Staying at home and managing diabetes

From diabetes.org.uk

We’ve put together these tips to support you in keeping well and managing diabetes while you’re at home, whether you're self-isolating or know someone who is.

We know that this advice may mean you have to completely change your way of life, and we know that may be daunting. We want you to know that we’re right here with you at this difficult time.
Whether you’re looking for ways to keep active in your home, easy recipe ideas, or want to know how to connect with others – we’ve got you covered. And if you’d like to share your own tips or stories, we’d love to hear from you so please get in touch.

Updates on coronavirus (COVID-19) and diabetes

We’re working hard to always get you the most up-to-date information and latest news from the government. Here is our latest guidance on coronavirus for people with diabetes.

Your emotional wellbeing

Being asked to stay at home or avoid other people is a difficult thing to do. But having diabetes to think about as well as everything else in life can feel overwhelming. Stress can affect your blood sugar levels, so we’ve got some useful advice to help you manage all sorts of emotions including stress.

The mental health charity Mind have put together some useful tips too, on taking care of your mental health while staying at home.

What to eat when you’re stuck at home

Eating a variety of healthy foods is important for everyone’s overall health and wellbeing. And though there’s no specific food or supplement that can prevent you from catching coronavirus, eating a well-balanced diet can help boost your immune system to fight infections if you’re healthy. Healthy eating can help you manage your diabetes, as well as help you reduce your risk of developing type 2 diabetes.

Avoiding snacking

Sometimes we don’t feel like eating certain foods. Sometimes we just snack because we’re bored or stressed. But this can make you feel worse in the long run, and impact your diabetes. We’ve got information to help you tackle these sorts of feelings about food, like starting a food diary or simply getting into more of a routine.

To help with keeping a routine, try to have fairly structured meal times.

And at this difficult time, you may struggle to get the kinds of foods you prefer and usually eat. Try not to worry if you’re having to eat a bit differently, just eat healthy food as much as possible and be mindful of portion sizes. We’re here to help you come up with new ideas of what to cook from your store cupboard and give you suggestions on adjusting recipes using the ingredients you have.

If you have coeliac disease and are having trouble getting hold of your usual gluten-free food, remember that many foods are naturally gluten free. Read about coeliac disease and diabetes.

Shopping hacks

At this time your food shopping trips should be just for essentials, so be sure to take a list with you to help stock up on essentials and avoid impulse buys.

If you’re finding it hard to get your usual foods, it can be frustrating, but you could use it as an opportunity to try something new. For example, you could get wraps, wholegrain muffins or crumpets instead of your usual loaf of bread. All of these freeze well and topped with tomato puree, plenty of veggies and a little grated mature reduced fat cheese make great alternative pizzas.

Try these other food hacks:

• Grains - If the shop is out of instant rice, why not swap it with couscous or brown rice, which you can pair with curries or stews. They also contain more fibre, which is essential for digestive health and can help you to keep your blood glucose and cholesterol under control. 
• Vegetables - Why not try frozen veg you would not normally buy or and tinned veg in water, these both work well in pasta, stew and soup dishes
• Fruit - if you’re having trouble getting hold of fresh or tinned fruit in natural juice, have a look for frozen fruit, or alternatively if all you can find is fruit in syrup you can simply drain and rinse this before use. They will still count towards your five-a-day. 
• Eggs - if you’re having trouble finding your usual eggs, try swapping with egg whites in cartons. 
• Pasta sauce - if you can’t find any in stores, why not try making your own? Simply dry fry an onion, soften it with a little water, and add tinned tomatoes and any dried herbs you have to hand. If you don’t have tinned tomatoes try using sundried tomatoes or chopped fresh tomatoes. 

Easy recipes 

Struggling for inspiration with what you’ve got in the cupboard or freezer? Here’s a starter for ten:

Porridge 

Start your day at home with this healthy porridge recipe. Any berries and nuts would work well here and use whatever milk you have available. If you can, try to go for unsweetened versions. Oats are high in fibre and contain a specific type of soluble fibre called beta-glucan which can help regulate cholesterol.

Noodles

This noodle dish is great for all the family and really easy to make. You can use whatever veg you have in the freezer. Perfect for lunch or dinner. This recipe uses chicken, but you could swap for oily fish, or a vegetarian alternative. Try not to use red or processed meat as these have links with heart problems and cancers. With fresh vegetables difficult to get hold of, don’t overlook any veg that you might normally put in your compost bin, such as any that might be starting to wilt.

Bean stew

Try this bean stew for dinner. Any combination of beans and lentils would work for this recipe, just check the cooking instructions. If you can’t find tinned beans, see if dried ones are available and follow the instructions on the packet. This might make the stew slightly more time consuming to make, but cooking can be a great way to pass the time.

You can make use of the herbs and spices you have in the cupboard for this recipe. Paprika will work fine if you don’t have chilli, or use a pinch of thyme or rosemary in place of oregano. This recipe contains lots of fibre which can be helpful in managing diabetes as it doesn’t affect blood sugars levels too much. Slow cookers are great to make stews and soups and can help stretch out ingredients. If you don’t have one a casserole dish or saucepan should do the trick.

Thai chicken stir fry

This Thai chicken stir fry is another great dinner option. Stir fries are an ideal way to help you get your five-a-day, and you can add in whatever you have to hand. Ordinary onions will work fine for this recipe if you don’t have spring onions, and you could swap chicken out with pork, beef, prawns or salmon. The basil adds flavour, but isn’t essential to the dish.

Blackberry and apple cake

Looking for a fun activity to do with your kids? You could try baking this delicious blackberry and apple cake. You could even turn baking into a science and geography lesson with the kids, and look on the internet and find out why ingredients change when they are cooked or combined together and where the ingredients come from. Any berries would work for this recipe, fresh or frozen, or if you can’t find anything you could simply use extra apple. You could even use dried fruit if that’s what you’ve got to hand. This recipe contains minimal free sugars which can be helpful for managing blood sugars.

And the good news is that you can freeze most things. It’s useful to do this so you always have food to hand if canned or frozen food runs low in your local shop. It’s also a great way to make the most of your food, and your money. Get our tips on freezing food.

You’ve also been asking us about diabetes and alcohol too, like how it affects your blood sugars. Get all the facts about alcohol and diabetes.

You can also get regular food tips and advice arriving straight in your inbox with our monthly Enjoy Food newsletter.

Keeping active at home

Getting active has so many benefits if you have diabetes or if you’re at risk of type 2 diabetes. And physical and mental health often affect one another. While we’re stuck inside, we can still find ways to get active and keep moving that much more.

We’ve got lots of info on how exercise can affect blood sugars too, so you can keep an eye on any highs and lows. There isn’t one type of activity that’s best for everyone with diabetes. It’s about finding what works for you and depends on lots of things, like what you enjoy and how much room you have in your living room.

Getting active can be anything that gets you moving more and – even better – something that increases your heart rate.
How about:

• Hoovering the house and cleaning all the windows 
• A spot of DIY– time to tackle that shelf you’ve been putting off
• Gardening – if you have a garden. If you don’t, do you have any house plants you can water, prune and re-pot while standing up?

Pop some music on while you’re doing this, it can help you feel motivated and move that much more.
If you need to start off at an easier pace, try standing during a TV advert. If you can manage it, work towards standing for the whole advert break, then to walking on the spot during adverts. You can mix this up by doing stretches instead, or jogging on the spot while the ads are on. This will help you get your steps up.

Everyone’s different, and some people find video workouts helpful to keep them motivated and follow a routine.

There are lots to choose from, but the NHS fitness studio might be a good place to start. Whether you’re into aerobics, Pilates, even belly dancing – there are plenty of options for beginners and experts.

But remember to warm your body up first, try this warm-up video from the NHS.
Staying connected with others can help with both your physical and mental health. The online workouts we’ve suggested could be done with family and friends through a webcam or an App.

Checking your feet

Having diabetes means you’re more likely to develop problems with your feet. But if you take good care of your feet and check them every day, you can reduce your risk of developing foot problems. This is especially important when you’re not able to go to your foot care appointments.

