Diabetes Care Community

Category: Coronavirus Support Resources

Diabetes Care Community team has created this special section of COVID-19 support services for our community during this time of staying at home, self-isolation or quarantine.

  • COVID-19 and mental health: where can I turn to for support?

    COVID-19 and mental health: where can I turn to for support?

    [vc_row][vc_column][vc_column_text]All of us have been affected in drastic and unexpected ways by the COVID-19 pandemic and will continue to be for the foreseeable future. At times it can feel like the pandemic will never end, and emotions such as fear, uncertainty and panic can leave us feeling immobilized. For people living with chronic conditions, including diabetes, these emotions are compounded due to the greater risks of COVID-19. The mental health impacts of the pandemic are only worsened by other factors of our lives, including isolation, financial strain and health status. A question many of us have asked is, “How can we protect our mental health during COVID-19 while living with diabetes?” Health and wellness look different for each of us, but there are a number of supports available that can help us ride the waves of this pandemic.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]Many people put their physical health needs first, but often neglect their mental health. Research has shown that people living with diabetes are more likely to experience a mental health concern, and rates of mental distress have risen during the pandemic. Now, more than ever, is the time to allow ourselves to focus on our mental health. Mental health counsellors can help you explore negative emotions and thoughts to help you develop more balanced, adaptive ways of thinking and living. For example, research into people with diabetes found that those who engaged in counselling not only improved their mental health, they were also more successful in managing their diabetes. Mental health counselling can feel scary and strange to many of us, but it can be a profound and positive life-changing experience for those who engage in it.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text][ad-slot slotcode=’div-gpt-ad-lb-resp-cont1′][/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]The availability of mental health services varies across Canada, but with technological advancements counselling is now more accessible than ever. Each province and territory has its own level of public mental health care available. Calling local information resource lines, such as 211 (a free helpline that connects you to community and social services in your area), can help you find what is available in your area. Most private insurers also cover counselling to some degree. If you have insurance, speak with your provider to learn the specifics of your coverage as this can vary widely between insurers. Online resource listings, such as Psychology Today, are a great way to help you find counsellors and therapists in your community that specialize in the areas you are looking for, and are covered by your insurer.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][read-also-article article-slug=”coronavirus-support-meditation-relaxation-and-mental-health/”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]To further give ourselves peace of mind, receiving a COVID-19 vaccine adds an extra layer of protection for both our physical and mental health. The COVID-19 vaccines have overwhelmingly been proven to be safe, including for people living with diabetes. The vaccines are protective not only against becoming infected, but against hospitalization and death. While we will have to live with the pandemic for some time, receiving a vaccine can reassure us that we are protected from the worst harms of the virus.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text][ad-slot slotcode=’div-gpt-ad-lb-resp-cont2′][/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]It is no secret that managing diabetes can be expensive. From purchasing diabetes supplies, to eating healthy foods diabetes can take a toll on our finances, particularly for those with lower incomes. Financial strain of any kind can cause mental distress in a number of ways. However, in Canada, there are public and charitable financial supports available for people living with diabetes. While the level of support varies across provinces and territories, a variety of public and charitable benefits are available. Your healthcare team can provide you with all the details of supports available to you.

    COVID-19’s impacts on us are wide ranging, and one of the most challenging aspects is the lack of control many of us feel in our lives. While we cannot control the pandemic, we can control how we care for ourselves during this time. Ultimately, we cannot care for our physical health unless we also care for our mental health.[/vc_column_text][/vc_column][/vc_row]

  • EXPERTS ANSWER COVID-19 QUESTIONS: Healthy Lifestyle Habits

    EXPERTS ANSWER COVID-19 QUESTIONS: Healthy Lifestyle Habits

    [vc_row][vc_column][vc_column_text]In this last of a four-part series, Nurse and Certified Diabetes Educator, Gail MacNeill, discusses healthy lifestyle habits during COVID-19 with Registered Dietitian, Lauren Rose.

    Here are their insights.

    What is the easiest and safest way to get access to nutritious food (in person and online)?

    There isn’t one easiest way to access nutritious food because it depends on your own comfort level. Right now, some people are feeling more comfortable heading to a grocery store than they did at the onset of the pandemic. But others may feel more comfortable ordering online groceries to avoid going out altogether.

