From healio.com
Susan Weiner, MS, RDN, CDCES, FADCES, talks with Stephen W. Ponder, MD, FAAP, CDCES, about the effects of COVID-19 infection and vaccination for people with diabetes.
Weiner: We know people with diabetes are at higher risk for severe illness with COVID-19. Can they lower their diabetes-related risk?
Ponder: The same steps used by others to reduce the risk of COVID infection applies to persons with diabetes — even more so. The basics: Masking, social distancing, avoiding large crowds and frequent hand-washing are vital to lowering risk for infection. A medical mask or N95 quality mask is more useful than a cloth mask if someone must go into risky areas. But keep in mind that friends and family members can also transmit the infection. Around our inner circle, there is always a greater tendency to let our guard down.
Isolation and hygiene measures, while essential, are not enough. Immunization with either the Moderna or the Pfizer vaccine, plus a later booster, provides the best proven method to lower risks for serious illness or death from COVID-19. Getting boosted with the non-original vaccine brand is a clever idea.
Working to get the best achievable blood glucose profile is associated with greater resiliency against any infection, COVID included. That means lowering HbA1c toward the goal set by the person with diabetes and the diabetes provider or team. If someone is overweight or obese, their risk is higher for serious effects from a COVID infection. If someone smokes or vapes, their risk is also higher. This is a good reason to resolve to make lifestyle changes that would help in all those areas.
Persons with diabetes are at elevated risk for death and serious illness from COVID-19. The need to take protective measures listed above is still important. Although spared from the worst outcomes, someone taking precautions can still get infected and spread the infection — even unknowingly — to others.
Persons with diabetes share many of the same risk factors as persons without diabetes: overweight or obesity, other chronic illnesses, poor health habits, etc. While many of these behaviours cannot be changed overnight, they will add to the risk one carries with a COVID infection, vaccinated or not.
Weiner: Do COVID vaccines affect blood glucose levels?
Ponder: The metabolic response a person has to any vaccine is an individual one. This is the same with COVID vaccines. Aside from a sore arm, the signs and symptoms are the same as with other vaccines and can range from nothing at all to fatigue, malaise, headache, gastrointestinal upset, low-grade fever and body aches. As with any other vaccine, the impact on blood glucose levels may be none to minimal to large. In most instances, it is more likely to be minimal.
In my case, there were no measurable effects on my blood glucose profiles after any of the COVID vaccines I received. I have also received influenza, shingles, pneumonia, hepatitis and tetanus vaccines as an adult and experienced no issues with my blood sugar after any of them either. Nevertheless, it is possible the immune response to any vaccine could influence one’s blood glucose. Therefore, I recommend careful attention to blood glucose levels after any vaccine, COVID or otherwise. Someone who experiences unexpected blood glucose changes should remember to employ their basic diabetes skills — correction doses of carbs or insulin — to manage them effectively.
Weiner: How do you discuss COVID vaccines with someone who may be reluctant to get one?
Ponder: Leading by example is one way to passively encourage others. If asked, I am happy to share that I was early to get my vaccine series, plus my later booster. As mentioned above: I experienced no serious adverse effects at all. I also have many patients and their parents who share their experiences with me that they did not have adverse reactions. For those who did have reactions, they were mild and quickly passed.
Unfortunately, leading by example does not directly address the widespread misinformation regarding COVID vaccines. The internet is the best place to find answers to questions that best suit our biases. Combined with some fancy talk and big technical words, health disinformation sites are ideally suited to confuse and sow doubt in the minds of good people. Such sites also aim to drive a wedge of distrust and suspicion regarding advice from reputable sources. COVID has highlighted this dark side of social media and the internet regarding its impact on our unity as a people.
In these cases, I realise there is little more I can do than provide support should it be necessary later. People must choose for themselves. Parents must also choose for their children. Frankly, there are no patients in my practice who follow every piece of preventive advice or recommendation given by me — or any other health care professional for that matter. Recommendations about COVID vaccines are no different in that regard, and I must live with that. It saddens me when I hear of serious illness or even death befalling someone who chose not to receive vaccines they were eligible for.
Weiner: What other advice do you give people with diabetes regarding COVID-19 infection or vaccination?
Ponder: The greatest medical advancements of the 20th century were the creation of antibiotics and vaccines. This saved countless lives globally for more than a century and continues to do so each day. Sadly, this is taken for granted in many areas of the world, especially in the U.S. Infectious diseases, regardless of their origins, are part of our collective past, present and future.
Most people with diabetes are dominating or living productive lives with a disease that was uniformly fatal before the 20th century. Success over diabetes is possible due to science and good sense to leverage every available tool with prudent and proactive decisions made each day. If you fall ill to COVID, the science behind its management improves daily. Vaccines unequivocally blunt COVID’s impact on us. Oral FDA-approved medications are now available to keep early COVID from overwhelming the body. As a person with diabetes, take these facts into account as you make your own choices regarding COVID-19 prevention and management.
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Stephen W. Ponder, MD, FAAP, CDCES, is a paediatric endocrinologist at Baylor Scott & White Health in Texas, and author of Sugar Surfing. He has lived with diabetes for more than 50 years. He can be reached at admin@sugarsurfing.com; Twitter: @StephenPonderMD.
Susan Weiner, MS, RDN, CDN, CDCES, FADCES, is co-author of The Complete Diabetes Organizer and Diabetes: 365 Tips for Living Well. She is the owner of Susan Weiner Nutrition PLLC and is the Endocrine Today Diabetes in Real Life column editor. She can be reached at susan@susanweinernutrition.com; Twitter: @susangweiner.
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