Having Diabetes During COVID-19

Many of us with diabetes were hit by COVID-19 when warnings came out from health experts about being a part of a population known as “high risk.”   Information was pouring out about people with autoimmune conditions considered to be at-risk for COVID-19. (https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html).  Diabetes was identified as one of those medical conditions.  This moment likely sent waves of concern, worry, and uncertainty as the world was trying to get a grip on COVID-19 and now it seemed to have a different fear because of the impact it could have on someone with diabetes.

The ride started going up…

The flood of thoughts as a type one diabetic look like:

“Wait, I have an autoimmune disorder!”

“Do I have enough insulin?”

“Am I more at risk of getting COVID-19?”

“What supplies do I need?”

“What’s going to happen to me if I get it?”

“What are they telling us to do?”

Recommendations and suggestions were pouring out and changing at a rapid pace.  Information was being scattered by the news, social media, government agencies, worldwide organizations, health resources, and individuals across the globe.  It was one thing trying to figure out what everyone else was going to do about COVID-19, and then it suddenly turned even more serious and close to home when they mention a condition you have is considered at risk.

Living with a chronic, medical condition often leaves you feeling vulnerable.  With someone who has type one diabetes, it’s a daily battle of managing blood sugars through finger pokes, counting carbohydrates in food, and administering insulin.  The struggle of having all the necessary supplies and making sure everything works. Now, take into effect other factors like contracting another disease, or having issues obtaining supplies, and additional stress.  You try your best to get into a routine with managing your diabetes. When that routine is disrupted, it can leave you feeling very vulnerable.   

Cases of COVID-19 in the U.S. started getting reported.  I was about to hop on a flight to Portland, Oregon to help my father with a business trip.   At first, I was going to wait and see if the company was going to cancel the event or if it was going to be highly recommended not to fly.  Neither happened. I was starting to face some anxiety of whether to go on the trip and I knew I had to make a choice.

The ride continued to climb higher…

I decided to research what the Juvenile Diabetes Research Foundation (JDRF) was saying regarding being a type one diabetic and COVID-19.  After a few minutes I was able to discover that type one diabetics were not more at risk of getting COVID-19. Still, I wasn’t entirely sold on whether that should be my go-ahead decision to take this trip.  I decided to consult with both my endocrinologist and new primary care physician about what to do. Both medical professionals recommended following all the CDC recommendations, monitoring my blood sugar levels extra close, having enough supplies on hand, and pay attention to any symptoms.  

Started going down on the ride and leveling out…

Based on the condition of my diabetes my doctor said he trusted my judgement about making the decision to go on the trip or stay home.  He did not say, “No, don’t go.” If he did, I would have made the choice right there to cancel it. For years I struggled with developing a trusting relationship with doctors.  As a teenager, every time I went to the hospital it was “meet and greet” a new doctor and I continued to lie about anything I could in order to get it over with. We are at a point where he trusts me with managing my diabetes and I trust him with my care.    

The decision was made to go on the trip.  You can bet I packed additional medications and diabetes supplies needed for the trip just in case.  I packed for probably a month’s worth of necessary medical supplies (even though I was only gone for about 48 hours).  There were still several thoughts and emotions swirling around all the possibilities of what might happen with the trip, COVID-19, and having diabetes. 

A little turn around the corner…

Nothing stood out at as being significantly different while traveling.  From Wisconsin I made a connecting flight in Colorado and then made it to Oregon.  During air travel the two things that stood out where the amount of people cleaning their area with wipes and more men were washing their hands in the bathroom then I’d ever noticed before.  We were not at a point where masks, social distancing, and quarantining were being recommended. The flights were not empty and were in fact all close to capacity. I flew out, completed the business part of it, enjoyed time spent with my father and returned without a problem.  The concern of diabetes and COVID-19 was calming down.