Watch our Head of Care and Diabetes Specialist Nurse Dan show you exactly what to do when it comes to checking your feet at home.

https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/staying-home?utm_source=bronto&utm_medium=email&utm_term=READ+MORE&utm_content=READ+MORE&utm_campaign=Enewsletter+April+2020+-+pt+1

COVID-19 Risk Demonstrates Importance of Keeping Diabetes Under Control

From ajmc.com

According to the CDC, individuals with diabetes may experience more serious complications from the novel coronavirus (COVID-19) than the general population

As the novel 2019 coronavirus (COVID-19) continues to spread, social distancing remains a vital mitigation practice, ensuring those over age 65 or with serious chronic medical conditions have limited chances of contracting the virus. Diabetes is one of the most prevalent pre-existing conditions in the country, with over 34.2 million Americans, including 14.3 million seniors, living with the disease in 2018.

The CDC has classified individuals with conditions like diabetes as being at higher risk of experiencing complications from COVID-19 than the general population. Citing the International Diabetes Federation, Kenneth Moritsugu, MD, chief medical officer of the American Diabetes Association (ADA), explained what exactly it means to be in a ‘high risk category.’

“Those of us who live with diabetes…are challenged every day. When we become ill, we are really ill-equipped to respond as well as somebody who is healthy, without diabetes. That challenge makes an infection with COVID-19 even more dangerous to our health and well-being,” said Moritsugu in a video published by the ADA.

It is still unknown whether there is a difference in risk among type 1 and type 2 patients. However, age, additional comorbidities, and management of the disease all play important roles when assessing complication risks.

In addition, there is currently not enough data to conclude whether individuals with diabetes are more likely to contract the virus in general.

“In China, where most cases have occurred so far, people with diabetes had much higher rates of serious complications and death than people without diabetes—and generally we believe that the more health conditions someone has (for example, diabetes and heart disease), the higher their chance of getting serious complications from COVID-19,” the ADA website states.

Along with practicing social distancing, responsible management of diabetes remains imperative. If individuals with diabetes effectively manage their condition, the risk of getting severely sick from COVID-19 is about the same as the general population.

Fluctuating blood sugar, a result of ill-managed diabetes, generally increases the risk of diabetes-related complications. “Having heart disease or other complications in addition to diabetes could worsen the chance of getting seriously ill from COVID-19, like other viral infections, because your body’s ability to fight off an infection is compromised,” the ADA website reads.

Viral infections can lead to increased inflammation and increased risk of diabetic ketoacidosis (DKA) among people with type 1 diabetes.

Ensuring medications are refilled, washing hands, not touching one’s face, and staying at home are steps individuals with diabetes can take to help mitigate the spread of COVID-19, and aid in effectively managing their diabetes throughout the pandemic.

Keeping sufficient supplies of oral drugs to manage blood sugar, insulin, and any related supplies such as syringes or pens, insulin pump supplies, pen needles, glucose strips, lancets, alcohol swabs, ketone strips, glucagon on hand, will help individuals and caretakers restrict trips to public spaces, according to Diatribe, a diabetes advocacy platform. The website also offers additional information on refilling prescriptions and how insurance companies have responded to the outbreak.

At this time, leading manufacturers report the pandemic has not impacted manufacturing and distribution of insulin. If individuals are struggling to afford insulin, they can visit InsulinHelp.org. The Juvenile Diabetes Research Foundation (JDRF) also lists suppliers’ public statements regarding supply chains on their website.

Healthy family members living in a household with individuals with diabetes should “conduct themselves as if they were a significant risk to [individuals with diabetes],” the ADA notes. This includes washing hands before interacting with family members with diabetes, cleaning all utensils and surfaces regularly, and, if possible, making a protected space for family members with diabetes.

“If a member of your household is sick, be sure to give them their own room, if possible, and keep the door closed. Have only one family member care for them and consider providing additional protections or more intensive care for household members over 65 years old or with underlying health conditions,” the ADA advises.

https://www.ajmc.com/focus-of-the-week/covid19-risk-demonstrates-importance-of-keeping-diabetes-under-control-

Recommendations For Patients with Diabetes During COVID-19 Outbreak (USA)

From uknow.uky.edu

LEXINGTON, Ky. (March 23, 2020) - The Centres for Disease Control and Prevention (CDC) report that some people are at higher risk of becoming very sick from COVID-19, which may include people with diabetes.

People with diabetes can be more susceptible to – and can become sicker if infected with – any virus. During this outbreak of COVID-19, it is important to be calm and make smart choices; that includes being well-prepared and watchful.

The good news is that for those who have diabetes, recommendations from the CDC for staying healthy are the same for COVID-19 as anyone else. If you have diabetes, the most important thing you can do should you become ill is have a plan. Here, Barnstable Brown Diabetes Centre Medical Director Dr. Kristen Stakelin and Daniel Stinnett with the Barnstable Brown Diabetes Education Team and Bluegrass Care Clinic provide some tips and information for patients with diabetes during the COVID-19 crisis.

Planning ahead is the best practice.

Here are some things you can do to keep yourself healthy:

• Wash your hands often and avoid touching your face excessively.
• Social distance as much as possible to decrease your exposure.
• Have enough of your medication (and other essentials) at home to be able to stay in for several weeks. This is especially true for insulin.
  
  • Here in Kentucky, Governor Andy Beshear has signed an executive order allowing pharmacies to refill prescriptions for up to 30 days to ensure everyone has access to needed prescriptions.

Make a plan for sick days. If you become ill, you will need to:

• Test blood glucose several times a day while sick. Call your healthcare provider if your numbers are much higher or lower than normal.
• Stay well hydrated with water.
• Make sure you have tissues, medications to lower fever, a thermometer and plenty of test strips – along with your diabetes medications.
  
  • Simple sources of carbohydrates such as glucose tablets, juice, regular cola, honey, jam, hard candies or regular gelatin in case you are too sick to eat.
• Call your healthcare provider if you have a fever over 100.4
• 
  
• Seek emergency help if:  
• You are short of breath.
• You experience chest pain unrelated to sore muscles from coughing.
• You cannot stay awake very well.
• You have severely low blood glucose levels.
• 
  
• Other resources:
• 
  
• UK HealthCare Questions and Answers about COVID-19: https://ukhealthcare.uky.edu/about/questions-answers-covid-19-coronavirus
  Lexington Coronavirus – COVID-19 Page: https://www.lexingtonky.gov/coronavirus-response
  State Updates: www.kycovid19.ky.gov
  State COVID-19 Hotline: 1-800-722-5725
  
  
• https://uknow.uky.edu/uk-healthcare/recommendations-patients-diabetes-during-covid-19-outbreak

Have diabetes? Here’s what you should know during the coronavirus pandemic

From channel3000.com
By Bram Sable-Smith of Wisconsin Public Radio/ Wisconsin Watch

People with diabetes often hear that they face higher risks of severe complications from COVID-19, the disease associated with the coronavirus. But why? And what precautions should they take?
Wisconsin Public Radio and Wisconsin Watch compiled your questions and sought answers from Dr. Dawn Davis. She is director of the Comprehensive Diabetes Center at the University of Wisconsin-Madison and Section Chief for Endocrinology at the William S. Middleton Memorial Veterans Hospital in Madison.
Davis offered her insight while cooped up in her “crazy-crowded house” — with her husband, three children, two cats, one dog, many fish and two European houseguests who “won’t be going home any time soon.”

Dr. Dawn Davis is the director of the Comprehensive Diabetes Center at the University of Wisconsin—Madison and Section Chief for Endocrinology at the William S. Middleton Memorial Veterans Hospital in Madison.

