Diabetes & COVID-19
Laura Alonso, M.D. Chief of Endocrinology, discusses diabetes & COVID-19. She shares how her team has been treating patients throughout COVID-19, how her patients have been handling these circumstances; both physically and emotionally, and what types of appointments can be done during a Video Visit.
Featured Speaker:
Learn more about Laura Alonso, MD
Laura Alonso, MD
An elected member of the American Society for Clinical Investigation, Dr. Alonso is a leading investigator on the basic biology of pancreatic beta cell regeneration. She is a standing member of, and has co-chaired, the NIH’s Molecular and Cellular Endocrinology Study Section and serves on the organizing panel for the Scientific Sessions of the American Diabetes Association.Learn more about Laura Alonso, MD
Transcription:
Diabetes & COVID-19
Melanie Cole: This is the Weill Cornell podcast on COVID-19 dated May 7th, 2020. Welcome to Back to Health, your source for the latest in health, wellness and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features, conversations about trending health topics and medical breakthroughs from our team of world renowned physicians at Weill Cornell Medicine. I'm Melanie Cole and today we're discussing COVID-19 and patients with diabetes. Joining me is Dr. Laura Alonso. She's the Chief of Endocrinology, Diabetes, and Metabolism at Weill Cornell Medicine. Dr. Alonso, it's such a pleasure to have you join us today. Tell us how you've been treating patients throughout COVID-19 and how have your patients been handling these extreme circumstances in this unprecedented time, both physically and emotionally?
Dr. Alonso: Well, thank you very much for having me on and for bringing up this really important topic. So we've been seeing a lot of patients with diabetes during the COVID pandemic, mostly through video visits. It's definitely been a big stress for our patients. Physically, I'm not sure. I think most people are at home and taking very good care of themselves as best they can. Emotionally has definitely been a challenge though for all of us. I think at many levels.
Host: Dr. Alonso, can you help us to better define essential care? For instance, have your patients been able to receive procedures, medications, treatments? How are you reassuring them about what essential care is? Tell us what that means.
Dr. Alonso: So people with diabetes have a lot of essential care, and that absolutely cannot stop during a pandemic or really for anything. For example, it's very, very important that every person with diabetes be able to continue their medication in the prescribed doses and with all of the technology and all of the care that they ordinarily get. Our patients at Weill Cornell have been able to see us pretty much through this entire pandemic using video visits. It turns out that endocrinology is actually really well suited for video visit care. Some of our providers have actually been within 90% of their normal volume without seeing any patients in person. It's all done by video visits and a lot of patients have really, really liked this because they don't have to leave their house. There's no commuting time, there's no risk of going outside when you feel worried about that.
There's also been a lot of changes recently that are helping us deliver care in ways that we really weren't doing before. For example, some pharmacies offer home delivery and that has been helpful to patients who are worried about going outside and exposing themselves. Also for diabetes and for other endocrine disorders. Blood tests are really important. Some of the phlebotomy labs in the area have implemented safeguards to make sure that coming in for a blood test can be provided safely. They have, for example, started issuing appointment times for blood tests so that people know that if they go to have their blood drawn they are expected and there should not be a line or a crowd of people. In addition, there are services that actually can draw your lab tests in your own home if it can be set up. So we have been doing everything we can to be able to provide care safely and continuously to all of our patients that need it.
So one of the best things, amazing new technology we have for diabetes are the insulin pumps which are getting more and more sophisticated and the continuous glucose monitors, which are also getting to be really very, very good. And these devices as you may know, can be connected to the internet and therefore the patient and the Doctor or provider on the other end of the video visit can see the blood sugar information and the insulin delivery information with incredible detail. And so essentially the video visits can be extremely effective as a way to adjust the insulin delivery and manage diabetes since essentially all of the relevant information is available at the time of the visit.
Host: Thank you so much for that answer. It's so interesting that endocrinology has really adapted well to this and I think we're seeing many of the medical specialties that are able to adapt well to this. For someone with diabetes, what do you want them to know about the importance of continuing their care and medication? You mentioned a little bit briefly if you would expand on that because having medications on hand during, you know, quarantine and social isolation and for people with diabetes, this is ultra important to make sure that they have enough of what they need.
Dr. Alonso: You're absolutely right is particularly important for people with diabetes to have an adequate supply of medications on hand. We're recommending as much as three months of medication on hand. If you can do that. Also, it's important to maintain contact with your physician and your care team through video visits as much as possible to make sure that there's no gap in taking care of what you need.
Host: When it comes to symptoms. They might be feeling in people who have had diabetes for a while, they know their bodies, they kind of know what it feels like, but there's a lot of other things going on right now. When it comes to symptoms that they might be feeling due to their preexisting conditions, are you advising them to use virtual urgent care as a first line of defense? What would you like them to know, you know if they are feeling some symptoms of COVID and when you think it's important that they come in?
