Let’s not panic, but let’s certainly be vigilant.
The world is currently going through unprecedented times with a novel virus causing fear and anxiety across vast swathes of the planet. We’ve certainly had worse with world wars - sending loved ones to fight to their death, and plagues - half of Europe was wiped out, but most people alive today would have never seen anything like this and it's turning every aspect of our lives upside-down.
Before we jump straight into what's happening right now regarding COVID-19 and diabetes - It is important to ask some pertinent questions:
1) What do we know?
2) What don't we know?
3) What can we do?
And once we've looked at that, we can ask the following:
4) How are diabetics affected?
5) What can we do to reduce risk to ourselves?
And if we're feeling particularly frisky, let's ask the following:
5) Is the global response relative to the risk?
6) What are the potential positives to come from the pandemic?
What do we know?
The novel coronavirus (COVID-19) is part of the family of coronaviruses including SARS (severe acute respiratory syndrome), and MERS (middle east respiratory syndrome). However, as this is new (novel), and has not been identified in humans, there is no immunity or vaccine. To see a more scientific explanation from the CDC, click HERE.
So far, we (the world) believes the virus originated in China (Wuhan), and despite no-one actually knowing, the most common guess is that it was transmitted from animal to human in late 2019, with the first reported case on November 17.
Whoever said one person can't change the world never ate an under-cooked bat!
Since then the media has gone into overdrive and we have been inundated with catastrophic stories and 'statistics' showing exponential increases in the number of confirmed cases (Brexit who?).
We know people who are vulnerable (elderly) and have a comorbidity (multiple underlying health conditions) are at the highest risk of serious complications or death from COVID-19.
We know it spreads easily from person to person, and the likelihood is one person will pass it on to an average of 2.5 people (hence exponential growth) - see image below as an example.
We know it's more serious than the flu - many people will require ventilation and it is more contagious. NB: How much more serious is a matter of endless contention.
Thankfully, children, young people and anyone who are generally fit and healthy are not as seriously affected and may only show mild symptoms similar to a cold (roughly 80% of cases). Unfortunately, not everyone is as lucky (hence social distancing and isolation).
The elderly and people with underlying health conditions are at an increased risk. This doesn’t mean that as soon as you get a sniffle the casket gets rolled out. We’re not talking the gravity of Ebola or MERS here (50% and 70% mortality rates respectively). No, we’re talking 2% mortality rates.. maybe. The honest answer is we don't know. Which leads me onto the next question.
What don't we know?
Well, the figures being produced are dependent on the states ability to test its citizens; How many testing kits they have; whether they are testing everyone who has symptoms or only people who present themselves to a hospital. The UK's official stance is that if you have the symptoms of COVID-19, you should stay at home until your symptoms reduce or if they get severe enough you have no choice but to call an ambulance.
Now you may be thinking that is a very callous stance from a country that is responsible for one of the most benevolent institutions on the planet - the NHS (National Health Service). But it is also a telling sign into what they are actually thinking - that thousands, if not hundreds of thousands have already contracted COVID-19, but have shown little to no symptoms (asymptomatic). This means the fatality rate would drop considerably and the measures being put into place would appear very severe indeed.
We simply don't know, so the response from heads of government must be to mitigate risk, and the risk on the surface is great.
The risks are great, particularly for our most vulnerable in society and this should be of paramount importance. After all, who we are as a society is very much dependant on how we look after our elderly and sick.
What can we do?
Well, quite a lot, actually.
We can stay at home and stay away from everyone that doesn't live with us. That is a minimum ask to be honest.
We can ensure that if we HAVE to leave the house, we are exercising high standards of hygiene; washing our hands; sneezing into our elbows or disposable tissues; keeping a good distance from all other people - at least 1.5 meters. This cannot be overemphasised as the impact to our vulnerable can be catastrophic.
We are also now seeing seemingly young and healthy people with no underlying conditions die from this virus. This is scary indeed so following the aforementioned advice is extremely important. You do not want to be a statistic.
We can also help our elderly neighbours, friends and family by getting their groceries or doing chores to keep them out of harm's way. Offering to drop over some goods is potentially stopping them from picking up a virus that could kill them, and it's very little time and effort on our part.
We're seeing more and more of this as this crisis continues and to be honest, it's heartwarming. Communities are coming together and showing a level of humanity many have never seen in their lifetime.
The Risk to Diabetics
First and foremost diabetes is a broad term, so let's break it down:
- Type 1 (including Gestational, LADA, Brittle, and MODY)
- Type 2 (including T1's with double diabetes)
Type 1 Diabetes
T1D means that you're insulin-dependent; you are of any age; any size and shape, and are always on shift. There's no lunchtime or holidays from T1D.
The one thing that brings all T1D's together though is our blood sugars. We must ensure they are in a target range for as long as possible to try and avoid complications.
That means that there is a potential that as a T1D you can be compromised BUT only if your blood sugars are regularly high (hyperglycemia). Chronically elevated or extreme fluctuations in blood sugars causes stress in the body and suppress your immune system. People with T1 and T2 are more prone to infection (and respiratory infection) if their blood sugars are not controlled.
