Diabetes is a state of high blood sugar, usually the result of the body just not being able to produce as much insulin anymore. Sometimes it is in the setting of resistance that we have to our own insulin.
Type 1 diabetes is an absolute deficiency of insulin. Patients need insulin to live. It used to be called juvenile diabetes. Type 2 diabetes is more common, 90% of all diabetes. This used to be called adult onset diabetes or type 2 diabetes and is the result of a mixture of lack of insulin production plus a resistance that the body has to insulin.
Usually it is people who are older in age, but even more importantly it is people who are overweight or obese, people who have a sedentary lifestyle. There is a large genetic component to this as well. People who have an unhealthy diet are at risk for adult onset or type 2, which is the most common type of diabetes.
For most people, there are no symptoms of diabetes and that’s what makes checking and monitoring for this condition so important. The symptoms that people might hear about — urinating all the time, thirst, fatigue, unintentional weight loss — typically only occur when blood sugars are floridly elevated, but that’s the minority of situations.
The main way to prevent diabetes is to make sure you’re getting regular checkups and make sure you’re getting proper blood work to screen. But if you know you’re at risk because of your genetics, you need to make sure that you’re eating right, staying healthy, and keeping your weight managed and under control.
It could be as high as 50% or more in many cases.
The answer unfortunately is yes in many cases. Patients have taken to comfort eating to cope with the pandemic, to cope with social isolation in many cases. That increase in calories is driving up people’s weight. Their outlets for exercise are not as accessible. Gyms that they might use, for example, are not available or are closed.
Some people are not able to afford their medications or the insulin that they might need for diabetes, which was a problem even prior to COVID, but particularly so now when people’s incomes are short. All this has served to raise blood sugars and worsen patient’s diabetes in many cases.
Anytime there’s an infection, when somebody has diabetes, the immune system is weakened. But in the higher risk conditions for a more complicated case of COVID, such as diabetes, many patients can have worsened symptoms, worsened respiratory complications, increased risk for hospitalization, increased risk for intubations and unfortunately, an increased risk potentially of death.
We know that if blood sugars are not well controlled regardless of the type of diabetes, that can lead to damage in the eyes, including blindness; damage to the kidneys, including a need for dialysis; damage to the nerves, including in the feet and possible foot amputation.
We also know that having diabetes, especially type 2 diabetes, for a long period of time can lead to increased risk for heart disease, heart attack, stroke. In fact, that’s how many patients with type 2 diabetes pass away.
The reality is there aren’t enough endocrinologists to manage everybody with diabetes. If somebody is at risk and knows they’re at risk for diabetes because of their family history, for example, they really need to make sure that they’re seeing their primary care physicians. Their primary care physician should be able to screen at least once a year during a general physical exam, with a test for blood sugar to make sure things aren’t going in the wrong direction.
Endocrinologists, such as myself, are hormone and metabolism specialists. Management of diabetes is our bread and butter. We certainly are available to treat patients with diabetes whose courses become more complicated, or if management of diabetes becomes more complicated than a particular primary care physician is comfortable working with and of course, if there are any questions that arise on the part of a patient or a physician.
We want patients to come to Scripps to get their care to make sure that their diabetes is well controlled. Precautions are being taken, from sanitation to mask wearing, to eyewear among the physicians. Patients who have COVID are seen separately from other patients who are coming in to manage their chronic conditions.
Telemedicine visits are an option as well for those who don’t want to come in to see their physician in person. There are all kinds of ways to continue to come into clinics like Scripps to get your care without having to shy away from your health care.
Lightly edited for clarity
Watch the San Diego Health video with host Susan Taylor and Dr. Levine discussing how to manage diabetes during COVID-19.