Coronavirus in Context: Advice on How to Stay Healthy and In Charge of Diabetes

Hello. I'm Dr. John Whyte, Chief Medical Officer at WebMD, and welcome to Coronavirus in Context. Our topic today is diabetes and coronavirus, and my guest is Dr. Anne Peters. She's a Professor of Medicine at the Keck School of Medicine at USC, and she's the director of the diabetes program. Dr. Peters, thanks for joining me today.

Thanks for having me.

Now, we're starting to hear about, potentially, this relationship between diabetes and coronavirus, or even that people who have diabetes are at a increased risk. Why do you think that might be the case.

Well, first of all, let me just start by saying that diabetes itself doesn't seem, to me, to be putting people at increased risk, but certain things do. So having higher blood sugar levels is not good for you. So it puts you at increased risk for infections. So somebody who's sugar levels are high should work to keep their sugar levels down.

So what's a high blood sugar right now for most people, and what do we consider normal nowadays? Is there a difference?

In my mind, I consider a high blood sugar right now above 200. And that's higher than my usual target, but that's just because I think everybody's stressed, and their lifestyles are different, and everything else, and I don't want people getting really worried if their blood sugar levels are higher than they're used to. So as a general rule of thumb, I think blood sugar levels should all be below 200 right now.

But in terms of normal or what's a normal target for people with diabetes, before eating, glucose levels should be between 80 and 130, and one to two hours after eating, it should be less than 180. So I think it's important to try to keep close to normal, but also to realize that unusual times can sometimes lead to higher sugars, and I don't want people to worry too much if they can't keep it in their normal target range.

We saw some data in Italy that 35% of patients who died had diabetes. Do you think if you get coronavirus, that diabetes puts you at greater risk of a complication?

No. What I think is, is that having complications of diabetes puts you at increased risk of doing poorly. But most people who are taking good care of their diabetes, who are under control, aren't those people. So you can't separate out the complications of diabetes from just having diabetes, and that's one of the problems. So older people with more complications with diabetes are at more risk, and I think that those people need to be extra careful not to get the virus, but I think everybody needs to be careful not to get the virus.

All right. And if we're staying at home, for some folks, it actually could be more difficult to be physically active. It might be harder to eat healthy, especially if you're not running to the grocery store or restaurants as often. What advice do you have for patients with diabetes to also focus on lifestyle during this time, which, you -- you know, can be difficult. And then there's stress that's part of all of this, perhaps affecting, you know, glucose control.

Well, so we know that stress and inactivity and poor diet make glucose levels higher, so I take this as a challenge. I think people should use this as a time to eat better, learn more about nutrition. I don't care if people are at home. They can walk around their living room. But people actually need to figure out ways to create an exercise program, even though they're at home, or eat well. And yes, people can have chocolate during this time of stress. I really think it's important that people get --

That is good to know. That's going to be the headline. You can eat chocolate.

It's not that they can eat a lot of chocolate. It's about portion size. So I want people to feel good.

And there's some concern about drug shortages. We know there's been some issues with contaminants in the past out before coronavirus. What do patients need to know that are on medicines, and often more than one medicine, during this, you know, pandemic, where it could be a challenge in some regions of the country to get medicine?

Well, I want to make it clear that at this moment, getting diabetes medicines is not a challenge. And in fact, people can and should get their diabetes medicines. And I think it's really a good idea for people to try to get three months worth of medication and maybe find a pharmacy or pharmacy service that delivers, but people shouldn't forget that they need to take their diabetes medicine right now. In fact, that's the worst thing people can do. And I think that most of us who take care of people with diabetes are available via telemedicine and even have clinic hours, if necessary. So people still have their health care providers to help them should they run out of medicine or need advice. We're here.

And we were talking earlier about, you know, diabetes is a chronic disease, and often there is a lot of interaction with the health care system. And right now, folks really are preoccupied with this pandemic. So is there concern on your part for patients with diabetes, that they're able to get adequate care? Is-- is telemedicine the right approach right now for most patients?

I think for a disease like diabetes, it's-- telemedicine is incredibly suited for helping patients, but patients have to do two things. One, obviously, they have to be willing to access their health care providers. But second of all, if they're told to check their blood sugars, they need to be checking their blood sugars, because I can't help someone with diabetes unless I know what their sugars are, in general.

So in patients where glucose testing is part of their treatment, they need to do that, and they need to report that. We can't let people with diabetes forget about their diabetes, because we don't want their glucose levels to go all out of control. I don't want patients to end up in the hospital because of their diabetes. I want people to stay at home and be healthy with their diabetes.

Should they test more often right now?

I think they should check more often if that's what their health care provider recommends, but I think that people need to take charge, a bit, of their own health, and diabetes is part of that. So if your home and your lifestyle is completely different and you can check your blood sugars, check your blood sugars in the morning before you eat or maybe before dinner. Just get a sense of things. I -- I think we all need to be proactive in terms of taking care of our own health.

Any different advice for kids with diabetes versus adults or for those with type 1 versus type 2?

Well, people have type 1 diabetes have a different kind of vulnerability, because if they get sick, they can develop something called ketoacidosis, which can be very serious. So even though I don't think that people with type 1 diabetes who are young and otherwise healthy are at increased risk for getting coronavirus, I think if they do, they can get into trouble with glucose management.

So people with type 1 diabetes need to absolutely be testing their glucose levels, and, ideally, have a way to test for ketones, which are the byproduct -- breakdown product that can lead to acidosis. So I think people -- kids in particular need to be sure that their parents are prepared to watch over them and be sure they don't go into ketoacidosis, because that's the severe problem that can come with having type 1 diabetes.

So we want to watch what we eat. We want to check our blood sugar more often. We want to be as physically active as we can inside as well as outside our homes. You said we can eat chocolate every now and then in moderation. Um, any other advice you -- you have for patients with diabetes? Does stress play a role here in terms of potentially increasing blood sugar?

Stress almost always, in my experience, increases blood sugar levels. Occasionally, there are actually patients who get low blood sugar levels because of stress. Who knows? But they do, in general, see an increase in glucose levels. And I can't tell people not to be stressed right now. It's an incredibly stressful time. But again, diabetes is a disease that people have some control over. And doing all the things -- the mindfulness, the meditation, you know, reaching out, even if you're by yourself, connecting with other people.

All of those good things that people do to connect and, sort of, reduce stress is very important right now. We all need to support each other through this. And I think people with diabetes need to not be extra afraid, but they do have the, sort of, added stress of having to take care of it, but they can. It's completely possible to take care of your diabetes through this and do well.

Well, there you go. We've been talking about we want to control what we can control and become educated and informed and aware, but not scared. So I want to thank you, Dr. Peters, for taking time today to talk about diabetes and what we need to be doing not only during the coronavirus, a pandemic, but every day in managing the care of diabetes. So thank you again. Stay safe.

You too. Thank you so much.