Which matters most, virus or host?

We’ve all read and watched countless sources who make the point that people with comorbidities like diabetes run the highest risk of doing poorly with a Covid-19 infection. But then the analysis stops and often moves on to other points that have been covered ad nauseam in the coronavirus media coverage.

It’s at this point that I’m looking for a discussion that might include some of the things that give me hope in the face of this pandemic. What about nutrition status? What about blood sugar control, obesity status, sleep quality, and stress management? These are the things that give me hope but almost no medical stories cover these topics.

I just watched Dr. Mark Hyman interview Dr. Elizabeth Boham, both functional medicine physicians. Functional medicine doctors like to take a broader view of sickness and health. They seek to target the root cause of illness and not just throw a prescription at a symptom and then lose all interest in the underlying cause of sickness.

Early on in this video, Dr. Hyman tells about the ongoing professional debate in the late 19th century between Louis Pasteur, credited with breakthrough vaccinations and founder of “germ theory”, and Claude Bernard. Bernard believed that the health quality of the host is the determinative aspect of how well anyone does when exposed to a germ. He argued that the “biological terrain” was much more significant than the germ itself. Simply put, “it’s the host that matters most.”

I heard two new terms in this discussion that give me hope for our community: immuno-resilience and immuno-rejuvenation. These terms recognize that we, as people with the significant comorbidity of diabetes, can actually fight back and tip the scales in our favor when it comes to not only surviving this pandemic but also improving the quality of our health in the longer run.

This 36-minute YouTube video answers many of the questions that almost every other story on this topic ignores. How can we, as people with diabetes, improve our chances of survival when threatened with Covid-19? Turns out, there’s much we can do and changes we make today can immediately improve our immuno-resilience. We’re talking days and weeks, not months and years.

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I enjoyed the video mostly because I do most of the things that they suggest and I can pat myself on the back. Although I eat extremely well,exercise daily, and am quite thin, I do not always sleep well and can get too stressed. I do need to work on breathing exercises. There is always something that one can work on.

Personally I don’t think I would do too well with the virus because of my age 69 and my diabetes. I am afraid that my extremely well controlled diabetes, would not be controlled well at all at a busy hospital especially if my husband couldn’t be there to back me up.

I am afraid that I wouldn’t have the energy to constantly keep on top of the doctors and nurses about my insulin and food needs. I find this rather terrifying. So between my age, my diabetes, and my hypotension I think my chances of surviving even with my healthy body are low.

Did you know that the FDA has allowed the use of CGMs in hospitals during this time? Check out this recent Juicebox podcast interview of a Dexcom official about this development.

:+1:

Of course I would wear my CGM as I did when I was in the hospital for a strange migraine last October. It helped me, but it didn’t help me get my insulin when I wanted it. I was in charge of my insulin doses, but it was only available when the nurses weren’t busy with someone else. In a busy hospital an insulin shot won’t be at the top of the staff’s list. Also I was constantly having to explain why I was doing what I was doing. Some of the staff gave me the respect someone with well controlled diabetes should get and some didn’t. 61 yrs and I still had an internist try to tell me how to control my diabetes! He was afraid of lows of course.

Luckily my new GP is in awe of how well controlled I am. He will do whatever I want and that is all I ask for from a doctor when it comes to my diabetes.

Even with a note from this well respected doctor, I have no idea if a hospitalist will try to tell me what to do concerning my diabetes.

I don’t know how someone with a pump would be treated. Maybe better. I do think with COVID 19 that all bets will be off.

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This triage of insulin administration to a low position on the nurse’s allocation of time exposes the overall attitude within the hospital staff about insulin, T1D, and optimal glycemic for healing. I’m guessing that this attitude is largely colored by their overwhelming exposure to T2D and lack of experience and understanding of T1D.

I think going into a hospital with a pump, providing you remain competent, gives an advantage with insulin dose size and timing. You still have no control over when your food shows up, however.

