A brief update on COVID-19 and type 1 diabetes recorded March 11, 2020. Stacey talks to Dr. Satish Garg, an endocrinologist at the Barbara Davis Center for Diabetes. Dr. Garg talks about what we know right now, what he’s telling patients and advice for anyone with T1D.
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Stacey Simms 0:00
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this is Diabetes Connections with Stacey Simms.
Stacey Simms 0:26
Welcome back to another episode of the podcast really glad to have you along. And once again, we are doing a short episode on Coronavirus and type one diabetes. I’m your host Stacey Simms. And you know after we put out an episode at the end of February about this, I heard from a lot of people who asked me to keep updates coming. Now as I have said before podcasting isn’t really the best medium for breaking news. You can listen to this episode immediately as it comes out. You could be listening to it weeks or months years down the line. But I do think we can use the podcast here to get some good information out. So in the limited way that we can, that’s what I’m trying to do.
This episode is going to be on the shorter side, maybe 15 minutes of the interview with an endocrinologist just sort of talking about where we are right now and answering some specific questions from listeners. We will have a regular Diabetes Connections, interview and show next week. I’m going to come back after the interview and I’ll talk a little bit more about the show going forward.
I am recording this on March 11. The same day the interview with Dr. Satish Garg was recorded, obviously, the information may change. That’s why I’m telling you the date. Please make sure you check the links in the show notes. They are on the episode homepage, or in the show notes. If you’re listening on an app. It’s kind of hard to find sometimes, but most podcast apps will have a place that says details or more information and that Where I’m putting the updated links, the ones that will automatically update when it comes to the coronavirus.
And one more thing, you’re going to hear Dr. Garg mentioned people with type one diabetes as having compromised immune systems. I did press him on this off the air and he says he uses that term to talk about people who have an autoimmune disorder like Type One Diabetes because he says, once you have one autoimmune disease, you’re likely to get more like celiac disease or Addison’s disease or other auto immune issues. He said, and you will hear him say this, it does not mean that people with type one diabetes are more likely to get sick from viruses like the flu, or COVID 19. With all due respect, I think it was a confusing way to talk about autoimmune conditions. And if you’ve listened to the show, a compromised immune system is not how anybody has talked about it before. So I did think that was worth pointing out to you.
All right here is my interview. It is with Dr. Satish Garg of the Barbara Davis Center for Diabetes.
Dr. Garg, thank you so much for spending some time with me. I know you’re not only seeing patients but you’re trying to reassure patients that I’m sure are calling in about the situation right now. how busy is your office at the moment? Are you fielding a lot of worried calls?
Dr. Satish Garg 3:24
Very many. I mean, my staff is swamped and getting calls and wanting us to write letters because they have Type One Diabetes should they go to work? And not only me and my emails are also we have nine different providers on the adult side here at the Barbara Davis center for diabetes and so many educators and all of them are swamped with these emails and text messages they’re getting from patients.
Stacey Simms 3:52
So what are you telling patients who are asking if they should go into work?
Dr. Satish Garg 3:56
We primarily tell them to go on to these websites. JDRF has created a nice website giving guidelines for people with type one diabetes and also tell them to go on our website we posted some through University of Colorado and to coronavirus.gov and that is to the CDC. And if they have some degree of comorbidities, for example, if they are older, older than, you know, 60 or 65, and they have heart disease, hypertension, obviously they have diabetes, they may want to avoid places where there are larger crowds, or they may want to avoid unnecessarily getting in contact with somebody, for example, going for rallies and things like that people need to avoid so general precautions nothing specific to people with type one diabetes, except if they have comorbidities.
We do recommend people to get the flu shot but they are specifically not at high risk of getting Any of these infections if their glucose control is good. But their immune system is compromised, because they have autoimmunity, it does get confusing. So the bottom line is that people have tried to maintain their glucose control as best they can to avoid hyperglycemia and avoid wide glucose excursions. And those are the general precautions. And of course, if their glucose control is not good, then they might be more prone to get bacterial infections and other infections, but their immune system is not normal, quote, unquote, on a healthy individual like you and I, who don’t have type one diabetes, our immune system is different than the ones with Type One Diabetes. So it makes sense.