    When it comes to safety, it’s all about taking the precautions we’ve been taught from the onset. Wear a mask when you’re out shopping and wash/disinfect your hands thoroughly after handling food/grocery carts. Safety also extends to the foods themselves, in terms of keeping hot foods hot and cold foods cold. Place cold items in the refrigerator at the right time, wash produce well, and cook foods properly, as needed.

    Here’s a list of online grocery services.

    Is there a risk of shopping in a grocery store and if so, how do you minimize this risk?

    Most grocery stores have been great at disinfecting shopping carts and keeping their premises clean. They’ve also eliminated buffets and other communal areas to minimize the risk of contamination. But you can further protect yourself by wearing a mask which is now mandatory in inside public spaces and following social/physical distancing rules when navigating the store. It also helps to come prepared with a grocery list so you can get in and out as quickly as possible.  As well, decide what you are buying and only pick up that item, to minimize touching many surfaces.

    Even with grocery deliveries, you still need to be diligent about safety. Wash your hands after handling packages and be sure to wash all produce thoroughly before eating.

    Is there any risk of getting COVID-19 from foods that I purchase? If so, how do you minimize the risk?

    There is no evidence supporting contracting COVID-19 from the food itself, but there are still concerns that the virus may be transmitted via surfaces.  That’s why washing your produce and your hands is so important—and the best way to minimize your risk.

    Is it better to buy packaged fresh food (e.g. apples) instead of picking it yourself to reduce the risk of infection?

    There is no evidence on the benefits of one over the other as even packaged foods have been handled by someone before you. The key is to thoroughly wash all produce before consuming—and wash your hands too.

    Do I need to stock up on foods because of COVID-19?

    Our food supply is pretty safe now, so there’s no need to stockpile. Instead, think about what you already have in your pantry, what you can afford to buy, and if you have the storage space for more. As a general rule, it’s wise to stock up on two week’s worth of groceries in case you do have to quarantine at any point in the future. In the meantime, get creative with the food you already have in your pantry to avoid waste.

    Here are some tips on how to stock a diabetes-friendly pantry as well as the best way to stock up on healthy foods.

    Is there any kind of support for someone living alone in terms of grocery shopping?

    There are plenty of grocery delivery services to help people who can’t get out to a grocery store. Plus, there are several reputable online resources, such as unlockfood.ca, with information on nutrition and healthy eating. Check out your local public health units for resources on where to access nutritious foods if you’re struggling.

    I find it hard to keep my weight down during COVID-19. Do you have any suggestions?

    If you were already working on weight loss goals before COVID-19 hit, it’s a good idea to try to maintain your healthy behaviours and stay on track.  However, this may not be the best time to embark on a brand-new weight-loss or exercise program because of the current restrictions and barriers in place (e.g. gyms and other fitness centres are still closed in many areas), in addition to the emotional stressors that may be barriers to making changes.

    That said, it is a good time to practice mindful eating. Take note of real hunger cues so you can make healthy eating choices as often as possible. Remember that it is just as important to focus on preventing weight gain as it is to celebrate the losses. Talk to your healthcare team for suggestions on what you can be doing to better manage your weight. Here’s some information on how to get motivated to tackle excess weight.

    When stressed I turn to comfort foods (high carbs). What can I do to avoid this?

    Nobody should try and eat perfectly 100% of the time because that’s rarely sustainable. Instead, practice the 80/20 rule and ensure you are making healthy food choices the majority (80%) of the time. Also, be sure to evaluate if you really are hungry or whether it’s an emotional hunger craving that may be managed with some self-nurturing. Instead of reaching for a snack, assess your hunger, try going for a walk, meditating or taking deep breaths to help distract from cravings.

    Giving yourself permission to indulge a little bit from time to time is important too. Be kind to yourself as this is a hard time for many people. Food is supposed to be enjoyed!

    How much exercise is enough?  And any recommendations on meeting exercise goals when isolating or the weather is not suitable to go outside?

    Plan time to stay active and be consistent with small, achievable goals. Treat exercise like a medication prescription or doctor’s appointment—it’s only going to work if you do it regularly and don’t miss the opportunity to get moving. If you can’t go outside, consider doing some indoor stretches, stair climbing or an online exercise video.