Q: By far the most common question we heard: “If I have diabetes, am I more susceptible to contracting the virus or more susceptible to worse outcomes? Or is it both?”
Davis: Unfortunately there’s still a lot that we don’t know about this virus, because it’s so new, and there are not a lot of published, well-controlled studies about it yet.
Researchers in China who dealt with the outbreak published a paper suggesting an increased risk of the severity of outcomes in patients who had diabetes. They saw more hospitalization, ICU care and overall mortality in patients who had diabetes.
It’s hard to know if those patients were already in the hospital and more exposed to the virus, or if they would have had a higher risk of problems had they been living in the community and been exposed to the virus. There’s a lot we just don’t know.
But our advice to people with diabetes is, yes, they should consider themselves at higher risk of more severe outcomes if they contract the virus. Avoiding getting it is the goal.

Q: What makes someone with diabetes potentially more susceptible to a viral infection?
Davis: Globally, we know diabetes patients are more susceptible to infections and tend to have more severe outcomes during other viral infections and outbreaks. That includes H1N1 influenza, and even seasonal influenza.
One big reason: There’s an impact on the immune system in patients who have diabetes. They may have increased baseline inflammation, and they also may be unable to mount a response to an infection as robustly as other patients.
In addition — especially with Type 2 diabetes — diabetes comes along with multiple other medical problems, including heart disease and high blood pressure. All of those things can contribute to poor outcomes if patients get an infection.

Q: Parents of children with diabetes asked us this question: Children are said to have a lower risk of developing a serious illness from coronavirus. Is that true even with children who have diabetes?
Davis:  We don’t know the answer to that question for this particular illness. Children certainly do seem to be somewhat more protected in the case of (COVID-19). That hasn’t been the case for other viral outbreaks. So there’s something a little bit unique about how this virus impacts children.
However, it’s not impossible for children to be infected or to have severe outcomes from coronavirus. It’s certainly not something to be blasé about.
And yes, Type 1 diabetes may slightly increase the risk of worse outcomes for infected children. It’s probably a lower risk than for an adult — certainly for an older adult.

Q: What precautions should people with diabetes be taking?
Davis: They should follow all recommendations to minimize their social contacts. That includes trying to stay home and avoiding other public places and people as much as possible.
We here at University of Wisconsin-Health and the VA are working hard to minimize the number of patients coming into our facilities. We’re converting a lot of patients to telephone visits or virtual visits if we can. If you have a routine visit scheduled, contact your provider about rescheduling or holding it over the phone.
We want to make sure patients are still getting care. I don’t want people just canceling their appointments.

Q: Are there any supplies or medicines that people should stock up on?
Davis: We don’t want to encourage people to advance-order tons of excess supplies. That could decrease the availability of supplies for people who need a standard refill or need to renew their supplies.
But now is a good time for patients to take stock of what they have in-house. They should have a 30- to 90-day supply.

Converting prescriptions to 90-day supplies is a good idea. It’s also a good idea to set up mail-order prescriptions — to avoid having to go to pharmacies, which may not remain open all the time.
Patients should also assess whether they have appropriate backup supplies. For example: We want our patients who use insulin pumps to have a backup supply of insulin if they needed injections.
We always have these guidelines for our patients, but now is a good time for everybody to make sure they’re thinking about those things and following up with their providers.

Q: People with diabetes say they are frustrated that they can’t get insurance companies to approve a 90-day supply of insulin. What should those patients do? 
Davis: That’s a real issue for a lot of people — not just with insulin, but with diabetic test strips and all kinds of things.
We don’t have any reason to anticipate a major shortage or supply chain issues. So I don’t know that we need to panic about not having a 90-day supply. If your insurance only allows the 30-day supply, you don’t have a ton of options — other than asking your insurer to waive their limit.
My advice is to continue to reach out to your providers if you are concerned.
That’s the other advantage of setting up mail-order prescriptions. By automating the process, you won’t have to worry about your local pharmacy running out of stock.

Q: For people with diabetes living in an area with community spread of coronavirus, is it safe to take your dog for a walk?
Davis: I’m not an infectious disease expert, and I’m not part of the public health team. But from what I understand from current guidance: Yes, if you go outdoors that is perfectly fine.
Again, limit your contact with other people. So don’t go to a crowded dog park or talk to five different people at close range.
We encourage people to do that as much as possible, because we want people to get a little bit of exercise — get a little bit of activity and break up the boredom and depression of sitting in your house all day.

Q: What else do you want people to know?
Davis: Patients who have diabetes — and particularly patients who have diabetes and other medical problems — need to be strict about social distancing and isolation to keep themselves safe.
That doesn’t mean that their medical providers don’t want to hear from them. We are all a bit overwhelmed with phone calls, and there might be some delays, but checking in and asking questions is the right way to go.

We’ll all get through this together.

https://www.channel3000.com/have-diabetes-heres-what-you-should-know-during-the-coronavirus-pandemic/

Type 2 diabetes: Add this supplement to your diet to lower blood sugar

From express.co.uk

TYPE 2 diabetes is a chronic condition that requires careful monitoring to ward off the threats posed by rising blood sugar levels. The most effective weapon against high blood sugar levels is following a healthy diet, and evidence suggests including an essential mineral in your diet can have a pronounced effect on blood sugar levels.

Type 2 diabetes is a condition whereby your pancreas doesn't produce enough insulin to regulate blood sugar levels. Blood sugar is the main sugar found in blood and is an important source of energy and nutrients for the body. The pancreas usually aids the absorption and storage of blood sugar so when the pancreas is out of action, blood sugar levels rise uncontrollably.

Over time, high blood sugar can inflict damage on your heart, eyes, kidneys, nerves, and blood vessels, so it is imperative to keep it in check.
To compensate for a faulty pancreas, you must modify aspects of your lifestyle to regulate blood sugar.

Diet forms an essential component of blood sugar management.
Research investigating the impact of certain dietary decisions on insulin resistance and blood sugar levels shows that certain items can improve these impaired mechanisms.

For example, chromium picolinate, a nutritional supplement containing the essential mineral chromium, has been shown to have a marked impact on diabetes management.
Several studies have indicated that taking chromium supplements can improve blood sugar for those with diabetes. One study found that 16 weeks of 200 μg/day of chromium was able to lower blood sugar and insulin while improving the body’s response to insulin.

Other research has shown that those with higher blood sugar and lower insulin sensitivity may respond better to chromium supplements.

Additionally, in a large study of over 62,000 adults, the likelihood of having diabetes was 27 percent lower in those who took dietary supplements containing chromium.
According to an Associate Professor of Medicine at University of Vermont, “prior human studies have suggested that chromium picolinate decreases insulin levels and improves blood sugar metabolism in both obese people and people with type 2 diabetes".

Echoing this positive assessment, Richard Anderson, of the US Department of Agriculture, said: “Essentially all the studies using chromium picolinate supplementation for impaired glucose intolerance and diabetes showed a positive effect.”

It is important to note that you should not rely on a single supplement to help regulate your blood sugar. Rather it is your overall dietary approach that will determine how effectively you govern your blood sugar levels.

The general consensus among health bodies is that a diet high in carbohydrates is to be avoided if you are trying to manage your blood sugar levels.

Carbohydrate is broken down into glucose relatively quickly and therefore has a more pronounced effect on blood sugar levels than either fat or protein.

A useful way to distinguish between high carb and low carb foods is to follow the Glycaemic Index (GI). The GI is a relative ranking of carbohydrate in foods according to how they affect blood glucose levels.

https://www.express.co.uk/life-style/health/1258533/type-2-diabetes-symptoms-diet-chromium-picolinate-lower-blood-sugar

A Doctor's Tips for Diabetes Patients During the COVID-19 Outbreak

From blogs.webmd.com
By Brunilda Nazario, MD
Board-certified internist and endocrinologist

If you have diabetes, the coronavirus outbreak probably feels like a rollercoaster of uncertainty. Right now, being prepared and reaching out is critical.

Speak to your doctor about maintaining a care plan with your diabetes team. Do they/will they offer telemedicine visits? Managing your diabetes and controlling your blood sugar is important for keeping your immune system at its best.

