There's a lot of information about the Coronavirus but there isn't a lot out there specifically for people with diabetes. This week, we're releasing our weekly episode early to bring you what you need to know.
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Stacey talks to CDE Gary Scheiner, who lives with type 1 diabetes. They go over everything from protecting yourself or your child (spoiler: not much different from what you'd do without diabetes), having a good sick day protocol in place in case you or your child does contract the virus. They also talk about about how we can be ready for in terms of social disruption. In other words, should we be stockpiling supplies? Gary says no and explains why.
CDC Coronavirus Information Page
Gary Scheiner's Integrated Diabetes Services
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Episode Transcription (please excuse grammar, spelling, punctuation)
UPDATE: Enhanced Transcript Here
Stacey Simms 0:00
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this is Diabetes Connections with Stacey Simms.
Stacey Simms 0:27
Welcome to a slightly different episode of Diabetes Connections as always, I am your host, Stacey Simms, but this week is going to be a little different because I just want to focus on one topic. we are going to talk about diabetes and the coronavirus. There is a lot of chatter online. There are a lot of concerns. I've taken a lot of calls and private messages. I'm sure you have to you know from well meaning family and friends who may not even have diabetes. And I thought rather than address it piece by piece, we would least start the conversation.
I'm sure it will not end here. But we'll start it by having a really grounded and factual conversation with a diabetes educator who can address everything from what the virus itself means for a person with diabetes, what precautions you may want or may not want to take what's real, what's fake. We're also going to be talking about if there are societal disruptions, right? They've been talking about if stores are closed, if schools are closed, what should we be thinking about now, in terms of medical supplies,
let me do a brief explanation of the corona virus I know most of you already know. But just in case you haven't heard of basic explanation, then we're going to get right to the interview with a certified diabetes educator and person with type one, Gary Scheiner.
Coronaviruses and there is more than one they are a large family of viruses. And it can be it could be the common cold that they cause it can be much more severe disease. The reason we're talking about This one in a different way is because it is a new strain. It hadn't been previously identified in people. As many of you know, it started in China, but it is spreading from person to person, somebody who's actively sick can spread the illness to others. The first case in the United States was reported January 21, the first confirmed instance of a person to person spread within the United States right, which is different from someone traveling here with it was reported on January 30.
You can find out a lot more from the CDC. I will be linking up the information page from the CDC and some other sources at the episode homepage at diabetes connections. com. I'll also let you know that a couple of days after the episode airs, I will be working to turn it into not just a transcript but more of a blog post so it's easily shareable. You know, a lot of people don't listen to podcasts, but they will read a blog post and I'd really like you to be able to share this with as many people as you can.
Media outlets are of course All over this but very few are talking about what it means for people with diabetes. So let's get to it. My guest this week is Gary Scheiner. He is the owner and clinical director of Integrated Diabetes Services, a company that specializes in remote consulting for people who use insulin and we'll talk about how remote consulting and remote services may play a part in the response to the coronavirus. Gary has also been living with Type One Diabetes since 1985. And in 2014, he was named as the Diabetes Educator of the Year by the American Association of Diabetes Educators. Gary is always a wonderful source of calm, reliable information here on the podcast. And he really came on with very short notice and I appreciate that very much.
One more quick thing. I'm going to jump back in at the end of the episode after the interview, I want to talk to you briefly about media and how you consume media, especially in a time like this. I worked in local TV and radio news for 20 years. So just some advice and some things to look out for. All right, here's my conversation with Gary Scheiner.
Stacey Simms4:07
Gary, thanks for jumping on with pretty short notice to talk about this. I really appreciate it.
Gary Scheiner 4:11
My pleasure.
Stacey Simms4:12
I don't want to downplay anything I know I'm here to get the information in. But I have to say, I'm really concerned with what I'm seeing online. Are you hearing from people who have have these concerns in the diabetes community and, frankly, getting frightened?
Gary Scheiner 4:27
Yeah, I mean, with good reason. This is a it's a pretty serious viral infection that's spreading around. It's not that much different from other viruses like the flu. And you know, the way we contain it and control it and prevented for that matter are very similar. But when people do get it, it's a tough one to fight. You don't have effective ways of treating it.