    Keep in mind that this is not the time to run a marathon. Create realistic, manageable goals for yourself that you can maintain during these pandemic times. Here are some physical activity ideas for when you’re stuck indoors.

    How much walking should I do in a day?

    Ten thousand steps a day is a general good guideline.  Recommendations suggest 30 minutes of activity at least 5 days per week.  If you’re already doing that, try and push yourself to do a little more. But if you’re only getting in a thousand steps a day, for example, increasing that by a thousand or more is a great step forward. Be active but also realistic about what is manageable for you during this time. Work on doing more than you are currently able to do.

    Any recommendations for building up strength after being ill for weeks? How do you keep motivated for following a healthy diet and exercise routine during COVID-19?

    Always start slow and be sure to speak to your healthcare provider about the kinds of activities that are suitable for you as you return to health. Make sure you stay hydrated at all times, but not with sugary drinks which can elevate blood sugar. Start with small, balanced and frequent meals as your appetite allows. Well-balanced meals will help improve your energy levels too.

    How do foods affect my blood sugar?

    Foods can have varying impacts on blood sugars. We know that foods that contain carbohydrates (starchy foods such as grains, potatoes, rice, pasta, breads, fruits, some vegetables and some dairy) can all impact blood sugar levels. Eating regularly throughout the day, not skipping meals, and maintaining consistency with your intake can help you manage your blood sugars.  Learning how your own diet impacts you is one of the keys to diabetes self-management.

    Here are some tips on how to understand sugar content on food labels.

    Any specific foods to keep my blood sugar down that are not too expensive?

    It’s always a good idea to add vegetables to your meals and snacks because they contain less carbohydrate and should not have a big impact on your blood sugar, but they are loaded with nutrients. Frozen vegetables can be cheaper and just as nutritious as fresh. Find creative ways to add more vegetables to your meals. It could be something as simple as adding lettuce and tomato to your sandwich. Here are some more tips on navigating the grocery store for vegetables and how to prepare healthy meals.

    There are also online resources to help you eat better on a budget.

    Remember, eating healthy can be challenging even in the best of times. Be kind to yourself and set small, achievable goals every day to help you maintain a healthy diabetes diet, even in pandemic times.

    Check out more expert answers to your COVID-19 questions here.[/vc_column_text][/vc_column][/vc_row]

  • EXPERTS ANSWER COVID-19 QUESTIONS: Medication Management

    EXPERTS ANSWER COVID-19 QUESTIONS: Medication Management

    [vc_row][vc_column][vc_column_text]In this third of a four-part series, nurse and Certified Diabetes Educator, Gail MacNeill, discusses medication management during COVID-19 with nurses and Certified Diabetes Educators, Violeta Nikolova and Barbara Cleave, as well as pharmacist and Certified Diabetes Educator, Susie Jin.

    Here are their insights.

    Is it okay to go into a pharmacy and what are the risks of picking up my medication there?

    Rest assured that pharmacies have put safety measures in place to protect you and pharmacy staff. It is safe to go into pharmacies as long as you also practice safety protocols. This means wearing a mask in the pharmacy, social distancing and washing your hands or using hand sanitizer before and after leaving the building.

    Some pharmacies are also offering online ordering, curbside pickup and/or delivery. Physicians are now calling or faxing in prescriptions. When you know your prescription is ready, be sure to ask the pharmacy staff about pick-up or delivery options.

    In order to minimize the number of times people have to go into a pharmacy, many pharmacies are offering a service, called ‘medication synchronization’ wherein they set up your medications so that they come due for refills at the same time.  Speak with your pharmacy team to see if they offer this service.

    Are there any issues in terms of continued diabetes medication access?

    When COVID-19 first started, some provinces were filling prescriptions for just a one-month supply, instead of the usual three months, to prevent shortages of essential medications. At this point, most pharmacies have returned to a three-month refill option. However, it’s important to call your pharmacy at least a week before you need refills to ensure the pharmacy has time to order the medication from the supplier if needed, to fax the primary care provider, if needed for refill authorizations, and to source the medications from various suppliers if needed.

    Are there any vitamins I should take to help my immune system and to fight the virus?

