The COVID-19 crisis is currently impacting almost everyone on the planet in an unprecedented way. Our Ascensia editorial board is scattered across the globe, yet we’re all currently in similar situations in self-isolation to help slow down the spread of the coronavirus. Life is different right now, but we all know that diabetes doesn’t just stop. That’s why it’s important to think about how we can readjust to this new reality while keeping a clear head and, ideally, stable blood sugars as well.
There has been some debate about whether or not people with type one diabetes are at a higher risk for contracting the coronavirus or higher risk of developing complications when we do get COVID-19. Whatever way you slice it, it seems clear that stable blood sugars help our immune system and chronically high blood sugars weaken it. So for many of us, that is a big motivation to keep our blood sugars in range - now more than ever. On the other hand, that is also a lot of pressure. It’s important to take care of our physical, as well as our mental well-being.
First off, I want to say very clearly that we are all dealing with this differently and we will all need to find our own way through it. We are also all in very different situations, some extremely privileged, others less so. However we have to or choose to deal with this, let’s be kind to each other and not judge each other for our choices. We are all just figuring things out as we go, because this is new for all of us. And there is no one way of coping that is right for everyone.
As for me personally, I am an absolute cliché: I am doing yoga, pampering myself with a different face mask each day, deep cleaning my apartment, gardening on my balcony and baking bread AND banana bread as if my life depends on it. I am also currently in mourning over the loss of my sourdough starter who decided to grow a mouldy beard. As I said: Cliché!
But you know what? That’s absolutely fine. Because that’s what gets me through this situation. And if you’re different, then you may want to do different things. This is important - in general diabetes management as well as during this specific crisis: You do you!
Expectation Management & Routine
As we’re trying to adapt to this new situation, we can see that our reactions are vastly different. While some of us are at an all-time productivity high, others are really struggling to get anything done. Both sides of the spectrum - and everything in between - are valid. What’s important is that we don’t expect too much from ourselves.
You don't have to make the most of a pandemic. You don’t have to write a novel and renovate your home simultaneously. If keeping busy helps you to release tension, that is amazing. But if you can, it’s also good to give yourself some downtime. In fact, while some talk about being bored and not knowing what to do with all this new found time, others are busier than ever, overextending themselves in balancing work and childcare at the same time. So let’s be gentle with ourselves and recognize some of these challenges.
If you’re currently unsure of what day it is, trust me, you’re not alone. But I’ve always felt that having a routine helps me a lot in my diabetes management. So even though I am spending all my time at home, I try to keep somewhat of a routine going: I get up, eat and go to bed at roughly the same time every day. This helps me a lot and gives me a good framework for my days and my blood sugars, too.
I think it’s good to strive for a sense of normalcy. But at the same time, we shouldn’t expect it. These are not normal times. So don't have normal expectations of yourself. There may be days where all you can do is exist and that is okay. Trust yourself and allow yourself to go through all this in the way that is right for you.
Everything I see and hear is about health right now. Yes, this is a health crisis. Yes, our public health and individual health are important. Yes, it makes sense to put a special focus on our own health right now. Because yes, we want to get through this crisis as healthy as possible.
But at the same time - and I feel very strongly about this - health is not an obligation! Health is not normative. We are not obliged to do the healthy thing, to work out, to ditch the pizza and stick to salad. We can all find our own way and our own balance. We are allowed to do things that are not healthy for us (as long as they don’t put anyone else at risk). That is our right and we do not deserve to be shamed for it.
Health is of course closely connected to the food we consume, especially as people with diabetes. I am a foodie through and through, so it’s not surprising that I would throw myself into the comforting arms of food during this unsettling time. But in life with diabetes, food is also a constant point of worry. What should I eat? How will it impact my blood glucose? How will that in turn impact my immune system?
I have seen a couple of posts recommending that people with diabetes should stay away from those foods that they know make their blood sugar difficult to handle. While that is of course a valid choice, I personally would do the opposite and take this time to a) indulge and b) finally master that specific food item. I love a challenge!
Again: You do you. Whatever you choose to eat during this time, whether you’re sticking to the meals that you can bolus for in your sleep, whether you’re trying loads of new recipes or whether you’re finally going to find out how to bolus for pizza. Do what's right for you.
Food is not the only health-related subject that is complicated through our diabetes. Another one is exercise. But one thing that is utterly uncomplicated: We do not need to exercise to earn our food. This one is important to remember, especially right now.
By now, most of us are spending a lot of time at home. Maybe that’s completely normal for you, or maybe you’re used to a very active lifestyle. Maybe you’re noticing that even though you don’t usually work out, you've started to miss that daily walk to the office or even just from your desk to the coffee machine within that office. Many of us are moving considerably less than usual and sitting for longer periods of time. This can make us our minds feel foggy and our bodies feel stiff and sore. It can also lead to higher insulin resistance.
