Do you remember what you were doing on Saturday, January 25th,2020? I can’t say that I do but no doubt I was at home or grocery shopping as per usual Saturday routine. However, I do recall hearing something about COVID on the radio but didn’t really pay close attention. Later that same day I heard the news again and decided to listen. January 25th, 2020 was the day the first case of COVID-19 was reported in Canada. Myself, like many others, had no idea the long road ahead of us.
COVID-19 has been part of everyones life since that time. It has resulted in significant morbidity and mortality across Canada and the world. According to the Government of Canada website updated March 13th,2021, there have been over 22,000 deaths in Canada. As of March 9th, the number of ICU beds occupied by COVID-19 patients was 548 and patients who were receiving mechanical ventilation was 302. Can you imagine the worry patient’s families and loved ones were/ are experiencing? The worry extends to the families of the health care workers who are providing care to these patients also.
At first we thought that COVID-19 only caused serious illness in the elderly who might suffer from several comorbidities, but this has not been the case. There has been serious cases and death in young, healthy individuals. For those who have contracted the disease and thought they had recovered, newer information is telling us that approximately 10% of people will continue to feel unwell more than 3 weeks after their infection and some even for months. We don’t know why this is happening. The best advice is to follow all the required guidelines for prevention as this is the best treatment. Refer to this website for prevention information.
COVID-19 & Diabetes
Since the beginning we have seen reports that both types of diabetes are one of the major comorbidities associated with the development of severe COVID-19 related adverse outcomes. There have been reports that suggested in-hospital deaths from COVID-19 were 2.85 times higher in adults living with diabetes compared to patients without diabetes. If we took 100 people as risk without diabetes, then that would be 285 people with diabetes. Just think,185 more deaths because of our diabetes. I find this pretty scary. Fortunately, so far it doesn’t appear that children with type 1 diabetes are at an increased risk of developing COVID-19 and if they do, their illness appears milder as compared to adults with diabetes.
There are many questions that remain unanswered such as the following ;
Is this virus unmasking or contributing toward the onset of type 1 diabetes?
More research is needed in this area but some thoughts have circulated such as: (1) the patient was already in a pre-existing stage of diabetes at the time of COVID-19 diagnosis: (2) some symptoms of COVID-19 upon presentation to the emergency room are similar to diabetic ketoacidosis (DKA) and thus it is suggested that clinicians monitor blood glucose or check for ketones in any new hospital admissions. In other words people might be considered in a state of diabetic ketoacidosis when they are suffering from COVID-19 symptoms. Thus a false diabetes diagnosis could happen easily.
Is COVID-19 infection causing stress related hyperglycemia?
During any acute illness, the body’s own mechanisms come into play and this could cause hyperglycemia due to the insulin resistance and glucose intolerance at this stage of illness. Any type of stress, such as intubation (ICU patient), steroid drugs (which we do know have been used in COVID-19 patients) can contribute to hyperglycemia. Keep in mind that patient’s in an intensive care unit (ICU) could be receiving sugar like solutions for energy/nutrition and are bed-ridden which can contribute to high blood glucose levels.
Diabetes Canada is monitoring research and will provide updates and information to help us understand this ever-evolving situation on the nature of this bidirectional relationship (diabetes and COVID-19).
Should you receive the COVID-19 Vaccination? What do we know about its’ use in people with diabetes?
Were there any diabetes patients in the trials for vaccine development?
Yes, both type 1 and type 2 diabetes patients were included in the Pfizer-BioNTech phase 3 study and the Moderna phase 3 study. The good news is that there was no increase in adverse events reported in these participants. I can only assume because of these results, patients with type 1 diabetes, who do have an autoimmune disease, were excluded from being in the NACI recommendations for being vaccinated in stage 1 of the vaccination roll-out. People with type 1 or 2 diabetes are not considered immunocompromised as per the COVID-19 clinical trials.
Vaccine development has played an important role in reducing mortality from infections like the measles, mumps, polio just to name a few. The 5 years before routine vaccine use, there were over 50,000 cases of measles reported and now between the years of 2011-2015 less than 300 cases are reported. That’s a 99% decrease.
What does it mean when they say Herd Immunity?