One of these decades, someone with the power to see things from the patient’s perspective will fix things like this and also prioritize patient sleep over the schedule of the lab blood draws, for instance. “Patient centered care” is a nice marketing platitude but it would be nice if they truly started to consider the patient’s point of view with these issues.

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I agree that sleep, exercise, and stress management are important. But I don’t feel it’s right to ask, “Which is more important, virus or host?” That’s like asking, “Which is more important, diet or insulin?” in regards to diabetes. Diet plays an important role in control for many, but insulin is absolutely vital for some. In the same vein, while working on stress management, sleep hygiene, and exercise routine is important, vaccination is absolutely vital if we are ever going to return to so-called “normal” life.

I also feel that I am in an incredibly lucky and privileged position to be able to be working on these personal aspects of my health. There are so many people who are struggling so, so much with this crisis. People with disabilities who cannot get out an exercise independently (a challenge for me). People struggling with crippling anxiety who previously had no mental health issues. People who previously managed stress well but suddenly have no income or are facing an uncertain future. I am grateful ever day for the position I’m in.

In addition to working on our own personal help, it’s so important to help our community. To reach out to support individuals who may be struggling far more than we are for various reasons. To families who may not have the personal time nor resources that we are so fortunate to have. The health of our communities has a measurable impact on the health of individuals who live and work within those communities, and all of that is being stressed right now. So many of these types of videos focus solely on improving personal health while ignoring all the other community-driven factors that affect health. I feel it is really important to reach out and support our communities, if we are lucky enough to be in a position where we can do so, in addition to focusing on improving our own personal health.

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Also, here is a video that covers similar topics, and that I find quite cute as a science-fiction (and specifically space opera) fan.

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Great video, Jen. At the 2 1/2 month mark, this resonates with me and I’m sure we all can identify with how this abundance of time affects our physical and mental health.

While I can see the benefit of clearly marking off physical spaces dedicated to discrete activities, I’ve been OK with blurring the lines between my entertainment and creative work places. I don’t have a TV so my laptop computer provides entertainment, social interaction (FaceTime, Zoom), educational, and creative pursuits (mostly writing).

I like the sentiment that our mission to return better than we left. I also like the explanation about how our core is comprised of our physical and mental halves and their interconnectedness helps each energize the other. I am committed to closing my Apple Watch activity rings each day and that does help with my mental health.

Thanks for posting this thought-provoking video!

Holy cow, @Terry4! Did you see this? What the heck!?!?!? Is this true? Is it just because EVERYONE has diabetes?

Yes, worrying news for anyone with diabetes. It has been broken down further now and the figures are that significantly more type 1s are dying then type 2s. I read that it’s thought to be connected to the toll that type 1 has on a person’s organs over their lifetime.

This concerns me. @CharlotteEngland references a UK Guardian story that reports that T1D Covid-19 patients are more likely to die than those with T2D. This report did say that this study has not completed peer review yet and that review could bring up a clearer story.

These reports fall under the heading of things that we cannot control. It makes it even more important to make good choices about the things that we can control. We can control, to some extent, how much exposure we have to other people infected with this virus. Don’t get suckered into the “reopening” mania spreading across the globe. I refuse to volunteer myself to be sacrificed on the altar of economic needs.

We can control what we eat and the insulin we take. We can commit to exercising every day. Adding in a mindfulness routine also helps, whether that be meditating, breathing exercises, praying, singing or some creative expression.

I’ve seen humorous references made online about people gaining weight in these quarantine circumstances we find ourselves in. People are reverting to consuming comfort food that is not good for much beyond the short feel-good emotional effects. This might border on the humorous for gluco-normals but this is serious business for those of us who live with diabetes.

This is a serious threat to us. We can’t control what fate will exact but we still control a lot about our metabolism. I remain hopeful that keeping blood glucose closer to normal, daily exercise, and mindfulness routines give me the best chance at surviving if I get infected.

