COVID-19 Q+A with Endocrinologist Dr. Anne Peters
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This interview was published in March 2020.
Dr. Anne Peters is a clinical diabetologist at the University of Southern California and serves on Beyond Type 1’s Leadership Council. She recently took the time to answer questions about COVID-19 sourced from the Beyond Type 1 community. Watch the entire interview in full!
Partial transcript below, edited for content and clarity
The number one question we get is – are people with Type 1 diabetes more susceptible to catching COVID-19?
Anne Peters: The answer we have as of this second is an answer that’s been informed by a number of my colleagues around the country because we’re all talking about this. And first of all, we have absolutely no idea, but I can tell you that I think that Type 1 diabetes all by itself is unlikely to be a risk factor for catching it and it’s probably not a risk factor for having a worse course. On the other hand, we do know that poorly controlled blood sugars are an increased risk for all infections and so there’s no reason to think that this would be different. But again, we don’t have cases with Type 1 and this disease. The things that are the worst, and I hate to say this because I’m in a worse subset, is our age and then the presence of other conditions like heart disease or hypertension.
So older people, sicker people need to be very, very careful not to get this. But younger people, healthy people, with good control – I don’t believe they are any higher risk except when you get sick with Type 1 diabetes, everyone knows your glucose levels may be harder to manage. Sometimes people go into diabetic ketoacidosis (DKA) if they don’t get enough insulin and have enough fluids so that you know you need to not get sicker when you get an infection. So my goal is to have everyone prepared with sick day rules, everyone ready to take care of anything that comes their way. I feel positively that people that are going to do fine, they just have to be sensible.
Are people living with Type 1 diabetes immunocompromised or immunosuppressed?
I don’t think you all are immunosuppressed, I don’t think Type 1 diabetes makes you immunosuppressed, but historically, that’s how people thought of it. Because if your sugars are sky high, it probably makes you more susceptible to infection, but it’s not immunocompromised like you’re on an anti-rejection drug or getting chemotherapy, it’s not the same thing. There’s a glucose effect on the immune system and higher glucose levels can make the immune system less robust, but I don’t see that as a state of immunosuppression in a well-controlled patient with Type 1 diabetes.
Are children with T1D unlikely to catch coronaviruss?
Well a) we don’t know, but it’s not that children are unlikely to catch it, it is unlikely that children will show signs of infection. One of the problems is they can be secret vectors of this – they can be asymptomatic… So that’s actually why you have to be careful about children because this is spread through sneezing, coughing, and spit. And if little kids are drooling, they could have it. But it’s actually been great that kids aren’t seeming to get this and get really sick from it, they just could carry it. There should be no difference in kids with Type 1. Again – we don’t know. We don’t have any experience with this and we’ll learn, but my bet is they’re just fine, just like everybody else.
Are people safe to go to the grocery store? Or if you’re living with diabetes + you have a job that you need to go to, what would you recommend? How much social interaction is appropriate?
Well, I would say probably just the same as everybody else. But let me just tell you, I’m a mother and my son is 28, and I’m a mother to all my patients. And I say, for once, use diabetes as a way to get out of things if you don’t want to do them. I have patients where they could work at home and their boss for whatever reason isn’t letting people, so I write a letter and say, “This person has diabetes, they’re at increased risk, let them work at home.” I feel like I just don’t want anybody to get it. If diabetes can help you get out of things for this one time in life, then do it. But I don’t think people with Type 1 diabetes need to live in fear. I think we’re all living in fear, but I don’t think you should live in extra fear. And I think that people need to go to the grocery store, people need to take walks outside, people need to socially distance… I think we can create a new normal because this is going to last for a while. So I think we just all have to say, okay, how are we going to do this in a way that lets us live our lives?
Are there any extra precautions you should be taking if you’re living with somebody who is out in the public a lot + you are staying home?
Well, the person with whom I live is 75 years old and he has diabetes and I can’t get him sick. And it’s not because of the diabetes, it’s because he’s 75 years old. So I am just insanely careful and we’re lucky enough that we have our own bathrooms – bathrooms are a point of spread. So if you can, have separate bathrooms. If you share a bathroom, decontaminate. You don’t want to share towels, you want to keep everything separate.