    There are no vitamins to date that have been proven to fight the virus. Although there have been studies that show that there is a strong correlation between severe vitamin D deficiency and mortality rates due to COVID-19, there are no vitamins to date, including vitamin D supplementation, that have been proven to fight the virus. Speak with your pharmacist or healthcare team to see if vitamin D supplementation would be appropriate for you.

    Of course, keeping your immune system strong through being a non-smoker, healthy eating, and regular exercise is always important in helping fight infections. Here is some information on herbs that have been shown to help keep you healthy, especially when you have diabetes.

    What if I get sick? What are the recommendations for sick day management and medication use if you have COVID-19?

    The recommendations are exactly the same as for managing other infections. When you are ill, it is important to follow these 4 steps:

    Checking blood sugar (glucose): when you’re sick, your blood glucose levels change and become unpredictable. That’s why it’s important to check your levels more often than usual (e.g. every 2-4 hours and during the night). If you have type 1 diabetes and your levels are consistently above 14 mmol/L and you’re having symptoms, you should be checking for ketones as well, with a urine or a blood test.

    Hydrating: it’s essential to stay hydrated with sugar-free fluids such as electrolytes, water or clear soup. Aim to consume one cup of fluid every hour while you’re sick.

    Insulin: never stop taking your insulin, even if you’re not able to eat solid foods, because you need more insulin when you’re sick. You may have to adjust your insulin dose, however, so reach out to your pharmacist or diabetes care team for guidance.

    Pills: if you get dehydrated you may need to temporarily stop some of your medications (e.g. some blood pressure, pain, and even blood sugar lowering medications). Be sure to have a printed list of all your medications ready to share with your healthcare provider as needed, and when in doubt be sure to ask.

    Are there any medications that should not be used if you develop COVID-19 symptoms (e.g. ibuprofen, acetaminophen)?

    Initially there was controversy around the use of ibuprofen and NSAIDs with COVID-19 but that has been debunked. Nonetheless, anyone with diabetes should start with acetaminophen before progressing to ibuprofen. If you do take ibuprofen, be sure to take it with food, and to stay hydrated with plenty of fluids to avoid kidney problems. Ibuprofen should only support people in self-management intermittently and short-term. If ibuprofen is needed more regularly and/or long-term, your health-care team should be involved to assess for appropriateness and to minimize any potential risks to you.

    Should I be testing more often during this pandemic?

    Yes, as long as you’re going to use the numbers to support you in making healthy behaviour choices and management changes (e.g. medication dosing) with the support of your healthcare team. For some, quarantine has impacted food choices and exercise, so information around daily sugar patterns may be needed to make informed decisions about diabetes management. Having a record of your sugar readings over a few weeks for your next virtual diabetes appointment is a good idea too. But checking more often just for the sake of COVID-19 is not necessary.

    Where can I get information on using insulin (I just started on it)?

    Even though there are fewer in-person physician visits happening now, there are still plenty of people who have started insulin during the COVID-19. Resources like Diabetes Canada and Banting & Best Diabetes Centre have some excellent videos and tools to help answer questions on how to administer insulin.

    If you still have specific questions, ask your diabetes healthcare team for answers. It’s important to understand when to take your insulin, how long it lasts and when to test your blood sugar to evaluate its effectiveness. Here are some practical tips on how to overcome the fear of giving yourself an insulin injection as well as some insulin best practices.

    How do I adjust insulin doses during the pandemic?

    If you’re new to insulin, you’ll get dosing titration instructions specific to you from your healthcare provider. That said, during the pandemic you may need to change your insulin dosing because your routine has changed (e.g. stress, food choices and activity all impact your blood sugar levels).

    Some of the new glucose meters make it easier to monitor your sugar and identify patterns that may signal a need to adjust your insulin. But remember, it may be better to consider changing food choices and activity to improve your blood sugar before changing your insulin.

    What are the best ways to manage hypoglycemia? How can I prevent lows at night?

    Hypoglycemia, or low blood sugar, is a major challenge for people living with diabetes. The first thing is to recognize the signs and symptoms of hypoglycemia, such as trembling, sweating, fatigue and anxiety. (Not all symptoms will be present at the same time and some people may not experience any symptoms at all.)

