Transcription:
Diabetes and COVID-19: What You Need to Know

Bill Klaproth (Host):   This MarinHealth podcast on COVID-19 recorded on April 16, 2020. So we’re all facing the threat of COVID-19. People living with diabetes have additional concerns. So let’s learn more about this with Dr. Linda Gaudian, an endocrinologist and the president of MarinHealth Endocrine and Diabetes Center and medical director MarinHealth Braden Diabetes Center. This is the Healing podcast from MarinHealth. I'm Bill Klaproth. Dr. Gaudiani, thank you so much for your time. So why are people with diabetes at higher risk for contracting COVID-19?

Linda Gaudiani, MD, FACE, FACP (Guest):   We’re not actually sure that they are at higher risk for contracting the disease. I think that since we now know that almost half of the population in our own country either has diabetes type 1 or type 2 or prediabetes. That’s such a huge number of people that the overlay between diabetes and many other comorbidities is very great. And any disease, any admission that you look up, the number of people who will also have diabetes is great. It appears that very healthy people with type 1 or type 2 diabetes who do not have other disease—heart disease, lung disease—and whose diabetes is in good shape may not be at increased risk for actually developing COVID.

When you think about it, there are so many people who have diabetes all across the age span and also, of course, have other things that those people are for one thing more exposed. They're going to laboratory studies more often. They're going to the hospital more often. They're going for x-ray more often. So they're going to be more exposed possibly. We do know from many other infections—and we’re assuming to be safe that this is going to be true for diabetes—that when patients are in poor diabetic control, they're at increased risk of all kinds of infection. And so we believe they are probably at increased risk of infection if they are poorly controlled. So we have to have that red flag up.

Host:   So you just used the phrase poor diabetes control. Can I ask you to explain that?

Dr. Gaudiani:   Poor diabetes control—and what I mean by that—that’s not a reflection on that person. There are many, many reasons why one person’s diabetes is more difficult to control that the next person. For folks who are listening who are not very experienced in hearing about diabetes hear this word control all of the time. It sounds like some kind of horse that’s out of the barn. What we’re really talking about scientifically is where are the blood sugars. What is diabetic control? Normally if a person does not have diabetes, the blood sugars—that is how much glucose or sugar is in the blood—will remain in extremely tight range between 70 and about 110, maybe after meals 130 no matter what we eat, no matter what we exercise. So it really isn’t fair because if a person doesn’t have diabetes, they could eat a whole birthday cake. Their blood sugars are going to stay normal.

For a person with diabetes, their blood sugars can fluctuate very greatly not just by virtue of what they eat. This isn’t just a disease that effects people that aren’t careful about how they eat. It’s a disease in which people either have a resistance to the way insulin works, which is the hormone that kind of controls glucose going into the cells, or they have an insufficiency of insulin itself. One or two of those or a combination makes a person susceptible. So then glucose, which is not a bad thing, right? That’s the fuel for the cell. It’s just like gasoline for the car. You have to have fuel. But the problem is if that glucose does not get into the cell, if it stays in the plasma, in the interstitial fluids of the body, it can't be fuel for the cell. So it’s kind of like the car is floating in gas, but you're not getting the gas into the engine. And that is associated with poor cellular function. And we know that that has a lot of effects in the body. And one of the things it can effect is the immune system. Bacteria and viruses appear to like better attacking an individual whose metabolic control, whose glucose control is abnormal. We don’t understand all of that. But I just want to get away from the sense that diabetes is something that people should be blamed for. Yes, lifestyle’s important. You cooperate or you don’t cooperate with it, but this is a disease that comes by virtue of an altered biochemistry. We have to respect that and protect diabetics, which is really why you’re talking to me today isn’t it?

Host:   It is. So speaking of protection, what should people with diabetes be doing now to prepare?

Dr. Gaudiani:   When I looked over the data to write some information for the hospitalists and put online about diabetes, I looked over the data that was published from China and also the data that’s come out of Italy. Although there was a slight increase in appeared risk of infection in diabetics across the board, it should be noted when we look at that statistic that their patients were very elderly. And so of course there were going to be more diabetics because type 2 increases with age. It starts most in the middle age and increases as we get older.

So, again, to go back to your first point, where those patients more susceptible or are there more diabetics coming in with COVID because they're also older, have heart disease, have lung disease, or just older and more frail? But even if you say well it’s the same, they're not at increased, what was very clear was that if you have type 2 diabetes and you get COVID, you are at twice the risk for needing ventilatory assistance—having to go on a respirator—and the mortality, unfortunately, is 2.2 times in both of those cohorts of people that they're published about. Because there's obviously more published data on China and Italy because they're a couple of months ahead of us in time. We’re accumulating this data too. Unfortunately we’ll have all too much of it. We are already seeing this in data that hasn’t come out in fully published studies yet, however. The diabetic patient, once they come in with COVID they are at increased risk.

