Remnants of the Pandemic

The title of this blogpost might indicate that I think Covid has gone away and is no longer a risk.

I don’t.

But I am fully vaccinated with two boosters and will have a third booster this week. I have chosen to believe that vaccinations will protect me from severe illness. Amazingly neither my husband nor I have contracted Covid in the last 2-1/2 years although we have had numerous close and not-so-close exposures. We don’t feel virtuous; just lucky. Some of our friends have had the virus and fortunately none with serious illness. My children and their families have taken Covid seriously with masks and vaccines. Even still, three of the four parents have had the virus in the last 6 months as have six of the seven grandchildren.

My daughter-in-law from the East Coast contracted Covid while staying at our house in August for a family wedding. My son (her husband) and the three children returned home on schedule so as not to get Covid one-by-one at my house and spend the rest of the summer with us. My poor DIL posted on Facebook that she had long dreamed of a solo getaway from the family. She just didn’t expect it to be in her in-law’s basement….

My current Covid behavior could be classified as inconsistently cautious. I wear a mask to Costco. I go to senior fitness classes at the YMCA unmasked. If the grocery store is crowded, I wear a mask. If it’s not, I don’t. I wore a mask on the crowded bus to the Minnesota State Fair but didn’t on the uncrowded bus on the way home. I wear a mask on airplanes. I don’t wear one for outdoor activities. I have never once had anyone criticize me for masking although I rarely see others masked. I’m not sure if I am wasting my time by wearing a mask sporadically or if I am putting myself at risk by not wearing one all of the time. 

Like everyone else, I just don’t know.

I am aware of how much the last two and a half years of pandemic life have changed me. Some of the changes are positive. Some of the changes are probably negative or at best iffy. Some changes are nothing more than doing things differently. For sure “Covid Caution” has given me a great excuse to avoid things I don’t want to do. 

Here are some good things.

I started Duolingo Spanish in 2020 and am now at Day 752 of daily Spanish lessons. I have learned a lot but am miles away from being a fluent Spanish speaker. I am currently on Unit 50 with Unit 211 as the end goal. I can read many things in Spanish and understand random words from Spanish speakers. I occasionally stumble through a sentence or two with my grandchildren’s nanny from South America. 

On an early walk during the pandemic I saw a pileated woodpecker and was inspired to learn more about birds. I am pretty good at common birds but not so good at LBB’s. (Little Brown Birds.) I enjoy the Merlin Bird ID App which gives size, color, and habitat clues to identification and identifies birds with recordings of their calls. 

Although I have always been a reader, I have definitely read more since the beginning of the pandemic. I am not reading important literature or much nonfiction. My reading can mostly be categorized as “high quality trash.” Interestingly I watch much less TV. 

I have let my hair grow out and proudly wear a ponytail. Much less work than shorter hair, especially hair that curls in weird places and frizzes in humidity.

Diabetes-wise my biggest bonanza from the pandemic has been Medicare coverage for telehealth visits. Hopefully this change will be permanent. I spend 5+ months in Arizona and telehealth allows me to easily satisfy Medicare’s requirement for endocrinology visits every 90 days. Other than that I don’t think my diabetes has changed much. 

Here are some iffy things.

I have gained weight. Some of this weight gain started before the pandemic with my slowing senior metabolism. My endo is thrilled and reminds me that frailty is a huge risk as I age and a little ”pudge” can be helpful if I get sick. I had a bone density scan in May and my scores improved significantly. More weight: stronger bones. I am okay with some of the weight gain but hate that a lot of my clothes are too tight. Plus I don’t like what I see in my bathroom mirror. (Maybe I never did.)

I have always been aware of personal space and am increasingly uncomfortable with people getting too close. When my local YMCA resumed in-person fitness classes after a year of the pandemic, the workout rooms had big colorful dots on the floor to show proper spacing. Unfortunately they removed the dots last fall. Now when I am at yoga and someone lays their mat too close to me, I want to yell “Go back to your dot!” But there are no dots….

