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What Covid 19 Taught Us

The impact of sick-day education for people with diabetes was thrown into the national spotlight by the Covid 19 Pandemic.

While infection rates for people with diabetes were not higher than the general public, we saw a significant increase in hospitalizations.

In a study of hospitalizations conducted 18 months after the identification of COVID 19 in the United States, hospitalizations of people with diabetes were more than 3x as likely as their non-diabetic counterparts (when adjusted for age and socioeconomic factors).

When considering hospitalization rates, those of the general public versus those with diabetes saw 30-40% of all Covid admissions were for people who had a diabetes diagnosis in their charts. Those people with diabetes who were admitted into the hospital saw ICU rates between 21-43%. And for those in the ICU fatality rates were nearly 25% (nearly double the non-diabetic population)!

HOWEVER, rates of illness and hospitalization, particularly among people with diabetes who were well controlled, were not significantly higher. But once hospitalized, even those who were well controlled faced far higher risks than the general public.

Keeping people with diabetes OUT of the hospital is a priority.

So, let’s take a step back and go over the physiology of sick-days, starting with diabetes itself.

Diabetes is, at its most basic level, the presence of elevated blood sugar.

However, that is where the simplicity stops, there are commonly two discussed forms of diabetes (but in reality there are dozens of causal factors.)

For the sake of today’s discussion we will refer to them by two categories, (but keep in mind that there are many forms of diabetes).

First, Type 1 Diabetes

Under this umbrella we will put all the pathologies that lead to a loss of the body’s ability to make sufficient insulin for supporting life. This may be autoimmune in nature, but it also may be surgical, a result of injury or trauma to the insulin making organ, the pancreas. Or it may be caused as a complication of another illness such as Cystic Fibrosis.

Whatever the cause, these patients cannot produce their own insulin in a large enough quantity to stay alive. Without exogenous insulin these patients will go into DKA and die. We will cover DKA shortly.

The second subset we will lump everyone else into is commonly referred to as Type 2 diabetes.

These patients are able to produce insulin, often in large quantities, however, for whatever reason, their bodies are not able to produce sufficient insulin to keep blood sugars in a healthy range. These patients may be managed with adjustments in diet, exercise, lifestyle, oral medications, injectables, insulin or, most likely, some combination of these therapies.

However, it is vital to remember that ALL persons with diabetes CAN be at risk for DKA under certain situations. Because the bottom line is that we are looking at a deficiency in insulin. Too often the first mistake clinicians make is not educating their patients that DKA is a risk for them. They also miss the signs and symptoms of DKA sitting in front of them because the patient is not on insulin--so we don’t even think that DKA is possible!