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Coping with COVID-19, Part 1: Eating, Meds, and Activity

By Michael Hattori

Nurse and diabetes educator (and person with type 2 diabetes in remission!) Michael Hattori ​introduces seven self-care behaviors that provide a foundation for managing your diabetes

COVID-19 has brought us into a new world, full of uncertainty, misinformation, and stress. Managing your diabetes is likely already enough of a challenge, even without a pandemic. So, what can you do to stay physically and mentally healthy? Read on for my strategies for keeping afloat during this crisis.

First of all, when things are changing rapidly and you feel like you’re on shaky ground, the best thing to do is to find something to hold on to. A safe harbor, if you will. Well, look no further! Fortunately for you, the AADE7 is a set of self-care behaviors that can provide you with that rock-solid grounding. Maybe you’ve already heard of it? It is still my go-to when I’m feeling out of control and need a framework to re-center myself.

These seven self-care behaviors are the result of huge amounts of thought and consideration from the Association of Diabetes Care & Education Specialists (ADCES), and they reflect the most up-to-date practice in diabetes self-management care and education (click to jump to a particular section):

In this two-part series we’ll talk about each of the seven pieces, with tips and resources for improving each area. Part 1 will include Healthy Coping, Healthy Eating, Taking Medication, and Being Active. In Part 2 we will talk about Monitoring, Reducing Risk, and Problem Solving.

We’ll start with the foundation of Healthy Coping.

Healthy Coping

Healthy Coping is first for one simple reason: if you can’t cope, you can’t hope. And if you can’t cope, how are you going to eat healthy? Manage your meds? Exercise? Forget it! The gym’s closed. Monitor? Who can be bothered with everything else that’s going on.

But if I’ve learned one thing in my 60 years on this planet, it’s this: how our lives are going is directly related to the conversations we are in. Are you in a conversation for hope, or despair? If it’s despair, you can be sure that that’s the way your life is going to go! The only way to reverse that downward spiral is to change your conversation. It’s simple: if you want a new life, say new things! When we’re down, a typical way of coping is to seek out others who are down, who will moan and groan along with us; a sympathetic ear seems comforting.  But all you really get out of that is another person moaning and groaning. It does nothing to change the conversation. You have to do it, but you are not alone.  

Here are ways you can change your conversation.

1. Gather support - don’t forget to reach out. There are so many options for support in the diabetes community, even if you live alone:

  • Do you have children in your life, or grandchildren? This is the perfect opportunity to get them involved. Get those kids to look up the latest diabetes apps and show you how to use them. Having those around you understand and support you is invaluable, and can lead to an upward, positive, can-do attitude.

  • Social Media: there are tons of support sites on social media for just about every type of diabetes. Type “diabetes” into the search box on Facebook, and you’ll be amazed at how many support groups there are. These sites can be great resources for support, with information and other people who are in the same boat. However, use some caution and make sure that information is valid.

  • Online Organizations: if you have access to a computer, tablet or smartphone, take a moment to find out what resources you have at hand, both locally and online, such as DLife, VeryWell Health, We Are Diabetes, the American Diabetes Association, and of course, diaTribe.

2. Telehealth!  COVID has brought about many new opportunities for remote access to healthcare.

  • Healthcare clinic: if you haven’t done so already, call your doctor and see what they offer in the way of telehealth; many are offering phone consultation or full telemedicine appointments. Perhaps your local diabetes clinic is offering remote diabetes education and support.

  • Pharmacy: check with your local pharmacy to see what options they are offering; many are offering free delivery, extended prescriptions and refills, and other discounts and deals. And if you’re using insulin and are possibly out of work, don’t forget about Walmart’s no-prescription-needed insulins from Lilly and Novo Nordisk. There are also new programs for financial assistance being offered. Check out Getting Insulin during COVID-19 for more information.