I am enjoying this part of the ride…  

After returning from the trip things immediately began to change.  I had an upcoming trip planned for Spain in April and did not know whether it was going to continue.  At the time, nothing about COVID-19 was being discussed in Spain. Nothing about travel bans was happening and I was already starting to think about what to do with the trip. 

I can see an incline coming up on the track…

The biggest concern that was constantly on my mind was what would happen regarding my health and diabetes.  I felt confident in being able to manage cancelled flights and reservations. I could do deal with the disappointed of not going or having to plan for a future trip.  The immediate concerns were how traveling and the uncertainties of what is happening in the world could impact my health. What if travel restrictions changed while we were gone?  What if we got stuck in Spain? What if I ran out of medication? What kind of insulin would they have in Spain? Would I be able to afford it? While most people might think about where they would stay, getting refunds on tickets or reservations, or moving dates of trips, my number one concern was how it was going to affect my diabetes.  

Despite the anxiety and concern this brought, it also showed significant change in how I prioritize my diabetes today in comparison to many years ago.  Before, it likely would have been low on the priority list. I avoided taking responsibility for it, neglected taking the right steps to stay healthy, didn’t check my blood sugars all the time, and even went without taking insulin for long periods of time.   

I wonder how high or long this incline is going to be…

Shortly after considering all our options, a travel ban was in put in place.  The notice was relieving as well as disappointing. Relieving that the decision was made and would not have to worry about having diabetes while traveling in a foreign country while the world deals with COVID-19.  Disappointing because of the plans made, expectations created, and looking forward to an incredible trip.  

This wasn’t the only event going on in my life either.  For March through May there was a plan to speak at a gambling conference, a scheduled presentation for an opioid convention, being a part of my cousin’s wedding, and attending my girlfriend’s graduation in San Diego.  There was uncertainty growing as to what was going to be cancelled and what was potentially going to press on. Day by day, things changed, and the amount of people recommended to gather in one place continued to decrease.  For a moment of time things once again cooled off and slowed down. Events were being cancelled and the schedule was becoming empty instead of packed with events. The hectic March through May became as clear as a recently purchased calendar.    

Okay, the hill and drop weren’t as bad as I initially thought…

Then, suddenly the changes started to come through like waves crashing in.  Additional travel bans, widespread events cancelled, schools being closed, businesses shutting down, daycares limiting their availability, and some places were working towards transitioning people working from home.  Not only that but worries about basic home supplies (like toilet paper) and being able to purchase food at grocery stores was creating panic.

More questions poured in:

“What about getting insulin?”

“Are they going to run out?”

“Is the pharmacy going to stay open?”

“Am I going to have enough food for sugar lows?”

“Are other medical supplies going to be available still?”

“How am I going to afford it if I’m laid off?”

“What happens if I have complications?”

That drop came suddenly…

States across the U.S. started issuing stay at home orders and the words “essential workers” were put in place for people deemed necessary to provide services.  There are those of us who have type one diabetes who also work in a profession that is considered essential. As a clinical supervisor of a medicated-assisted treatment program for opioid dependency it wasn’t going to be close the doors and quarantine until this is over.  We treat over four hundred patients who have a diagnosed substance use disorder.  

Days at work were tough.  E-mails were coming in non-stop about policies, procedures, and the next steps for managing COVID-19.  At the same time, we were trying to provide treatment for patients, answer their questions about “what is going to happen,” and support our staff who were informed that we are considered essential and would continue to keep our doors open.  Informing patients of changes and helping staff adjust to new policies was exhausting. While some people experienced a reduction in work or complete shutdown, a few of us were coming in even earlier to try and help manage the clinic for the patients and staff.  

This ride is crazy, like nothing I’ve ever been on before…

Each day I started asking myself, “Should I be staying home?”  I continued to have uncertainty as to whether I am more at risk with having diabetes.  Plus, the number of family members, girlfriend, friends, and even co-workers expressing concern over what I was going to do was growing as well.  I continued to come into work, provide supervision to counselors, support staff, counsel patients, follow policies, and return home. However, doing it more often didn’t make it any easier.  As the number of cases in the U.S. continued to grow it made it a little more daunting to come in every day with having type one diabetes.  

