Diabetes: ‘a ticking time bomb’ during the Covid-19 pandemic

Diabetes: ‘a ticking time bomb’ during the Covid-19 pandemicDiabetes. Credit: Flickr/ Dennis Skley

In this personal account, journalist Karyn Maughan explains how the Covid-19 outbreak “has powerfully illustrated how deadly the poor management of diabetes can be.”

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I was four and a half years old when I was diagnosed with Type One diabetes. At the time, my mother did not even know what diabetes was. She explained away my dramatic weight loss as the probable result of a growth spurt and my sudden bed-wetting as a consequence of my father being away from home on business trips. She thought I was missing him. 

But, when I started gulping down the sweet tea she made for me and my siblings in the mornings, my mother started to become concerned and talked to a friend about my symptoms. 

“You need to get Karyn to a doctor,” the friend said, “she may have diabetes.” 

When I was first diagnosed, my blood sugar level was at a truly frightening level of 36. Normal blood sugar levels for healthy non-diabetics sits around 5, so it was unsurprising that our family doctor insisted that I needed to be hospitalised. 

It was the beginning of a life that I am now very used to: blood sugar monitoring, careful eating, regular exercise, no drinking or smoking, and enduring injections three to five times a day. 

I have never hidden the fact that I am diabetic and am proud that, after years of trial and error, I am wellcontrolled and healthy. That was until 2020 and Covid-19. This global pandemic has, for the first time in my life, forced me to see my illness, not as an interesting biographical detail, but as a terrible vulnerability. I feel fragile, and that is hard. 

I am a journalist – I love going out into the world to tell stories and interview interesting human beings. But, even before lockdown formally started, I had to confront the fact that, at least for the next few months, that part of my life was over. My Type One diabetes is the consequence of a polyglandular autoimmune disorder. My endocrine system is compromised in a number of ways: I have been diagnosed with a thyroid condition, anemia and osteoporosis. I get sick easily, and I religiously get the flu shot and take multivitamins to protect myself from the prospect of serious illness. 

‘Just stay inside’ 

That does not always work. 

In 2019, I ended up in hospital after a cold turned into flu and then pneumonia. The memory of being unable to stop coughing and needing to keep an oxygen mask on my face so that I could breathe, haunts me. I feel like my diabetes, once an aspect of my life that I was happy to live with, is now a ticking time bomb that I have little to no control over.  

I am a privileged middle-class white woman with a medical aid, and access to help and advice whenever I need it. But the reality is that my diabetes still leaves me extraordinarily vulnerable to the worst outcomes associated with Covid-19 infection. The virus is unpredictable but has already shown terrible outcomes in patients with so-called “comorbidities”, which include diabetes. 

My younger sister Debble, who works in Cape Town as a state doctor, has encountered the vulnerability of diabetics in the course of her work treating seriously ill Covid-19 patients. She is a calm and rational person, but she has made it clear to me that I place myself at massive risk by leaving my flat and venturing out into public spaces. 

“Stay inside Karyn,” she tells me, “just stay inside.” 

I have, for the most part, listened to her. I am deeply fortunate to have a close network of friends who do their best to ensure that my contact with the outside world is minimal.  

Last year, my friend Kearabilwe Tlhabane started living with me because she stayed in Pretoria and was completing an internship in Johannesburg. When the lockdown was announced, I fully expected – and would have understood – if she had moved back to Pretoria to stay with her family.  

Instead, she told her mother that could not leave me on my own, and she stayed. She is militant in her constant sanitisation of the flat we share and does all our shopping, so that I never need to take the risks associated with going out into crowded public spaces. On the rare occasions that I do go out, I wear a mask and sanitise my hands constantly. 

I know that my levels of diabetic blood sugar control are pivotal to my chances of surviving Covid-19, should I become infected. I test my blood far more regularly than I would normally so – with the aim of keeping it within a safe and manageable range. 

Diabetes treatment unequal 

Tragically, for many diabetics being treated in state hospitals, access to testing machines and the strips needed to measure blood sugar is extremely limited. That means that Type One or Two diabetics without medical aid may have little to no ability to check their blood sugar and, as a result, cannot effectively regulate high or low blood sugar readings. 

That’s a terrifying thought for a diabetic like me, who has had first-hand experience of misreading the signs of low or high blood sugar and, before actually testing my blood, believing that I needed to take action, like eating sweets or taking insulin, that actually worsened my condition. 

Constant testing has been crucial to me reaching a place of effective control in the management of my own diabetes and I genuinely don’t know how diabetics, without access to the resources that I have, have any hope of ensuring that their sugar levels do not spiral out of control.  In the time of Covid-19, the ability to test and control your blood sugar is, literally, a matter of life and death. 

Diabetes is not an easy condition to manage. From my own experience, I know how important access to advice and help from healthcare workers is when I feel that I am not in control of my condition or fear that I am developing complications as a consequence of poor control. I can do that. But most of my fellow diabetics cannot. 

In an overburdened and under-resourced state health care system, diabetics seem not to be a particularly urgent priority – and may be perceived as being the sole cause of their own complications and mismanagement. 

Until that mentality changes, and the state system is willing and able to understand how pivotal testing and education is to the effective management of diabetes, this condition will continue to be a significant drain on healthcare resources.  

Covid-19 has powerfully illustrated how deadly the poor management of diabetes can be. But, while diabetics like me are able to mitigate that risk because of our access to private healthcare resources, the majority of South African diabetics have no real ability to protect themselves. 

They are deeply vulnerable – not just as a consequence of their condition, but also because of the stigma, ignorance and victim-blaming that surrounds having this condition. – Health-e News