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I too am doing everything I can to try to stay healthy, so that if I somehow catch the virus I might live through it. After seeing the nurse yesterday, who lost so much weight during his long bout with the virus, I am worried about my weight. If I lost even 20 lbs there wouldn’t be much left of me.

My husband and I are going to continue to isolate ourselves until there is a proven vaccine which could take months to years to develop and distribute. We have seen our son twice from about 15 ft away, we do curbside pickup to get our groceries and prescriptions. We are fortunate to live in the country so we have a large yard with a dog and wild animals.

I am meditating again to try to cope with the mess America and the world are in.

I am amazed at how lightly some people are taking all of this and how some think it is a hoax. They must not be old and diabetic. They must not have already been fighting for most of their lives just to stay alive.

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I agree with you, Marilyn. Even if you gained 10 pounds, that would help with survival, if infected. I’ve never been faced with a need to gain weight. My reflexive choice would be more ice cream! Do you have any ideas how to do that?

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Put on 10 lbs, @Marilyn6. I agree.

We have reopened (to a small degree), but you can see the change. People are out and about. There’s gonna be a huge spike in 3 weeks. I don’t think this is a kind thing to do to our nurses.

I find that I am needing to start from scratch - calling my pals with chronic illness. I remind them that this re-opening is NOT meant for them. They cannot go to the gym. It is all very alarming again. I believe that we start loosing people from our patient community now. People are confused.

In 2 months we might be close to knowing when a vaccine comes. If you get covid tomorrow, you may still be sick then.

You all just stay where your at, despite the re-opening. Hold your positions. We will see this effect in 3 - 4 weeks. Then, we can re-evaluate.

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I heard one report of a nurse who jumped in to do an emergency procedure on a Covid-19 patient when her only protection was a thin surgical mask. There were no N95 masks available. She became infected and died. This breaks my heart.

We owe it to providers like this nurse to act responsibly and make good social choices. Even if some of our leaders are morally confused, we each can make a better choice, one that will survive well in the historical analysis in the years to come.

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I know you all are smart. I know that you are conscientious beyond belief. gives me hope, but boy am I worried about the others. We are all just crazy enough to survive. Time for some old school SEAL, lol. (He has lupus)

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I have purposely lost weight to try to reduce my 114 LDL. Believe me if I didn’t have heart stents I wouldn’t worry about this good number.

I can’t take medications to try to reduce my LDL. Statins have given me neuropathy and I extremely angry about it. 60 yrs without diabetic neuropathy and I get it from a statin. The over the counter meds that help many with diabetic neuropathy worsen prescription induced neuropathy. I have tried them, and the burning is worse and the neuropathy is spreading. It just feels like a slap in the face. For almost 20 yrs, my A1c numbers have been. 4:6 to 5.5 except for one 5.9. The 20 yrs before that I was under 7. This isn’t diabetic neuropathy.

I think I am more worried about my arteries at this point, but it is a choice and I might be making the wrong choice. I don’t know. Our beloved son is getting married in Oct 2021, and we sure hope that we can attend in person. No vaccine, no attendance for us. What a different world we are living in.

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Darn it. A catch-22. Its ok, your gonna stay a home and be safe.

I would bet my life we have something before Oct 2021. They are working like horses.

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I have remained quiet, for the most part, on your remarks about this in other threads. I don’t share the belief that LDL cholesterol matters in the large scheme of things. I am not a doctor, researcher or academic but I am wagering my life on this belief.

I think that the only metabolic measures that matter are a normal A1c, normal blood pressure, high HDL, low triglycerides, and a normal waist circumference.

I think large pharmaceutical concerns and a flawed physician standard of practice has led to this wholesale attempt to beat up a number. Only 1 in 8 people are seen as metabolically healthy in this country.

Perhaps now is the time to give up pursuing your attempt to suppress your LDL to a low number. I’m sorry if this may irritate you and that is not my intention. You are doing so many things well to enhance your health. Maybe this is just one metric that you should relax your vigilance.