To prepare, here’s what I recommend:

• Monitor your diabetes even more closely than usual. During stress, it makes sense to monitor your blood sugars more often.
• Have extra meds. Ask your doctor or pharmacist for refills now. This may be out of sync with your insurance coverage and you may need to pay out-of-pocket but chose generics like old-fashion insulin vials and syringes. Have one extra week of supplies in case you get sick. If you can’t go out, have them delivered or reach out to a neighbour to help.
• Stay connected. Our community helps us thrive. Use Facetime, Zoom, or just your phone to connect during this crisis. 
• Stock up. Make sure to have plenty of canned and frozen fruits and vegetables on hand. Before using, rinse them thoroughly before using since they have excess salt or sugar, which can throw a monkey wrench in your diabetes management.
• Don't forget carbs. Have simple carbs available – regular soda, honey, jam, Jell-O, hard candies or popsicles help keep your blood sugar up if you are at risk for lows or too ill to eat.
• Be creative with your meals. It's never too late to experiment in the kitchen with diabetes-friendly recipes. American Diabetes Association has plenty of heart and diabetes recipes.
• Exercise daily. While you may not be able to keep your regular routine of going to the gym, you do need to keep exercising. It’s a must for managing blood sugars and decreasing stress. So, set up a corner of your home with equipment, mats, video, etc. Now’s a great time to try a new workout app.
• Get plenty of sleep. To set yourself for a good night’s rest, practice mediation, prayer, and optimism – AND place a curfew on the internet and news. At a certain time in the evening, start dimming the lights in your home and put away screens.
• Stay up to date. Information changes rapidly. Check your local /state authorities on recent changes in your community.

https://blogs.webmd.com/webmd-doctors/20200320/a-doctors-tips-for-diabetes-patients-during-the-covid-19-outbreak

Coronavirus (COVID-19) – advice for people living with diabetes

From diabetes.org.uk

UPDATED 20 MARCH: This page is currently up-to-date, and based on the most recent guidance available. We’ll continue updating this page to share with new guidance as it is released.

Coronavirus (COVID-19) advice for people living with diabetes and their families

If you have diabetes, you are at increased risk of severe illness from coronavirus (COVID-19) and according to current government guidance you should be particularly stringent in following social distancing measures, including significantly limiting face-to-face interaction with friends and family if possible.

How to avoid coronavirus (social distancing)

1. Avoid contact with someone who is displaying symptoms of coronavirus (COVID-19). These symptoms include high temperature and/or a new and continuous cough.
2. Wash your hands regularly for 20 seconds, each time using soap and water, or use hand sanitiser. 
3. Avoid non-essential use of public transport, varying your travel times to avoid rush hour, when possible.
4. Work from home, where possible. Your employer should support you to do this. Please refer to gov.uk guidance for employers for more information.
5. Avoid large gatherings, and gatherings in smaller public spaces such as pubs, cinemas, restaurants, theatres, bars or clubs.
6. Avoid gatherings with friends and family. Keep in touch using remote technology instead, such as phone, internet, and social media.
7. Use telephone or online services to contact your GP practice or other essential services.

Symptoms of coronavirus

The most common symptoms of coronavirus (COVID-19) are recent onset of a:

• new continuous cough and/or
• high temperature.

What to do if you have coronavirus symptoms

If you have coronavirus symptoms, however mild:

• Do not go to a GP surgery, pharmacy or hospital.
• If you live alone, stay at home for 7 days from when your symptoms started. 
• If you live with others and you or one of them have symptoms of coronavirus, then all household members must stay at home and not leave the house for 14 days. The 14-day period starts from the day when the first person in the house became ill. 
• Follow the advice of your GP practice, practice nurse or diabetes team regarding your medication.
• If you routinely check your blood sugar at home you'll probably need to do it more often.
• If you don't check your blood sugar levels at home, be aware of the signs of a hyper (hyperglycaemia), which include passing more urine than normal (especially at night), being very thirsty, headaches, tiredness and lethargy. You should contact your GP practice if you have hyper symptoms. 
• Stay hydrated – have plenty of unsweetened drinks and eat little and often.
• If you have type 1 diabetes, check your blood sugar at least every four hours, including during the night, and check your ketones if your blood sugar level is high (generally 15mmol/l or more, or 13mmol/l if you use an insulin pump, but your team may have given you different targets). If ketones are present, contact your diabetes team.
• Keep eating or drinking – if you can’t keep food down, try snacks or drinks with carbohydrates in to give you energy. Try to sip sugary drinks (such as fruit juice or non-diet cola or lemonade) or suck on glucose tablets or sweets like jelly beans. Letting fizzy drinks go flat may help keep them down. If you're vomiting, or not able to keep fluids down, get medical help as soon as possible.

If you feel you cannot cope with your symptoms at home, or your condition gets worse, or your symptoms do not get better after 7 days, then use the NHS 111 online coronavirus service. If you do not have internet access, call NHS 111. For a medical emergency, dial 999.

If you have hospital and GP appointments during this period

Do not go to a GP surgery, pharmacy or hospital if you have coronavirus symptoms even if you have an appointment.

For those who don't have symptoms and want to attend their appointments, the NHS advises everyone to access medical assistance remotely, wherever possible. However, if you have a scheduled hospital or other medical appointment during this period, talk to your GP practice or clinician to ensure you continue to receive the care you need and consider whether appointments can be postponed.

If you miss your annual diabetes review where your 15 healthcare essentials are checked, you should be able to reschedule once normal service resumes. It's ok to miss things such as your eye screening and routine foot checks in these circumstances. But in the meantime, follow your current routine including checking your feet daily, keep to a healthy diet and try to keep active.

If you or your family need to seek medical advice

Seek prompt medical attention if your illness or the illness in any household members is worsening. If it’s not an emergency, go online to use NHS 111. If you have no internet access, you should call NHS 111. If it is an emergency and you need to call an ambulance, dial 999 and inform the call handler or operator that you or your relative have coronavirus symptoms.

All routine medical and dental appointments should usually be cancelled whilst you and the family are staying at home. If you are concerned or have been asked to attend in person within the period you are home isolating, discuss this with your medical contact first (for example, your GP practice, local hospital or outpatient service), using the number they have provided. If your concerns are related to your coronavirus symptoms contact NHS 111 online. If you have no internet access, you should call NHS 111.

Visit the gov.uk website for more information on COVID-19: guidance for households with possible coronavirus infection.

If one of your healthcare team is diagnosed with coronavirus

If your clinician is diagnosed with coronavirus and you have not seen them recently, then you are unlikely to have been exposed to coronavirus. The risk associated with any healthcare workers who become infected with coronavirus is assessed on a case by case basis and appropriate action taken. You should follow the advice given to you if you are contacted because you have been exposed to coronavirus in this way.

Coronavirus and your emotional wellbeing

You might be feeling worried and anxious about coronavirus and how it might affect you or your family and friends. We know this could be a stressful time, so you may need support with how you’re feeling.
We have some helpful information to help you cope with stress and other emotions, or you might like to call our helpline to talk it through with someone. We also have a useful coronavirus thread on our online forum, where members are sharing information and experiences so you might find answers to any more questions.

How coronavirus can affect people with diabetes

Coronaviruses can cause more severe symptoms and complications in people with diabetes, as well as in older people and those with other long-term conditions, such as cancer or chronic lung disease.
Everyone with diabetes, including those with type 1 and type 2, is more at risk of a severe complications if they develop coronavirus, but the way it affects you can vary depending on what type of diabetes you have.

When you have diabetes, being ill can make your blood sugar go all over the place. Your body tries to fight the illness by releasing stored glucose (sugar) into your blood stream to give you energy. But your body can’t produce insulin to cope with this, so your blood sugars rise.
Your body is working overtime to fight the illness, making it harder to manage your diabetes. This means you’re more at risk of having serious blood sugar highs and lows, as well as longer-term problems with your eyes, feet and other areas of your body.

