Managing Type-2 Diabetes During a Pandemic
The challenges of chronic illness management during the pandemic.
Posted Jun 08, 2020
The Coronavirus pandemic of 2020 has presented multiple challenges for maintaining one’s health and overall well-being. These challenges are compounded for older men and women who are also struggling to manage chronic conditions. Eighty percent of older adults have at least one chronic condition such as type 2 diabetes. There are more than 425 million type-2 diabetes casualties around the world, including over 35 million in the United States (Global Diabetes Research Center [GDRC], 2020).
One out of every four adults over the age of 65 is diagnosed with the disease; two out of four are pre-diabetic. The rates are even higher for those living in poverty (Center for Disease Control (CDC), 2020). Diabetes is the 7th leading cause of death in the US. While these numbers are shocking, the psychological, social, and economic consequences of diabetes are even more devastating, particularly during a pandemic.
Vulnerability to type-2 diabetes increases with age and weight gain. It results when sugar is not able to pass from the bloodstream into the cells of the body leading to numerous health concerns, sometimes with no symptoms, other times with symptoms such as frequent urination, tiredness, thirst, even unhealthy weight loss. When sugar or glucose is not able to enter cells, they are deprived of their basic fuel that gives one energy. Diabetes also has many associated problems including possible blindness, loss of a limb, heart disease, kidney failure, and death. It is a diagnosis that, on a psychological level, can lead to feelings of helplessness, anxiety, and depression. These feelings have risen for everyone during the Covid-19 pandemic, for those who are managing type-2 diabetes, the virus is even more frightening. The death rate for adults with type-2 diabetes who contract the Coronavirus is one in 10.
There are also multiple challenges associated with illness management during the pandemic. Diet and exercise are important in managing diabetes. Maintaining a healthy diet is difficult during isolation, procuring healthy foods, the potential desire for comfort food, much of which is highly caloric and often laden with carbohydrates, combined with the loneliness and isolation associated with quarantine can increase stress (Tahmaseb McConatha et al., 2019).
In addition to diet, for diabetic patients, one of the most important aspects of illness management is regular exercise. Exercise significantly impacts blood sugar levels. Blood tests can monitor blood sugar levels making certain that it stays below 6.5, which is the level of type-2 diabetes. Normal levels are below 5.7 and 5.7 to 6.4 indicate pre-diabetes (Cleveland Clinic, 2018). Exercise can also serve as a positive coping mechanism improving physical and psychological health and overall well-being. It can improve mood and help manage or reduce weight.
Being overweight is a risk factor associated with type-2. Weight gain tends to occur with age, sometimes even to the point of obesity. In the past 20 years obesity rates have risen from about 30 to 42 percent in the US (CDC, 2020b). One important way of combating weight gain is to exercise regularly, unfortunately, only about one-quarter of older Americans exercise the recommended 30 minutes, five times a week.
Pandemic isolation can further reduce exercise patterns for older women and men, particularly walking and bicycling. News articles appearing during the pandemic also frequently discuss age-related risks, at times alluding to “elder safety” as a reason for closures and the need for isolation. Such messages can lead to stigmatization of older women and men and increase age discrimination. Age discrimination—stereotyping, prejudice, and discrimination towards people based on age—is frequently experienced by older adults. It is the most universal form of discrimination because it can be experienced by anyone who lives long enough (WHO, 2020).
During the Coronavirus pandemic, age discrimination may increase given the increased vulnerability and poorer outcome of older adults and those with chronic conditions, especially marginalized elders. Being victimized by discrimination, including age discrimination, is also related to poorer overall self-reported health and increased anxiety and depression (Jackson, Hackett, & Steptoe, 2019).
The Coronavirus pandemic has become a social reality resulting in the need to isolate and distance to minimize the spread of this deadly virus. At the same time, the intersecting influences of age, illness, and marginalization also serve as a barrier to health promotion and illness management. For example, avoiding exercising in public due to a fear of being stigmatized. Regular exercise is central to health promotion and illness management for type-2.
Exercise also helps manage anxiety and makes people feel better about their bodies and their overall self-image. Exercise can reduce the discrepancy between one’s “ideal self” and “actual self” (Higgens, 1987). It prevents disease, decreases the risk of falling and injury, improves sleep, and enhances overall mood (Harvard Health Publishing). The results of epidemiological studies have indicated that proper diet combined with exercise is not only useful in preventing type-2 diabetes and improving disease status, but it is also effective in the prevention and treatment of many other chronic conditions.
During the pandemic, exercise can also help combat the stressors associated with isolation. It is one important factor shaping coping at this a vulnerable time. Life has changed significantly during the pandemic, for older adults the changes are also connected to increased vulnerability and fear that they may not live to see life return to “normal”. There are many small steps that can make this stressful time more manageable, and exercising, even for short periods, is one of those steps.
American Diabetes Association. (2020). How COVID-19 Impacts People with Diabetes. Retrieved from https://www.diabetes.org/coronavirus-covid-19/how-coronavirus-impacts-people-with-diabetes
Centers for Disease Control and Prevention [CDC]. (2020). Mortality in the United States, 2018. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db355.htm#section_2
Centers for Disease Control and Prevention [CDC]. (2020b). Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db360-h.pdf
Cleveland Clinic. (2018). Diabetes Mellitus: An Overview. Retrieved from https://my.clevelandclinic.org/health/diseases/7104-diabetes-mellitus-an-overview
Harvard Health Publishing. (2014). Exercise and aging: Can you walk away from father time? Retrieved from https://www.health.harvard.edu/staying-healthy/exercise-and-aging-can-you-walk-away-from-father-time
Higgins, E.T. (1987). Self-discrepancy: A theory relating self and affect. Psychological Review, 94, 319-340.
Jackson, S. E., Hackett, R. A., & Steptoe, A. (2019). Associations between age discrimination and health and wellbeing: cross-sectional and prospective analysis of the English Longitudinal Study of Ageing. Lancett Public Health, 4, 200-208 https://doi.org/10.1016/S2468-2667(19)30035-0
Tahmaseb McConatha, J., Kumar, V. K., Raymond, E., & Akwarandu, A. (2019). Cultural Dimensions of Diabetes Management: A Qualitative Study of Middle