Stacey Simms4:48
So we're going to talk a lot about diabetes here. Obviously, that's what we're all about. But let me just start by defining a few things. Do people with diabetes in general, get more viruses. Can you speak to that? Because I've been told time and time again, Type One Diabetes is an autoimmune disease, it doesn't mean that your immune system is suppressed,
Gary Scheiner 5:09
if anything, our immune systems have that hyperactive, right, okay. But yes, people with diabetes generally are higher risks for all kinds of infections, both bacterial and viral, but it really comes down to the degree of glucose control that a person has. There are certain things that impair proper immune function and one of those is high blood sugar. chronically elevated glucose levels can impair immune function of the other things are things like lack of sleep and a very poor diet and very high stress levels. But for someone with diabetes who's not managing their glucose, well, their risk for infection is certainly increased.
Stacey Simms5:50
Okay. So if someone with a higher frequency and elevated agency who is not getting for whatever reason, you know, access to healthcare or even their own education, if they're at higher risk What about people who have lower agencies who what I guess we would call generally better controlled or well controlled? Are they still at more risk for getting viruses,
Gary Scheiner 6:09
it's less of an increased risk. But you have to consider glucose variability in the equation as well, which is a stress on the body, it seems to cause inflammatory responses. So you know what we're talking about. You can have a beautiful looking a one c but but have a lot of peaks and valleys, highs and lows throughout the day. And that sets us up for all kinds of acute and chronic health problems.
Stacey Simms6:35
Okay, well, let's cut to the chase though. If I have two kids. I have a kid with a 7.5 A1C, for example, and I have another child who doesn't have type one at all. Do I have to lock one in the house and the other one is going to be okay?
Gary Scheiner 6:46
Well locking her in the house might be a good idea anyway (laughs). I mean, yes, she is going to be at a little bit of an increased risk. We see the risk of these types of problems almost go up exponentially when the A1C starts getting up into the 9 or 10 range and with an A1C in the 6 or 7s, the risk is slightly increased. I wouldn't say it's dramatically higher than in someone without diabetes, but there is some increased risk. The other issue is managing the glucose if you do get sick, which becomes more challenging, but even more important, because when glucose levels are elevated, you're sort of aiding and abetting the infection that virus or bacteria has a lot of fuel to grow off of. So you're feeding the enemy in a way if your blood sugar is poorly controlled, when you're sick, running a lot of high blood sugars is going to extend your recovery time and cause your symptoms they become that much worse.
Stacey Simms7:44
Well and that's tough to begin with because, at least in my personal experience, when my son gets any kind of illness, his blood sugar goes up.
Gary Scheiner 7:51
this strategies for managing it though, teach most of our patients about self adjusting their basal insulin doses weather right A pub or shots, ramping up the basal insulin is a very effective way to combat the insulin resistance that's caused by the illness.
Stacey Simms8:08
I guess step one, then is with Coronavirus or any illness have a sick day plan, right? Call your health care provider, call your endo if you don't have a sick day plan of attack, like you said, even raising basal rates doing other things. Yeah,
Gary Scheiner 8:21
yeah, we try to it has to be customized a little bit depending on what kind of treatment every patients receiving. In the certain tenants, though, that applied almost everyone who's on insulin, the insulin dose is likely going to need to be increased, especially if they start noticing elevated blood sugar. ketone checks become pretty important. It helps us figure out the severity of the illness and the magnitude of insulin increase that's going to be required. Hydration is extremely important as well and people with diabetes are more prone to dehydration when they're sick and then someone without diabetes and adequate nutrition. Also, the body still needs energy to combat the illness so you don't want to starve a person when there's Yeah, they still need that. I think parents used to refer to this as the BRAT diet it's just easily digested simple foods that you don't have to work too hard to break down. I don't remember exactly what brats
Stacey Simms9:18
I think I might get it wrong. I think it's bananas rice, apples toast, but I might have made that up.
Gary Scheiner 9:24
Maybe apple sauce,
Stacey Simms9:25
sauce, apple sauce Apples seem a little yucky when you’re sick.
Gary Scheiner 9:29
we tell people you know all those foods they avoid because they spike their blood sugar. Those are the things you want to eat when you're sick. You know, the soft fruits, cereals, things like that. Oatmeal, things that just digest quickly and easily just to lessen the load on the body
Stacey Simms9:45
with Coronavirus itself. In terms of sick day, do we know enough to know how it might affect people with diabetes yet?