For most people, coronavirus is a mild illness, but some people develop a more serious form of the virus, and could die.
It is important that people with diabetes follow the sick day rules should they become ill from any illness. If you routinely check your blood sugar at home, you'll probably need to do it more often – at least every four hours, including during the night.
If your blood sugar is persistently high or low, or if you have symptoms of a hyper contact your GP practice or diabetes team by phone who will help you if you have any queries or if you are unsure about what to do regarding your diabetes.

Children with diabetes

Everyone, including children with diabetes can get coronavirus. NHS guidance states that anyone under 70 with an underlying health condition, including diabetes, is at increased risk of severe illness from coronavirus and should be particularly stringent in following social distancing measures.

If you are pregnant

The same rules apply to you as for everyone with diabetes. If you’re pregnant and have diabetes, then you are more at risk of getting the virus. This is because you’re more vulnerable to getting infections and illnesses. It's really important you follow the government advice and limit face-to-face interaction as much as possible.
If you’re worried about things like going to your antenatal appointments, you can find all the latest information about this and more from the Royal College of Obstetricians and Gynaecologists.

If you are in type 2 diabetes remission

Diabetes remission works differently for different people, and we still don't know enough about it. So we don't know for sure what your risk of developing the virus is and given that you have had a diagnosis of diabetes in the past, you remain at risk.

Work and coronavirus 

Current government guidance is that employees of all ages with diabetes, including those under 70, should be strongly advised – and supported by employers – to stay at home and work from there if possible. And those people with diabetes who follow advice to stay at home and who cannot work as a result will be able to get statutory sick pay (SSP), even if they are not sick.
Take a look at gov.uk employer guidance for more information.
For more general information and support about your rights at work, see our guide to work and diabetes.

Travel advice

We know lots of people are worrying about holidays they’ve booked and whether they’re more at risk if they do travel. We’ve also had questions about whether it’s safe to see friends or family who have travelled from affected areas.
The Foreign Office has the most up-to-date information. As of 17th March, they are advising British nationals against all but essential international travel. Any country or area may restrict travel without notice.

If you look after or live with someone who has diabetes

We recommend everyone follows the NHS advice around reducing the risk of picking up infections including thoroughly washing your hands frequently, practicing good hygiene and avoiding contact with people who are unwell.
If you live with someone who has a continuous cough or a high temperature, you should stay at home for 14 days from the day the first person got symptoms. If you then develop symptoms, you should stay at home for 7 days from the day your symptoms start, even if it means you're at home for longer than 14 days.
If you have been in close contact with someone with confirmed coronavirus, use the NHS 111 online coronavirus service.

https://www.diabetes.org.uk/about_us/news/coronavirus?utm_source=bronto&utm_medium=email&utm_term=https://www.diabetes.org.uk/coronavirus&utm_content=https://www.diabetes.org.uk/coronavirus&utm_campaign=Coronavirus+update+18+March+2020

Diabetes And The Coronavirus: An Endocrinologist Answers Your Questions

From wpr.org

Practicing Social Distancing, Getting A 90-Day Supply Of Medications, Among Recommendations For Diabetes Patients

People with diabetes often hear that they face higher risks of severe complications from COVID-19, the disease associated with the novel coronavirus. But why? And what precautions should they take? 

Wisconsin Public Radio and Wisconsin Watch compiled your questions and sought answers from Dr. Dawn Davis. She is director of the Comprehensive Diabetes Centre at the University of Wisconsin-Madison and section chief for Endocrinology at the William S. Middleton Memorial Veterans Hospital in Madison.
Davis offered her insight while cooped up in her "crazy-crowded house" — with her husband, three children, two cats, one dog, many fish and two European houseguests who "won’t be going home any time soon."

This transcript has been edited for brevity and clarity.

Q: By far the most common question we heard: If I have diabetes, am I more susceptible to contracting the virus or more susceptible to worse outcomes? Or is it both?
Dr. Dawn Davis: Unfortunately there's still a lot that we don't know about this virus, because it's so new, and there are not a lot of published, well-controlled studies about it yet.
Researchers in China who dealt with the outbreak published a paper suggesting an increased risk of the severity of outcomes in patients who had diabetes. They saw more hospitalization, ICU care and overall mortality in patients who had diabetes.
It’s hard to know if those patients were already in the hospital and more exposed to the virus, or if they would have had a higher risk of problems had they been living in the community and been exposed to the virus. There’s a lot we just don't know.
But our advice to people with diabetes is, yes, they should consider themselves at higher risk of more severe outcomes if they contract the virus. Avoiding getting it is the goal.

Q: What makes someone with diabetes potentially more susceptible to a viral infection?
DD: Globally, we know diabetes patients are more susceptible to infections and tend to have more severe outcomes during other viral infections and outbreaks. That includes H1N1 influenza, and even seasonal influenza.
One big reason: There's an impact on the immune system in patients who have diabetes. They may have increased baseline inflammation, and they also may be unable to mount a response to an infection as robustly as other patients.
In addition — especially with Type 2 diabetes — diabetes comes along with multiple other medical problems, including heart disease and high blood pressure. All of those things can contribute to poor outcomes if patients get an infection.

Q: Parents of children with diabetes asked us this question: Children are said to have a lower risk of developing a serious illness from coronavirus. Is that true even with children who have diabetes?
DD:  We don't know the answer to that question for this particular illness. Children certainly do seem to be somewhat more protected in the case of (COVID-19). That hasn't been the case for other viral outbreaks. So there's something a little bit unique about how this virus impacts children.
However, it’s not impossible for children to be infected or to have severe outcomes from coronavirus. It's certainly not something to be blasé about.
And yes, Type 1 diabetes may slightly increase the risk of worse outcomes for infected children. It’s probably a lower risk than for an adult — certainly for an older adult.

Q: What precautions should people with diabetes be taking?
DD: They should follow all recommendations to minimize their social contacts. That includes trying to stay home and avoiding other public places and people as much as possible.
We here at University of Wisconsin-Health and the VA are working hard to minimize the number of patients coming into our facilities. We're converting a lot of patients to telephone visits or virtual visits if we can. If you have a routine visit scheduled, contact your provider about rescheduling or holding it over the phone.
We want to make sure patients are still getting care. I don't want people just cancelling their appointments.

Q: Are there any supplies or medicines that people should stock up on?
DD: We don't want to encourage people to advance-order tons of excess supplies. That could decrease the availability of supplies for people who need a standard refill or need to renew their supplies.
But now is a good time for patients to take stock of what they have in-house. They should have a 30- to 90-day supply.
Converting prescriptions to 90-day supplies is a good idea. It’s also a good idea to set up mail-order prescriptions — to avoid having to go to pharmacies, which may not remain open all the time.
Patients should also assess whether they have appropriate backup supplies. For example: We want our patients who use insulin pumps to have a backup supply of insulin if they needed injections.
We always have these guidelines for our patients, but now is a good time for everybody to make sure they're thinking about those things and following up with their providers.

Q: People with diabetes say they are frustrated that they can’t get insurance companies to approve a 90-day supply of insulin. What should those patients do? 
DD: That's a real issue for a lot of people — not just with insulin, but with diabetic test strips and all kinds of things.
We don't have any reason to anticipate a major shortage or supply chain issues. So I don't know that we need to panic about not having a 90-day supply. If your insurance only allows the 30-day supply, you don't have a ton of options — other than asking your insurer to waive their limit. 
My advice is to continue to reach out to your providers if you are concerned.
That's the other advantage of setting up mail-order prescriptions. By automating the process, you won’t have to worry about your local pharmacy running out of stock.

Q: For people with diabetes living in an area with community spread of coronavirus, is it safe to take your dog for a walk?
DD: I'm not an infectious disease expert, and I'm not part of the public health team. But from what I understand from current guidance: Yes, if you go outdoors that is perfectly fine.
Again, limit your contact with other people. So don't go to a crowded dog park or talk to five different people at close range.
We encourage people to do that as much as possible, because we want people to get a little bit of exercise — get a little bit of activity and break up the boredom and depression of sitting in your house all day.