Stacey Simms 5:45
Yes, absolutely. I totally understand where you’re coming from with that. But bottom line, good glucose control, you are not more likely to get COVID 19 if you have type one diabetes.
You said right before we started taping that you had just seen an 84 year old patient with type one, what’s your advice for that person?
Dr. Satish Garg 6:05
So we have more than about 400 patients who are older than 60-65 who have type majority of them have type one diabetes and some have type two, but they are requiring insulin therapy. Anybody who is in that age group, I always advise them especially many of them have comorbidities hypertension, hypercholesterolemia, heart disease. So those individuals I tell them specifically avoid, I’m not asking them to quarantine. Of course, if they have dry cough, and they start running fever, they should self quarantine, do advise them not to travel because right now, we don’t know how the aircraft and what have you are being cleaned. Avoid large crowds. So just the general precautions that CDC advises that’s what we are recommending to go People go they are definitely at high risk, one because of the age, second type one diabetes. And third, they have majority of them have some degree of comorbidities.
Stacey Simms 7:11
You know, one of the questions that we see a lot is, how can I prepare to be self quarantined? You know, a person with diabetes or household that has a person with type one diabetes in it. What are you recommending people keep on hand for two weeks, 30 days?
Dr. Satish Garg 7:28
Well, I think there might have been an overreaction to that people are slightly overreacting. Oh my God, we might suddenly be locked down, like Italy’s logged on, like part of China was locked down. I hope that doesn’t happen. So people are going on ordering insulin, masks and what have you. We don’t anticipate that for example, in the state of Colorado, we only had about 15 to 20 cases now having a tip that they haven’t tested a whole lot once you get a lot of people tested that One will really know the hard numbers right now, unfortunately, we do not have the hard numbers to how many people have been really affected by this disease. But we just give general advice to these individual.
Stacey Simms 8:15
You mentioned people trying to stock up on insulin. You know, one of the problems is a lot of insurance companies will not pay for that much, right, people are trying to get the prescriptions renewed. Are you running into that same thing,
Dr. Satish Garg 8:26
most of our patients would have about three months of supply, and if some of the insurance companies won’t give them luckily for us at the Barbara Davis center, we have so many samples, we just give them one or two extra pens or vials so that they don’t have to worry about it. Again, I’m hoping that this won’t be a major event. Let’s hope as the temperature turns around, that this virus will be just like what was Spanish Flu back in 1918. That will go through the cycle, but we don’t know that a lot of people most of us Do not know the exact cause of this particular virus.
Stacey Simms 9:03
I will defer to you as the medical professional, but you’re hoping it’s like the Spanish Flu of 1918? That killed an awful lot of people.
Dr. Satish Garg 9:11
Well, but the Times have changed. You’re right, that killed millions of people. No, we’re not seeing anywhere close to that. Because what healthcare was 1918 100 years later is night and day. For example, back 40 years ago, I used to tell all my type ones, you’re not going to live beyond 35 to 40 years of age. Today, I tell all of them, you’re going to reach 80-90 years of age, I’m not aiming at 100. But you’re going to reach nearly full potential of your life expectancy. So times have changed healthcare quality and what is available had changed night and day. So I think it’ll be unfair to say that we’re going to see those sort of mortality rates, but we saw back in 1918 because of the health care standards that are changed dramatically.
Stacey Simms 10:01
Um, you know, another listener of mine, I’m reading you some questions that I took from my listeners. And one of them had asked that there are some studies that people with type one have worse outcomes after major events like heart attacks, because of the autoimmune issues that people with type one already have. So she’s concerned about that with Corona virus. Is there any indication? I know it’s still early that one of the reasons that it kills people is because it does affect the immune system.
Dr. Satish Garg 10:32
So here’s the problem, Stacy with that we do not have data to say that affect anything right now we have so few deaths in the US or even worldwide, and leave alone people with type one diabetes now convert to the best of my knowledge. None of the patients with type one diabetes has died. But again, that may be what I know of the numbers.
