Dr. Ampeters spends an almost virtual week between a diabetes clinic in the west of Los Angeles and a diabetes clinic in the east of a vast city.
I treat people with well-controlled diabetes three days a week. They have insurance so they can buy the latest medicines and blood monitoring devices. They can exercise and eat well. West LA patients, who were generally wealthy who underwent COVID-19, developed mild to moderate symptoms-although distressing-are treatable and are followed up closely at home.
“All right, they should do worse, but most don’t even go to the hospital,” said Peters, director of the USC Clinical Diabetes Program.
The remaining two days of her work week are another story.
In East LA, many patients were uninsured even before the pandemic. Due to widespread layoffs today, layoffs are even lower. They live in a desert that lacks cars and gas to go to a grocery store with fresh fruits and vegetables. You cannot stay at home because they are integral workers in grocery stores, healthcare facilities and delivery services. And because they live in multi-generational homes, they can be infected by young relatives who are unable to do so, even if the elderly remain laid.
They tend to get COVID-19 more often, and when they get sick they have more symptoms and are more likely to reach hospitals or die, said Peters, who is also a member of the Beyond Type 1 Leadership Council. It was Diabetes research and advocacy group.
“It doesn’t mean that all my eastern patients have been destined,” she stressed.
However, COVID-19 has unequal effects, suggesting that the poor and already ill are struggling to be much healthier than those on the other side of the town.
Tracy Brown knew that for years.
“What the COVID-19 pandemic has done is a very bright highlight of this existing epidemic,” said Brown, CEO of the American Diabetes Association. Approximately one in ten Americans – as well as about 32 million – Brown has diabetes himself.
“We’re in 2020 and every five minutes someone loses their limbs,” she said. “Every 10 minutes, someone has renal failure.”
She said that Americans with diabetes and related health conditions were 12 times more likely to die from COVID-19 than Americans without such conditions. Approximately 90% of Americans who die of COVID-19 have diabetes or other underlying illness. And the people of color are highly overrepresented among the sick and dead.
Diabetes increases COVID risk
The data are clear: people with diabetes are at greater risk of developing bad cases of COVID-19, and those with diabetes who have poorly controlled blood sugar are at even greater risk, says Professor Liam Smeeth of the Department of Epidemiology and Population Health. States. London School of Health and Tropical Medicine. He and his colleagues Combing data from 17 million people in the UK To come to their conclusions.
Diabetes is often paired with other health problems such as obesity and high blood pressure. “Adding smoking can really make things worse, especially for people with diabetes,” Smoos said.
High blood sugar makes white blood cells inoperable, making diabetics vulnerable to many types of infections.
“In vitro, we can see that high sugars reduce the functioning of protective cells,” she said.
Peters recently saw a patient with diabetes caused by COVID-19. Supported by one recent study..
Going to the hospital with a viral illness can cause blood sugar spikes with or without diabetes. According to Peters, some drugs used to treat severe cases of COVID-19 may “break sugar”.
Peters says that patients who take COVID-19 but are not hospitalized often need to reduce their insulin to make up for the fact that they don’t eat much.
According to Smeeth, low income appears to be a risk factor for bad cases of COVID-19, regardless of age, weight, blood pressure, or blood sugar. “We have a strong connection to poverty.”
Some of them are caused by occupational risks, and poor people cannot avoid work from home or high-risk jobs. Some are related to housing conditions and crowded apartments to save money. And some may be related to underlying health conditions.
But he said the relationship was correct.
Peters recently saw a long-standing friend lose his husband. He was 60 years old, diabetic, and was fired for COVID. He developed a foot ulcer that he could not afford to treat. He ignored it and went to the hospital until he could not stand it anymore.
After surgery, he was released to a rehab facility where he signed a COVID. He returned to the hospital and died four days later.
“He died not because of COVID, but because of diabetes, and because he didn’t have access to health care when needed to keep the whole process from happening,” Peters told the family. He added that he could not see it. Died on his last day and alone. “It just breaks your heart.”
Take Action-Personally and Nationally
Peters added that it is now a great time to improve diabetes management. Many restaurants and most bars are closed, giving people more control over the food they eat. Eliminating commuting leaves more time for exercise.
That’s what David Miller managed to do. Miller, 65, Austin, Texas, said he walked a nearby high school track four times a week for 40 minutes in the morning to strengthen his exercise routine. The hours were cool enough and the trucks were not crowded, said Miller, an insurance agent who was able to work from home during the pandemic. “It’s a more consistent movement than I’ve ever done.”
His blood sugar wasn’t exactly what he wanted, he said, but his new fitness routine helped him lose some weight and better control his blood sugar. Eating less is still a challenge. “I’m one of the middle-aged men who is used to eating together,” he said. “It can be a difficult habit to shake.”
Miller said he wasn’t too worried about getting the COVID-19.
“I tried to limit my exposure to a reasonable range,” he said, and he noted that he was wearing a mask when he could in the public. “To be honest, I don’t feel particularly vulnerable to anyone else.”
The British epidemiologist, Mr. Smith, said that people with diabetes should know that they are not helpless, although the risk of bad outcomes is high.
“The traditional public health message of being overweight, quitting cigarettes, and staying active is valid for COVID,” he said. In addition, people with diabetes should prioritize flu vaccination this fall to avoid further exacerbating their risk, he said.
(For more practical recommendations for people with diabetes during a pandemic, coronavirusdiabetes.org.. )
In Los Angeles, low-income people now have easy access to diabetes medications, Peters said. You can now take 3 months of medication instead of 1 month. “We supplement the medicines of everyone to make sure that people have access to the tools,” she said, advocates of diabetes help people get health insurance. He added that they also did what they could to help.
Controlling blood sugar helps everyone, not just people with diabetes, Peters said. Someone hospitalized with uncontrolled blood sugar makes use of a bed that is otherwise available to COVID-19 patients.
Brown of the American Diabetes Association is advocating these measures at a national level and is strengthening testing in low-income communities. just now, Most test centers are in wealthy areas, She said, and assuming everyone who needs a test has a car, many are drive-throughs.
Her organization is also lobbying for health insurance coverage if someone with diabetes loses her job, and legislation to get rid of out-of-pocket diabetes medications.
“The last thing we want to happen is that during this financially difficult time, people will start to distribute or skip doses of insulin and other prescription drugs,” Brown said. This leads to uncontrolled diabetes and complications such as ulcers and amputations. “Diabetes is one of the illnesses you can control. You don’t have to suffer or die.”
Contact Weintraub at [email protected]
Health and patient security in USA TODAY has been made possible in part by grants from the Masimo Foundation for Health in Ethics and Innovation and Competition for Healthcare. Masimo Foundation does not provide editorial input.
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