  • Here is an article on preparing for your telehealth visit: Top Nine Tips For Diving Into Telemedicine With Your Doctor During COVID-19

Healthy Eating

With limited access to grocery stores and restaurants, plus empty shelves at stores, many people are resorting to unhealthy food choices, such as frozen pizza, snack foods, and fast food. Maybe you’ve noticed that in most stores, the only part that’s consistently full is the produce section. Don’t give in to the temptation to raid the frozen pizza section – you have so many other options, and healthy eating is a cornerstone to successfully managing your diabetes. You know this! Here are some options you might consider:

Frozen Foods: thank goodness for FROZEN FOOD. Even if you don’t cook, or can’t cook, there are still options in the frozen section that are healthy. One of my favorite brands of frozen meals is Amy’s Organic; but there are a lot of other diabetes-friendly choices, too. Of course, you must read labels and pay attention to carbs and added sugar. Here are two articles that might help you choose:

Delivery Services: with the advent of COVID-19, grocery delivery and meal services have popped up everywhere. I love using Instacart, since it offers to deliver groceries from many local stores (including pharmacies, in some locations) for only $3.99. A quick search on the internet will bring up other options.

If you don’t want to bother with frozen foods, there are many services that will deliver hot food to you. Here are some options:

Pantry: if you are going to shop and cook yourself, here are two articles on how to stock your kitchen for diabetes:

If you’re like me, when I’m stressed all I want to do is eat carbs. But don’t cave in. If you have a family, your food choices may be a challenge. With everyone home, this is the perfect opportunity to sit down with them and plan meals together. If you are taking care of them, your health is a top priority too, right? So, talk about how this is affecting you and your household, and see if you can come up with a health plan for everyone. One good thing about frozen food is that you can pretty much cater to everyone with minimal fuss, and still have healthy choices for you.

Just remember: Garbage in, garbage out. What you eat affects just about every aspect of diabetes, particularly your medications and insulin, which is why Healthy Eating is self-care behavior #2. Speaking of meds….

Taking Medication

Although Taking Meds is actually #3 here, it’s just as important as Healthy Eating, especially if you take insulin, as the two create a balance that helps you manage your blood sugar levels and stay in your target range. This is even more important if you are also taking meds for blood pressure, high cholesterol, heart disease, kidney disease, or any other health complications.

Here are some things you can do to stay on track with your meds:

1. Update your med list. Many people with diabetes do not have updated medication lists. This is such an important part of taking meds correctly, so take the opportunity to do it today:

Get all of your medications and, one by one, write them down – name, dosage, number of times a day you take the medicine and at what time(s). Check expiration dates as well. How many of your meds are you actually taking? When were they last updated by your doctor? Studies have shown that medications often don’t get regularly updated, which can lead to less time in range. This is a prime opportunity for you to examine what you’re taking and how effective it actually is, and to speak with your doctor about your medications.

A great idea while you’re whiling away the hours at home is to keep a log. And not only for medications, but diet, exercise, and blood sugar levels, too. There are tons of phone apps out there to help you. I like One Drop, as it allows me to track just about everything: meds, blood sugar, net carbs, blood pressure, heart rate, activity, weight, and A1C. Do it for a solid week, and see what you notice; perhaps you haven’t had the time to really examine how your meds are working until now. Doing this will not only give you a much clearer idea, but it can also help set you on a new and better track towards managing your diabetes. It’s a new conversation! It’s also part of Problem Solving and Reducing Risk, which we’ll get to shortly.

Another great tool is a pill organizer. I use a weekly organizer for all my cholesterol meds and vitamins. Not only does it help to keep your dosages straight, it’s a great reminder of whether you’ve taken your pills or not. There are a lot of different pill organizers available, some with several daily compartments if you take your meds at different times during the day. My One Drop phone app also gives me reminders to take pills: audible beeps with a list of the meds and dosages to take.