    For mild and moderate hypoglycemia (when blood glucose is less than 4.0 mmol/L), we recommend taking 15 g of carbohydrates (e.g. juice box, glucose tablets) and then to retest your blood sugar after 15 minutes and repeat the process if your levels remain low (below 4mmol/L). When your levels go back to normal (above 4.0 mmol/L), you should eat a regular meal or snack.

    Severe hypoglycemia (when you are unconscious) can be treated with a medication called glucagon. It’s available via injection or nasal powder for easy use. Ask your doctor or any of your diabetes healthcare team members for more information.

    Low blood sugar at night is dangerous. Resolving this may require changes to insulin, food intake or lifestyle. One common strategy is to have a light snack before bedtime (e.g. a glass of milk, crackers and cheese or a slice of bread with peanut butter). Check with your healthcare team to determine the best way to treat this condition for you.

    Here are more tips on how to manage low blood sugars overnight.

    Will I still need to get my annual flu shot this year?

    Yes, it is important to get your flu shot this year, along with any other routine vaccinations. Ask your pharmacist or healthcare provider if you’re unsure about the vaccines recommended for you.

    What is the status of COVID-19 vaccines?

    The good news is that for the first time ever we are seeing collaboration between pharmaceutical companies and research centres in developing a vaccine for COVID-19. Fortunately, there are several companies at different stages of developing a vaccine. Vaccine technologies differ in how they are developed, how they stimulate the immune system to mount a protective response and their immunization schedule. We may get lucky and see more than one COVID-19 vaccine commercially available.  There are many regulatory steps to complete before the vaccine becomes available, including testing for safety and efficacy, but these are all in process.

    Are there other vaccines I should consider getting?

    Yes, be sure to continue with all routine vaccinations, especially for infants. Getting the flu shot is important. Other vaccines to consider would be the shingles vaccine and immunizations to prevent pneumonia. If you’re unsure of which vaccines are recommended for you, contact your healthcare provider for information. Of course, when the COVID-19 vaccine becomes available, that will be recommended too.

     

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  • EXPERTS ANSWER COVID-19 QUESTIONS: VIRTUAL CARE

    EXPERTS ANSWER COVID-19 QUESTIONS: VIRTUAL CARE

    [vc_row][vc_column][vc_column_text]In this second of a four-part series, nurse and Certified Diabetes Educator, Gail MacNeil, discusses ‘diabetes management in an era of virtual care’ during COVID-19 with endocrinologist, Dr. Alanna Weisman, and nurse Certified Diabetes Educator, Violeta Nikolova.

    Here are their insights.

    Is it safe to get routine blood tests during this time?

    Yes, now is a good time to get blood work done, as the number of cases are decreasing and the risk of infection is lower. We are encouraging patients to book their appointments online to minimize their time in waiting rooms. But labs are well equipped and are using appropriate equipment and social distancing, so patients shouldn’t be putting blood work off. In fact, it’s probably an ideal time to get tests done before the fall and winter when we may see a resurgence of COVID-19 cases again. If we do see cases increase in the future, we may hold off on lab work. Also, patients who use continuous glucose sensors may not need to do routine bloodwork, so it’s a good idea to check with your doctor or diabetes care team before booking a lab appointment.

    How can I get a diabetes consultation, and what other support is available?

    You can talk to your doctor to be referred to a diabetes specialist and get access to a diabetes education team in your area. There may also be community pharmacists certified in diabetes education who can offer counselling and support in your area. Look for some great online diabetes resources available through sites like Diabetes Care Community and Diabetes Canada too.

    All diabetes clinics have to comply with provincial guidelines, so if in doubt about where to go, contact your diabetes care team to find out what is available to you.

    Can I still have my routine diabetes checkups during COVID-19?

    Most diabetes specialists are still connecting with patients with the same frequency as before, but using the telephone or virtual check-ups. As things continue to re-open, we may see a return to more in-person visits, however, expect that virtual visits will continue as well. While we can’t do everything online when it comes to patient assessments, there is a lot we can do, so you’ll likely see a combination of both types of appointments in the future. For certain things such as blood pressure monitoring and foot exams, for example, we’ll still want in-person visits.

    How can I monitor things like blood pressure, or get my feet, teeth or eyes checked?