Herd immunity is based on the idea that if enough people get vaccinated against the disease, this will also offer protection for those who aren’t vaccinated. There are some individuals in the population who are unable to get the vaccination due to weakened immune systems, so they count on the rest of us to help protect them. One way to think of this is you are experiencing hypoglycemia and there is only one other person in the room, the other being non-diabetic and there is one glass of orange juice. The person without diabetes sees that you are weak and offers the juice to you even though he/she is very thirsty. He/she is offering you protection from further devasting effects of hypoglycemia.
The proportion of the population that must be vaccinated to achieve herd immunity varies by the rate at which the virus or disease spreads. Herd Immunity for COVID-19 is not known at this time but estimates range anywhere from 70-80% of the population need to be vaccinated to achieve this herd immunity. However as more variants of the disease surface, this number can easily fluctuate over time.
What are the benefits of receiving the vaccination?
The approved vaccines are all effective at preventing an individual from acquiring COVID-19 and its associated morbidity and mortality. There is also some evidence that if a person did get the virus after receiving the vaccination, the vaccine likely will reduce your chance of getting seriously ill and may also reduce your chance of passing the infection to a loved one.
If I had COVID-19, do I still need to get the vaccination?
The current answer is yes. Different countries are taking different approaches but according to the Center for Disease Control (CDC) COVID-19 sufferers should still receive the entire vaccination schedule.
Are there side effects from receiving the vaccination?
All drugs can cause unwanted effects and vaccines certainly fall into this category. I have noticed on one of the diabetes facebook groups that several people have received the vaccination with no after effects, while some have suggested it causes hyperglycemia. I suppose this is possible but it could also be due to stress and fear of the vaccination or several other causes for hyperglycemia that particular day. I received mine on March 18th and didn’t have any ill effects so far.
Side effects from COVID-19 vaccination are normal signs that your body is building protection. It may feel like you have the flu and could even affect your ability to do daily activities, but this won’t last long and in a few days you should be back to feeling well again.
If you have pain or swelling on the arm where the shot was given, apply a clean, cool, wet washcloth over the area and keep your arm active by moving it frequently. If after 24 hours the redness and pain haven’t improved, consult with a health-care professional.
Other side effect symptoms that might occur in the rest of your body include fever, chills, headache and added tiredness. To reduce fever and discomfort, drink plenty of fluids and dress lightly. Check before you receive the vaccination if it is ok to take acetaminophen or ibuprofen for pain or any discomfort. Have a thermometer handy to check your temperature every 2-3 hours.
Monitor your blood sugars more frequently when you receive any new type of medication. Every person’s body handles medication in a different way, so be cautious and alert and aware of any unusual symptoms and be prepared to call for help/advice. Keep your sick day guidelines close by and be sure to have treatment available in case of low blood sugar reaction.
Remember: for full protection offered by the vaccines, you must receive the proper number of doses and then wait about two weeks before you can consider yourself fully protected.
This morning as I was listening to the news there were interviews with people who had received their first dose of the vaccine. The reporter asked them what was the first thing they were going to do and some of them replied “ go hug my grand-children” which is great in thought but not advised since it is still to early for the vaccine to offer immunity and they could still contract the disease. So please, be careful and continue to follow all other precautions as we have learned over the past year.
Discussion:
These vaccines were developed very rapidly but they all had to meet criteria for safety and effectiveness as set out by health agencies and governing bodies. Long-term effects are unknown, but that is true for most new medical treatments. Keep in mind that all drug side effects and complications during any study/clinical trial of the drug have to be reported and many times a particular side effect may occur in less than 1% of those who received the treatment but it still has to be reported..
Another area that continues to be studied is the question of how long will the immunity last? Will this become like the influenza vaccine which we should receive yearly or will we need a booster shot in 5 years? We can only guess at this time but I feel confident investigators will be studying this if not already.
Please give consideratio to receiving this vaccine. If you are hesitant, learn as much as you can from reliable resources. Many insurance companies have information on their website, the federal and provincial governments have good information and of course your local health-care facilities.
Stay safe and be well.
This information is not intended to replace that of your health-care providers. It is for your information use only. References: Diabetes Canada, Center for Disease Control, Government of Canada (websites as indicated in document)