research doesn’t conclusively suggest T1s have the same risk, so that’s what I’ve been expecting for a while now (and have said elsewhere on this thread). It is entirely appropriate and accurate to classify T1 as “might” be at increased risk. Lots of things people think might qualify them as higher risk are in that category, like asthma, taking immunosuppressive therapies for autoimmune disorders, etc, because the data just hasn’t shown those to be conclusively linked to risk. The conditions listed in the highest risk category are the ones with overwhelming evidence. IMO, they should use those two tiers in those orders, since that’s the best evidence-informed practice.

I am fine with “might be” at risk being behind “significant” risk.

On a personal level, risk mitigation is the overall goal of vaccination and a “might” person could have good reason to want or need to mitigate that risk by getting vaccinated. Not sure about the other 63 year old Type 1’s out there, but I have been hunkered down for 8 months in order to mitigate that risk. On a personal level, and in consultation with my endo, “might be” was enough to hunker down. Now we are told that “might be” is not enough to get priority for the vaccine.

I am not fine with the lack of gradations to the prioritization below age 65. I believe the cutoff age of 65 is arbitrary.

In WA it appears that a 64 year old Type 1 is going to be at equal priority or possibly behind a 29 year old “essential” banker or tech worker. Despite the clear evidence that hospitalization and etc. risk are much greater for any 64 year old. And despite the fact that Type 1 “might” further increase that risk. And despite the fact that many of the “essential” workers are and will continue to be working from home.

I know it’s hard for the powers that be to inject a more gradational prioritization into this but I think they went too far in the opposite direction.

Prioritize COVID-19 Vaccination in Both Types of Diabetes, Say Docs (medscape.com)

Looks like the classification of Type 1 as “might be” at increased risk is disputed.

I think if T1 (or T2) is hospitalized with COVID, part of the problem is that many hospitals want to administer all meds, including insulin. They are getting better, but you usually have to have notes from endo and signed papers to assert you are taking responsibility of your insulin, and they still may deny you to do so.

But if your health deteriorates, they will likely take over, using injections even if you’re on pump.