Diabetics must beware covid19

DR FAITH BYISRAEL

Imani.Consulting.Tobago@gmail.com

Those of us living with diabetes need to actively try to prevent getting covid19, because the consequences may be dire.

DIABETES IN TT

In 2019, President Paula-Mae Weekes, in her World Diabetes Day address, highlighted the fact that diabetes affected 14.5 per cent of the population. Using very rough calculations, it means that over 174,000 people nationally or over 8,700 people in Tobago are affected by diabetes. Anecdotally those numbers make sense, because we all either have diabetes or know someone with diabetes. The Pan American Health Organisation (PAHO) has listed diabetes as one of the top five leading causes of death in TT since 1997.

DIABETES & COVID19

Given the vast number of people living with diabetes in TT, I’m duty-bound to discuss the added risk of severe complications (even death) associated with having both diabetes and covid19. Of course, we continue to learn more and more about covid19, so the information provided would need to be updated, as we learn more about the interaction between these two diseases.

The American Diabetes Association outlines two key issues:

1. The link between covid-19 and diabetes. There is currently no evidence showing that people who have diabetes are more likely to contract covid19. There is mounting evidence though, that when someone who has diabetes contracts covid19, the complications tend to be worse compared to individuals who do not have diabetes. This should come as no surprise, because health professionals have been preaching that individuals with “co-morbidities” (other diseases) tend to have worse symptoms and outcomes. Fortunately, if you have controlled diabetes (meaning that you take your medications, eat correctly, and therefore manage your blood sugar) you are less likely to get very sick if you contract covid19. As is expected, if you have more than one co-morbidity you are more likely to get very sick or even die.

2. Diabetic ketoacidosis (DKA) becomes a critical issue. According to the American Diabetes Association, “diabetic ketoacidosis (DKA) is a serious condition that can lead to diabetic coma (passing out for a long time) or even death. When your cells don't get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Ketones are chemicals that the body creates when it breaks down fat to use for energy. The body does this when it doesn’t have enough insulin to use glucose, the body’s normal source of energy. When ketones build up in the blood, they make it more acidic.”

When people with diabetes get viral infections, like covid19, they are more likely to also have DKA. DKA makes it difficult to manage systemic fluid intake and therefore it becomes difficult to manage the electrolyte levels in your body. Electrolytes are essential minerals – ike sodium, calcium, and potassium – that are vital to many key functions in the body. Your electrolyte levels is therefore the balance of the concentration of electrolytes compared to the amount of fluid in your system. Think of a mug of juice – the water to sugar ratio is a critical one, because too much or too little sugar can negatively affect the taste of the juice. Electrolyte imbalance is frequently associated with sepsis and septic shock. If sepsis progresses to septic shock, your blood pressure drops drastically, which can lead to death. As a result, sepsis needs to be treated immediately!

You should seek medical help immediately if you have:

• Difficulty breathing or shortness of breath

• Persistent pain or pressure in the chest

• New confusion

• Difficulty waking or staying awake

• Bluish lips or face.

WORLD DIABETES DAY

November 14 was World Diabetes Day. This year the theme was “The Nurse and Diabetes,” which brings into focus the importance of nurses in the critical treatment and care of patients living with diabetes. Of the many functions tasked to nurses, education of the patient and their families may be the most critical, since the internalised knowledge of each patient (and their families) significantly influences their compliance with their diet restrictions, exercise recommendations and medication regiments. The nurse has forever been, and will forever be, the foundation of the medical system, and therefore needs to continually be commended.

If you currently have diabetes, the aim of this article was not to frighten you, but to provide crystal clear reasons why you should do everything in your power to prevent the infection of covid19. There is mounting evidence that the basic measures, used together, are reducing the risks of contracting the virus. These measures include constantly washing your hands with soap and water; not touching your eyes/mouth,/nose (face); covering your cough and sneeze; staying at home when you have flu-like symptoms; not congregating (and staying at least six feet away when you are forced to congregate); and probably most importantly, wearing a mask to cover your mouth and nose when you have to interact with other people. The measures, though they require some getting used to, are certainly easier to experience, compared to being in hospital on a ventilator. Unfortunately, it seems like we will be living with covid19 for the foreseeable future, so the faster we adjust to the required changes, the faster we could get back to some level of normalcy.

Dr Faith BYisrael is a health educator, social scientist, public health specialist and politician.

Email address: Imani.Consulting.Tobago@gmail.com

Phone number: 494-8827

Facebook Page: @ImaniConsultingAndFoundationTobago

References:

Mayo Clinic, “Sepsis”: https://www.mayoclinic.org/diseases-conditions/sepsis/symptoms-causes/syc-20351214

American Diabetes Association, “DKA (Ketoacidosis) & Ketones”: https://www.diabetes.org/diabetes/complications/dka-ketoacidosis-ketones.