Q: What else do you want people to know?
DD: Patients who have diabetes — and particularly patients who have diabetes and other medical problems — need to be strict about social distancing and isolation to keep themselves safe.
That doesn't mean that their medical providers don't want to hear from them. We are all a bit overwhelmed with phone calls, and there might be some delays, but checking in and asking questions is the right way to go.
We'll all get through this together.

https://www.wpr.org/diabetes-and-coronavirus-endocrinologist-answers-your-questions

Vegan Tips to Prevent, Reverse, and Manage Diabetes

From vegnews.com

Spoiler alert: you don’t have to fear fruit or carbs

We all know someone who is affected by diabetes—it could be your aunt with type 2, your brother with type 1, a prediabetic friend, or even yourself. It is commonly accepted that there is no cure—merely management—particularly for type 1. However, the founders of the Mastering Diabetes program (and recently released book by the same name) think differently. Both type 1 diabetics, Robby Barbaro, MPH, and Cyrus Khambatta, PhD, have done the research and the work to help others gain healthy independence from their diagnosis—no matter what form. Khambatta sat down with us to offer their best practices to prevent, reverse, and manage diabetes on a plant-based diet. 

VegNews: What is diabetes?
Cyrus Khambatta: The term “diabetes” is given to a collection of conditions that are all characterized by elevated blood glucose values. There are many types of diabetes including type 1, type 1.5, type 2, prediabetes, and gestational diabetes.

VN: Can you break down these different types?
CK: Both type 1 and 1.5 are autoimmune conditions that can destroy insulin-producing beta cells. This results in the need to inject insulin by way of a needle or pump. The difference is that type 1.5 only occurs in adults over 30, whereas type 1 can be diagnosed regardless of age.
Prediabetes acts as a warning sign for type 2 diabetes—it occurs when your muscles and liver have become resistant to insulin, resulting in a minor “traffic jam” of both glucose and insulin in your blood that slightly elevates your fasting blood glucose. Finally, gestational diabetes is a version of diabetes that affects pregnant women and usually disappears after giving birth. 

VN: Once diagnosed, is diabetes a disease someone has to manage for life?CK: Not necessarily. Prediabetes, type 2, and gestational diabetes can be reversed (or even prevented) using plant-based food as medicine.

VN: Your program advocates for carbohydrate-rich whole foods, but we’ve heard diabetics should avoid carbs. Can you explain? CK: The “controversial” aspect of whole-food nutrition is that carbohydrate-rich foods are actually some of the most nutrient-dense foods on the planet and are excellent choices for people with all forms of diabetes. Carbohydrate-rich foods are easy to metabolize when your total fat intake is kept low (especially saturated fat). When you’re consistently eating a maximum of 15 percent of your total calories as fat, your body’s ability to metabolize whole carbohydrate-rich foods will increase over time, allowing you to eat larger quantities of carbohydrate-rich foods while maintaining excellent blood glucose control.

VN: What are a few foods you’d consider essential or highly advantageous for those with diabetes?CK: There are so many! Just off the bat: fruit (bananas, mangoes, oranges), starchy vegetables (potatoes and butternut squash), legumes (beans, lentils, peas), intact whole grains (brown rice, quinoa, farro), non-starchy vegetables (broccoli, cucumbers, tomatoes), leafy greens, fresh or dried herbs and spices, and a variety of mushrooms.

VN: What are a few recipes readers should start with from your new book?CK: I’ll give you a little bit sweet and a little bit savory: Nature’s Candy Bowl, Chickpea Scramble (I promise it’s the best scramble you’ll ever have), and the Hearty Sweet Potato and Squash Soup (it’s so good I crave it even when it’s horribly humid in my home of Costa Rica).

VN: In the age of Vegan Everything, do you think “junk food vegans” are at risk for becoming diabetic? How can we prevent the onset of type 2 or prediabetes and still enjoy a few scoops of our favourite non-dairy ice cream?CK: In today’s world with vegan foods readily available, we believe that many people will actually become unhealthier even though they are trying to eat healthier. While eating processed vegan foods is a step in the right direction, optimal health is attained by eating a whole-food, plant-based diet that focuses on eating from the produce section of the grocery store. However, we also believe in the 80/20 principle. If people simply ate 80 percent of their vegan diet from whole foods and only 20 percent of their diet from processed food, then they would likely become healthier people and also develop a sustainable eating pattern that would last for many years.

Tanya Flink is a Digital Editor at VegNews as well as a writer and runner living in Orange County, CA.

https://vegnews.com/2020/3/vegan-tips-to-prevent-reverse-and-manage-diabetes

Why is coronavirus more dangerous for people with diabetes?

From sacbee.com

People with diabetes have a higher risk for complications from coronavirus, medical experts say.
Those with serious medical conditions, including diabetes, have an increased risk of getting sicker from COVID-19, according to the Centres for Disease Control and Prevention.

Read more here: https://www.sacbee.com/news/coronavirus/article241276626.html#storylink=cpy

It can be harder to treat a viral infection for people with diabetes because of blood glucose level fluctuations and possible diabetes complications, according to the International Diabetes Federation.

“Firstly, the immune system is compromised, making it harder to fight the virus and likely leading to a longer recovery period,” the group wrote. “Secondly, the virus may thrive in an environment of elevated blood glucose.”
People with Type 1 diabetes, which is when the immune system attacks cells that make insulin, have a higher risk for diabetic ketoacidosis, USA Today reported.

Read more here: https://www.sacbee.com/news/coronavirus/article241276626.html#storylink=cpy

Diabetic ketoacidosis can hinder managing fluid intake and electrolyte levels, which is integral to managing sepsis, according to the American Diabetes Association. Septic shock and sepsis are serious complications experienced by some coronavirus patients, according to the organization.

People who had diabetes and got coronavirus have died at a 7% rate, compared with 0.9% for those who died without an underlying medical condition, according to the CDC. The death rates are based on 44,000 confirmed coronavirus cases in China.

To decrease your chances of getting sick, the CDC recommends keeping space between yourself and others, stocking up on supplies, avoiding crowds and those who are sick, washing hands often, and staying at home as much as possible.

Read more here: https://www.sacbee.com/news/coronavirus/article241276626.html#storylink=cpy

https://www.sacbee.com/news/coronavirus/article241276626.html

Read more here: https://www.sacbee.com/news/coronavirus/article241276626.html#storylink=cpy

Read more here: https://www.sacbee.com/news/coronavirus/article241276626.html#storylink=cpy

Read more here: https://www.sacbee.com/news/coronavirus/article241276626.html#storylink=cpy

Read more here: https://www.sacbee.com/news/coronavirus/article241276626.html#storylink=cpy

Read more here: https://www.sacbee.com/news/coronavirus/article241276626.html#storylink=cpy

Type 1 diabetes may be two conditions that need different treatments

From newscientist.com

Diabetes is generally thought to come in two forms: type 1 and type 2. But a study suggests type 1 diabetes could be two separate conditions, meaning there are more forms than we realised.

People with diabetes tend to have high blood sugar levels. This is because they either lack or don’t respond to insulin, a hormone that allows sugar to be taken up by our cells and either converted to energy or stored. Those who have type 1 diabetes develop it because their immune system attacks the cells in the pancreas that make insulin.

The age at which a person is diagnosed with type 1 diabetes seems to be linked to the severity of their symptoms. “A child diagnosed before the age of 5 is likely to have a more severe form of disease than someone over 30,” says Sarah Richardson at the University of Exeter, UK.

To find out why, Richardson and her colleagues looked at 32 pancreas samples from young people with diabetes who died in the 1950s. They found two distinct categories. In one, some pancreases didn’t appear to make insulin properly and experienced a stronger immune system attack.

In the other category, the pancreas samples contained fewer immune cells and there were also signs that they were better at making insulin. The immune attack appears totally different in these two categories, says Richardson.

Different categories

The researchers then looked at blood samples taken from 171 people who had been diagnosed with type 1 diabetes before they turned 30. They found the same pattern: people seemed to fall into one of the two categories, depending on how well their pancreases made insulin.

