Returning to ‘Normal’ with Diabetes
By Cheryl Alkon
By Cheryl Alkon
When can people with diabetes feel normal again following the COVID-19 crisis? When can we stop wearing masks, start seeing friends and family, and comfortably send kids to school?
When will things feel like normal again following the COVID-19 pandemic? Honestly, most healthcare experts have no idea.
While COVID-19 vaccinations are rolling out across the United States and the rest of the world, eligibility and availability vary — country to country, state to state, person to person — and for people with diabetes, vaccine rules can differ between type 1 and type 2 diabetes.
In early March, the CDC announced that people who have been fully vaccinated could gather indoors with other fully vaccinated people without the need for masks or social distancing, and could gather indoors with unvaccinated people from a single household who are considered at low-risk for getting severe COVID-19 without masks or distancing. Fully vaccinated people can also skip being tested for COVID-19 or quarantining if they have been exposed to the virus – unless they show any signs of illness.
However, those with diabetes may want to be a bit more cautious. “People with diabetes should not let their guard down just because they have received a vaccine,” said Dr. Scott Isaacs, medical director of Atlanta Endocrine Associations and spokesperson for the American Association of Clinical Endocrinologists. “COVID-19 vaccines are not 100 percent effective, and people with diabetes remain at higher risk for complications, compared to the general population. People with diabetes [along with everyone, until the CDC says otherwise] should continue to wear masks in public and use social distancing for the foreseeable future. Public health restrictions will be eased only when we achieve herd immunity.”
Melissa Young, a clinical pharmacy specialist and spokesperson for the Association of Diabetes Care & Education Specialists, agreed. “We are still learning how the vaccine will prevent transmission of COVID-19 and the new variants of the disease. So even when fully vaccinated, it is recommended to take the same preventative steps in public, around people who are unvaccinated from other households, or around those at increased risk of severe illness from COVID-19.” These precautions include wearing a well-fitting face mask, social distancing, washing your hands, and monitoring your health.
And those at increased risk include people with diabetes.
“Recommendations for returning to a ‘new normal’ are constantly changing, as more people are vaccinated and the government is monitoring new cases of COVID-19,” Young said. What healthcare experts do agree on is the importance of following established public health recommendations, even after receiving a COVID-19 vaccination.
When will people with diabetes feel safe in public?
Public health measures should continue this spring and beyond as they have for the past year, said Dr. Ruth Weinstock, Division Chief of Endocrinology, Diabetes and Metabolism at SUNY Upstate Medical University in Syracuse, New York, and a spokesperson for the American Diabetes Association. She warned, however, such measures could change depending on the emergence of COVID-19 variants, how effective current and future vaccines are against these variants, the possibility of future surges in infection rates, and geographic variability in infection and vaccine rates.
We encourage all people with diabetes to talk to their healthcare team about getting a vaccine. With guidelines constantly changing, you may be eligible for vaccination in your state – learn more about getting the vaccine here. If you’ve received a complete vaccination for COVID-19 – which requires two injections of the Moderna or Pfizer-BioNTech vaccines, or one injection of the Johnson & Johnson vaccine (currently the three COVID vaccines that have received emergency approval in the US) – you must wait two weeks after your final shot before you are considered fully vaccinated. This means continuing to follow public health measures to prevent contracting the virus or spreading it to others, during that two-week wait post-injection and beyond.
“My advice is to still wear well-fitting masks in public, to continue to wash hands regularly, to socialize outdoors, to maintain social distancing of at least six feet from others, and to avoid crowds and poorly-ventilated venues,” Weinstock said.
Young also recommended that people with diabetes avoid close contact with others, such as having close-range conversations, and skip unnecessary travel.
Those who have diabetes but haven’t yet been vaccinated should follow CDC guidelines for protection, including avoiding public spaces and contact with people from outside of your household, and getting a COVID vaccine as soon as it’s available to you. According to Isaacs, unvaccinated people with diabetes should stay home as much as possible this spring. Isaacs advised: “Think about what you are doing. Do you really need to go out in public? Why would you ignore the advice of public health officials? Talk to your doctor about getting a letter to allow telework and stay home as much as possible.”
And, as always, the usual advice about managing blood sugars applies. “Work with your diabetes care team to manage blood glucose,” Young said, adding that those “with unmanaged diabetes and those with complications and comorbidities fared less well with COVID.”
When can we stop wearing masks?
Face masks are here to stay for a while, at least until the pandemic is considered over and perhaps for some time afterwards, experts said. The CDC has urged people to wear well-fitting face masks throughout the pandemic, and as of early February, mandated wearing masks on all public transportation.
“Masks were put in place for public safety, and people cannot stop wearing them until local regulations and CDC guidance allow this to happen,” Young said.
When can I see friends and family?
If you’ve received the vaccine and are planning to see others, remember that unvaccinated people with diabetes are still at high risk for severe COVID-19 illness. Weinstock acknowledged the real mental and emotional toll from the year-long separation some people have had from seeing family and friends in person, but she said her medical experience supports her advice to stay vigilant.
“I tend to be cautious and conservative, because I have seen what COVID does to people with diabetes, and it breaks my heart,” she said. “We have a number of people with diabetes who developed COVID and could stay home and fully recover. But if you look at statistics, if you get COVID with diabetes, you have an increased risk of requiring mechanical ventilation and the need to be in the hospital. I’ve seen people die of COVID, and you have to respect the virus.”
Isaacs was more blunt about whether people with diabetes should see others, saying those encounters should wait “until the pandemic is over. It’s better to connect using Zoom or FaceTime” for now.
When can I comfortably send my kid to school?
While nearly every school in the United States shut down “live learning” in March 2020, full re-openings have varied across the country based on state regulations and changing rates of illness and virus transmission. As an increasing number of states mandate that schools fully reopen, how will parents with diabetes and parents of children with diabetes know whether it is safe for them to return?
“For schools, it will vary by geographic area,” Weinstein advised. The CDC ranks areas by COVID transmission over the prior seven days, using colors to indicate higher-risk and lower-risk zones to determine whether schools should open or close.
Parents can ask school leaders about what the school is doing to minimize the risk of transmitting the virus. Such efforts can include universal and correct use of masks, physical distancing, handwashing and respiratory etiquette, cleaning and maintaining healthy facilities, and contact tracing to isolate and quarantine infected people through the local health department, said Young.
The CDC also offers a checklist of questions that parents can ask themselves about whether they feel comfortable sending their children back to in-person school. To read more on deciding whether to send your kids back to school, read “Corona School Daze: Going Back to School (Or Not) with Diabetes.”
Ultimately, as COVID is an ever-changing situation, information about how to coexist with the virus continues to evolve.
“It’s important to stay up to date, as the recommendations will constantly change,” Weinstock said. “Look at the CDC’s website and contact your local health department to find out about local conditions. You can also always ask your healthcare professionals, because they are getting updates all the time.”
And finally, know that things may never feel exactly the same as they did before the COVID pandemic began.
“COVID-19 is likely to become an endemic disease, always part of our environment, and something we will always have to deal with in one way or another,” Young said. “Think of it like the annual influenza virus. But through vaccination and preventative measures, we can attain a new normal.”