T1D in the COVID-19 Era

Throwing together some advocacy discussion fodder more publicly here, as requested:

There have been reports of type 1 diabetes onset status post COVID-19 infection, as well as diabetic ketoacidosis (DKA) and insulin resistance being related threats when it comes to COVID-19 treatment. While I’d be remiss not to mention the main grad school 101 lesson, “Correlation doesn’t equal causation,” (meaning that we do not know for sure that COVID-19 may or may not cause or complicate diabetes yet), we can still take commonsensical precautions in the interim to prevent further possible suffering. I will be the first to admit that I’m not going to do your homework for you here and link to various articles and tweet threads on these topics; they’re out there if interested, and I’m writing this blog as a highly-generalized, well-intentioned commentary with the disclaimer that we do not have all of the answers yet and the advice here is shared in an abundance of caution and transparent discourse.

We need more research data and more analyses of these theories, plain and simple. ‘Awareness’ is often a diluted catch phrase in healthcare advocacy, but in this instance, knowing what may happen – while we iron out the scientific facts of the matter – could possibly save lives and quality of lives. For these reasons, I don’t think relaying the message hurts us, with the understanding that more research must occur.

The prevalent theory on the cause of type 1 diabetes (T1D), an autoimmune condition, is that the perfect storm of factors – viral trigger, genetic predisposition, and environment (often stressor-related)- culminates in a diagnosis- that is if one survives the common DKA at onset and is swiftly treated with insulin. Time is of the essence, life or death, here.

Theoretically, COVID-19 plays into this theory perfectly, being the viral trigger that gets the ball rolling in some cases of T1D, with the person’s immune system having been sent into overdrive by the infection. Healthcare professionals have reported that COVID-19 does not play well with pancreatic function, often requiring highly elevated basal insulin rates and thwarting DKA in the process of treating COVID. None of this sounds remotely fun and should be impetus to us all to do our part to protect ourselves and others.

If you’ve contracted COVID-19 recently, in my humble opinion it is wise to be aware of the warning signs of type 1 diabetes given a qualitatively potential risk post-Covid-infection. There are fancy posters and awareness campaigns which display this information in a prettier way than this blog post, but for what it’s worth, the main symptoms of T1D which I advise others to watch for are the following, among others:

Extreme thirst

Frequent urination

Fruity breath / odor

Blurry vision

Significant weight loss

Ketones may present a heartburn-like sensation.

If any of these symptoms are present, contact a healthcare professional (HCP) / emergency room immediately, and demand to be tested for T1D. If HCPs are downplaying the odds, and if you can afford this option, purchase a blood glucose meter and test strips, or urine ketone strips, over the counter at your local pharmacy and check on your own. If results are elevated, this bolsters your point that you need to be seen immediately regarding a possible diabetes diagnosis.

The anecdotal evidence is quite strong that we may face an influx of diabetes in the era of COVID-19. We might as well start talking about it.

Awake

What have I learned during this November, another ‘National Diabetes Awareness Month’ (NDAM)?

Call me jaded, but I am already quite aware of diabetes every time I poke my skin with one of hundreds of thousands of needles involved since my T1D diagnosis almost 29 years ago; or, when tweeting out the bat signal during a 4:07 am low blood sugar yet again interrupting a healthy sleep cycle, and seeing dozens of Twitter folks nodding in solidarity.

During NDAM this year, I felt a sense of “been there, done that.”  Frankly, at times, I did not even like this month- having the unwanted spotlight on me per se, as one member of the diabetes demographic.

November has its merits: sharing the warning signs of diabetes to prevent future death and disability related to preventable DKA; highlighting the high price of insulin; detailing why #weneedacure; finding much-needed new voices here in the diabetes community; involving people without diabetes in the diabetes cause.  All good stuff.

I suppose for me, personally, the pivotal “woke” advocacy moment did not occur this November, though.  Rather, it was in September 2019, when watching the peaceful protest video of Nicole Smith-Holt, hearing the anguish in her voice as she said her son’s name then, and continuing to hear it resonate now.  That is good advocacy- the kind that wakes you up, makes you think many months later.

Some media coverage of that September citation moment was passive in its reporting.  ‘Protester tripped and fell into a cop car’ sort of stuff.  Far from it.  Given the circumstances, Nicole and other advocates see a need for change, and they bravely and gracefully take action to get us there.

During November, I shared a few random tweets about life with diabetes, the hope for a cure, etc.  But mostly, I tried to do more listening than talking this time around.  As I tackle other challenges lately, diabetes has not taken up as much space in my world.  Perhaps that is a change of interests, my admitted privilege, or a combination of these and other factors.

But at the end of the month, it’s not all about me.  It’s simply about making our world better for all people touched by diabetes- honoring the past, present, and future.  Whether it is November or December, we have no other choice but to continue showing up to the diabetes fight.

Perhaps, here in the informed online diabetes realm, we are aware enough already.

The real question may well be: Are we awake yet?

Spare.

Spare.

Dictionary.com defines the verb as “to give or lend, as from a supply, especially without inconvenience or loss.”

At that rate, why wouldn’t we spare roses this February, and perhaps all year long?

The premise is simple: click here, donate $5- the cost of a rose you may normally give to a loved one on Valentine’s Day (or, set up additional monthly donations if you can!), and save a child by providing life-sustaining insulin through your donation.

If you are reading this blog post from a cell phone or a computer screen, chances are you have $5.00 to spare.  If you do not, that is okay, too; instead, please help to spread the word about #sparearose.

What is $5.00 worth?

-one medium coffee and one donut from your local coffee shop

-half of a movie ticket  (What use is that?!)

-crappy red wine and a headache you don’t need, anyway

-an overpriced bottle of water at a sporting event

 

*****-And oh, yeah, A LIFE!!!!!!!!

 

Close your eyes and think of a time when you did not receive a viable amount of insulin for a few hours.  We have all been there: a kinked insulin pump cannula, diabetic ketoacidosis (DKA) during diagnosis or severe illness, or whatever the case may have been.  We have felt the heartburn and nausea of high ketones, the unquenchable thirst, and the longing for comfort that takes too long to get there.

For most of us, those days represent acute instances of distress.  Scary, yes.  Life-threatening, sometimes.  But if we are reading this blog post today, we somehow escaped diabetes’ wrath and are feeling better thanks to the insulin taking up all of the shelf space in our refrigerators.

Without insulin, kids in developing countries know that type of suffering intimately.  Those of us who are more fortunate cannot lay our heads on our pillows at night and be okay with that.  We understand diabetic ketoacidosis.  We have a moral obligation to curtail DKA as best we can before it senselessly takes any more lives.

If my words come off too harsh here- well, it is a risk I am willing to take.  If our moral obligation leaves us momentarily uncomfortable in our realization of its truth, so be it.  These kids are more than uncomfortable as they await insulin that they should have to begin with.  We owe it to them to do the right thing.

If you can, please spare a rose this February.  Through the simple act of sparing, we can dry so many tears.

Thank you

spare a rose 2015