These categories seem to correspond with age. People whose type 1 diabetes involved poor insulin production and a stronger immune attack tended to be younger, says Richardson. Her team calls this group “endotype 1”. In the study, “pretty much everyone under the age of 7 falls into this category”, says Richardson.

People diagnosed when they were 13 or older tended to fall into the category made up of individuals whose pancreases had fewer immune cells, which the team calls “endotype 2”. Those aged between 7 and 12 when diagnosed could fall in either category.

At the moment, “the outcome is the same – they both need insulin – but they may have got there through a different pathway”, says Richardson. In future, she thinks the two types may do best with different treatments. People who have endotype 2 might benefit from treatment that preserves the pancreas cells that make insulin, but we don’t have any treatments like that yet.

At the moment, type 1 diabetes is treated with insulin, although researchers have been trialling new immunotherapies that kill the immune cells that attack the pancreas. So far, clinical trials in adults haven’t been promising. But the treatment might work better in younger children because immune cells seem to play more of a role in their disease, says Richardson.

In 2018, researchers based in Sweden and Finland classified almost 15,000 people with diabetes into one of five categories – not just two – based on their age, body mass index, blood sugar, and insulin production and sensitivity. Richardson and her team say one of the endotypes seems to align with one of these five categories, but the other doesn’t, which she says makes it possible there may be six types of diabetes.

https://www.newscientist.com/article/2237221-type-1-diabetes-may-be-two-conditions-that-need-different-treatments/

Coronavirus (COVID-19) – advice for people living with diabetes (UK)

From diabetes.org.uk

Updated 10th March - A number of you have been in touch looking for advice relating to the global Coronavirus (also known as COVID-19) outbreak. We have developed this detailed advice on coronavirus for people living with diabetes with NHS England and NHS Improvement, and Public Health England.

Specific advice on coronavirus for people living with diabetes

Coronaviruses can cause more severe symptoms and complications in people with diabetes, as well as in older people, and those with other long term conditions such as cancer or chronic lung disease.
If you have diabetes and you have symptoms such as a cough, high temperature and feeling short of breath, you need to continue taking your medication and call the NHS 111 phone service. For those who routinely monitor their blood glucose, on the advice of their clinical team, they should continue to do this more often.

If you have diabetes and have been travelling abroad, and you think you may have been exposed to Coronavirus, follow the most up-to-date advice on what to do which can be found on the NHS or government websites.

If you have diabetes and you become unwell for any reason, it’s important that you follow ‘sick day rules’.

Sick day rules

• Contact your GP, Practice Nurse or Diabetes team, who will help you if you have any queries or if you are unsure about what to do.
• Follow the advice of your GP, Practice Nurse or Diabetes team regarding your medication if you feel unwell.
• If you routinely check your blood sugar at home you'll probably need to do it more often. This will depend on your normal medications and how you use insulin.
• If you don't test your blood sugar levels at home, be aware of the signs of a hyper (hyperglycaemia); which include passing more urine than normal, especially at night; being very thirsty; headaches; tiredness and lethargy. If you have hyper symptoms contact your GP.
• Stay hydrated – have plenty of unsweetened drinks and eat little and often.
• If you have type 1 diabetes, check your blood sugar at least every four hours, including during the night, and check your ketones if your blood sugar level is high (generally 15mmol/l or more, or 13mmol/l if you use an insulin pump, but your team may have given you different targets). If ketones are present, contact your diabetes team.
• Keep eating or drinking – if you can’t keep food down, try snacks or drinks with carbohydrates in to give you energy. Try to sip sugary drinks (such as fruit juice or non-diet cola or lemonade) or suck on glucose tablets or sweets like jelly beans. Letting fizzy drinks go flat may help keep them down. If you're vomiting, or not able to keep fluids down, get medical help as soon as possible.

Attending routine appointments

People with diabetes should continue to attend their routine appointments as normal – unless they hear otherwise from their local GP practice, hospital or diabetes team.

Coronavirus Q&A

People living with diabetes

Question 1: Do I need to do anything differently to the general public living without diabetes in regard to coronavirus?
We recommend everyone follows the NHS advice around reducing the risk of picking up infections including thoroughly washing your hands frequently, practicing good hygiene and avoiding contact with people who are unwell.  
Coronaviruses can cause more severe symptoms and complications in people with diabetes, as well as in older people, and those with other long term conditions such as cancer or chronic lung disease.
If you are worried you might have been in contact with someone with confirmed coronavirus, call 111 (England, Wales and Scotland) or 0300 200 7885 (Northern Ireland). 

Question 2: The NHS website says the symptoms and complications of coronavirus can be worse in people with diabetes. Would I be more likely to die? 
Coronaviruses can cause more severe symptoms and complications in people with diabetes, as well as in older people, and those with other long term conditions such as cancer or chronic lung disease. The risk of death from coronavirus is quite low, and the majority of people with coronavirus will have a comparatively mild illness.
It is important that people with diabetes follow the sick day rules should they become ill from any illness. If you routinely check your blood sugar at home, you'll probably need to do it more often – at least every four hours, including during the night.

Question 3: What will happen to my diabetes appointments? Will they be postponed? Should I still go to hospital and GP appointments?
The NHS will continue to provide diabetes appointments as normal, therefore people with diabetes should continue to attend appointments as normal. In the event of any disruption you will be informed ahead of your appointment by your local GP practice or hospital.

Question 4: What are the symptoms likely to be?
The NHS outlines the common symptoms of coronavirus on its website. These symptoms are the same for people living with diabetes. Coronavirus can have serious effects on anyone who has a long term health condition or a weakened immune system. Follow advice on avoiding catching or spreading germs as above.
Get advice straight away if you are in contact with someone with confirmed coronavirus, or if you need medical help.

Question 5: What should I do if my clinician is diagnosed with coronavirus?
If your clinician is diagnosed with coronavirus and you have not seen them recently, then you are unlikely to have been exposed to coronavirus. The risk associated with any healthcare workers who become infected with coronavirus is assessed on a case by case basis and appropriate action taken. You should follow the advice given to you if you are contacted because you have been exposed to coronavirus in this way.

Question 6: Should I go to work / not see friends / not see friends who’ve travelled from affected areas?
We recommend everyone follows the NHS and government advice around reducing the risk of picking up infections, including following the latest guidance on avoiding crowded places if this becomes necessary, or coming into contact with the condition.
We recommend everyone follows the NHS and government advice about what to do if they are concerned they have come into contact with someone with the coronavirus.
The Foreign Office has the most up-to-date information about how different countries are affected.

Question 7: What if I have travel planned or a holiday booked to one of the affected areas – am I more at risk if I do travel?
The Foreign Office has the most up-to-date information about how different countries are affected.

Family, friends or carers of people living with diabetes

Question 8: I have been exposed to the virus and am a carer for someone with diabetes. What should I do?
We recommend everyone follows the NHS advice around reducing the risk of picking up infections including thoroughly washing your hands frequently, practicing good hygiene and avoiding contact with people who are unwell.
If you have been in close contact with someone with confirmed coronavirus, call 111 (England, Scotland and Wales) or 0300 200 7885 (Northern Ireland).
If you are advised by 111 staff or other medical professionals to self-isolate then this would include minimising close contact with others. 

Question 9: I am a carer to someone with diabetes. Should I be doing anything differently?
We recommend everyone follows the NHS advice on reducing the risk of picking up infections including thoroughly washing your hands frequently, practicing good hygiene and avoiding contact with people who are unwell.

The future

Question 10: If the pressure on the NHS grows, will my appointments be delayed, or will I have problems accessing my medication?
The NHS is continuing to provide diabetes appointments as normal. In the event of any disruption, clinicians will always make decisions to prioritise treatment for those most in need and in consultation with patients. Local health systems will also put in place contingency arrangements to best support patients. The NHS has conducted extensive work on supply chains to ensure a secure supply of necessary drugs.

