Dr. Irl Hirsch discusses diabetes and COVID-19: Part 1

Brook is committed to bringing you up-to-date and accurate info about COVID-19. Brook Health Director Heather King interviewed Dr. Irl Hirsch (virtually of course!) to answer some common questions and concerns. In the first part of this interview series, Dr. Hirsch discusses COVID-19 and how it may affect those with diabetes. 

Irl Hirsch, MD, Endocrinologist and Professor at University of Washington, and Head of Brook’s Medical Advisory Board

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Hi Dr. Hirsch, thanks for having this virtual meeting with me. A lot has changed since we spoke a few weeks back.

Good to see you. And, yes, it is a very different world than the last time we spoke. So much is changing constantly. With every passing day, we are learning more about this virus and how it is affecting people.

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What can you share with us specifically about diabetes and this virus?

Having a diagnosis of diabetes does not mean you are more likely to get COVID-19. However, having high blood sugars (consistently over 180 mg/dL) does increase your likelihood of having bad outcomes if you do get sick. In other words, someone with diabetes and well-controlled blood sugar who gets sick with COVID-19 will tend to have a less severe illness than someone with diabetes and poorly-controlled blood sugar who gets sick with the virus..

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So, if someone has high blood sugar, they face a greater risk of getting very sick if they come down with COVID-19?

There’s a continuum here – your risk of poor outcome is lower for someone who has an A1c of 6.5% versus someone who has an A1c of 8%, and it’s lower for someone who has an 8% versus someone who has a 10%, etc. So, even if you can’t get your A1c down under 7%, which is ideal, it is still beneficial to get your blood sugar in as good control as you possibly can.

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What should someone do if their blood sugar is not in good control right now and they are having trouble achieving that control, especially if they do feel sick?

Absolutely contact your provider if your blood sugar is running high. When your sugars are over 180 mg/dL, your white blood cells, an important part of your immune system, can’t function properly. When you are ill, with any infection, it can be more difficult to keep your blood sugar in good control. So, your provider might want to change or adjust your medication to make sure your sugars are staying in the ideal zone for most people of 70 – 180 mg/dL.

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What specific advice do you have for people with diabetes who do get sick and have to go to the hospital?

This is such IMPORTANT ADVICE to share with your users: if you end up going to the hospital, bring your OWN glucose meter and medication. In the current environment, hospital glucose meters need to be fully sterilized in between each patient. This can take 10 – 15 minutes, and nurses are so swamped right now. As a result, blood sugar testing is not happening as frequently as it should, and we’re seeing some out-of-control blood sugars in hospital patients. If you bring your own glucose meter, and meds, you won’t need to wait for hospital supplies to be available to you.

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As far as getting emergency help, what else can you share with us?

One thing my colleagues and I are seeing right now, is that people with non-COVID-19 related health issues are avoiding seeking medical care until they are in a later stage of their symptoms. It’s important to remember that other serious medical problems are still happening, and these should not be ignored. If you, or someone in your family, is experiencing any concerning signs or symptoms of illness, please contact your health care team or call 911.

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That’s great advice. Thank you. Other than keeping blood sugar in good control and staying in touch with your health care team, what other at-home recommendations do you have for people with diabetes?

Focus on the lifestyle factors that have always had the biggest impact on your diabetes: food, fitness, sleep, and stress management. It’s easy to let these slip as we’re all holed up in our houses. But it’s important to minimize foods like refined carbohydrates, and to make sure you have daily physical activity to the best of your ability. I’m on a treadmill desk right now as we speak!

If you have diabetes, it is more important than ever to maintain really good blood sugar control. Based on what we know about how most infections affect people with diabetes, poor blood control likely increases your risk for having poorer outcomes from COVID-19 if you do end up contracting the disease. 

So, again, keep in contact with your doctor, and practice good daily habits to maintain your blood sugar control.

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That’s great…and you’re not even breathing hard! What are some of the other things you’re doing in your own home that we can learn from?

I consider that everything coming into my house from the outside can potentially harbor the virus. We still need more research, but initial data shows that this virus can live on surfaces for up to 3 days. So, I ‘quarantine’ items coming into my house – packages, mail, canned goods, etc – for at least 3 days before I unpack or handle them. For the newspaper, I take off the plastic cover, throw it away, and wash my hands thoroughly before doing anything else. With fresh foods that can’t sit for 3 days, I wipe everything down with a household cleaner and a cloth or wipe, before putting it away. Then I wash my hands. Again.

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That’s good, practical advice for protecting yourself. Any other thoughts to share?

Reach out to your support systems right now – whether that is online, on the phone, or mail…connect with others.  Brook is a good place to start – your service is doing ‘social un-distancing’ by being available to its users every day. It’s important we stay linked…to family and friends, as well as to our health care teams.

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Thank you, Dr. Hirsch. We are honored to have the trust of our users, and to be able to offer support and assistance at this time. I appreciate you sharing your own wisdom and advice with our users as well.

My pleasure. Stay safe and healthy, and we’ll talk soon.

Responses were edited for length and clarity.

We understand that there’s a lot of information and, unfortunately, misinformation going around right now. Google and Facebook can be a scary place. Brook’s medical board and team of health experts are working to sift through the information to bring you what’s pertinent, important, and true.

Reach out to our team of Health Coaches in your Brook app any day of the week for questions or support.

If you feel like you are experiencing symptoms of COVID-19, stay home, be sure to call your healthcare provider and follow protocols established by the CDC or World Health Organization.

Interview done by Heather King, MS, RDN​, CDE

on March 22 and March 29, 2020. Heather is a Certified Diabetes Educator, has been a Registered Dietitian for over 12 years and is Brook's Health Director.