Diabetes and COVID-19 Talk

Professor Andrew Hattersley gave a Zoom talk about Covid-19 and Diabetes to the group. This was a very well attended and successful event. Andrew gave us an overview of the local situation and some information about the risks of COVID-19 for people with diabetes. He also answered people's specific questions either submitted in advance or during the session. It was a very interesting and informative event; it was helpful to hear the facts from someone we can trust. A special thank you to Julia and Tom for arranging this.
If you missed it, you can read the notes that were taken during the talk below. 

Please note this event took place on 8th September 2020 and the content was based on information and guidance at that time. Please be aware that regulations are constantly changing. To get the latest information on COVID-19 guidelines visit the Devon County Council https://www.devon.gov.uk/ (you can subscribe and get a weekly email) or
Diabetes UK https://www.diabetes.org.uk/about_us/news/coronavirus websites.
Diabetes and Covid-19 – what’s your risk of contracting it? There were concerns due to the percentage of people dying from Covid-19 who also had diabetes. The major risk factor for Covid-19 mortality is age. The other is being overweight or obese whereby you are more likely to develop a serious infection. Men are at greater risk also. So, if you are an older, male and obese you are more likely to also have Type 2 diabetes alongside having a greater risk of death from Covid-19. Your ethnicity also increases your risk. If your diabetes is well controlled you should add five years onto your age to work out your age risk group. If your diabetes is not well controlled, you should add ten years. The risk here is higher, but not much higher. If you have Type 1 diabetes then your risk is slightly higher. You are not more likely to get Covid-19 because you have diabetes. You are more likely to get it if your immune system is compromised as is the case with cancer. It is not having diabetes that increases your risk but your age, weight and ethnicity which are also risk factor for Type 2 diabetes.
What if you get Covid-19? The loss of taste and smell is specific to Covid-19. However, some people will get no symptoms at all. The older you are, the more severe the infection is likely to be. Healthcare professionals are more likely to get it, as are security guards and those running nursing homes, Covid-19 is not just the flu. It’s not nothing, it’s very unpleasant and you should do all you can to avoid contracting it. If you are infected your blood sugars will go up. Patient who are ill in intensive care can become insulin resistant and may have to have 4-5 times more insulin than usual as a result. Use of steroids to treat the infections will also impact insulin and result in requiring more insulin than usual. The respiratory issues associated with Covid-19 are a challenge as is kidney failure. There is no research to show it causes diabetes. Heat and diabetes – you will have more rapid absorption of insulin in the heat. You are also more likely to eat salads and fewer carbs when it is warmer. Some people returning to India for example with Type 2 diabetes will find that they no longer need insulin for example. A high temperature from a fever is a different matter. It is close to nil chance that if a Type 1 was placed on a ventilator their blood sugars could drop without the knowledge of the healthcare professional. If you are on a ventilator you will have someone monitoring your blood glucose levels every hour and an infusion of insulin set up. We are using ventilators less frequently now that our understanding of Covid-19 has improved.
What does the future look like? There is no sign of us returning ‘to normal’. Without a vaccine we must learn to live with social distancing. A vaccine will reduce your risk of contracting Covid-19 by 20 – 30% - this is not sufficient to eradicate Covid-19 in the same way we were able to eradicate polio for example. This infection is different – we cannot get rid of it. We are trying to work out how to balance things. Someone with Type 1 diabetes would be safe to have the vaccine when it is developed. All those who are eligible should ensure they have their flu vaccination early so you do not have any uncertainty if you become unwell over whether your symptoms are the flu or Covid-19.
Questions from attendees
Q) Our emotional and mental state will be affected by this and I have noticed I am not sleeping so well. How can we manage this? The lack of social contact is a challenge for humans and affects different people differently. Some prefer this reduced contact; others are devastated by it. If you are feeling this way it is important to acknowledge it and acknowledge that this is hard. You can meet people outside now and you should do. Go for a walk and talk. You need discussion with people, you need to meet people. My sleep has also been a lot worse; I have followed the NHS advice for getting a good night’s sleep but it is still fitful. It is hard for us to understand our subconscious. Such fitful sleep will affect your blood glucose levels. Anxiety will put your levels up. Depression will affect your motivation. Many had a burst of motivation at the start of lockdown but now it is harder. Humans are social and you need to find a safe way to meet.
Q) Are you saying having diabetes does not lower our immune defences? Diabetes affects the blood cells that deal with bacterial infection not viral infection. Covid-19 is a viral infection and not a bacterial infection. Whereas someone with cancer will have significantly fewer white blood cells which protect us against viruses, this is not the case for people with diabetes so someone with diabetes is not more likely to contract Covid-19.
 Q) Can we meet in the church? Any large gathering inside is a risk as it is predominantly transmitted by aerosol. So, if 50 of you are in a cathedral it is not the same level of risk as if 50 of you were inside a small chapel. It’s the fact you are inside. If going to church is important to you, you need to balance the risks for yourself with your needs. If you are in the lower risk group you can start to do the things that are important to you.
Q) I work in a supermarket in town. Should shielding be available to me? It is inside so the risk of transmission is higher. Think through what I said earlier to determine your own risk, if your diabetes is well controlled, increase your age by 5 years to see what risk group you are in, if it is poorly managed increase it by 10 years. Consider your weight, ethnicity. Then with your risk level better understood consider whether you wish to remain at home alone or do you want to be at work and only you can decide that. Diabetes on its own is not a reason to shield as it does not present enough of a risk to do so.
 Q) Would a FFP3 mask make it safer indoors or for flying for example? A mask will reduce your risk but not to zero. Again, you need to balance the risks for yourself.
Q) Is the virus weakening or strengthening? We have been involved in sequencing the virus. We know almost all the infections in Exeter were from Italy. We know the virus does not mutate much whereas usually viruses change every two weeks. It is more likely that people are now avoiding large exposure. For example, the prime minister shaking hands with everyone in a hospital presented a significant risk – our behaviours have now changed and it is this behaviour change that has lessened our exposure to the virus and lessened the seriousness of the infections we are seeing. We know that 1,200 different strains of Covid-19 came into the country from different sources. The outcomes are improving and you are now more likely to return home from hospital.
Q) If elderly and have diabetes and you notice a loss of taste and smell, at what point should I call for help? Do I just stay at home? If anyone has symptoms you should go online and find your local testing information. So firstly, take action to find out whether you have it or not as quickly as possible. Do not wait to get a test. You can always call your GP or diabetes centre for help if you are unsure or cannot access the internet.
 Q) What is happening with diabetes appointments? The Diabetes Centre moved online and that is working well. All our diabetes consultants have slots available for face to face appointment as well. We think it is now safe for people to come in.