40% of deaths have been diabetics, and I think around 1/3 of hospitalizations. There is an undeniable correlation that has existed since the start. The Chinese saw it first and everyone since has confirmed.
Although, I think they primarily generalize the highest risk in people who are old, fat, and male. Diabetes is a significant risk factor for severe illness - there’s debate here, but at least some people are thinking type 1 is higher risk than type 2.
There is absolutely no data to make any generalizations about level of BG control and it doesn’t seem to really matter in that once covid hits, they see goofy BGs, insulin resistance, etc leading to highs. What is strange is that they see this across the board - even non-diabetics are coming in hyperglycemic. Its strange.
That’s also my understanding. Controlling diabetes while ill is hard enough when your at home. But in a hospital with your body under extreme stress and your physically confined is a tall order.
I asked my endo how the hospital where he practices, (and where I’d do my damndest to be admitted) handles it. He said they have teams of endocrinologists and CDE’s available to assist the ER/ICU staff. I expressed my concern that no one knows how to control my diabetes better than myself and I don’t want to cede responsibility to the ER/ICU staff. He said he would arrange that so long as I didn’t need IV insulin or sedation. He said to bring three weeks worth of EVERYTHING I need for self management. Getting those things from the hospital would be a big challenge.
Of course not getting infected is the best defense. I’m doing that, but I must admit it’s ever more challenging to toe the line as this drags on.
This is exactly how I feel but I don’t hold out much hope that my wishes wouldn’t be over-ruled in an ER/ICU setting.
I watched the two-day meeting of the Diabetes Science and Technology group a few weeks back. One of the medical presenters addressed treating diabetes in-patients in a Covid-19 situation. This presenter said that with diabetics, they target 160-180 mg/dL and are highly motivated to avoid hypoglycemia at all costs. The greater BG danger, however, is going into diabetic ketoacidosis (DKA), a more complicated and life-threatening scenario.
I don’t agree with this weak BG target either but perhaps it is totally reasonable when a person with diabetes is fighting Covid and their body has become highly insulin resistant. Better to cruise at 160-180 than to slide into DKA.
One item that I would lobby hard for is 24/7 monitoring with a CGM with one display available to me bedside. That, to me, would not be negotiable. I would bring at least three weeks of CGM gear with me.
This is where our real power lies; set your mind for the long haul. We don’t have much choice.
I agree. I watched the same presentation. Setting a 160-180 target point is reasonable for the reasons you mentioned. But that in and of itself is not justification for taking control away from a well informed and experienced patient. I’d argue that the odds of staying in that range are improved under that type of patient’s stewardship.
I’ve thankfully had just one ICU experience and the endo I had at that time gave these instructions and the ICU personal complied. Of course that was 19 years ago when the ICU wasn’t overwhelmed. Hopefully if we all do our part the healthcare system will stay well under maximum capacity.
A couple months back they did a series covering covid related to diabetes.
One thing that really struck me, they focus a lot on how can they care for a diabetic with the premise of a nurse only entering the room every 4 hours.
I understand the why (protect the nurses, reduce use of PPE) but it’s scary that many are getting that type of care. They come in every 4 hours take your blood sugar and maybe adjust your IV insulin.
They did discuss and were in favor of patients taking over their own blood sugar management if they were able.
So if you end up in the hospital in my opinion your going to get very poor care when it comes to blood sugar management.
High sugars slow recovery and increase the changes of complications. Insurance companies consider low blood sugar issues something that should never happen and won’t cover them leading to hospitals airing on the side of keeping it high to avoid literally paying for any problems a low causes.
Also the issue of CGM came up. The FDA is allowing emergency use of CGM to help hospitals monitor patients without entering the room.
One issue many of us wouldn’t think of is they are concerned with how do we bill for this. Its an issue they don’t like CGM because they can’t bill for it because its not something hospitals normally offer. They also want to be able to bill for having a nurse prick your finger.
Also hospitals often don’t have a way to electronicly add the CGM results to your chart so they don’t like it to use them.
If anyone is interested I’d recommend listening to some of the COVID special podcast at the ADA.
I’ve been worried about how difficult it will be to manage BG while bedridden in a hospital with Covid, knock on wood none of us comes down with this terrible virus. That’s my biggest concern…I have no doubt that all my basal settings, I:C ratio for meals, everything would be thrown off by that scenario. I see it as a chicken and egg problem…hospitalization causes BG to run higher which then worsens the Covid symptoms. I think that after a week of average BG at 180 my body will no longer care or remember what my A1c “used to be” when healthy.
For me, when inactivity or other curveballs hamper my BG management it usually causes some nasty lingering high BG that is difficult to reliably bring back in range. It’s possible that a BG averaging 160-180 is the best that can be achieved under those Covid hospitalization circumstances with all the curveballs thrown at the patient. Not sure how to come up with a self-management strategy that would do much better than that, especially if the nurses and doctors would be going nuts every time my BG gets close to 70.
My hope is if I get sick with COVID or anything else that if I am well enough I will try to manage my own sugar.
If your on an IV drip and getting sugar tested every 4 hours I think its very likely you will be way out of range all the time. If your able to test your self and dose your self you have a better chance to keep it closer to in range.
All this depends on you:
Mentally capable
Physically capable
Allowed to consume sugar in some form if needed
Have access to your own supplies
I don’t think hospitals have the personal and experience to properly manage diabetics and that is probably part of why we are more likely to have bad out comes in the hospital, it just takes too much time to manage.
I live in France and they have just released a study on diabetic patients here during spring 2020 (peak of the pandemic in France). The findings show that age is the main factor and that not a single type 1 diabetic under the age of 50 died from Covid-19 (at least not publicly recorded or in any hospital). A huge percentile of those who died were type II and over 70. Also, the majority of those who died or were placed in critical care units were men (the gender question has already been addressed in other studies and is true for the population at large, not just diabetics). Of course certain factors will vary by country (access to care, insulin, etc.), but I found it at least a small comfort to see that type I diabetics fared better than I had imagined. Of course, this is all very concerning for the elderly and type IIs or those with vascular complications, etc.