Dr. Alonso: That's really a great question, so I would suggest that people with diabetes try to figure out whether the symptoms they're feeling are most likely to be related to their endocrine disorder, in which case the first call should be to their endocrine office. And we would be more than happy to help you figure out whether or not the symptoms that you're feeling are related to maybe your diabetes under worse control or whether there might be something else going on. If you think your symptoms really seem like they could be related to COVID-19 then probably the best first step would be a video visit with urgent care in order to assess whether or not you can safely manage your symptoms at home or whether you should go to be seen in person. I would like to emphasize though that if you are having any kind of symptoms that you think are worrisome in particular that could be related to chest pain or shortness of breath or any symptoms that you would ordinarily think need to be evaluated in an emergency room that you do not hesitate to seek care. One of our biggest fears has been that people with legitimate non-COVID illness might be afraid to come into the emergency room and this actually could be dangerous. Our ER volume has actually declined a lot recently and they are ready and waiting to take care of your illness safely. If you are having severe symptoms, if you are only having mild symptoms that possibly or probably could be taken care of at home, then I would advise that you call for an urgent care video visit.
Host: Well that's certainly really important advice and one of the things that I think anyone with preexisting conditions right now is our mental and emotional health. What about the stress we're feeling? It seems to be worldwide. There's a feeling of anxiety, but for someone with diabetes this can be magnified. What would you like them to know? Put it into perspective for us to help them manage the emotional challenges because we know that stress and diabetes do not mix very well and you want them to really continue their care. This continuum of care is so important. What would you like to tell them about managing those things at this time?
Dr. Alonso: So first of all, I'd like to say that it is 100% normal to feel anxious right now to feel stress, even depressed or angry or frustrated. The whole gamut of feelings right now is normal. It is true though that having higher stress level can affect diabetes and it can raise your blood sugars. It can make it hard to make good choices with respect to the food you eat and taking the medication. It's really important though that you maintain the excellent care that you normally take of your body, and I will say that some of my patients have actually been able to take better care of themselves during this pandemic. For example, people have more time to prepare food at home and some people have actually been eating more healthy food. Certainly all of the ways that are talked about to relieve stress are important now. If you can get physical activity that can be very helpful. I would definitely encourage everyone to connect with friends and family by video when possible in order to maintain all of those connections that help us get through these difficult times. Also, I'd like to reassure everybody that this will end at some point and we will all get through this together.
Host: Dr. Alonzo, please wrap it up for us with your summary and best advice. When people have diabetes and we're dealing with COVID-19 right now, what would you like them to know about the care that you can give at Weill Cornell Medical Center and the help that you want them to know is available?
Dr. Alonso: So I would like everyone to know that we are here for you, that this is a difficult time, but you have all the tools to take excellent care of your diabetes and we would be more than happy to see you by video visit until our offices reopen. We can help you obtain lab test results and interpret them. We can help you manage your blood sugars, we can help you with your food choices and with all of the stress relieving relaxation techniques that can help control your diabetes but also help you feel healthy and well. So I would strongly encourage if you have any questions, whether you're an existing patient or you haven't seen us before, we would love to get to know you and we would love to help you manage your diabetes as best we can together.
Host: Thank you so much Dr. Alonso. That was really a great wrap up and thank you so much for coming on and sharing your expertise in explaining to patients why they shouldn't worry and why you are there for them. Thank you again for more information on how to manage the emotional challenges of this pandemic. Please visit Weillcornell.org/news, you'll also learn about how Weill Cornell Medicine is taking extra precautions to prioritize your patient experience in office and offering more resources via digital health on Weill cornell.org/digital-health-services. That concludes today's episode of Back to Health. We'd like to thank our listeners and invite our audience to download, subscribe, rate, and review back to health on Apple Podcast, Spotify and Google Play Music. For more health tips, please visit WeillCornell.org and search podcasts. Parents, don't forget to check out Kids' Health Cast. I'm Melanie Cole.
Conclusion: Rehabilitation medicine can help patients with a wide array of disorders and diseases including cancer. If cancer care's of interest, listen to Cancer Cast, Weill Cornell Medicine's dedicated oncology podcast featuring leaders in the field and patient stories. Cancer Cast highlights dynamic discussions about the exciting developments in oncology. All information contained in this podcast is intended for informational and educational purposes. The information is not intended nor suited to be a replacement or substitute for professional medical treatment or for professional medical advice relative to a specific medical question or condition. We urge you to always seek the advice of your physician or medical professional with respect to your medical condition or questions. Weill Cornell Medicine makes no warranty, guarantee, or representation as to the accuracy or sufficiency of the information featured in this podcast and any reliance on such information is done at your own risk. Participants may have consulting, equity, board membership, or other relationships with pharmaceutical, biotech, or device companies unrelated to their role in this podcast. No payments have been made by any company to endorse any treatments, devices, or procedures, and Weill Cornell medicine does not endorse, approve, or recommend any product service or entity mentioned in this podcast. Opinions expressed in this podcast are those of the speaker and do not represent the perspectives of Weill Cornell Medicine as an institution.