Again, we do not have any for example here, the Barbara Davis center. We don’t have any patient with the corona virus, and they have a significant number just like any other clinic of comorbidities. But we don’t have any such problem right now. We are telling people in general to avoid travel for example, please don’t be on a cruise ship that is a living source of petri dish that you’re going to be definitely there is even 1% chance that you can avoid that you should avoid going on a cruise ship. Now, regarding other travel, the University of Colorado has already banned all our personal and domestic and international travel. So some common sense is to be taken into con in the sense if you really don’t have to travel anywhere. avoid that. That this thing’s bad. Through, hopefully just like a flu virus, and over time, it will all go away, we’ll hopefully find a vaccine. And this will be a thing of the past. But right now, there is too much unknown, especially in patients with type one diabetes.
Stacey Simms 12:14
All right, so I have a question for you from Julia, one of my listeners who is actually a flight attendant, so she says, I have no one to ask this question. I don’t know if you’ll be able to answer it, but we’ll give it a try. She says I fly internationally to London. I do everything I should to avoid getting it but I have accepted is likely I will get COVID 19. When this happens, and I’m told to self quarantine, unless it’s very life threatening. She says, What should she do for herself in a mild case scenario? So here’s the question a person with type one who does get this and is not having a life threatening incident of it. What should they do?
Dr. Satish Garg 12:54
I would do self quarantine. Make sure you have enough insulin, fluids and whatever else necessities of day to day life you need. Yeah, they should be no different course to the best of our knowledge. Again, as you asked me earlier, the effect on diabetes, But again, we have no data that anybody with type one diabetes who is well controlled, behave any differently than the ones who don’t have type one diabetes. So, General precautions, you got mild cough, small fever, self quarantine, and you should do fine, just like you would do it for a regular flu
Stacey Simms 13:33
and your regular sick day plan that everybody should have their endocrinologist in ketones, that sort of thing.
Dr. Satish Garg 13:39
Stacey Simms 13:40
You know, we’ve said well controlled several times, and I know every one is different. And I almost hate to ask this question, having a child with type one for 13 years. So I think I know the answer, but I’ll ask it anyway. When you mean well controlled, is there a number again, knowing that everybody’s different? Is it an A one C of 7.5? Is it a Is it an in range? The time in range number, you know, when do we start worrying about well controlled type one diabetes, we know an A1C of 14 isn’t going to cut it.
Dr. Satish Garg 14:08
So there are many ways here, as you rightly said, for example, somebody at the age of 70 or 80, I probably don’t want their A1Cs to be in the 7s, because they have lived their life. They don’t have any significant comorbidities. Why don’t you just take it easy and avoid the risk of hyperglycemia. Someday in the teenagers 30s and 40s, you probably want to me one sees around seven, with a time in range of 65 to 70%. That’s our goal.
70% of our patients use some sort of a continuous glucose monitor, which is what we recommend and that is true for everybody who is at risk of getting Corona virus. That is one advice I would definitely give them that they should go on a continuous glucose monitor if they don’t have one just because when you’re sick, your blood sugars are To be higher that you need to be rather than having to finger prick every five minutes. Why don’t you have a continuous glucose monitor, preferably a Dexcom g six because that is far more accurate as compared to the average Libra, which is cheaper. However most insurance companies pay and thus you can continuously be monitored and adjust your insulin dose accordingly. Rather than having to prick yourself 10 times a day. That’s the only advice I would make change, especially to the flight attendant. Also, if she’s not using a CGM, I would strongly recommend that to use as one.
Stacey Simms 15:36
It’s interesting when you mentioned cost. I did get a question and I know it varies state to state. I know you’re a doctor, not an insurance expert. But do you know when a governor declares a state of emergency, you know, in North Carolina, our governor has recently done that it is mostly about federal funding. It’s not about emergencies in the street. I think most people recognize that by now. Is there any leeway for people To get extra supplies to be able to pay for things at the pharmacy, like a Dexcom?
Dr. Satish Garg 16:09
Yeah. I mean, I wish I had an answer for that. The only thing I would say is, if that scenario happens, I’m sure we can get a special prior authorization. This is a scenario that nobody has seen or confronted with. So we don’t know answers to many of the questions you’re asking. However, if one is facing that situation, we could definitely look into it and get a prior authorization for that individual.