Gary Scheiner 9:53
Well, it'll it'll affect them just like it affects a person without diabetes, but in a person with diabetes It's gonna cause the glucose levels to rise as well. But in somebody with diabetes and without you're going to see some intense inflammation of the respiratory tract. One of the unique things about it compared to some other viruses like the flu is it can cause some severe shortness of breath which we don't always see with with other communicable common illnesses. So that's something to watch for. The preventive measures are the same. We do we would do the same things to prevent Khurana virus as we would know the common cold and the flu. No frequent hand washing is a very important thing. You know, I tell patients to be a bit OCD about your handwashing be very compulsive about that. Get a flu shot, because you can prevent any form of the flu it anytime that's beneficial. Be very careful around people who have signs of respiratory illnesses who are coughing, sneezing, etc. Keep your distance or just try to be very cautious about physical contact with them. extra hand washing
Stacey Simms11:13
do those masks that people are buying do those work I've heard mixed results
Gary Scheiner 11:18
they will only work if you're within coughing vicinity of somebody who is contracted the illness in general they don't work I mean walking around the airport cetera with these masks on is going to do virtually no good. These airborne germs can still get into your nasal passages and into your lungs and spread from there. So in general, the masks are not a very effective preventive option. It's more than the traditional stuff. You know the handwashing get your flu shot. Try to avoid indoor air too much research related air is no good to be in a humid environment that also is beneficial. If your house is dry especially in the wintertime use a humidifier. That's the first place where germs can penetrate into the body is the nasal passages and if they dry out due to dry air, you're kind of opening the door and marshaling a germs into your into your system. So you humid environment does help.
Stacey Simms12:19
You mentioned handwashing, do hand sanitizers work at all,
Gary Scheiner 12:22
they're a little bit beneficial, but just washing with soap and water is generally sufficient. It may not be convenient to do that anytime, anywhere. So carrying hand sanitizer after you've been like at a meeting, shaking hands, etc is a good idea. Even though places like the grocery store where your hands on the cart and you're touching a lot of things, using a hand sanitizer, there is a good idea.
Stacey Simms12:48
One of the things that's been reported and this may change as we learn more and more about the coronavirus and and any effects it has here is that we may see more of a social and a societal disruption Then we do run the risk of actually contracting it. In other words, there may be times when your municipality says, you know, stay home, or they ask people not to travel or there's disruptions in trade. So one of the things that I've heard from several people, and again, this is something we are talking about, and that's something that has been announced. So as you listen, please take it as we're discussing it here as a potential should I be stockpiling diabetes supplies?
Gary Scheiner 13:26
I just got off the phone with a patient in Cincinnati who asked me the same exact question that you brought up, should I be stockpiling insulin and strips and sensors and this and that, and right now, the answer is no. You really don't need to do that. The pharmaceutical companies are, manufacture things under very sterile conditions, and even their distribution channels handle things in a very sterile way. So you should be fine, as far as getting your supplies and getting supplies. That are guaranteed to be safe and clean. So you really don't need to be hoarding supplies at this point. Order response is kind of dangerous, because you may cause shortages for people who really need things.
Stacey Simms14:15
That always worries me because that's exactly the problem, right? We think, Okay, I'm going to help myself, but in doing so you might wind up overdoing and hurting others. So just to clarify what you said, again, this is from social media, Gary, so I apologize for even bringing it up. But I have seen it I know others have as well. It's been these things have been circulating now that you know, we get so much of our medication from overseas and cheap stuff from China, that now you have to be scared of your medicine because of the coronavirus. I have no idea if there's any truth to that. I hate bringing up something right. We can't verify it, but I couldn't think of anything diabetes related that we can't track to where it is manufactured.
Gary Scheiner 14:53
Right. Now the virtually everything we're using in the states is manufactured here. And you have to also consider The Coronavirus like any virus, it's a living organism, it has to be attached to something that is providing it with some form of nutrient plastic packaging and pills and bottles are not going to provide nutrients that keep a virus alive. So generally speaking, you don't have to be concerned about contamination that way.
