The COVID-19 pandemic has changed the way we go to the grocery store, work, and take care of our health, among other things. If you have a chronic condition like diabetes, COVID-19 has probably brought new challenges in managing your care and keeping your blood sugar levels within your target range.
Diabetes happens when your glucose, or blood sugar, is too high, according to the National Institute of Diabetes and Digestive and Kidney Diseases. This may occur because your body either doesn’t make enough insulin (a hormone that helps regulate blood sugar) or doesn’t use your insulin sufficiently. There are two main types of diabetes, but they can both cause high blood sugar levels, which can lead to nerve damage, heart disease, and kidney problems over time. Consistently monitoring your blood sugar levels and checking in with your health care team for proper treatment can prevent that from happening.
But keeping up with your routine medical appointments and lab tests has likely been more challenging lately as venturing out to medical offices conflicts with the general advice to stay at home and social-distance. Since people with diabetes are at an increased risk of complications from COVID-19, it can be particularly daunting to figure out how to manage both your condition and your risk of infection.
At this point in the pandemic, you may have missed a few routine medical appointments or not checked in with your doctors for quite some time and are wondering what to do next. First, know that there is no reason to feel guilty for the lapse and that an empathetic doctor will understand if you didn’t check in. Second, it’s a good idea to reach out to your physician if you have any questions—or even if it’s just been awhile since your last visit—since the best plan should be individualized to suit your particular situation. To offer some guidance, we asked medical experts for their advice on maintaining your diabetes care during a pandemic. (This story can also help you navigate making medical appointments right now.) Here’s what they said.
1. Check if you need an A1C test.
You may already be measuring your blood sugar using glucose test strips several times a day or a continuous glucose monitor (CGM) that automatically tracks your numbers throughout the day. But it could have been a while since you’ve gone into your doctor’s office or medical lab for an A1C test. (Also known as a hemoglobin A1C, this test measures your blood glucose levels over the past three months and creates an average that’s reported as a percentage. The higher the percentage, the higher your blood sugar levels have been.) Generally, people with diabetes get an A1C test at least twice a year. Your doctor may recommend more frequent tests, such as every three to four months, if you’re having trouble maintaining control over your blood glucose levels, according to Jorge Moreno, M.D., an internal medicine physician with Yale Medicine who is also board certified in obesity medicine.
An A1C test provides a comprehensive look at your blood sugar levels over time and can be used in addition to your CGM to help your doctor determine whether you need to change your care plan. If you haven’t already, you should reach out to your doctor to discuss the timing of your last A1C test, whether it’s time for you to have another, and whether you can miss or delay your test if you’re not comfortable going in for lab work.
“The answer depends on the specific situation of each patient,” Oscar Morey Vargas, M.D., an endocrinologist at the Cleveland Clinic, tells SELF. “It is a decision that has to be made by the provider that follows the diabetes care of the patient.”
If you’re reluctant to venture into a clinic for blood work, it’s important to communicate that to your physician and ask what is best for your situation. They should be able to explain their COVID-19 safety precautions and offer solutions that make you feel more comfortable about being in a public office, says Kim Pierce, R.D., a certified diabetes care and education specialist at the Cleveland Clinic. Pierce says she is more than happy to talk to people about the protocols her workplace has enacted, including regular temperature checks, mask requirements, frequent cleanings of exam rooms, and blocked-off seating areas in the waiting rooms.
“We’ve seen a lot of people being scared to come into the facilities,” Pierce tells SELF, but she reiterates that her facility, like many others, has taken steps to make it as safe as possible under the circumstances.
Many health care workers have already been vaccinated against COVID-19, so you might feel comfortable being around the medical team but not other patients. If that’s the case, you can ask for an appointment during times when the office is usually slowest. Another option is to wait in the car and ask for the office to call you when the doctor or nurse is ready to see you. (If you’re getting tested at an outside lab, you may want to call ahead of time to ask about their COVID-19 precautions as well as your options for limiting your exposure to other patients.)
