Healthcare is failing people with diabetes
COVID, COVID, COVID. For the past year, we have been COVID crazy in this nation, and yet we cannot seem to stop the dying. One thing we learned last spring is that people with diabetes seem to be dying at a much higher rate than people without any comorbidities. Yet, healthcare isn't making any changes to how we manage diabetes. We are failing you.
The A1C lab test for diabetics may be a good prognostic indicator of COVID severity (Wang, Du, & Zhu, 2020). In Australia, where it’s my understanding Aussies have socialized healthcare, one study found many who were hospitalized for COVID didn’t even know they had diabetes (Klein, Fries, & Kaser, 2020). Furthermore, 85% of those hospitalized in four COVID intensive care units in Australia were all diabetic with a median A1C of 6.5% (Klein et al, 2020).
From that one study, we can postulate those of us who have diabetes at just a 6.5% are at much higher risk for severe complications and death from COVID. But how is healthcare managing diabetes? It’s recommended to aim for an A1C of less than 7% in most diabetics, allow a higher A1C in those expected to live less than 10 additional years, and aim for a little lower in younger people (Qassem, Wilt, Kansagara, et al, 2018). The rationale is that it’s easier for a younger person to exercise and be more aware of one’s hypoglycemia, and hypoglycemia is dangerous for older people.
The concerns with hypoglycemia (low glucose) are real. If you are a diabetic patient of mine, chances are you’ve heard me say high glucose will kill you long and low glucose can kill you fast. Hypoglycemia can cause all sorts of problems such as falls, seizures, and even heart failure (Hypoglycemia, 2020). And, over time with frequent hypoglycemic episodes, diabetics stop being able to feel the lows. That’s incredibly dangerous.
But my main point is, healthcare isn’t doing enough to educate diabetics on maintaining glucose low enough to prevent severe COVID. I am of the opinion we should be aiming for A1Cs below 5.7%, which is the level for which non-diabetics test. In other words, we should be doing more to help you regain your health to the level you never had diabetes, or manage it so well your health status is akin to a nondiabetic.
There are several things we as practitioners can do to help you achieve lower A1Cs. My holistic model of starting with the body, then incorporating vitamins, minerals, and herbal supplements, then including pharmaceuticals can all be beneficial for diabetes management.
Starting with the body, we can initiate exercise and follow low-carb diets. Also, routine checks (every 3 months) of your A1C, as well as checking your fasting and postprandial (after meals) glucose, and keeping a glucose/diet log can help us measure how close we are to your target A1C. There are several targeted supplements that can assist with increasing insulin sensitivity, thus lowering the need for insulin. Finally, in the pharmaceutical realm, we have access to prescribe biguanides, sulfonylureas, DPP-4, SGLT-2, and insulins can all be used to attain an A1C <7%.
Every person who has prediabetes, type 1 diabetes, or type 2 diabetes is a unique individual. Each diabetic goal and program should be customized to your specific needs and desires. But it starts with a checkup. We try to keep our prices as affordable as possible because lack of access to healthcare is part of the problem in taking control of one’s health. Call us if you would like an appointment to discuss your diabetes management further.
Hypoglycemia is a condition. (March 13, 2020). Retrieved from https://www.mayoclinic.org/diseases-conditions/hypoglycemia/symptoms-causes/syc-20373685#:~:text=Over%20time%2C%20repeated%20episodes%20of,%2C%20life%2Dthreatening%20hypoglycemia%20increases.
Klein, S.J., Fries, D., Kaser, S. et al. (2020). Unrecognized diabetes in critically ill COVID-19 patients. Critical Care 24, 406. https://doi.org/10.1186/s13054-020-03139-3
Wang, Z., Du, Z., & Zhu, F. (2020). Glycosylated hemoglobin is associated with systemic inflammation, hypercoagulability, and prognosis of COVID-19 patients. Diabetes research and clinical practice, 164, 108214. https://doi.org/10.1016/j.diabres.2020.108214
Qaseem, A., Wilt, T., Kansagara, D., Horwitch, C,. Barry, M., Forciea, M. (2018). Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy for Nonpregnant Adults With Type 2 Diabetes Mellitus: A Guidance Statement Update From the American College of Physicians. Annals of Internal Medicine. https://doi.org/10.7326/M17-0939