Ask the Pediatrician: T1D and COVID-19
May 14, 2020
JDRF invited a leading type 1 diabetes (T1D) expert to discuss the probability of young people contracting COVID-19 and the necessary precautions they and their families can take to ensure their well-being during the pandemic.
Dr. Mahmud shared this information and more during our Facebook Live Q & A event, which you can watch below.
Dr. Mahmud also answered several live questions from the audience. Here are the top themes:
Q. Are people living with T1D at greater risk of getting infected by COVID-19?
A. No. Individuals with T1D are not at inherent higher risk of getting COVID-19 or other viral infections.
Q. Is COVID-19 a common occurrence in young people with T1D?
A. No, we are not seeing that in Canada, although there have been a few cases here of young people with mild symptoms that resolved after a few days with appropriate management. These are experiences that are helpful to us in order to be prepared. And I think of preparation as a balance of being reasonable, but not being fearful, and being patient, but not panicky. And filling this uncertainty with education and knowledge as much as we can. Health care professionals are still here and while we may have different ways of communicating with our patients and families and are limiting face-to-face interactions, we can still connect with them through virtual means. It is really important that we adopt that model.
Q. Will people’s fear of going to the hospital lead to further T1D complications?
A. It is a fear that health care professionals are worried about and of which we must be mindful. If a person living with T1D is unwell or has concerns, he/she should reach out to his/her health care team and be prepared with knowledge about how to manage the virus with T1D.
Q. Should teenagers with T1D who have part-time jobs still go to work?
A. If their jobs are non-essential roles, then no. If they are assisting in a family business, for example, then best to take precautions like wearing a mask, disinfecting everything and washing hands frequently. However, if going to work can be avoided, that is preferable.
Q. Is a return to school safe?
A. Yes. Young people without complications and normal blood sugar control would not be immune compromised. We must trust that the school system will have appropriate sanitizers and structures in place. There’s going to be that element where we are going to go over this complete lockdown and I think mentally we have to be ready for that, be it how we think of our days and balance COVID-19 – in the absence of a vaccine– in our lives. And as parents, we must be open to sharing our concerns with our educators.
Q. Where can blood work be done?
A. Blood work can be done certainly in the hospitals or in an outside lab as most of these areas have instituted significant precautions. It is recommended to wear a mask when you come in and wash hands regularly.
Q. Do we need to assess A1C levels?
A. You probably don’t need to come in for an A1C check unless there are other health concerns. Health care teams can host virtual visits where they can assess measures that are equally valuable for individuals using continuous glucose monitoring, such as time in range. We can also use records to discuss blood sugar management in patients who are monitoring glucose by standard methods.
Q. How do we empower ourselves and our children?
A. With reason. Instill the habit of handwashing and the fear of getting sick. The vast majority of young people with T1D who contracted COVID-19 recovered and remain relatively healthy.
Q. Can high blood sugar levels negatively impact your immune system?
A. If an individual has properly managed T1D and is without complications, he/she is not at risk. No one has perfect blood sugar levels throughout the day, and we would not be seeing significant alterations to the immune system (during this pandemic) that would make the person or his/her child immune compromised.
Q. Will insulin be readily available?
A. All the major manufacturers/pharmaceuticals have reassured us that there will be no problems with insulin supplies during this time. The Canadian Pharmacists Association has addressed the issue by having a one-month supply for all medications so that we can ensure there is enough for everybody.
Q. Should health care professionals working on the front lines move out and stay elsewhere if they have a child with T1D at home?
A. No, but they should take safety precautions before, during and after work. They should not wear jewelry on the job, only use disposable containers for lunch, leave shoes outside upon returning home, and launder their clothes and disinfect their mobile phone every day.
Q. What do you suggest to lower anxiety, worry and stress during this time?
A. Diet and exercise, self-compassion and self-forgiveness. Like kids, adults will have both good and bad days. They are struggling with everyone under the same roof. So, it is important to have some type of schedule, but at the same time to be spontaneous and look after themselves because they have been thrown into a situation that isn’t perfect and that they didn’t plan for. They have to practice self-compassion and understand that they are doing the best job they can to make decisions in real time. I think exercise, activity and having time to be alone with their thoughts are very important because with all of these stresses they have to be careful to not be overly reactive and to be nurturing to their children who are going through this as well, and temper what they’re hearing 24/7 re – news.
Q. Are diabetes complications more likely among individuals with T1D once they contract COVID-19?
A. No, that is not an outcome we are seeing; the virus is not affecting any organs like the kidneys, eye, etc. among these people. And the experiences from Europe and China must be very much shared as they have had some good outcomes stemming from the significant hardship. Thankfully, our hospitals here in Canada are coping and are not jam-packed.
Q. How do we keep children on routine re – their diabetes management?
A. Parents and their children should work with their health care team to get structure. I think this is an opportunity to optimize as much as we can.
Q. How can parents prepare if they contract COVID-19 and they can not access their network of grandparents/older relatives to care for their children?
A. In this situation, they should communicate with their medical team as they may have to be hospitalized. Their condition may also be able to be virtually assessed and family-centred care may be provided by the institution.
Q. Would patients with T1D be the first to be vaccinated against COVID-19?
A. No. Older adults are at highest risk, so they would likely be the first to be vaccinated against COVID-19.
For more info on T1D and COVID-19 please visit jdrf.ca/coronavirus.