    For blood pressure management, now might be a good time to invest in a home blood pressure monitor. (Check resources such as Hypertension Canada for information on the best, clinically approved home monitors.) As for foot, eye or dental care, it depends on your history and past complications, as well as your level of risk. If you don’t feel comfortable going out at this time, perhaps you can delay your visit or do it virtually. Keep in mind that COVID-19 may be here for a while, so for urgent concerns, be sure to contact your healthcare providers. You don’t want to delay care and risk future complications. For example, someone with active retinopathy or a foot infection should still be getting an examination. Your healthcare provider will advise on whether it is best for you to be seen in person.

    In the meantime, here are some resources for how to care for your feet when you have diabetes.[/vc_column_text][read-also-article article-slug=”coronavirus-support-services/”][vc_column_text]

    How can I get help with dietary needs during COVID-19?

    You can access a dietitian through your diabetes clinic, some grocery stores and even access a dietitian online. You can also find some good tips on what to eat for a healthy diabetes diet here.

    Is emergency non-COVID-19 care available if I need it?

    Absolutely! All healthcare providers are stressing the importance of seeking care when you need it. Hospitals are using strict protocols during this time and patients should not be afraid to come into the hospital. We recommend checking on what policies are in place for each healthcare environment in terms of COVID-19 protocols, but certainly don’t be fearful of accessing care for non-COVID-19 conditions.

    What will the future of diabetes care look like?

    Technology will continue to complement face-to-face patient visits. We’ll continue to communicate through phone, email, video and other digital means. Protocols such as mandatory personal protective equipment will continue, and so will designated entrance/exits to minimize traffic inside healthcare facilities. We also have to be flexible in terms of how care is delivered. At times we may be doing more in-person visits or we may shift back to more virtual care visits.

    How do I prepare for a virtual appointment?

    Have all your medical and drug information accessible and ready to share, including your blood sugar levels. Be sure to have your pharmacy contact available in case your provider needs to send in a prescription, as well as contact information for any other healthcare providers in your circle of care. Write down any questions you have so you don’t forget to ask.

    If possible, download your blood sugar values or take a picture of your log book to send to your provider ahead of time. The same goes for blood pressure readings.

    What platforms are being used for virtual care appointments and which one is best?

    Phone or video are the most common platforms used. There are advantages and disadvantages to both. Video is useful in being able to see a patient’s non-verbal cues and putting a face to a patient, especially for initial consultations. It is also easier to do demonstrations via video.

    On the other hand, not all people have access to the technology needed for video calls. The telephone is more accessible, simpler to use and less likely to have technical glitches. However, some of that personal connection that video enables may be lost.

    As mentioned above, COVID-19 may be here for a while, so don’t delay urgent concerns, and be sure to contact your healthcare providers.[/vc_column_text][read-also-article article-slug=”experts-answer-covid-19-questions-risks-complications-stress/”][/vc_column][/vc_row]

  • EXPERTS ANSWER COVID-19 QUESTIONS: Risks, Complications & Stress

    EXPERTS ANSWER COVID-19 QUESTIONS: Risks, Complications & Stress

    [vc_row][vc_column][vc_column_text]In the midst of a pandemic felt the world over, we asked our diabetes community here in Canada to provide us with their most “burning questions” around COVID-19. Your response was overwhelming. So, in an effort to address your COVID-19 concerns as accurately as possible, we assembled a group of leading healthcare experts to tackle your questions.

    In this first of a four-part series, nurse and Certified Diabetes Educator, Gail MacNeil, discusses the risks, complications and stresses associated with COVID-19 with endocrinologist, Dr. Alanna Weisman, and psychiatrist, Dr. Barry Simon. Here are their insights.

    Are people with diabetes at higher risk of getting COVID-19?

     It’s important to note that the research is ongoing, so we’re learning more each day. But from what we know right now, we do not believe that people with diabetes are at higher risk for becoming infected with COVID-19 compared to those without diabetes.

    At this time, we believe the risk of acquiring the infection has more to do with exposure to the virus, which can be mitigated by social distancing, wearing a mask, etc.

    How does COVID-19 impact blood sugar?

    Similar to other illnesses, being infected with COVID-19 can have an effect on blood sugar levels. There have been reports of some patients experiencing low blood sugar (hypoglycemia), which might be the result of not eating as much when you feel ill.