As a senior with multiple autoimmune conditions, I think that Covid Caution continues to be a good way for me to live. But I know that I use it as a copout. I didn’t want to go to a large indoor wedding reception this summer because I wouldn’t know anyone. I just said “Covid Caution” and was excused without hurt feelings. I don’t love traveling a lot and am a happy homebody. Covid caution and I can stay home or at least avoid trips outside the continental USA. I am not a party person and probably use Covid too often as an excuse to avoid large groups. At the same time I am aware that as I age, it is not good to be socially isolated. 

So where am I?

I don’t lose sleep over Covid. In early 2020 I was concerned that if I got the virus my overactive immune system might drive me into a cytokine storm. I live now trusting that my up-to-date vaccinations will prevent that. I have been lucky to have not lost close relatives or friends to Covid and don’t have traumatic memories from the last couple of years. I realize that not everyone is so fortunate,

Looking forward, as a senior I think that the biggest risk to my longevity is a fall. I dutifully hold onto stair railings and pay attention to my environment. I go to senior fitness classes where balance exercises are emphasized. A broken hip with a resulting surgery, hospitalization, and forced inactivity seems a bigger risk to me than Covid. My internist would say that as a person with longterm diabetes, heart disease is my biggest risk.

I don’t know my future and at some point it is just pick your poison. (Actually it probably won’t be my choice….) Until then I will do my best to stay active–both physically and mentally. I will work to avoid total social isolation but mostly with outside activities and gatherings. I will hope that vaccinations continue to help most of us avoid hospitalization and death from Covid. I will listen to experts and adjust my behavior accordingly.

For the time being I will continue to hope that what I am doing is good enough.

Tangled and Intertwined: Diabetes and Covid-19

A while back I started a blogpost with the words “tangled” and “intertwined.” The emotions prompting those words were powerful but I abandoned the post in favor of laziness.

Last Saturday I “attended” a virtual session at Friends for Life Orlando titled “Avoiding and Overcoming Diabetes Burnout.” The moderators were William Polonsky, PhD, CDE and Kerri Sparling. Partway through the session Kerri mentioned something about her diabetes and coronavirus being iinseparable and I thought “yes!” That is what I had originally been planning to write about. No doubt if Kerri were still blogging, she would say it better than I will, but we likely have the same thoughts muddling through our brains.

A lot of my musings go back to late January when I began using Dexcom G6 and Basal IQ on my Tandem X2 pump followed by Control IQ. I was on Control IQ for less than six weeks when the coronavirus invaded my world. For those of you not knowledgeable about diabetes tech, Control IQ is defined by Tandem Diabetes:

ControlIQ technology is an advanced hybrid closed-loop system that uses an algorithm to automatically adjust insulin in response to predicted glucose levels to help increase time in the American Diabetes Association-recommended target range (70-180 mg/dL).

I wrote a couple of blogposts about my early experiences with Control IQ and I don’t think that my opinions have changed a lot since the March post titled “Six Weeks: More Thoughts on Control IQ.” I am mostly okay with it and really appreciate the fact that I have almost zero low blood sugars. But my average blood sugar is higher than pre-Control IQ and I am frustrated that I am required to use Tandem’s conservative BG goals instead of the targets that I prefer. In general I am still trying to figure out how to lower my average blood sugar without constant suspensions of insulin that result in sticky highs later on. Some people on Facebook seem to do that successfully and post daily graphs that don’t make sense to me based on my experiences. At a late May appointment I questioned my endocrinologist on whether she had any suggestions, and she said “No. Control IQ is doing what it is supposed to do and you are doing great.”

And she is right. But diabetes is never independent of mental health and I struggle to accept the new numbers when I liked the old numbers and don’t completely understand the new numbers. But the old numbers reflected many low blood sugars and a lot of glucose tabs. At the same time the new numbers don’t display what I think the Sleep Mode of Control IQ should target. I have never experienced classical diabetes burnout but my diabetes is mucked up with anxiety, perfection, lack of perfection, unattainable goals, and just plain never-getting-a-vacation.

In the last paragraph I introduced “mental health.” Enter Coronavirus. I am 68 years old and have lived with diabetes for 43 years. I consider myself to be healthy but I deal with multitude autoimmune conditions. If I get diagnosed with Covid-19, I am probably doomed. But who knows? My self-destructive side just wants to get the virus and be done with it. Either die or hopefully recover with ongoing immunity. But don’t get worried. I am not attending Covid-19 parties and have recently started using InstaCart for grocery and Costco deliveries. 