There are at-home A1C tests, but doctors typically prefer lab tests because they are the gold standard of care, according to Dr. Moreno. If you’re really uncomfortable with going into a medical office for blood work, ask your doctor whether an at-home test is appropriate for you—but home tests might not be covered by your insurance, so check with your insurance company before purchasing a test.
2. Keep up with your preventive screenings if you can.
Aside from the A1C test, there are a few other screenings your doctor probably recommends as part of your diabetes care.
Normally, your doctor might suggest that you take a kidney disease test every year to measure the levels of protein found in your urine. Higher amounts of protein could indicate that you’re developing diabetic kidney disease (also called diabetic nephropathy), which can lead to kidney failure if not addressed. “If the prior screens have been negative, a delay of a month or so is fine, but a check should be done as close as possible to a year from the last,” Ruchi Mathur, M.D., an endocrinologist at Cedars-Sinai in Los Angeles, tells SELF.
Speaking to your doctor can help you decide on the best time to get tested. For example, if you have other medical conditions that increase your risk of developing diabetic kidney disease, such as high blood pressure, or if you have a family history of kidney disease, your doctor might encourage you not to delay this test—just to be safe.
Speaking of risk factors for kidney disease, high blood pressure is a very real problem for people with diabetes—and according to John Hopkins Medicine, it is twice as common in people with diabetes. Many times your blood pressure gets checked during routine doctor’s appointments (which is what the American Diabetes Association recommends for those with diabetes), but if you haven’t gone in for any medical exams throughout the pandemic, then it’s definitely been a while since you’ve had this done. Ask your doctor if you need to come in to get it checked. (If you already have high blood pressure, your doctor might want you to check your own blood pressure at home on a regular basis, too.)
3. See your dentist if you have signs of gum disease.
While we’re talking about preventive measures, we can’t ignore caring for your teeth and gums. Typically, it’s recommended that people go in for a routine dental check-up and professional cleaning twice a year, according to the Mayo Clinic, but it’s completely understandable if you’ve missed these during the pandemic.
It’s important to know that diabetes increases your risk for gum disease, so oral health should be a part of your care plan. Additionally, gum disease could cause your blood sugar levels to rise, making it harder for you to manage your condition. By identifying gum disease before it becomes too advanced, your dentist can help you ward off that potential problem.
If it’s been more than six months since your last cleaning and you feel comfortable doing so, then you might want to call your dentist and schedule a check-up, says Scott Kirkley, M.D., an internal medicine physician and chief medical officer at Parkland Health Center in Farmington, Missouri. “I typically recommend all patients, including diabetics, get a twice-yearly dental evaluation and cleaning. If their teeth are in good order, this could be delayed during the pandemic,” he tells SELF.
If you’re overdue for a dental check-up but are still uncomfortable about going in for a cleaning, call your dentist and talk through your concerns. In addition to explaining their office’s COVID-19 precautions, your dentist can give their opinion about whether you might be at risk for gum disease based on your medical history and offer a more individualized suggestion. And in the meantime, keep up with brushing your teeth and flossing twice daily, and watch for any redness, swelling, or bleeding in your gums that might be early signs of gum disease.
If you do notice any of these signs of gum disease, even if it’s between visits, it’s a good idea to call your dentist because you may need a thorough check-up for a proper diagnosis. Treatment options range depending on the severity of your case but can include removing bacteria and tartar or using a prescription mouthwash.
4. Perform regular foot checks.
You might remember having your feet checked during a routine doctor’s visit; that’s because people with diabetes often develop neuropathy, or nerve damage, in their legs and feet. Generally, your physician will look for foot sores and ask if you experience any numbness and tingling, since these can all be indicators of nerve damage, according to the Centers for Disease Control and Prevention.
Sometimes you might get a cut or a blister on your foot and not realize it’s there. Unfortunately, that small wound can become infected and have trouble healing due to nerve damage and poor circulation. Although this is the worst-case scenario, sores that don’t heal may require the infected part of your toe or foot to be amputated, according to the CDC. This is why it’s extremely important to regularly look at your feet, according to Dr. Kirkley.
