Friday, May 29, 2020 - 15:44

The current coronavirus (COVID19) pandemic has led to a lot of changes and readjustments in the daily lives of people and when you mix living with diabetes with it, it just all becomes overwhelming.

The world has come to days full of uncertainty, misinformation, and stressors and it is quite possible to get entangled in all of these emotions and feel lost. During times like these it’s natural to feel afraid, anxious, or threatened. Being resilient during the times of coronavirus can help all of us surpass this phase together.

But what about people living with diabetes?

It is a known fact that people with diabetes are at increased risk of infections. Patients with diabetes who get coronavirus disease are at risk of a severe disease course and mortality. Several factors especially the impaired immune response and heightened inflammatory response contribute to the increased disease severity. These are some of the factors which are well researched but can we avoid feeling stressed thinking about these?

Self-management of blood sugars as part of daily routines, dealing with the financial costs of the insulin and other diabetes supplies, and encountering social stigma or discrimination often are some of the challenges associated with living with diabetes.

So, as a person living with diabetes for more than 12 years, I often believe we are already at war with our bodies and all that it needs from us is being better planned. That’s what makes us more prepared to manage the daily challenges and ensure to have good experiences in other parts of our lives apart from diabetes.

Although resilience has sometimes been thought of as a personality trait, it is better defined as the achievement of positive outcomes in the face of adversity or significant risk. One can look for ways to be resilient coping up during these times of crisis. Staying healthy doesn’t only mean managing blood sugars and taking your insulin but taking care of your mental health is equally important.

Not sure where to begin?

Here are some ways, from my personal experiences being Type 1 diabetic, we can ensure holistic diabetes management during the uncertainty and stress of the pandemic:

1. Routine .. Routine .. Routine –

Who hasn’t heard this from their endocrinologists, “You got to have a meal plan and a routine to inject insulin on time”.

If you are living with diabetes you know how important having a routine in your life means. Delay/ missing your meal in your day can land you in a hypoglycaemia (blood sugar <70mg/dl) and on the other hand just a little change in your schedule can show massive changes on your blood sugars. For many of us the sleep cycle has taken a toss and we often note a difference when we wake up with higher fasting blood sugars.

But why?

Stress can impact the blood sugars in a negative way. For people living with diabetes stress can make blood sugars a lot more difficult to manage. With most of us sitting in our houses in the nationwide lockdown there has been disbalance in our routines and so has had a toll on our blood sugars. Haven’t they?

Giving a structure to your day can help ease out some of the stress.

• Test blood sugar levels more often; your body may be reacting differently under these new circumstances.
• Learn to check for ketones at home using urine ketone test strips if you are facing uncontrolled blood sugars.
• Ensure you are well stocked up with your insulin, blood sugars strips, batteries and insulin pump essential supply. For any insulin pump failures, contact the helplines and keep emergency supply of syringes.
• Maintain a routine of physical movement and exercise through several online home workouts.
• Contact your doctor or your diabetes care team for diabetes management questions and concerns.

2. Mindful Monitoring -

Monitoring isn’t limited to just checking your blood sugar and maintaining a daily log. It’s also about carbohydrate, calorie intake, weight, activity, mood, sleep, medication, foot care and skin health, among other types of self-care. Monitoring is a great way to get motivated and stay motivated. It can help you set goals, stay accountable, and feel better about yourself. As you monitor, also be mindful of how you evaluate all that data in your daily log.

• Make healthy food choices. Utilise this as a perfect time to learn new dishes and experiment on your carbohydrate counts. Utilise this time to slow down to become mindful about managing diabetes. There is a lot to learn.
• Be kind to yourself. It’s okay if you aren’t able to get your numbers in range. Don’t Fret! Show kindness to yourself and acknowledge yourself that you are doing the best you can in this difficult situation.
• Seek immediate medical attention for symptoms including fruity smelling breath, vomiting, weight loss, dehydration, confusion, and hyperventilation.

3. Reducing the risk & follow the National guidelines -

Having diabetes increases our risk of being hospitalized if we contract infections. There are some ways risk can be reduced:

• Minimize contact by avoiding exposure outside your homes.
• Practice the national guidelines shared by CDC, WHO and MOHFW to prevent exposure to the coronavirus by ensuring social distancing, use of face masks, sanitizing and regular handwashing.
• Secure a sufficient amount of food, supplies, and medications to minimize grocery visits.
• Stay active, monitor your blood sugars and take insulin as per your requirements.
• Be alert and follow reliable information from official health sources. Do not spread or share any unverified news or information further.

4. Get connected and gather support-

Even the Director General, World Health Organisation shared, “ We must combat the virus through unity and global solidarity.”

• Utilise this time as a perfect opportunity to connect with family and friends over the phone or video calls just to be there for each other.
• The diabetes community on social media has been really powerful and has been successful in reaching out to many people living with type one diabetes unleashing their hidden potentials. . So wait no more… if you still haven’t found your community just hop on social media and take this time to make new friends.
• The pandemic doesn’t impact the adults and children equally. Children and adolescents may respond to stress in many different ways. Respond to their reaction in a supportive way by giving them extra time and attention.

5. Take care of not just yourself but also your surroundings-

These are tough challenging times for all of us. While you take care of yourself ensure your surroundings are healthy too. Understand if someone around you needs advice, food or other essentials. Be willing to share.

• If you become sick/ develop fever, your insulin management may need to be adjusted based on the sick-day guidelines. Seek medical advice immediately and never stop taking your insulin.
• Take professional medical care for your family/friends in case of any symptoms suggestive of coronavirus infection.
• Viruses don’t discriminate and neither should we! The panic and chaos caused by the spread of COVID-19 can lead to stigma against people, places and communities. We must not stigmatize and practice empathy.

If you’ve stuck with me to the end I want you to know that as a person living with type one diabetes and as a medical professional I feel the same emotions of fear as you.

Let us together continue to curtail the infection with stringent norms and lockdown rules to prevent the spread of infection from one person to another, to protect the vulnerable and others in our community.

Written by : Dr Apoorva Gomber (MBBS, MD)

Disclaimer: This blog are personal views of the Patient and do not represent the views or opinion of Medtronic. Blog should not be used as medical advice to teat any medical condition in either yourself or others and should not be used in any legal capacity whatsoever. If the reader has a medical concern, consult a qualified healthcare provider for diagnosis and treatment of any and all medical condition. Under no circumstances shall Medtronic be responsible for damages arising from use of the blog.