The Latest on COVID-19 From Dr. Anne Peters
Editor’s Note: We have a simple goal: tap into the power of the global diabetes community to save lives. Visit coronavirusdiabetes.org to learn more about what you can do as a person with diabetes to keep yourself and others safe from COVID-19 until we’re all safe.
This article was published in April 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 more questions and share her latest updates about COVID-19 with the Beyond Type 1 community. Watch the entire interview in full!
Partial transcript below, edited for content and clarity
For someone who has COVID-19 and diabetes, what would treatment in a hospital be like? How do hospitals manage diabetes treatment in general versus those admitted with coronavirus?
Anne Peters: I’m going to answer this in steps because first of all, in my patients with type 1 diabetes, I have not seen a single case of COVID-19. But I have heard about other patients around the country with type 1 diabetes who’ve been admitted, some with COVID-19, others with diabetic ketoacidosis (DKA). That didn’t happen because of COVID-19, just because they went into ketoacidosis—and therein is the problem, which I’ll explain.
When anybody is admitted to the hospital with type 1 diabetes—if it’s elective, obviously you want to discuss this in advance. But if it’s an emergency, some places will allow patients to monitor themselves and use their own insulin and use their pumps and everything else. And what’s recommended is that at least somebody on the staff of that hospital have some clue about managing technology. If you’re in a coma or something, then the physicians are going to manage it with an insulin drip. But I tell patients that they should be prepared if they go into the hospital to manage their diabetes themselves as much as the hospital policies will allow them to.
One of my caveats, though, with the COVID-19 problem is that you’re not necessarily allowed visitors because they’re keeping everybody out of the hospital. And so there’ve been times when patients needed a new infusion set or other things where a family members brought them. So now what I tell people is have a kit of your own, so that if you went to the hospital, you would have everything you needed to manage your diabetes. Infusion sets or sensors, strips and such—just have your own supplies because ideally, you’ll be able to manage your diabetes in the hospital and you will probably know better than anybody, but you’re not going to have somebody be able to bring, for instance, your charger for your iPhone that you may need. So just make sure you’re very focused on being prepared.
What’s been happening in the hospitals is when people have gone into ketoacidosis, they’ve waited too long. So normally if people are dehydrated and really can’t keep fluids down, they may go to the emergency department sooner. Nowadays, people are waiting because they don’t want to go, but then they end up really sick by the time they go to the emergency department. So prevention is everything. Everyone should have the ability to check for ketones, something so that they don’t vomit, and the ability to have fluids at home (sugary fluids, non-sugary fluids) to keep them out of the hospital. But if you’re too sick to drink fluids and give insulin at home, you’ve got to go early because then you’ll get even sicker. The problem is that once you’re admitted, in typical protocols for people with type 1 diabetes, your blood sugar is checked by the nurses every hour, and then they’re going to adjust the insulin drip. Well, we can’t do that now because nurses can’t keep going into your room every hour because they have to use personal protective equipment (PPE).
And we don’t have enough of that for nurses to take it on and put it off. So we’re finding a real problem in monitoring patients with type 1 diabetes in the hospital and whether or not they have COVID-19, that’s a problem. So we’re trying to ask the FDA to allow us to use Dexcom because that way it could actually transmit to the nursing station so someone wouldn’t have to keep coming into your room. But that’s why I tell patients, bring the capacity to monitor your own sugars to the hospital because that’s the one thing that requires somebody to come in. And normally we don’t think about it, a nurse just comes in, but now they can’t. So be prepared particularly to monitor and do your best to not have to go into the hospital.
We’ve gotten questions from people who were already in the process of switching to a new therapy before the pandemic. Do you have any suggestions? Would this be a bad time to switch or if they already had it underway, could they continue as planned?
Well, so it’s done on a case by case basis if you ask me. I’m working really hard with my patients to keep them healthy and I’ve had some patients who wanted to switch to a pump and have the pump and they’re ready to go. But I haven’t felt that I had the personal bandwidth to give them the attention that they need to make them safe, so I’ve said “Wait.” I feel like it’s all about safety and it’s a good time switch because you’ve got time, but if you can’t do it safely, then don’t do it on your own, you need to have somebody there with you.
If you have a diabetes educator who can be there with you and make sure it goes well, then it’s fine. But don’t do anything that rocks the boat too wildly. So for instance, the big concern is people with type 1 who are on sodium-glucose cotransporter 2 (SGLT-2) inhibitors. And I certainly wouldn’t start one now and maybe people would be better off not on them because they increase the risk for DKA. So if people are well controlled on it and they know this stuff, that’s great, but don’t do anything to increase the risk of ketoacidosis.
You mentioned personal protective equipment (PPE) earlier and initially, the WHO and CDC said there was no need for people to wear masks out in public. Increasingly people are pushing for everyone to wear masks in public. Do you have an opinion on that?