And I actually now go to work in a set of scrubs. When I go to work, I just leave the house in the scrubs, I come back, and before I do anything, I take off the scrubs, throw them in the washing machine, run upstairs and take a shower. So I decontaminate myself, and as soon as you’ve done that, you can be in the same house just fine. So I just say let’s not contaminate each other and you can do that. I’m in a high risk position cause I’m seeing patients all day. So just to be mindful of that for all of us.
Along those lines, if somebody has a routine checkup with their endocrinologist, would it be wise to reschedule it at this point? What’s the recommendation for routine maintenance?
So my concern is that people with chronic diseases in China got left behind. And my feeling is that I’m a social person, and connecting with my patients makes me feel like I’m giving them something. If it’s advice about how to live with this pandemic, if it’s advice about adjusting their blood sugars, I want to keep doing that, but I can do it through telemedicine. So most of us now have switched to telemedicine and it’s a little bit harder because I particularly have older patients who aren’t used to uploading their devices to the cloud. We actually spend a lot of time helping people do that, but I can do a perfectly normal visit on telemedicine. I would say not to forgo a routine visit, but rather to try to transfer it to telemedicine.
What are you recommending in terms of people refilling their prescriptions?
I’ve been told that a number of insurance companies are making it so you can stock up on things. The insulin companies have all reassured the American Diabetes Association, JDRF and therefore me that we’re not going to run out of insulin. Alcohol pads on the other hand may be hard to come by, but insulin will be available. I think it’s really good to get insulin delivered in three month’s supply so that you don’t have to go to a pharmacy. And there are pharmacies that deliver, so I would make sure prescriptions are for three months and transferred to mail order. Anything you can do to not have to go to a pharmacy is good.
The harder thing is devices, because the paperwork to get you your devices is so overwhelming that we may not be able to do it because every device requires three different forms… So everyone’s going to have to know how to give injections if they’re on a pump and everyone’s going to have to know how to revert back to finger sticks. Everybody needs to have test strips at home. Everybody needs to be ready in case they can’t get their devices.
At what point should someone with diabetes reach out for help? What symptoms should trigger somebody to reach out to their medical team?
COVID-19 is a fever first and foremost, and then a bad cough. It’s not a headache. It’s not a runny nose, it’s not a sore throat, it’s not even muscle aches. It’s a fever, so everybody should have a thermometer at home. And frankly I’ve taken to taking my temperature every night because again, I’m at more risk because I’m a healthcare provider and I want to make sure I’m not getting a fever… It’s very likely that that fever and cough in somebody who’s below the age of 50 is going to just resolve and you’ll feel achy and icky and you’ll drink fluids and that’s fine. But if you get shortness of breath, that’s when you want to go and get tested for COVID-19 and may end up in the hospital.
For someone with Type 1 diabetes, if their blood glucose levels start to be too high or too low, if they see a lot of insulin resistance because they’re sick, particularly if they’re vomiting, any of that would require contact with their endocrine team or whoever their diabetes management team is. And then if they’re really sick, go to the hospital. But this is one of those times when you want to self-manage at home, so if your glucose levels are low and you’re sick, if you can consume carbohydrate-containing fluids and give insulin and keep yourself out of ketosis, that’s what I want to see. We want to keep everybody out of the hospitals because it’s not a good place to be.
Is there anything else you would want to tell the people out there living with diabetes who might be worried about this?
I think it’s normal to be worried and it’s normal to be upset because all of our lives have changed so much. But I think that the Type 1 diabetes community is a wonderful group because it’s so interconnected and I think that everybody just needs to connect with each other. I think it’s really a good time to support each other. Don’t fall prey to misinformation because we just hear so many things. Stick to the basics of Type 1 diabetes, you all know how to live with it, you know how to deal with it. That’s not going to change… We’ll create a new normal, this will get hopefully better… I do believe that at some point we’ll have a vaccine, I believe at some point we’ll have treatments. And young people are at much less risk than older people. I think it’s awful on some level, but it’s also quite survivable on another, so just don’t panic.
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