Dr. Richard Bernstein has a very clear message for people with diabetes: avoid coronavirus as much as possible and for as long as possible. The danger to people with diabetes \u2013 both from coronavirus itself and from the resultant stress placed on the healthcare system \u2013 is real.<\/p>\n
\u00a0\u201cIt\u2019s much better to avoid getting infected than attempting to treat the infection, and to do that you need total isolation.\u201d<\/p>\n
Many of our readers will already be familiar with Dr. Bernstein<\/a>. It\u2019s very likely that no one person has ever known more about diabetes, and certainly nobody has ever understood its proper management more vitally.<\/p>\n This week Dr. Bernstein spoke about diabetes and the risks of COVID-19, the novel coronavirus, in the latest installment of his Youtube question & answer series<\/a>.<\/p>\n Noting the extreme speed with which the pandemic has developed – \u201cwhat I\u2019m telling you today could well be outdated within a week\u201d \u2013 Dr. Bernstein went on to describe COVID-19 as a very serious peril for people with Types 1 & 2 diabetes.<\/p>\n \u201cI think that we have to do the maximum to not get infected. And that means not only adhering to what the local authorities tell you to do, but anticipating the local authorities, staying away from other people, especially if you\u2019re in a locality where there are cases of COVID-19 within 20 miles of your home. You shouldn\u2019t go to stores. Don\u2019t invite people to your homes, don\u2019t visit other people. Even other family members in other homes, stay away from them.\u201d<\/p>\n Dr. Bernstein himself has arranged for all of his grocery, drugs and other supplies to be delivered to his front door. He answers the doorbell wearing a mask and gloves, and signs receipts with his own pen. He even recommends spraying down packages with rubbing alcohol.<\/p>\n \u201cThat\u2019s how careful you have to be.\u201d<\/p>\n <\/p>\n \u201cMy guess is yes\u2026 but are there any real statistics on this? I don\u2019t know.\u201d\u00a0<\/strong><\/p>\n It seems that nobody is sure if diabetes makes one more prone to initial infection with the novel coronavirus, nor how age and diabetes type might affect the probabilities. Accordingly, Dr. Bernstein applied many caveats to his discussion of this topic.<\/p>\n \u201cWe do know from general experience that diabetics are more susceptible to infection. Historically, this has been bacterial infections.\u201d<\/p>\n \u201cWhat\u2019s the story with viral infections? I haven\u2019t seen any studies indicating diabetics getting more viral infections. They may be out there, but I haven\u2019t stumbled upon them. I can understand why the immune system would be impaired by high blood sugars<\/a> \u2026 I certainly would expect that if you have a high blood sugar, that that large amount of glucose in your blood will predispose you to infections. Now that\u2019s my guess, it\u2019s just a guess.\u201d<\/p>\n Those with healthier blood glucose levels, both in the present moment and in the past months and years, likely stand a better chance of resisting the virus.<\/p>\n <\/p>\n We have known from the early days of the pandemic that people with \u201cdiabetes\u201d are much more likely to develop severe health consequences from COVID-19, including death. There has been much speculation over whether or not people with Type 1 diabetes should be included among the higher risk group<\/a>, and how younger people with either type might be affected. The CDC declined to speculate<\/a> on this subject.<\/p>\n Dr. Bernstein made it clear that all<\/em> people of diabetes should consider themselves among the higher risk population:<\/p>\n \u201cOnce you have a viral infection, almost inevitably, almost in every case, the blood sugars go up.\u201d<\/p>\n Rising blood sugars are known to hinder your own body\u2019s ability to fight off infections. People with Type 1 diabetes have an additional, major concern:<\/p>\n \u201cIf the blood sugars go up high enough, you could get severely dehydrated and go into diabetic ketoacidosis. So, you could end up getting killed by your diabetes because you\u2019re infected by a virus and you didn\u2019t take adequate measures to treat the viral infection.\u201d<\/p>\n Even those who lack the other preexisting conditions that make COVID-19 infection more dangerous, such as hypertension or old age, would be well-advised to consider their immune systems impaired. Many people with diabetes have years of hyperglycemia in their past, and although some of that damage is reversible with good glucose control, not all is.<\/p>\n \u201cI see that virtually 100% of longstanding diabetics that come to see me have autonomic neuropathy. The largest nerve in the body is injured by high blood sugars. And you could bet that a lot of other things are injured. Perhaps every tissue in your body is adversely affected by the glucose. And why shouldn\u2019t the immune system be likewise impaired? That\u2019s guessing, that\u2019s all it is, but I think we can expect it.\u201d<\/p>\n <\/p>\n Not all of us are lucky enough to have the opportunity to practice total isolation \u2013 indeed, there are people with diabetes on the very front lines of the battle against the illness \u2013 and undoubtedly even some of the most careful will contract the illness before a vaccine is developed. Much of Dr. Bernstein\u2019s talk therefore concentrated on what people with diabetes should do if they suspect that they\u2019ve contracted COVID-19.<\/p>\n One clear message emerged: care for yourself at home as much as possible.<\/p>\n \u201cHospitalization, for a diabetic, is very dangerous. If you get a fever and don\u2019t have trouble breathing, you might be safer staying at home.