Much like many diseases (i.e. cancer), COVID-19 is more pernicious in a high glucose environment. So the logical answer would be to reduce the dietary glucose to either create a better preventative environment in your body or give it a better chance if infected.
If, however, you are in control of your blood sugars; are slim; exercise and generally healthy you are at the same risk as a non-diabetic. Note the use of the words slim and exercise - this is important and is what we will touch upon next. In the meantime, remember, type 1 diabetes is an autoimmune disease but that DOES NOT mean your entire immune system isn't working. It probably works very well, just not as far as your beta cells in your pancreas is concerned.
Type 2 Diabetes
Type 2 diabetes is categorised as insulin resistance, leading to hyperglycemia, and is often accompanied with obesity and a sedentary lifestyle. This is certainly not always the case, but when a person is insulin resistant, they will put weight on easier and it will be much more difficult to stay slim (if not impossible) following a standard western diet.
There is a strong link between hyperinsulinemia (chronically high levels of insulin), insulin resistance, chronic inflammation and type 2 diabetes. This puts T2D's at a greater risk of serious complications due to COVID-19.
As mentioned, a typical condition of T2D is hyperinsulinemia. Unfortunately, cardiovascular disease, hypertension and metabolic syndrome accompany this condition, So keeping your insulin levels in check is of vital importance if you want to be healthy, now more than ever.
There are worrying statistics emerging concerning the rate of fatality in people with pre-diabetes and full type 2 diabetes. People may not even know they have this condition, but if you have a BMI over 22 with a fat percentage over 20% there's reason for concern.
So, without sounding too extreme, if you have pre or full type 2 diabetes, stay at home. Self-isolate; get your groceries delivered; practice impeccable hygiene, and think long and hard about your diet.
Why? because western medicine isn't coming to the rescue. This is about preventative medicine now, and that means eating foods that don't elicit large blood sugar responses and chronically high insulin levels.
It means more fresh, organic produce. Not tinned, processed carbohydrates. It means more grass-fed, hormone-free meat, not something slapped in a packet covered in a sugary sauce. It means thinking more about what you put on your plate and how that might - one day - help you stave off a novel infection.
I'm sorry, that all sounds very dire. So to firmly place my point, please see the below picture of New York City's Deaths as of 1st April 2020 - and please note the cases with no underlying conditions and that the USA has a population with 50% pre and full type 2 diabetes.
What can we do to reduce the risk to (at risk) diabetics?
- Stay at home
- Practice impeccable hygiene
- Stay at least 1.5m from people - social distancing
- Eat a very healthy low-carb diet to reduce blood sugar rises and keep insulin levels low
- Stay active - exercise where and when possible
- Stay at home
- Stay at home
- Stay at home
Is the global response relative to the risk?
There is a growing divide in the community, and that is:
a) Are we going too far shutting down the entire planet? - crippling our economies; forcing life-changing social unrest; sky-rocketing numbers of unemployment; untold damage to mental health and dramatically decreasing quality of life for a virus that may have a fatality rate only slightly higher than the flu?
b) Are we not going far enough? Should we be keeping people in their homes until we're sure it's subsided; should we be building new hospitals, increasing ICU capacity; stopping all commercial activities unless absolutely necessary. The list goes on.
Without good data, we are forced to make decisions that are impacting the whole planet for years to come - and what is driving this hysteria?
People rushed to the shops and bought 6 months supply of toilet paper because of the news; because of social media; because they were led to believe the end of humanity was nigh. But it's not. Not even close.
People also started thinking a cough and splutter was going to kill them and ran straight to the hospital. Our hospitals are already under pressure before we had a novel virus. So what happens then? What was driving this? - well, the media didn't help.
That doesn't mean we don't have to show responsibility with social distancing, high standards of hygiene and ensuring our most vulnerable are protected - of course, we do, but we're only looking at what's happening, not what COULD happen.
I am not talking down the severity of COVID-19. I am talking up the unknown damage of shutting down the planet. We can track the data of a person dying due to COVID-19, but it's far harder to track someone dying from suicide due to losing their job, house, and family in the midst of a global financial crash and make no mistake, that's on its way.
What are the potential positives to come from the pandemic?
We are already seeing amazing acts of kindness and community. People are looking after their vulnerable neighbours and helping each other where possible. Dog and cat homes are seeing more than double their re-homed animals, as people look for companionship during lock-down (or to avoid their partners, but whatever works :)
People are decorating their homes like Christmas and huge sums of money have been raised for our charities on the front line.
On a far grander scale, we are seeing a healing of the planet. Roughly seven million people die every year due to pollution. How many lives will be saved with no planes in the air; coal mines closed; industrial tankers not spreading oil throughout the ocean.
Amidst the chaos and calamity, there is an unusual but beautiful and captivating calm. With classrooms empty and offices cleared... Can we go back to the way it once was?
Do we want to?
Believe the hypo