Stacey Simms 16:36
Has there been any information coming out of you know, China or Italy or elsewhere, where they’ve been dealing with this for longer about people with diabetes and about how it reacts with COVID 19. I know when we say diabetes, that they lump everybody in there as one part to separate it, but have you been able to parse anything
Dr. Satish Garg 16:55
and that’s what I was going to tell you next one in China. According to To quote unquote, what they say, Type One Diabetes is rare. I don’t know to what extent is that rare, they just don’t have the information on that attack. Secondly, they lump all diabetes, type one, type two, type two, who has a lot more comorbidity is a very different ballgame falls into those individuals who are more vulnerable and who are elderly. So I don’t think those criteria may fit. So we don’t have any data to that effect, specifically, type one diabetes.
Stacey Simms 17:30
What are you all doing in your office? As you said, You’re seeing patients, you’re they’re talking to me today? What are you doing to stay safe?
Dr. Satish Garg 17:38
Just the general precautions, asked my staff to make sure they clean all the clinic rooms, we have like 44 exam rooms, clean all the exam rooms, surfaces and whatnot. And again, we’ve been lucky. None of our patients have yet been at least reported to have any of these coronavirus to so far be unlucky but who knows when you Going to be confronted, I’m sure you must have heard there was a meeting in Boston, where there were 200 biotech people, and I believe 17 or 20 of them have come down with the corona virus. So that is obviously put issue, whether we should have these large gatherings at all. And I would just lastly say to all patients with type one diabetes, just take care of your diabetes, the usual way, it’s not a bad idea to have some extra supplies in case like what they have done in New Rochelle in New York area where they’re calling it containment, basically, allowing less movement in the community. So it’s not a bad idea, do a few extra days worth of the supplies but take care of your diabetes, the usual way as best as possible. I strongly recommend using a continuous glucose monitor does if you were to be infected, you have continuous access to the data. just you glucose management much better. But otherwise there is lack of data in specifically to type one diabetes and there is no different we will behave just like as a non diabetic individual.
Stacey Simms 19:13
Well, thank you so much for spending some time with me. I appreciate it very much. And we’ll check back. If any of the information changes or frankly, we get more of it. Right. We’ll get it out there. But thank you so much.
Unknown Speaker 19:29
You’re listening to Diabetes Connections with Stacey Simms.
Stacey Simms 19:34
As Dr. Garg mentioned, there is a lot that we as recording on March 11 still do not know especially any kind of breakout information when it comes to type one diabetes. So keep in mind as of right now, when you’re hearing people talk about diabetes, they’re lumping everybody with every type of diabetes together.
You will find more information in the episode homepage including The links that Dr. Guard mentioned at the very beginning of that interview. Alright, so here’s the situation on the show going forward. And you know, this may just be for this next week, I have no idea. Like I just said, there’s a lot of uncertainty here. But I am not going to make the show all about COVID 19. At least not right now. In the Facebook group at Diabetes Connections, the group, I took a poll, and the vast majority of listeners wanted regular podcast programming with COVID 19 updates as needed.
Now, I do come from a news background as you probably remember. So I admit, it’s just a little hard for me to pull myself back from breaking news mode. I mean, I’m thinking you know, wall to wall coverage. This is how we would do it. This is how you’re seeing media do it, but I hear you, and I’m here for you and to do what you as listeners want to hear.
Because I’m getting this episode out early, the next one may not air Tuesday, our episodes usually drop on Tuesdays. If you subscribe to the show, that is probably your best bet. It’ll just come to whatever app you use. And if you follow on social media, of course, I will post there, too. So please check back in. And let me know what you’re thinking and what you want to hear. And by the way, maybe I should have said this upfront. If I sound a little bit different, it’s because I have moved my office. And frankly, I wasn’t really ready to record yet, but we moved this up so I don’t have everything in its perfect place. Hopefully it sounds just fine. But if it’s a little different, that is why All right, thank you so much, john, you can as my editor for rolling with these changes and being able to get these episodes out. I very much appreciated. Thank you for listening. And please check back into the Facebook group, social media or wherever you listen for the next episode. I’ll see you back here then.
Unknown Speaker 21:52
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