I actually kind of think it’s a good thing. N95 masks are the masks the healthcare providers use and specifically designed to protect us healthcare providers from getting sick from someone else. And you have to be trained on how to wear them correctly—they have to fit. You can’t have a beard and have them work. So N95 masks should be reserved for healthcare providers. The regular surgical masks are meant to prevent you getting something from me. And if you think about it, if we don’t know the carriers of this and we know that there’s at least a quarter of the people who could give it to you who don’t know it. If everybody’s wearing a mask, you cut down on transmission because if people coughed or sneezed, it wouldn’t go to you. I think it reminds you that we’re having a problem, this is something that we need to be aware of. It also should make you touch your face less—it’s very important not to touch your face… If you’re going to have a mask, wear it correctly.
Are there any extra precautions people who are pregnant with diabetes should be taking?
The answer is not extra special precautions compared to anybody else. The data increasingly says if you have diabetes, your risk of getting COVID-19 is not increased. But if you get diabetes and you’re sick in the hospital, then you may have worse outcomes. In pregnancy in particular, it’s a really scary time, but the data from the Chinese series shows that the babies didn’t have a problem, and even with moms who had COVID-19. Again, you want to try to not get it, we don’t know for sure but the outcomes we’ve seen in pregnancy haven’t shown a problem in the babies or the moms. It’s been okay.
One of the issues is the fact that often you can’t have your partner with you in the hospital, so you may have to deliver the baby by yourself. At this particular point, having a healthy mom and a healthy baby is the most important thing here, so it may not be the delivery one plans, but that’s okay… Everybody with type 1 or 2 and pregnancy needs to be in contact with their healthcare team. You still need insulin dose. It’s still pregnancy and diabetes. So we’re here, that’s our role. I wouldn’t be extra worried, it’s hard not to be, but what we know from the data is the babies will be fine and the moms will be fine even if the mom gets COVID-19. Try not to, but it’s going to be okay.
Do you have any advice for people who might not be able to access telehealth? Are there any additional resources for the underserved, low income or recently unemployed communities who are living with diabetes?
In California, we’re trying to make sure that people who have chronic conditions and lose their jobs or whatever else have some capacity to get healthcare. I work in the County of Los Angeles part of the time and I still go to clinic there because my patients with type 1 don’t have the ability to do telemedicine… Those of us who work in the county healthcare systems are aware of the vulnerability of our patients and we’re still open. So at least in California, we’re making a real effort to provide care and people should go look at their local health department to see which clinics are open and just go. We’re here. We have resources to help people.
We are getting questions along the lines of “How will we know when it’s safe to go back to normal?” Is it when the government lifts the shelter in place? When there’s a vaccine?
Well, I have many, many answers to that question, but let me start with the beginning… Everybody, every year is at risk for the flu and people do and don’t get the flu shot, but people aren’t freaked out about it. People are freaked out about this because there’s no vaccine and there’s no treatment. So we’re not going to be truly safe from this until there’s a vaccine and then everybody needs to get the vaccine. I think what we’re going to go back to is that once the peaks are down, they’ll still be this virus. The flu doesn’t go away. It stays out there and it comes back seasonally. We have no idea about the seasonality of this. But you can’t fight it until we have a vaccine or a treatment, so it will be a risk.
The vast majority of people who get this with or without diabetes will have a mild illness or a moderate illness. And for most people, unless you’re older or have other health conditions, you’re going to be fine. And in fact, I think what’s going to be fascinating is in another couple of months we’ll be able to do a test where we can tell if you’ve had it…
To have had it isn’t a bad thing because most of you all are going to be fine. It’s older people with other problems who are going to be not so fine. So the reason we’re preventing this is because we don’t want people to die and we don’t want to ruin our healthcare system. But it won’t go away… People used to be more careful about hand-washing. People used to not hang out with somebody who was coughing. We want people to say, “Oh gee, I am having a cough, I’ll wear a mask to work today,” or “I’m not going into work today.” So until we get a vaccine, this has to be in our brain.
I think we’ll be able to go back out when they say it’s okay, but my older patients, I’m going to keep them in a bubble for a year. I’m not joking. For some people, they can go out, but I don’t want them to be in a crowd and looking to go to a movie theater. I would say for older people, rock concerts are out, but for younger people, wait… I do think once we can test to see who’s had it, it’ll be interesting, because more people will be immune. And once you’re immune, we think that there’s going to be at least partial immunity, if not a full immunity going forward. So on some level, hope that you get it, but it’s mild and you’re done with it, because then you’re done.
Do you think that a test will be available soon to test whether or not you’ve ever had COVID-19?
I think so because we can tell if you’ve ever had all sorts of things by measuring your blood. We can tell if you’ve had hepatitis, we can tell if you’ve had all sorts of viruses. We can tell if you’re immune to pneumonia. But I know that they’re working on that because it’s important to know if you’ve had it because it puts you in a different category. It kind of is freeing, oddly. And I don’t want anyone to get it, but if you happen to get it and it’s mild, like I said, that’s pretty good.
Get some more answers from Dr. Peters on Coronavirus—COVID-19 Q + A with Dr. Anne Peters.