2. Fill Prescriptions. This may be a challenge during the COVID-19 crisis, especially if you’re not working or have reduced income and can’t afford your meds. But there are some solutions available:

  • NovoNordisk is offering free insulin for up to 90 days for those who have lost their insurance due to COVID-19, with some qualifications.

  • Lilly has a new Insulin Value Program, which allows anyone who has commercial insurance or no insurance to fill their monthly prescription of Lilly insulin for $35. This program covers most Lilly insulins, including Humalog, and the $35 cap applies regardless of number of insulin doses required.

  • Insulin discount cards and copay assistance: in addition to the above, some companies offer insulin discount cards or copay assistance for insulin and other meds . There may be certain requirements or limitations, so be sure to read carefully.

  • Free Delivery: many pharmacies are offering free delivery. Mail order is another great option and may be a better deal than what your local pharmacy offers.

Being Active

One of the positive things about COVID-19 is that despite the order to “shelter in,” I see more people out walking and being active than I ever have before. I get “cabin fever” quickly, so I’m out the door at least two or three, or sometimes ever four times a day. And with spring in the air, in many places the weather is perfect for being outdoors.

We all know that being active, whether through walking, exercising at the gym, or doing arm and leg raises in a chair, helps bring blood sugar down!. It’s a proven fact that even mild to moderate activity, like walking, causes your body’s cells to be more receptive to insulin, which is the key to the door that lets glucose into your cells. And not only that, it’s also proven that the effect can last for hours after you exercise. Anyone who takes insulin and is very active probably knows this well, having experienced low blood sugars many hours after exercising.

So, get up out of your chair and move! Again, it doesn’t have to leave you panting and dripping sweat; even just a 10-minute walk around the neighborhood is better than sitting in a chair

What if I can’t exercise? If you’ve got problem with your feet and can’t walk, or have other physical limitations, this is a great time to talk to your healthcare team about what you can do. There are many options, such as chair exercises, resistance bands, or light weights.

I do best when I have a plan. Goal setting is vital not only for motivation, but giving you something to aim for. Just saying, “Yeah, I’ll exercise,” won’t get you far.  I like to make a weekly schedule, with a goal of walking 10,000 steps every day. I split it up into two or three walks and put it on a white dry erase board. I put a check after each walk, and I now actually feel guilty if I don’t get all my checkmarks. Plus, it’s a great visual reminder to myself, and a great way to keep track of what I’m doing. Another way to stay accountable is to make a deal with someone else – pick up the phone and see if you can get someone to walk with you. Or if you have family around, get them in on it, too. Everyone needs to be active, especially now when it’s so tempting to just sit and watch TV. It’s also much more enjoyable to walk with someone else – it helps distract you and the time just flies.

It’s very important to check your blood sugar before and after exercising, particularly if you are taking insulin. If you’ve not been active before, you may be surprised by how much exercise can affect your blood sugar, so checking it is vital to avoid low blood sugar, or hypoglycemia. Make sure you have some source of glucose with you when you exercise, in case you start to feel like your blood sugar is low.

That leads me to the next topic: Monitoring. Monitoring – along with Reducing Risk and Problem Solving – will be covered in my next article. Click here to check out Part 2 of Coping with COVID-19!

This article is part of a series on time in range. 
 
The diaTribe Foundation, in concert with the Time in Range Coalition, is committed to helping people with diabetes and their caregivers understand time in range to maximize patients' health. Learn more about the Time in Range Coalition here. 

About Michael

Michael Hattori has been a Registered Nurse for 23 years (including 19 years in the Operating Room), and is currently training to become a Certified Diabetes Care and Education Specialist after being diagnosed with type 2 diabetes in 2019. He has since achieved remission, but still closely follows the AADE 7 Self Care Behaviors to keep on track. He is a huge fan and major advocate of continuous glucose monitoring (CGM) and attributes his remission in large part to CGM. 

Michael is an avid chef, photographer, musician, and fiber artist in his free time. 

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