Stacey Simms15:21
Well, I think we, it's a great point, because I think we do have this sense when these scares come up, that these germs are catching a ride, and just, you know, hop it in the storage container. So I know it's kind of funny to talk about it that way. But you know, that's what I think a lot of us we have these misconceptions, so thank you for clearing them up. I don't remember who it was SARS or h1 and one. But when we've had you know, scares in the past, that's when a lot of grocery stores decided to test that order in advance, use your phone to order groceries and then drive up and pick them up afterwards. They did that because they were concerned that people would not go to the grocery store. So you don't know what's going to come out of these things. Because, you know, and now people do that because It's just super convenient and nobody wants to wait.
Gary Scheiner 16:02
Right. It's the same reason we've been doing. Providing tele health care people for years now is its convenience. It's also it's it is a little bit safer, you know, going out and being in an office with a lot of other people. Yeah, you knows what you could catch.
Stacey Simms16:18
You mentioned earlier at the very beginning of this interview, that people with diabetes you If anything, the immune system is overactive. And I know that, as you said, there are risks there are, especially with higher agencies, but does that overactive immune system do anything that we haven't talked about when it's hit with a virus like this?
Gary Scheiner 16:38
Not really, it overacted in a very selective way. Okay. Yeah, it's only targeting those beta cells. It would be nice if it could attack viruses and bacteria we would be super humans.
Stacey Simms16:51
That's what I was hoping you were gonna say that sometimes, you know,
Gary Scheiner 16:54
humans who require insulin that's that would be great, but we don't quite have that level. Whole superpower just yet.
Stacey Simms17:03
Not to say for stockpiling, but when we talk about sick days, is there anything that you would recommend people have on hand? I'll give you an example my doctor especially when it was very little would recommend we have full sugar popsicles, because we never kept those in the house. You know, not an a sick day, but they were great because a little kid who doesn't want to eat but needs insulin for ketones could do that. Anything else come to mind?
Gary Scheiner 17:27
Well, something that I keep around is is something like Gatorade, or with kids Pedialyte, just beverages that have a low sugar concentration that are easily absorbed easily digest that even if somebody has an upset stomach is nauseous is weak, it those things provide some electrolytes. They provide a little bit of carbohydrate and fluids which is critical. So that's that's a good thing to keep around. It's pretty accessible. You could walk in any convenience store and pick that sort of thing up but other things Things like ibuprofen acetaminophen is good to have around in case there's fever. If they're Imodium is a good product for for diarrhea, just those kind of things are are helpful Keto Stix. Most people don't think they'll ever need them. But when you're sick, it's very important to be checking for ketones. That's something to get ahold of now,
Stacey Simms18:22
does it matter if you use the sticks or the blood ketone meter? Do you have a preference as an educator?
Gary Scheiner 18:28
Well, the blood meter is better, it's a more timely measurement. It'll take several hours for ketones in the bloodstream to show up in the year and to catch ketones sooner with a blood test. The blood test also gives you a more specific measurable value, the urine strips you're you're comparing different shades of pink and tan and it's a very subtle difference. So to be able to communicate with your health team and say I don't know how high it's pink it's tan, but you know on a on a blood meter You will get a specific measure of ketones in the bloodstream, you'll get, like 1.3. That's your number that's easier to share with your clinicians.
Stacey Simms19:09
Let me ask you one more question about this. And it's okay if you don't want to answer but as a person who lives with type one, I mean, obviously, you educate many people, you are a healthcare provider for many people, but for yourself, when this kind of thing happens, do you worry more because of type one?
Gary Scheiner 19:25
I really don't. I feel like the things I'm doing day in and day out, minimize my risk. You know, there's some things that we have control over in life and some things we don't, the things we do day in and day out to manage our diabetes, that's within our control. Whether those blood sugars look great or not, is not always in our control because of all the variables and it's the same thing with with an illness like a Coronavirus or the flu or pneumonia. You take certain precautions, you put yourself in a position to avoid them. But if you sit around just worrying about that that doesn't do any good. In fact, the stress that that cause can compromise your own immune system. So it's really best to just do the right things feel good about that, and then let the chips fall where they may.
Stacey Simms20:12
Well, Gary, I really appreciate you helping me with good information and taking the time tonight. And I know, hey, you're in the middle of seeing patients. And so I appreciate you taking some time out for this. Thanks so much.