But like every other person in the world, I mourn my former life. I miss fitness classes at the YMCA and reminisce about hanging out at McDonald’s drinking cheap Diet Coke while surfing the web and writing blogposts. I miss going to the movies. I long for lunch and coffee with friends. I desperately want to visit my Maryland grandchildren and currently accept the risk of outdoor babysitting the local grandkids. I am okay most days but about once a week I wake up with a black cloud over my head.

The black cloud is part coronavirus and part diabetes-Control IQ. I can’t untangle what is what and for sure I haven’t figured out a way to eliminate the occasional days that are plagued with pit-in-the-stomach sadness and frustration. I am totally cognizant of the fact that 42+ things influence blood sugar and that I will never be a “Perfect Diabetic.” I am fine most days but the wind periodically blows in black clouds that suffocate my normally optimistic view of life. 

I am sad. I am frustrated.

I am healthy. I am mostly happy.

I know that I live a privileged life. I have no worries about acquiring insulin, CGM sensors, and pump supplies. I have access to online fitness and yoga classes and live near safe walking trails. My husband is employed and at the moment we are safe financially. My children have jobs and their families are doing relatively well considering the stress of home schooling and few daycare resources. 

But when the black clouds park above my psyche, I can’t tell whether they are the result of diabetes or Covid-19.

It doesn’t matter.

In my world diabetes and Covid-19 are tangled and intertwined. 

ADA Webinars and Podcasts: Inpatient Care for Covid-19 Patients with Diabetes

In recent weeks Diabetes Connections and The Juicebox Podcast have featured interviews with individuals with Type 1 diabetes who contracted and recovered from Covid-19. These podcasts have also shared conversations with medical professionals discussing the coronavirus and diabetes. While these episodes were interesting, they did not address my biggest Covid-19 concerns as a person with diabetes. How will my diabetes be handled if I am hospitalized with Covid-19? Not if I have a mild-to-moderate case and can mostly self-manage my diabetes. How will it be handled if I am incredibly ill on a regular hospital floor or even in the ICU? Nothing I have listened to or read has answered these questions.

Until now.

For several years I have listened to the podcast Diabetes Core Update sponsored by the American Diabetes Association. The podcast has historically been a monthly review of “clinically relevant” studies from ADA professional publications. Most of the articles address Type 2 medications so the podcast is not usually relevant to me. But I listen anyway hoping to learn something and hear an occasional Type 1 discussion.

In April Diabetes Core Update released about 10 podcasts directly related to diabetes and the coronavirus. Although these podcasts are directed towards medical professionals, they contain the information that I as an engaged patient am starved for.

Last weekend I finally hit the goldmine with two episodes directly addressing the inpatient care of patients with diabetes, particularly those patients on insulin therapy. This population includes all of us with Type 1 diabetes and medical professionals in the trenches are finding that many/most patients with Type 2 diabetes and even pre-diabetes and undiagnosed diabetes are ending up requiring insulin when battling coronavirus. 

The first podcast is titled American Diabetes Association Town Hall: COVID-19 & Inpatient Care for People with Diabetes. The 6 panelists are: Shivani Agarwal, MD, MPH, Albert Einstein College of Medicine; Jennifer Clements, PharmD, FCCP, BCPS, CDE, BCACP, American Pharmacists Association; Robert Eckel, MD, ADA President, Medicine & Science; Irl Hirsch, MD, University of Washington; Melanie Mabrey, DNP, Co-Chair – American Association of Nurse Practitioners – Endocrine Specialty Practice Group; Jane Jeffrie-Seley, DNP, BC-ADM, CDCES, Association of Diabetes Care and Education Specialists. 

The topics discussed include insulin regimens in the hospital, blood sugar targets, use of patient devices such as meters, CGMs, and pumps, how coronavirus seems to affect BG levels, lots of dangerous hypoglycemia, and so on. 