The government action plan, issued on 3 March, says that if transmission of the virus becomes established in the UK population, the nature and scale of the response will change: “The chief focus will be to provide essential services, helping those most at risk to access the right treatment. This means that treatment and the requirement for medicines and other clinical countermeasures might start to increase, with the need to draw down on existing stockpiles of the most important medicines, medical devices and clinical consumables.”

https://www.diabetes.org.uk/about_us/news/coronavirus?utm_source=bronto&utm_medium=email&utm_term=Find+out+more&utm_content=Find+out+more&utm_campaign=Enewsletter+March+2020

For those with diabetes, vaccines are a must

From galvnews.com
By DRS. MEGAN BERMAN AND RICHARD RUPP

Chances are that you know someone with diabetes mellitus. It affects almost 10 percent of the population, and odds of having diabetes increase with age, with 1 in 4 people having diabetes after age 65. Diabetes mellitus, often referred to as “sugar diabetes” because of the inability to regulate blood sugar levels, results from the body not making enough insulin or not being able to use insulin properly.

Insulin is necessary to move sugar from the blood into cells to be used for energy. Without working insulin, blood sugar rises and damages the blood vessels and other body tissues leading to blindness, nerve disease, kidney failure, heart attacks and strokes.

What does this all have to do with vaccines? It turns out vaccines can play a major role in helping keep individuals with diabetes well.

Diabetes impairs the immune system and interferes with the ability of cells in the body to release chemicals that defend against germs. Additionally, the immune cells that gobble up bacteria or kill infected cells don’t work as well. Researchers have found that some of these issues result from high sugar levels but others don’t. Put another way, even a diabetic with excellent blood sugar control is still at increased risk of infection.

Besides the weakened immune system, diabetics have other problems leading to infection. Nerve damage keeps diabetics from sensing when they may become injured or develop pressure sores. Resulting cuts and ulcers heal slowly due to poor circulation. The open wounds provide easy entry for bacteria and fungi.

Bacteria grow faster in body tissues with elevated sugar levels and this may be the reason diabetics are at risk of infections of the lung (pneumonia), blood (septicemia), spinal cord and brain (meningitis) and urinary tract.

Serious complications are four times more likely to develop in diabetics with these infections compared to otherwise healthy individuals. The stress from fighting an infection can send a diabetic’s blood sugars spiralling dangerously out of control further complicating the course.

Given the additional difficulties, diabetics are much more likely to die than healthy individuals with similar infections. Vaccines, however, can provided needed protection.

Pneumovax, a pneumonia vaccine, is a must. Diabetics should receive it once younger than the age of 65 and again in the senior years. Due to diabetics’ increased risk of skin infections and the fact that tetanus bacteria are just about everywhere in the environment, a tetanus shot is essential every 10 years. A flu shot is needed every year as the flu strikes diabetics particularly hard. Diabetics are at increased risk of shingles and should receive Shingrix once they turn 50.

Diabetics have twice the risk of catching hepatitis B compared to healthy individuals. Many adults have never been vaccinated. Luckily, there’s a new hepatitis B vaccine, Heplisav-B, which requires two shots instead of three and better stimulates the immune system.

Diabetics, who track their blood sugars, follow diet guidelines, take their prescribed medications and are vaccinated, have the best chance at a long, healthy life.

https://www.galvnews.com/health/free/article_12378c48-8272-5a43-aa98-6fc7b8fd0fcb.html

Coronavirus and Diabetes: What You Need to Know

From frontporchnewstexas.com
By Johanna Hicks

Unless you’ve been living under a rock the past few weeks, you have heard of a new and deadly virus that has quickly been spreading around the world: Coronavirus, or COVID-19, which is a highly infectious, acute respiratory disease.  This disease only affects mammals and birds, and seems to have originated from a seafood market in the Wuhan Province of China.  The numbers are changing daily, but the most recent numbers show that over 76,000 people have been infected with the virus, with 99% of them occurring within mainland China.

Because diabetes education is my passion, I wanted to share some information from author Christine Fallabel, Diabetes Daily.  So how dangerous is the Coronavirus, and what do you need to know as a person living with diabetes?  Many people who are infected with the virus never seek treatment.  According to the World Health Organization, signs of the infection include fever, cough, shortness of breath, and difficulty breathing. If you suspect you may be infected, see your doctor right away.

To protect yourself from getting any type of seasonal virus, it’s best to avoid contact with other sick people, wash your hands frequently (especially and always after using the restroom and before preparing food!), wear a protective mask when traveling through airports or busy bus/train stations, get your flu vaccination, maintain a healthy sleep schedule, and eat plenty of fruits and vegetables.  According to the CDC, Coronavirus is spread by respiratory droplets in the air when an infected person sneezes or coughs. The virus can also be spread when an uninfected person touches a surface where the virus is (bathroom countertops or door handles), and then touches their face or mouth.  Carrying antimicrobial hand sanitizer with you can help to eliminate this threat.

Sometimes your diabetes gives clues when you’re starting to get sick, and one of those clues is higher-than-normal blood sugars. If you’re starting to see your numbers creep up for no reason, it could be a sign that you’re coming down with something.  Stay on top of your diabetes when you get ill.  This will include more frequent blood glucose testing, staying hydrated, checking ketones, and if on insulin, might require extra dosages.

Even though most cases are mild, having a chronic illness and a virus at the same time can cause major trouble.  Seek help from a physician if you suspect something is beyond your control.  Even though we are not in crisis mode concerning the Coronavirus in the United States, always be prepared with extra diabetes supplies – lancets, test strips, medications.  The main goal is to be proactive in protecting yourself and being aware of how your body responds.

http://frontporchnewstexas.com/2020/03/06/coronavirus-and-diabetes-what-you-need-to-know-by-johanna-hicks-family-community-health-agent/

Walking more steps daily lowers risk for diabetes, hypertension

From healio.com

A higher volume of steps per day in middle-aged adults lowered the risk for type 2 diabetes and stage 2 hypertension, according to data presented at the American Heart Association Epidemiology, Prevention, Lifestyle and Cardiometabolic Health Scientific Sessions.

“Steps are a simple metric to communicate with patients,” Amanda E. Paluch, PhD, assistant professor at the University of Massachusetts in Amherst, told Healio. “Furthermore, it does not require a large increase in your steps/day to see benefits. Even an increase in 1,000 steps could have meaningful benefits to your cardiometabolic health. Steps can be accumulated however works best for the patients vs. in one single 'exercise' bout. Clinicians can encourage their patients to find opportunities to walk more throughout their typical day such as parking further away or taking the stairs more often.”

Researchers analysed data from 1,923 participants (mean age, 45 years; 58% women) from the CARDIA study with available accelerometer data for at least 4 days and at least 10 hours per day in 2005-2006. Patients also attended at least one follow-up visit 5 or 10 years later.

During a mean follow-up of 9.7 years, every increase of 1,000 steps per day was linked to a 5% lower risk for hypertension and a 10% lower risk for diabetes after adjusting for lifestyle characteristics and demographics. Adding comorbidities to the model slightly attenuated this relationship, although it remained significant for diabetes (HR = 0.93; 95% CI, 0.87-0.99).

Patients in the highest quartile had a 43% lower risk for diabetes and a 31% lower risk for hypertension compared with those in the lowest quartile.

Researchers observed a significant interaction between sex and obesity when testing for interactions by sex or race. The number of steps was associated with obesity in women. Every 1,000-step increase per day was linked to a 13% lower risk for obesity. Patients in the highest quartile were 61% less likely to have obesity compared with the lowest quartile.

“More studies using device-based measures of steps looking at long-term health outcomes is needed to further advance our understanding on the importance of steps with health,” Paluch said in an interview. “Adding pedometers to new or existing trials is relatively affordable and easy to implement and can provide valuable data and is of high relevance given the booming wearable technology industry.” – by Darlene Dobkowski

https://www.healio.com/cardiology/diabetes/news/online/%7B2156680f-068f-41ff-8ef1-1dfb1c05af73%7D/walking-more-steps-daily-lowers-risk-for-diabetes-hypertension