Diabetes & COVID-19
Melanie Cole: This is the Weill Cornell podcast on COVID-19 dated May 7th, 2020. Welcome to Back to Health, your source for the latest in health, wellness and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features, conversations about trending health topics and medical breakthroughs from our team of world renowned physicians at Weill Cornell Medicine. I'm Melanie Cole and today we're discussing COVID-19 and patients with diabetes. Joining me is Dr. Laura Alonso. She's the Chief of Endocrinology, Diabetes, and Metabolism at Weill Cornell Medicine. Dr. Alonso, it's such a pleasure to have you join us today. Tell us how you've been treating patients throughout COVID-19 and how have your patients been handling these extreme circumstances in this unprecedented time, both physically and emotionally?
Dr. Alonso: Well, thank you very much for having me on and for bringing up this really important topic. So we've been seeing a lot of patients with diabetes during the COVID pandemic, mostly through video visits. It's definitely been a big stress for our patients. Physically, I'm not sure. I think most people are at home and taking very good care of themselves as best they can. Emotionally has definitely been a challenge though for all of us. I think at many levels.
Host: Dr. Alonso, can you help us to better define essential care? For instance, have your patients been able to receive procedures, medications, treatments? How are you reassuring them about what essential care is? Tell us what that means.
Dr. Alonso: So people with diabetes have a lot of essential care, and that absolutely cannot stop during a pandemic or really for anything. For example, it's very, very important that every person with diabetes be able to continue their medication in the prescribed doses and with all of the technology and all of the care that they ordinarily get. Our patients at Weill Cornell have been able to see us pretty much through this entire pandemic using video visits. It turns out that endocrinology is actually really well suited for video visit care. Some of our providers have actually been within 90% of their normal volume without seeing any patients in person. It's all done by video visits and a lot of patients have really, really liked this because they don't have to leave their house. There's no commuting time, there's no risk of going outside when you feel worried about that.
There's also been a lot of changes recently that are helping us deliver care in ways that we really weren't doing before. For example, some pharmacies offer home delivery and that has been helpful to patients who are worried about going outside and exposing themselves. Also for diabetes and for other endocrine disorders. Blood tests are really important. Some of the phlebotomy labs in the area have implemented safeguards to make sure that coming in for a blood test can be provided safely. They have, for example, started issuing appointment times for blood tests so that people know that if they go to have their blood drawn they are expected and there should not be a line or a crowd of people. In addition, there are services that actually can draw your lab tests in your own home if it can be set up. So we have been doing everything we can to be able to provide care safely and continuously to all of our patients that need it.
So one of the best things, amazing new technology we have for diabetes are the insulin pumps which are getting more and more sophisticated and the continuous glucose monitors, which are also getting to be really very, very good. And these devices as you may know, can be connected to the internet and therefore the patient and the Doctor or provider on the other end of the video visit can see the blood sugar information and the insulin delivery information with incredible detail. And so essentially the video visits can be extremely effective as a way to adjust the insulin delivery and manage diabetes since essentially all of the relevant information is available at the time of the visit.
Host: Thank you so much for that answer. It's so interesting that endocrinology has really adapted well to this and I think we're seeing many of the medical specialties that are able to adapt well to this. For someone with diabetes, what do you want them to know about the importance of continuing their care and medication? You mentioned a little bit briefly if you would expand on that because having medications on hand during, you know, quarantine and social isolation and for people with diabetes, this is ultra important to make sure that they have enough of what they need.
Dr. Alonso: You're absolutely right is particularly important for people with diabetes to have an adequate supply of medications on hand. We're recommending as much as three months of medication on hand. If you can do that. Also, it's important to maintain contact with your physician and your care team through video visits as much as possible to make sure that there's no gap in taking care of what you need.
Host: When it comes to symptoms. They might be feeling in people who have had diabetes for a while, they know their bodies, they kind of know what it feels like, but there's a lot of other things going on right now. When it comes to symptoms that they might be feeling due to their preexisting conditions, are you advising them to use virtual urgent care as a first line of defense? What would you like them to know, you know if they are feeling some symptoms of COVID and when you think it's important that they come in?