The town hall can be seen as a webinar at this link:  American Diabetes Association Town Hall: COVID-19 & Inpatient Care for People with Diabetes

To access the podcast, go to Diabetes Core Update Podcasts and find this episode which is titled Covid-19 Inpatient Town Hall and was released on April 23. This page will give you the ability to open the podcast in Google Play, Apple Podcasts, or listen on your device.

The second podcast/webinar is titled Inpatient Care Questions April 15 Update and includes questions and discussion related to the topics from the Town Hall. The panelists are:  Robert Eckel, MD, ADA President, Medicine & Science; Irl Hirsch, MD, University of Washington; Mary Korytkowski, MD, University of Pittsburgh.

You can access the webinar at this link:  Answering Your Questions: Inpatient Care Questions April 15 Update.

To access the podcast, go to Diabetes Core Update Podcasts and find the episode titled Covid-19: Inpatient Management #2 which was also released on April 23. This page will give you the ability to open the podcast in Google Play, Apple Podcasts, or listen on your device.

My thoughts:  Although I strongly suggest that you listen to both podcasts, here are some things that I heard. Coronavirus seems to raise blood glucose numbers drastically and many patients require multiple times their normal insulin. Many people who didn’t previously require insulin do need it while hospitalized. IV insulin is frequently used in the ICU but injected insulin is more common on regular floors. Patients are encouraged to bring their own supplies including meters, pumps, and CGMs. As long as you are able to safely operate your pump, you will most like be able to keep it. That might differ in smaller community hospitals. 

Severe hypoglycemia has been seen in some patients, especially elderly patients. For that reason BG levels are often targeted to be in the range of 140-180 rather than 110-180. Nursing staffs are trying to minimize the number of direct patient contacts and will try to bundle BG checks, vital checks, and medication administration into each visit. 

Although there is currently no hard data to support the hypothesis, the medical professionals thought that those with well-controlled diabetes prior to Covid-19 have a better prognosis than those with complications and co-morbidities. But they all considered blood glucose control in the inpatient setting to be hugely important.

I am terrified of contracting Covid-19 and being so sick that I must be hospitalized. Along with most people I know with diabetes, I will continue to stay home most of the time and social distance when I am at the grocery store or walking in my neighborhood. My next project is to organize a Diabetes Go-Bag to use if I do end up going to the hospital. I am currently woefully unprepared for that scenario. 

** Please note that these episodes have somewhat different titles on different webpages, but I think you’ll be able to find them.

Diabetes Daily: How Covid-19 is Affecting People with Diabetes

Background: Several years ago Diabetes Daily teamed with Thrivable Insights to create the Diabetes Research Panel. In late March 1,300 people with diabetes (48% Type 1 and 52% Type 2) responded to a survey addressing their concerns and fears about the coronavirus and what they were doing to protect themselves.

Here is an infographic sharing the results of this initial study. If you would like to read an excellent interpretation of the results by Maria Muccioli Ph.D, her blogpost at Diabetes Daily is available here. Below the infographic is information from Diabetes Daily about joining the ongoing study.

 

This is a copy of an email I received from Diabetes Daily. Please join the project to let your voice by heard!

Dear Friends,

Want to help with the COVID-19 pandemic? Your data can make the difference!

We have donated our rapid research platform to help leaders respond to the epidemic.

Fill out this 3-minute survey to join the project:

Join the Study Covid Project

Your anonymous insights on symptoms, social distancing, masks, the economy, and more will be analyzed by a talented group of epidemiologists and public health experts and shared publicly.

Who can participate? 

The project is open to everyone 18+ living in the USA.

How will my data be used?

Your data will only be used for research purposes. You will not receive any marketing messages. All personally identifiable information will be removed prior to the sharing or publishing of any data.

Who is behind the project?

Thrivable, the organization that created Diabetes Daily, has donated its rapid research platform to this project. The project is led by a group of leaders in public health who have important questions about your attitudes and behaviors around COVID-19. You can see the team here.

Can I share this with family and friends?

Yes! Please share far and wide. You can copy and paste this message to share:

Want to help with the COVID-19 pandemic? Your data can make the difference! Join me and sign up for the Study Covid Project at https://www.StudyCovid.org.

Best,

The Diabetes Daily Team