    We’re seeing some patients, especially those sick enough to be admitted to hospital, with severely high blood sugar (hyperglycemia), which requires a massive increase in insulin doses. We’re also seeing diabetic ketoacidosis in infected patients, especially those with type 1 diabetes, where consistently high blood sugar levels cause toxic compounds to build up in the blood and urine.

    It’s very important to monitor your blood sugars more carefully if you have diabetes and become infected to see if you might require a change in your insulin dose.

    What is the risk of complications for people with diabetes infected with COVID-19?

    While there isn’t a greater risk of contracting COVID-19 if you have diabetes, there is a higher risk of a more severe illness if you become infected. This means a greater chance of being hospitalized and needing intensive care support.

    How does stress during COVID-19 impact blood sugar levels?

    Remember that a stress, whether it’s an emotional or physical strain, is something we don’t believe we can cope with.[/vc_column_text][vc_single_image image=”19180″ img_size=”660 x 330″][vc_column_text]One of the problems with COVID-19 is the unknown: not knowing when it’s going to end or if we or our family members are going to get it. It’s a stressor we are all facing, and when we have a stressor, our bodies go into fight or flight mode. As a result, for some patients it is tougher to manage blood sugar levels.

    What are some ways to manage COVID-related stress when you have diabetes?

    We can separate stress into the things we can control and those we can’t. Focusing on the things you can control, or even making a list of these things, will reduce stress and help you gain some sense of control.

    Another simple psychotherapy intervention is to literally label your feelings. Studies have shown that if you put just one word to what you’re feeling (e.g. frustrated), the brain will quiet down. The simple rule is that if you can ‘name it’ (the feeling), you can ‘tame it’.

    Meditation is another great way to calm the mind, and now there are several downloadable apps to help you meditate (e.g. headspace, CALM, insight Timer).[/vc_column_text][vc_single_image image=”19181″ img_size=”660 x 330″][vc_column_text]Also, consider implementing these three Cs to help relieve stress:

    • Connection (reaching out to friends and family to share concerns)
    • Contribution (checking in and helping others takes the focus off yourself)
    • Creativity (finding new things to invest your time in instead of worrying)

    Here are some good apps and websites to help reduce anxiety during COVID[/vc_column_text][vc_column_text]Are there pre-existing complications/risks that can impact the outcome of COVID-19?

    People with obesity and poorly controlled blood sugar levels may have a higher risk of severe COVID-19 symptoms. Making positive lifestyle changes to reduce weight and trying to optimize blood sugar control will help minimize the risk of severe outcomes from COVID-19. These are changes recommended to anyone with diabetes, even outside of COVID-19.

    Just keep in mind that this is not the time for extreme changes. Any dramatic changes to your diet and lifestyle should be discussed with your healthcare team first.

    Is there any difference in risk of COVID-19 for people with type 1 vs type 2 diabetes?

    In addition to the higher risk of diabetic ketoacidosis in people with type 1 diabetes mentioned above, we are hearing about cardiovascular complications in people with type 2 diabetes who are infected. Otherwise the risks are similar for both, namely that the symptoms of COVID-19 will be more severe in people with diabetes, compared to those without.

    Beyond diabetes, age is also a risk factor, as are other underlying conditions such as kidney or cardiovascular disease.

    What is the risk of death due to COVID-19 in people with diabetes?

    There is no data available yet for Canada. What we’ve seen in other countries is that the risk of death is 50-75% higher in people with diabetes compared to those without. But it’s important to remember that the risk of death overall is still quite small.

    Do people with prediabetes face the same risks as those with diabetes?

    Yes, like people with diabetes, they run the risk of having more severe COVID-19 symptoms. There’s also the potential of newly recognized diabetes throughout the course of COVID-19 illness. For those with prediabetes who get COVID-19, it’s important they know how to recognize the symptoms of high blood sugar, such as increased thirst or changes to vision.

    What is support like for non-COVID emergencies now?

    While some elements of healthcare are not happening at the same rate (e.g., elective surgery), primary care physicians and diabetes specialists are readily available, at least for virtual appointments. In fact, we can deal with a lot of concerns virtually and then bring in patients if needed.

    Hospitals and clinics have personal protective equipment readily available and patients shouldn’t be afraid to get seen if they have concerns. You don’t want to a get a more serious illness because you’ve ignored symptoms and delayed care.