So to get to your question, it’s super important that diabetic patients do everything they can to avoid infection. What are those things? The first thing is to practice the most stringed precautions for social distancing. And I think anyone with diabetes should really stay home as much as they can. Send relatives to do the shopping. If they must go out, wear the masks, wear the gloves. Really try to stay away from any source of infection. Certainly people who have travelled, travelling family members no matter how much you love them. Secondly, they should avoid all unnecessary procedures. That even includes lab that we think is important. Like six months ago my doctor told me to go for lab. Your doctor didn’t know about COVID six months ago. Unless it’s a life threatening situation—and there are some people that are on blood thinners or cancer drugs where you call your doctor and they say, “Yes, you absolutely have to have that lab.” But otherwise I tell my patients don’t go in for any routine lab, any routine x-rays, any routine elective procedures. All of those have to be put off until we’re COVID safe.

And then just because in general virus and bacteria prefer the high blood sugar environment. We want to try to keep the blood sugars during this time as closely managed and as well managed as possible. So we at MarinHealth are doing telehealth visits. I'm proud to say we picked it up and learned it very quickly. Health center was very supportive in transitioning us to telehealth calls. Many people are afraid they can't manage it. I will say that from young to really old folks, they're managing it beautifully. We give a little training session. And people get on and we’re really able to adjust their meds and address the issue of getting their diabetes as well controlled as possible to aid in whatever way we can with prevention.

Host:   So those are some really good tips to prepare. Make sure you pay attention to social distancing, avoid unnecessary procedures such as labs, then you also said keep your blood sugars as closely managed as possible. So then in general, how can people with diabetes minimize their risk of becoming ill because staying healthy now is more important than ever. Is that right?

Dr. Gaudiani:   You're absolutely right. Staying well right now is super important. Occasionally there are certain medications that we use in diabetes that we want to just have patients understand. If you get sick, x, y, and z medications might want to be discontinued. So let us know if you get sick. The first thing is let your doctors, let your healthcare workers know if you’re sick. Not just if you're COVID, if you have typical COVID symptoms because in fact we don’t exactly know what all of them are. We know that people are contracting the virus who don’t even have symptoms. So if you're not feeling well, raise your hand. That means make a call because you will be triaged to go to different places depending on what people think you have on the basis of your symptoms. So if you are feeling ill, let us know. Number two, go over your medications with your doctors. Make sure that they are right. Number three, practice those lifestyles that we seem to think reinforce health and wellness. Healthy diet, super important. Exercise as much as you can get even in your house. I have an older couple who say they're wearing a hole in their rugs just walking around. But I said bravo. You can always get new rugs. You can't get a new set of lungs. So stay as active as you can so that you maintain healthy weight. And exercise those hearts and lungs because if any of us get sick, we’re going to be depending on our cardiovascular wellness.

I harp a lot. And anyone who is my patient in the almost 40 years I've been in practice in Marin will know that I'm a big proponent of lifestyle, of healthy exercise, and maintaining a healthy of weight as we can with diet and exercise and with the help of medications when necessary. We didn’t know that COVID was going to come along. We don’t know what else will come along. In addition to those folks who have diabetes doing very poorly if they get COVID, it turns out that obesity is a bad actor in combination with COVID. We are finding that patients who are obese who contract COVID have a much more difficult time. They also end up requiring ventilators much more frequently and often, unfortunately, they can't get off.

So although I think in our culture we tend to associate the reasons to lose weight with cosmetic, it has nothing to do with cosmetic. When we say we want you to lose weight and get healthy, it’s all for the health of your lungs and your heart. And now we know—Here’s an example where if you did that, if you lost weight last year. If you came into the diabetes prevention program or followed the advice of your primary care doctor or your cardiologist and you lost some weight, good for you because you’ve already reduced your risks. If you haven’t gotten to it yet, come on board because we don’t know. When this first wave of the illness dies down because we are social distancing and as we turn back to life that’s a little bit more normal while we’re waiting for the vaccinations and treatments, we might come across another wave of infection or another virus could emerge. All of us will be healthier if we pay attention to our cardiovascular wellness, our cardiometabolic wellness with health diet, exercise, and avoidance of obesity.

Host:   Such a great point and great advice for all of us, especially for people with diabetes. As you were saying earlier, you don’t want to become ill. So number one, let your doctor know if you're sick. Number two, go over your meds with your doc. Number three, practice lifestyles that reinforce healthy habits. And then I love when you said we all need to pay attention to the health of our lungs and heart. That really makes sense. And great advice not only for people with diabetes but for all of us. And last question Dr. Gaudiani and thank you for your time. What should you do if you have diabetes and contract COVID-19? What do we need to know?

Dr. Gaudiani:   So if you have had an exposure or you have symptoms that you think are suggestive of COVID, you need to call your primary care physician as soon as possible or call your local hospital so that you get directed to the appropriate screening place. Bring all of your diabetic supplies, including your pump if you use one or your continuous glucose monitor if you use that.

Host:   Fantastic. Thank you for doing this interview Dr. Gaudiani. I know you're at home right now. We hear your dog in the background, but we’re all staying at home and doing what we can to flatten the curve. So thank you so much for your time. We appreciate it.

Dr. Gaudiani:   You're so welcome. Bye bye now. Thank you.

Host:   That’s Dr. Linda Gaudiani. For more information, please visit mymarinhealth.org/covid19. That’s mymarinhealth.org/covid19. You can also find more information about diabetes and COVID-19 on the Braden Diabetes Center page. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is the healing podcast brought to you by MarinHeatlh. I'm Bill Klaproth. Thanks for listening.