Diabetes and Health Management in the post Covid Era- World Diabetes Day

14th November is internationally observed as ‘World Diabetes Day’ in order to draw attention towards the growing concerns about this escalating health threat posed by diabetes. Celebrated as the world’s largest diabetes awareness campaign to a global audience of over 1 billion people in more than 160 countries, this initiative draws attention to issues of paramount importance to the diabetes world and keeps diabetes firmly in the public and political spotlight. Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose, commonly known as blood sugar, which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves. The most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin or doesn’t make enough insulin. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself. For people living with diabetes, access to affordable treatment, including insulin, is critical to their survival. There is a globally agreed target to halt the rise in diabetes and obesity by 2025. According to the WHO about 422 million people worldwide have diabetes with majority living in low-and middle-income countries, and 1.6 million deaths are directly attributed to diabetes each year. Both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades. Moreover, now that the corona virus has settled throughout nations, it has become more significant for people with chronic diseases to be cautious while stepping out. Several scientific studies have shown the association of diabetes and covid19, therefore there is no denying the risk. Not only are covid outcomes more severe in people with diabetes and metabolic dysfunction, but recent data suggests that COVID-19 could precipitate acute metabolic complications of diabetes, such as diabetic ketoacidosis and hyperglycaemia. 

Dr Tejal Lathia, a consultant endocrinologist at Apollo and Fortis Hospitals, Navi Mumbai has a passion for improving doctor-patient communication in the context of chronic conditions like diabetes to make the experience of the condition better for people living with them. With over 15 years of experience in treating diabetes, thyroid, PCOS and other hormonal conditions, she has several international scientific publications and is a faculty and speaker at national and international conferences. Dr. Lathia is also the lead co-author of “Language Matters for people living with Type 2 diabetes” and co-designer of the “HEAL-PCOS” program both of which focus on patient experiences of their condition.

“People living with Type 2 diabetes mellitus who are not at goal for their blood sugars are at a slightly increased risk of a prolonged or complicated course of illness if they contract COVID 19.” Dr. Lathia said, “Many times, people are not aware of what near normal blood glucose values are and assume that if blood sugar is less than 200 it is alright. Near normal blood glucose levels for most people living with Type 2 diabetes mean a fasting blood glucose between 90-130 and a 2 hrs post meal blood glucose less than 180 mg/dl and/or an average 3 month blood glucose ( called glycosylated hemoglobin) value of 7% or less. So, people with diabetes need not be afraid of COVID 19 but instead focus on appropriate scientific treatment and following basic precautions like wearing masks in public spaces and washing hands regularly. Take your medications, check blood glucose levels regularly, if blood glucose levels are not near normal, see your doctor, avoid unnecessary travel and social gatherings and stay home if you can.”

Speaking on the media response and propaganda regarding this, Dr. Lathia believes that constant reminders by social media and TV channels of increased risk of COVID 19 with diabetes is not helping, unless portrayed in a positive manner. 

“Loud, frequent repetition of the risk can also scare people badly and I think the message needs to be tempered with hope and encouragement, positivity!” says Dr. Lathia, “A very frequent experience during this pandemic has been people struggling with panic attacks, not being able to sleep, mood swings and anxiety. Staying calm and positive with regular meditation or pranayama helps beat the stress associated with being house-bound for so many months.” Dr. Lathia added.

As a recommendation for diabetic patients, she suggests ignoring misleading advertisements of immunity boosters and quick fixes like vitamins and kadhas. “I have seen several patients overdosing on these so-called immunity boosters that can do more than harm than good.” Dr. Lathia stated, “The best safeguards against COVID 19 are the time-honoured pillars of diabetes management – healthy food, regular moderate intensity exercise, timely medications and monitoring of blood glucose values. Attention to other conditions frequently associated with diabetes like raised blood pressure, raised cholesterol levels and being overweight also need to be managed concomitantly.”

Schools will soon reopen as the lockdown across many countries has slowly begun to lift. However, this worries the parents about their children’s safety and it is a possibility that kids diagnosed with diabetes can be at more risk. 

“Young children with diabetes who require insulin on a regular basis are prone to elevations of blood glucose when they have COVID 19 – so unexplained increase in blood glucose levels can be a clue to COVID 19 infection. However, the risk of children having complicated COVID 19 infections is less, children do better than adults and parents can breathe easy.” Dr. Lathia reassured, “Of course, these children need to follow the same precautions – wearing masks, avoiding gatherings, washing hands, maintaining 6 feet distance at all times. Also, they can consult their doctor online rather than visiting hospitals.”

“I want to tell young people that diabetes poses a risk for Indians that we may not be able to avoid completely. We have a hormonal condition called insulin resistance which predisposes us to diabetes.” says Dr. Lathia, “However, there are exciting breakthroughs in technology and medications which give a lot of hope and positivity. Timely diagnosis and scientific approach to treatment from the start can support them to live healthy productive lives rather than searching for elusive cures. They need not experience diabetes related issues like the previous generation.”