Dr. Alonso: That's really a great question, so I would suggest that people with diabetes try to figure out whether the symptoms they're feeling are most likely to be related to their endocrine disorder, in which case the first call should be to their endocrine office. And we would be more than happy to help you figure out whether or not the symptoms that you're feeling are related to maybe your diabetes under worse control or whether there might be something else going on. If you think your symptoms really seem like they could be related to COVID-19 then probably the best first step would be a video visit with urgent care in order to assess whether or not you can safely manage your symptoms at home or whether you should go to be seen in person. I would like to emphasize though that if you are having any kind of symptoms that you think are worrisome in particular that could be related to chest pain or shortness of breath or any symptoms that you would ordinarily think need to be evaluated in an emergency room that you do not hesitate to seek care. One of our biggest fears has been that people with legitimate non-COVID illness might be afraid to come into the emergency room and this actually could be dangerous. Our ER volume has actually declined a lot recently and they are ready and waiting to take care of your illness safely. If you are having severe symptoms, if you are only having mild symptoms that possibly or probably could be taken care of at home, then I would advise that you call for an urgent care video visit.
Host: Well that's certainly really important advice and one of the things that I think anyone with preexisting conditions right now is our mental and emotional health. What about the stress we're feeling? It seems to be worldwide. There's a feeling of anxiety, but for someone with diabetes this can be magnified. What would you like them to know? Put it into perspective for us to help them manage the emotional challenges because we know that stress and diabetes do not mix very well and you want them to really continue their care. This continuum of care is so important. What would you like to tell them about managing those things at this time?
Dr. Alonso: So first of all, I'd like to say that it is 100% normal to feel anxious right now to feel stress, even depressed or angry or frustrated. The whole gamut of feelings right now is normal. It is true though that having higher stress level can affect diabetes and it can raise your blood sugars. It can make it hard to make good choices with respect to the food you eat and taking the medication. It's really important though that you maintain the excellent care that you normally take of your body, and I will say that some of my patients have actually been able to take better care of themselves during this pandemic. For example, people have more time to prepare food at home and some people have actually been eating more healthy food. Certainly all of the ways that are talked about to relieve stress are important now. If you can get physical activity that can be very helpful. I would definitely encourage everyone to connect with friends and family by video when possible in order to maintain all of those connections that help us get through these difficult times. Also, I'd like to reassure everybody that this will end at some point and we will all get through this together.
Host: Dr. Alonzo, please wrap it up for us with your summary and best advice. When people have diabetes and we're dealing with COVID-19 right now, what would you like them to know about the care that you can give at Weill Cornell Medical Center and the help that you want them to know is available?
Dr. Alonso: So I would like everyone to know that we are here for you, that this is a difficult time, but you have all the tools to take excellent care of your diabetes and we would be more than happy to see you by video visit until our offices reopen. We can help you obtain lab test results and interpret them. We can help you manage your blood sugars, we can help you with your food choices and with all of the stress relieving relaxation techniques that can help control your diabetes but also help you feel healthy and well. So I would strongly encourage if you have any questions, whether you're an existing patient or you haven't seen us before, we would love to get to know you and we would love to help you manage your diabetes as best we can together.
Host: Thank you so much Dr. Alonso. That was really a great wrap up and thank you so much for coming on and sharing your expertise in explaining to patients why they shouldn't worry and why you are there for them. Thank you again for more information on how to manage the emotional challenges of this pandemic. Please visit Weillcornell.org/news, you'll also learn about how Weill Cornell Medicine is taking extra precautions to prioritize your patient experience in office and offering more resources via digital health on Weill cornell.org/digital-health-services. That concludes today's episode of Back to Health. We'd like to thank our listeners and invite our audience to download, subscribe, rate, and review back to health on Apple Podcast, Spotify and Google Play Music. For more health tips, please visit WeillCornell.org and search podcasts. Parents, don't forget to check out Kids' Health Cast. I'm Melanie Cole.
Conclusion: Rehabilitation medicine can help patients with a wide array of disorders and diseases including cancer. If cancer care's of interest, listen to Cancer Cast, Weill Cornell Medicine's dedicated oncology podcast featuring leaders in the field and patient stories. Cancer Cast highlights dynamic discussions about the exciting developments in oncology. All information contained in this podcast is intended for informational and educational purposes. The information is not intended nor suited to be a replacement or substitute for professional medical treatment or for professional medical advice relative to a specific medical question or condition. We urge you to always seek the advice of your physician or medical professional with respect to your medical condition or questions. Weill Cornell Medicine makes no warranty, guarantee, or representation as to the accuracy or sufficiency of the information featured in this podcast and any reliance on such information is done at your own risk. Participants may have consulting, equity, board membership, or other relationships with pharmaceutical, biotech, or device companies unrelated to their role in this podcast. No payments have been made by any company to endorse any treatments, devices, or procedures, and Weill Cornell medicine does not endorse, approve, or recommend any product service or entity mentioned in this podcast. Opinions expressed in this podcast are those of the speaker and do not represent the perspectives of Weill Cornell Medicine as an institution.