    What are the concerns in terms of returning to work?

    It depends on your individual risks (age, other medical conditions, blood sugar control). Then there are the risks of the actual workplace that will vary depending on what the work involves and how many people you will be coming in contact with.

    Diabetes Canada has developed an advocacy letter people can show their employers to help them understand the risks of COVID-19 for people with diabetes. Your healthcare team can also help you advocate for modifications when possible to minimize the risk of exposure. Advocating for yourself is also another way to minimize stress by taking control of the situation.

    What is the risk of working in healthcare for someone living with diabetes?

    It depends on individual risks and making decisions based on your own specific circumstances. Some experts have recommended that people with diabetes working in healthcare should have accommodations to minimize their direct contact with patients if possible.

    How do I overcome my fears around COVID-19, especially when I see people wearing masks on the street?

    Seeing people with masks can be distressing no doubt. But keep in mind that some people are choosing to wear masks because of their own individual circumstances (e.g. living with someone elderly or immune-compromised).

    Find more information on ways to protect yourself during COVID-19 here.[/vc_column_text][vc_column_text]

    How can I keep myself healthy during this pandemic?

    Focus on the things you can control, such as maintaining good blood sugar control, exercising and eating a healthy diet. There are patients whose blood sugar levels have improved during this time because they’re able to spend a lot more time and energy on diabetes management.

    Trying to make positive changes in your diabetes management now is even more important in the context of this pandemic.

    Find fitness activities you can do from the comfort of your home here.

    Any final tips on how to stay motivated?

    Remind yourself that this pandemic will eventually end and it’s about figuring out how you’re going to rise above this in the meantime. Remember the three Cs: Connection, Contribution and Creativity. Even with physical distancing and other restrictions, here’s a chance to reconnect with old friends, spend quality time with a pet, or get back to an activity you enjoyed in the past.

    Here are some online entertainment and social activities to consider as you’re socially distancing

    [/vc_column_text][read-also-article article-slug=”covid-19-support-services/”][/vc_column][/vc_row]

  • Coronavirus support: Meditation, relaxation, and mental health

    Coronavirus support: Meditation, relaxation, and mental health

    [vc_row][vc_column][vc_column_text]In this post you will find a collection of apps, websites and expert opinions to help you reduce anxiety and stress to help you cope during these difficult times![/vc_column_text][vc_single_image image=”18855″ img_size=”660 x 330″][vc_column_text]

    Meditation and Relaxation Resources

    Calm is the #1 app for sleep, meditation and relaxation, with over 50 million downloads and over 700,000 5-star reviews.

    Headspace’s mission is to improve the health and happiness of the world. And with millions of users in more than 190 countries, they are well on their way.  You can try Headspace for yourself and learn the essentials of meditation and mindfulness with the free basics course.

    Insight Timer publish the world’s largest collection of free guided meditations with over 40,000 titles.

    Breathe (Stop, Breathe, Think) is an emotional wellness platform for the “under 25” generation. At Stop, Breathe & Think, we believe that when more people find peace of mind, it makes the world a better place. Our mission is to help kids, teens and young adults build the emotional strength to tackle life’s ups and downs.

    Yoga with Adriene This playlist was assembled to support you in times of uncertainty. May this collection serve to remind you that you are not alone, to support you through unknown times, and to help you find peace through your home practice.

    Chris Hatfield gives an expert perspective on what we can accomplish while in self-isolation.[/vc_column_text][vc_column_text]

    Mental Health Professional Support

    Mental Health Commission of Canada mission is to make meaningful contributions to the wellness of Canadians through world-class mental health courses. Please check out their Covid-19 self-care and resilience guide.

    Centre for Addiction and Mental Health is where you will find many resources including coping with stress and anxiety and dealing with isolation.

    Wellness Together Canada provides immediate virtual mental health and substance use support. Services offered include immediate crisis support, mental health screening, self-assessment tools, peer-to-peer support, educational courses, Cognitive Behavioural Therapy and counselling support by phone, text or live chat. Available in English and French, across Canada.[/vc_column_text][read-also-article article-slug=”coping-strategies-for-trying-times/”][/vc_column][/vc_row]