Exercise may be helpful here, as it can increase insulin sensitivity and support our mood and mental health. If you’re looking for an endorphin-boost, then there are loads of exercises that you can do from your home, be it a live yoga class, a body weight exercise or a dance workout. The abundance of online offers is actually quite overwhelming right now and it’s certainly not for everyone (see this vs. this).
A more relaxing alternative to an intense home workout is simply going for a walk around the neighbourhood. This way, you also move your body and potentially calm your mind. But again: You are not obligated to move at all and if you choose to do so, you can also stay on your couch. No judgement here!
As always in diabetes, our bodies are all different and therefore they will react differently during this time. I count myself lucky because my less unpredictable and chaotic isolation lifestyle has resulted in more stable blood sugars than usual. At the same time, I know many people are struggling with stubborn up and down blood sugars right now. Stress and anxiety are definitely affecting people’s bodies and therefore also their diabetes.
Not everyone has more time or the right head space at the moment - but if you do, you could use this motivation to fine tune some aspects of your diabetes management. Maybe this is the time for a round of basal testing? Or maybe you want to take a step back and work on the arts of carb counting and pre-bolusing?
Personally, I usually struggle with pre-bolusing because my days differ heavily, so a) I don’t always know too far in advance when exactly I will eat and b) I’m worried about going low. I am now experimenting with this and trying to be a bit more daring - all in the safety of my own home where a cup of juice is never far away. Being home makes me feel safe and less afraid of lows, so now I am growing in confidence and actually giving myself a huge pre-bolus for that huge bowl of pasta. And the results are encouraging!
If you’re not keen on changing up your actual diabetes management, but want to feel like you’re still "doing something": How about a "spring clean"? You could clear out your diabetes supply drawers (If you’re going full-on Marie Kondo, consider donating the supplies you no longer need!). Maybe it would be a start to just to wipe down the kit that you use and touch on a daily basis. Or maybe - just maybe - you’re finally going to change that bloody lancet!
Speaking of diabetes supplies – of course it is essential that you have enough insulin and consumables. But: Please check your privilege and act responsibly. This is an extremely difficult issue in normal times, which is now intensified by this crisis: Too many people across the globe struggle to access what they need on any day. If you're lucky enough to have access, don't exploit it and stockpile. Keep in mind that not everyone can afford to bulk buy and that stockpiling can endanger supply chains. Be considerate.
When it comes to medical appointments, speak to your medical team to discuss which appointments can be done virtually, which should be postponed and which are important enough to keep in the diary. If you're in need of medical attention, don't shy away from it because of the current situation. In most countries hospitals and clinics are still open if you need to use them.
Diabetes or not - your mental health is just as important as your physical health. We should not only consider how we are feeding and moving our bodies, but also what we’re thinking and saying to ourselves, as well as what we’re exposing ourselves to.
My advice: Focus on what you want to do, not what you think you should be doing. Don’t let yourself get pressured by others or by yourself. Now is a great time to really curate your social media feeds and unfollow accounts that make you feel bad about yourself, your body or your diabetes.
Speaking of media: I am someone who loves reading and watching the news. It’s part of my usual routine: I like to feel informed and it gives me a sense of control, even when the news are bad. During this crisis however, I have found that constantly checking the latest numbers and developments was just too much and took a toll on my mental health. That’s why for the last couple of weeks, I have tried to only check the news once a day - ideally in the morning. I’ve found that that’s more than enough and a huge relief for my mental well-being.
A bit of escapism is not selfish, but okay. Instead of watching the news several times a day, I try to feed my soul with positive stories, interesting books, podcasts, movies and TV shows. Some of them are stimulating, others mind-numbing. All of them are valid.
Another thing that’s important to remember: Physical distancing does not mean social isolation. Even though it may not be the same as hugging and meeting people face-to-face, you can still stay connected with your friends, family and diabuddies. You can pick up the phone, write letters or e-mails, or set up a video call.
If you’re feeling lonely while everyone else seems to be meeting with everyone and their dog for an endless amount of Zoom parties, please know that you are not alone. "The irony of loneliness is we all feel it at the same time - together" says poet Rupi Kaur and she couldn’t be more right. If you feel like talking to someone, try to reach out. I promise that you are not alone.
It’s okay to not be okay right now. Whatever you’re feeling is valid. This situation is really tough. But so are you.
We’re all in this together!
If I’ve learned anything over these past few weeks, it’s that our diabetes online community is strong! We are all in this together, so let’s be kind to each other, support one another and get through this together.