“At the end of the day, when you take your socks and shoes off, you should take your hands and rub them all over your feet and make sure you don’t have any open wounds or sores,” Dr. Kirkley tells SELF. If you notice any of the following, call your doctor, as you may be developing an infection:
- Blisters or cuts that are taking longer than usual to heal.
- Injuries that look red or feel warm to the touch.
- Skin that’s turning black or green and smells bad.
Should you notice any sores or infections, you’ll want to call your doctor’s office to discuss whether you should come in or if your situation can be assessed during a virtual appointment. And if you haven’t had a foot check in over a year, consult with your physician about whether they think you should come in for a thorough checkup and foot exam.
5. Ask your doctor if you need a dilated eye exam.
When was the last time you had a comprehensive eye exam where your eyes were dilated? This is another preventive measure that you may have overlooked because of the pandemic. However, this is an important test for people with diabetes because chronically high blood sugar can damage blood vessels in your body—including your eyes—and lead to diabetic retinopathy.
“Diabetic retinopathy in its earliest forms does not have any symptoms,” retina specialist Christina Weng, M.D., an associate professor with the Baylor College of Medicine-Cullen Eye Institute, tells SELF. “Often, until it gets into the late stage, it does not have any symptoms. It’s the number one cause of vision loss in working-age Americans today—the leading cause.”
This is why eye exams are so important when you have diabetes. Putting dilating drops in your eyes lets your doctor see the back of your eyeball more clearly, making it easier to spot early signs of diabetic retinopathy, such as little hemorrhages or abnormal growth of blood vessels in the retina. Treatment can vary depending on how advanced your case is. In the early stages, your doctor might just want you to come in for more frequent eye exams to monitor your condition and look for signs the disease is progressing.
“With early detection and early treatment, you can largely prevent blindness and vision loss. That is why it is so crucial to be evaluated regularly,” Dr. Weng says. Given our current situation, it may have been more than a year since your last dilated eye exam. If so, she recommends scheduling an appointment just to be safe.
“We don’t recommend going past a year because the longer you go between exams, the more likely you are to miss something that is growing,” Dr. Weng says. “Obviously, if it’s only one month past a year, it’s probably okay, but it’s easy for one month to become three months or six months or another year.”
Optometrists and ophthalmologists across the country are scheduling in-office visits and continuing to implement the CDC’s COVID-19 safety recommendations by wearing face coverings and practicing physical distancing at their practices. If you’re at all uncomfortable with going in for a recommended exam, ask your eye doctor about the precautions their office is taking against.
6. Get vaccinated against COVID-19 as soon as you’re able to.
Dr. Kirkley says he typically recommends that his patients with diabetes get vaccinated as soon as they can if they’re comfortable doing so. “I do think that the vaccine is safe,” he says. “It’s effective, and it’s the best way for us to put an end to this pandemic as soon as possible.”
The CDC also maintains that the COVID-19 vaccines are safe, having been evaluated in clinical trials involving tens of thousands of patients. Currently there are three vaccines that are authorized for use in the United States: the Pfizer-BioNTech vaccine, the Moderna vaccine, and Johnson & Johnson’s Janssen vaccine.
Having another health condition like heart disease or high blood pressure in addition to your diabetes (which the CDC says is common) can also make COVID-19 more severe for you. Getting vaccinated when it’s your time can reduce your risk of getting COVID-19 and developing any complications from the disease.
The last year has been tough, and managing a chronic condition during this time isn’t easy. But checking in with your health care team about the best ways to manage your diabetes is important to your overall health—not just now but for the long-term.
“Living with diabetes is like running a marathon, not a sprint,” says Dr. Mathur. “It’s the long-term planning and goals that will make all the difference. Although COVID-19 has thrown us all a curveball, we can move forward with the goal of getting back on track and making the changes needed so that we continue to live our best and most healthy lives.”