Gary Scheiner 20:23
Oh, anytime for you, Stacy.
Stacey Simms20:30
You're listening to diabetes connections with Stacey Simms.
Stacey Simms20:36
I'll link up lots of information at diabetes connections dot com and as I said, I'll be working in the days after this episode airs to turn this into not just a transcript, which will be available immediately at the episode homepage, but also into a blog post because I think it's easier to read if you've seen our transcripts. I think they're really good compared to you know what is out there right now, especially with diabetes speak, but honestly Reading a transcript is not like reading a blog post, right? We don't talk the way we write. So I would like to be able to share this with as many people as possible. And I'll get that to you as soon as I can. (UPDATE: Blog post here)
I mentioned before the interview with Gary that I wanted to talk to you about media for just a moment. And I think it's really important to think about how you consume media at all times. But especially at a time like this, when Let's face it, a lot of people are going to be talking about things that they know nothing about. So please, if you're watching your local TV news, I'm not disparaging anyone. I'm not saying that. Nobody knows what they're talking about. I'm saying watch and listen carefully.
I've worked at these stations. I know how it rolls, they're completely understaffed. There are very few beat reporters anymore. So it's a very good chance that the person covering this story was covering City Hall yesterday and was covering the local sports team the day after that. It doesn't mean that they're smart. It doesn't mean they're giving you bad information. It may mean especially on the local level that they are overwhelmed. So I would listen more to the source than the reporter on this. I have already seen as this is social media, which is a different story altogether. I have already seen local reporters, and I'm sure this is happening on the national level as well say things like, I'm not sure this feels right. Or this is what they're saying. But what do you think? Right? And using words like seems like sounds like feels like, that's not a reporter's job. I don't mind if the doctor the local hospital is saying something like that to me, right? Or if the reporter is quoting someone, but if your local TV anchor starts talking about feelings, it's time to stop listening to the Medical News that they're trying to import. Same thing for cable news roundtables. I mean, I think we all know this, but I don't know a lot of people who will, you know, say it out loud. If somebody is telling you what they think or feel, and they are not a medical professional. I'd be really careful about listening to that.
Nobody wants a panic here. I don't anybody's trying to hide information. But you know, there's a reason why all those masks have sold out even though everyone is telling us they don't work, right. I mean, Gary alluded to it, but I'm sure you've heard the reporting that as soon as the mask is moist from your breath, or you know, just from the droplets, it sounds gross from your mouth, you've probably got an hour before it's permeable, right? These are not surgical grade meant to be worn for a long time masks that your friends are walking through the airport with, I'm certainly not going to panic. I'm in a place right now where I am listening. I am learning. I am cautious.
I think back to other pandemics that we've been through, and big Hey, red light flashing warning. I'm going to talk to you about how this feels to me. Right. So this is the opinion part where I'm just sharing what's going through my brain, not to give you any sort of medical advice. You know, I think back to the SARS outbreak, which seemed equally scary at the time, I think back to h one in one, which was in 2009 because it really impacted us It hit people in Our area and my daughter's summer camp, a four week session was canceled. Because there were people who were ill at the camp already they had figured out that that week of pre camp where people are working and setting up and the counselors are arriving, there were people with symptoms and signs and then a diagnosed case. So they canceled the session out of proactive safety.
So things are going to start happening, things are going to feel scary. I think it's really important that we seek out good sources of information that can help us because as families touched by diabetes, we do have to think about different things. So I think in closing, let's rely on reliable sources. Let's be careful of what we're posting on social media. Let's look at the facts. Let's be smart. And let's keep learning
footnote before I let you go. This episode was taped on Thursday, February 27. The Interview with Gary was done on Wednesday, February 26. I don't always timestamp the interviews and episodes like this. But you know, podcasting is not the best way. Breaking news source. So I really think it's important and I'll put those dates out there when I post on social media as well, because I want you to know when and where the information came from.
All right, thank you, as always to my editor John Bukenas. From audio editing solutions. Thank you very much for listening to this different shorter episode of diabetes connections will be back on Thursday with one of the mini episodes and then next Tuesday back to our regularly scheduled programming. I'm Stacey Simms, and I'll see you back here on Thursday.
Diabetes Connections is a production of Stacey Simms media. All rights reserved. All rounds avenged
Transcribed by https://otter.ai