\u201d<\/p>\n Why? Well, for starters, the emergency room is a great place to get infected with COVID-19 if it turns out that you don\u2019t already have it. But even at the best of times, many doctors and nurses are painfully inexperienced at managing the blood glucose levels of a person with diabetes. And if these professionals are as tragically overburdened as predicted, they will be even less able to pay attention to this critical element of care.<\/p>\n And with hospitals banning visitors, it will be even more difficult than ever for parents or caretakers to help monitor and adjust the blood sugar levels of their wards.<\/p>\n \u201cIt\u2019s a real dilemma and there are no magical solutions. You might have to be on your toes on how to handle one situation after another if you\u2019re in a hospital.\u201d<\/p>\n If you are in the hospital and are capable of managing your own glucose levels, you should do what you can to retain control. Dr. Bernstein suggests you make a deal with your caregivers:<\/p>\n \u201cYou guys treat my COVID, I\u2019ll treat my diabetes.\u201d<\/p>\n At what point should COVID-19 symptoms prompt a trip to the hospital?<\/p>\n \u201cIt\u2019s not that easy to answer… if it were me, I\u2019d go if I were having trouble breathing.\u201d<\/p>\n This generally dovetails with CDC recommendations<\/a>, which are to stay at home unless you feel \u201cemergency warning signs.\u201d Those signs include trouble breathing, persistent chest pain or pressure, lethargy and bluish lips or face.<\/p>\n <\/p>\n If you view the hospital only as a last resort, then you need to be prepared to care for yourself at home. Self-care is more challenging for people with diabetes, and Dr. Bernstein\u2019s sick day preparations, while familiar in most regards, are very aggressive.<\/p>\n In order to avoid sending patients to the hospital, he advises extreme preemptive measures against dehydration, which can rapidly spiral into DKA. For patients that can afford it, he\u2019ll prescribe a stockpile of injectable liquid Tigan<\/a>, a powerful entiemetic used to combat nausea and vomiting. Zofran<\/a> is another option, although he cautioned that insurers will rarely cover enough for a full application. He advises everyone to have a stash of Lomotil<\/a>, in case of diarrhea. And if your immediate family has anyone trained in medicine, he even recommends keeping saline bags on hand so that you can hook up an IV set.<\/p>\n While vomiting and diarrhea are not among the most common symptoms of COVID-19, they are present in a certain percentage of cases, and should be particularly feared by patients who require insulin.<\/p>\n There are plenty more details \u2013 such as how Dr. Bernstein adjusts insulin to bring glucose levels down during illness \u2013 in the video.<\/p>\n <\/p>\n Dr. Bernstein also answered questions about potential new treatments for COVID-19.<\/p>\n \u201cThere have been a number of papers demonstrating efficacy of hydroxychloroquine, which is one of several old agents to treat malaria, and then subsequently used to treat rheumatoid arthritis, that they found were effective in stopping the attacks upon the lungs of the COVID virus.\u201d<\/p>\n Dr. Bernstein recommends hydroxychloroquine use, but not prophylactically, only \u201cif I were exposed \u2013 that is in contact with someone that I knew that had COVID-19 \u2013 or if I started getting the symptoms.\u201d<\/p>\n The media has also been abuzz with reports of a very small study<\/a> that found that the combination of hydroxychloroquine and the antibiotic azithromycin had remarkable success in treating the virus. Dr. Bernstein is more doubtful about the use of azithromycin, both because the study was so small and because of the additional hazard that an antibiotic can present.<\/p>\n \u201cThere\u2019s a tax to azithromycin. If you give a patient azithromycin, the first thing that\u2019s going to happen is that you\u2019re gonna knock out their microbiome\u2026 there\u2019s great hazard to this.\u201d The hazard is the increased risk of contracting new illnesses, such as C. diff<\/em>.\u201d<\/p>\n \u201cI would take at least the hydroxychloroquine, and question mark the azithromycin. So it\u2019s not an easy answer to this particular question \u2026 Now we might find that in 2 weeks some big studies will be done and we\u2019ll know that the azithromycin may be a must, or that it\u2019s a no-no. We just don\u2019t know right now.\u201d<\/p>\n <\/p>\n But hydroxychloroquine may not be available again any time soon. President Trump recently called hydroxychloroquine \u201ca game changer,\u201d and demand exploded overnight. The latest news is that doctors are hoarding the drug for themselves<\/a> and that India, a major manufacturer, will cease exporting it<\/a> altogether. Meanwhile, studies only days old have raised doubts about its efficacy<\/a>.<\/p>\n There have also been reports<\/a> that Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) that could either enhance (or inhibit) COVID-19 infection. Dr. Bernstein is taking a wait and see approach:<\/p>\n \u201cI would, at this point of uncertainty, suggest that you continue doing whatever you\u2019re doing. If you\u2019re taking ACE-inhibitors, keep taking them, if you\u2019re not, don\u2019t start them on account of COVID-19. Now, that can change in a week. There could be more data coming up.\u201d<\/p>\n The entire video<\/a> is well worth a watch for even greater detail on all of these topics. The video was edited by David Dikeman<\/a>, a teen with Type 1 diabetes who follows Dr. Bernstein’s low carb dietary recommendations.\u00a0<\/p>\nDoes Diabetes Make You More Likely to Contract COVID-19?\u00a0<\/h3>\n
Does Diabetes Make COVID-19 More Dangerous?<\/h3>\n
If You Get Sick<\/h3>\n
At Home Care<\/h3>\n
New Treatments for COVID-19?\u00a0<\/h3>\n