Is this ride every going to end…

I received a sigh of relief when I opened an updated e-mail from JDRF about common questions regarding COVID-19 and having type one diabetes.  After consulting with several medical professionals, it was identified that type one diabetics are not more likely to get COVID-19; however, if we do get COVID-19 we are at risk because of what our bodies go through when we fight being sick.  When our bodies fight being sick our blood sugars rise; and when our blood sugars rise we face greater likelihood of complications.  

What a dip in the anxiety and then a sudden rise again.  It was relieving to find out we are not more at risk of contracting COVID-10; however, it can drive fears and concerns about the possibilities of what was going to happen if we were to get it.  An important aspect was identified when it came to the condition of someone’s diabetes and their A1C number. The A1C is the average blood sugar levels for someone over the past three to four months.  As a type one diabetic we have this routinely checked when seeing our endocrinologist.     

Whew, I can catch my breath finally…

For many early years after my diagnosis I hated hearing about the A1C.  It was frustrating, annoying, painful, and dreadful. A major portion of this was driven by the fact I was not taking care of my diabetes.  Therefore, every time I went to see the doctor the number was not impressive and eventually became downright dangerous. Getting my A1C on track over the years was a life changing experience in my life.  It was a turning point I wrote about in my book Life on Insulin.  

Why is this important now?  Today marks the 23^rd Diaversary and I have seven consecutive years of having an A1C at a 7.9 or below.  Knowing that being considered in good condition is right in that range brought such relief and joy during this time of COVID-19.  I never thought I would be so grateful knowing that number that I dreaded and hated became a source of comfort and relief. That was not an indication I was invincible or could “do what I want” because my diabetes was in good condition.  It reiterated what I needed to do in order to help protect my health at this time: continue to take care of my diabetes.

I tug at the belt on the ride to stay reminded by some of the things that keep me safe…

At the time of writing this, everything with COVID-19 continues to be an up and down, every changing moment of learning how to ride a wave and rollercoaster filled with uncertainties and challenges that lay ahead.  Riding a rollercoaster filled with numerous thoughts and emotions is all too familiar to a person with type one diabetes; because this is the life we ride daily.  

Twenty-three years of living with type one diabetes during this time of COVID-19 helps me to see that diabetes has brought more strength then weakness.  It has provided comfort more than it has fear. It continues to be a reminder of being smart about the decisions I make instead of trying to be strong. It encourages the importance of practicing acceptance of what I have and what we are facing instead of trying to fight the wrong side of the battle. 

We are still on this ride with everything having to deal with COVID-19.  Our experiences with it are filled with similarities and differences. This has been a glimpse of what it’s been like for someone with type one diabetes managing life day by day as the COVID-19 issues continue to impact us globally.  For all the other people with type one diabetes, know that:

• It is okay to have questions about how COVID-19 impacts our disease.
• It is okay to have concerns and worries about how COVID-19 could affect you.
• Talk with family members and support peers about what you are experiencing and listen to what others are going through.
• Connect with other peers who have type one diabetes.
• Find out additional information and reach out to resources.
• Ask for help and reach out to your providers to answer any of the questions or concerns you might have about your health.
• Be vigilant in monitoring your blood glucose levels even if it is more than the recommended amount.
• Be mindful of your food and water intake.
• Have enough supplies on your person and where you are staying.  I have taken additional medication supplies as I continue to go to work.
• It is okay if in the past you struggled with managing your diabetes; starting now is a good as time as any to work on improvements.
• Make taking care of your diabetes a top priority now, and always, because without managing our diabetes we will continue to put ourselves at risk.
• We know how it is to be on a roller coaster filled with ups and downs, many thoughts and emotions, trials and triumphs, doubts and certainties; and if its one thing diabetes has taught us is we become better at learning how to manage the ride.