After an insect bite on his back became infectious, a retired truck driver in rural Alabama waited six hours in a packed emergency room with his wife before getting a coronaviruses vaccine. The telltale symptoms of Covid-19 began to appear a few days later.
The virus barely slowed her down, but I ended up surrounded by nurses in hazmat suits. His recovery has left him dependent on a wheelchair.
Mr. Donner has diabetes, a chronic disease that ravages the body's ability to regulate blood sugar and wreaks havoc on circulation and other vital organs.
After older people and nursing home residents, perhaps no group has been harder hit by the Pandemic than people with diabetes. According to recent studies, 30 to 40 percent of all coronaviruses deaths in the United States have occurred among people with diabetes, a sobering figure that has been subsumed by other grim data from a public health disaster that is on track to claim a million American lives sometime this month.
People with diabetes are vulnerable to severe illness from Covid due to the fact that the disease impairs the immune system, and also due to the fact that people with the disease often struggle with high blood pressure, Obesity and other underlying medical conditions.
Giuseppina Imperatore, who oversees diabetes prevention and treatment at the Centers for Disease Control and Prevention, said it was hard to overstate how devastating the epidemic has been for Americans with diabetes.
Diabetes patients hospitalized with Covid spend more time in the I.C.U., are more likely to be intubated and are less likely to survive, according to several studies. Most agree that uncontrolled diabetes impairs the immune system and decreases a patient's ability to resist coronaviruses.
Most people with diabetes don't appear to be ill, which makes the disease invisible and ubiquitous. It affects 13 percent of all adults but is less well known than other major killers like cancer, Alzheimer and heart disease.
Even as the public's attention is focused on the swine flu, researchers, clinicians and other experts in the field are hoping the disproportionate suffering and death of people with diabetes will bring renewed attention to the disease.
Millions of Americans were already struggling with diabetes, and then Covid came along and cut a huge swath of suffering and misery that has been largely overlooked by the public and policymakers.
The burden of diabetes falls more heavily on Latino and Black Americans than it does on the rest of the population, and this is due to the fact that health care delivery has failed the poor. Some studies suggest that a coronaviruses can heighten the risk of developing type 2 diabetes, a disease that is largely preventable through a healthy diet and exercise. juvenile diabetes is a genetic disorder that tends to emerge early in life and is sometimes referred to as type 1 diabetes. type 2 is the most common type of diabetes in the United States.
A study published last month found that patients who recovered from Covid were 40 percent more likely to be diagnosed with type 2 diabetes within a year.
There has been a sharp rise in the number of young people being diagnosed with type 2 diabetes over the past two years.
According to the C.D.C., about 1.5 million Americans are diagnosed with diabetes each year.
Although the number of new diagnoses has begun to decline, the number of Americans with diabetes has doubled in the past two decades, an increase that is mirrored by the rise of Obesity.
Diabetes increases the risks of premature blindness, stroke, and circulatory and neurological problems that can lead to infections requiring amputation of gangrenous toes and feet. The poor and people of color are more likely to be diagnosed with diabetes. Black and Latino Americans are more likely to be diagnosed with diabetes than whites, and it can be difficult for them to juggle the complex diet, monitoring and treatment regimen that can save their lives. Many believe that a Covid diagnosis can be made worse by diabetes. Inflammation inside the body can be caused by a sedentary lifestyle, putting on extra weight or failing to keep a close eye on blood sugar levels.
Inflammation causes the body to release small proteins that regulate its immune response. For people with diabetes and chronic inflammation, all those cytokines can damage healthy tissue. Covid can cause an uncontrollable release of cytokines, which can wreak havoc on vital organs like the lungs, leading to dire outcomes and death.
People with type 2 diabetes fare worse than those with type 1 in part because they are younger.
The adoption of technology that enables remote management of the disease has already had some positive effects on diabetes care. It is now possible for health care providers to spot a worrisome foot wound on a homebound patient thanks to the increased embrace of Telemedicine.
Hospitals and long-term care facilities were given permission by the Food and Drug Administration to distribute continuous glucose monitoring devices to coronaviruses patients as a way of reducing the risks to health care workers. Clinicians have learned how to care for hospitalized diabetics with Covid through more intensive monitoring and management of blood sugar levels.
Many advances have been distributed differently. Black and Hispanic patients are less likely to receive new technologies and treatments when they are uninsured, because doctors are less likely to offer them when they are covered by insurance.
The advances of recent years have been stunning, but not everyone has access to them, said Dr. Ruth S. Weinstock, a board member of the American Diabetes Association.
The poor have been hit harder by the soaring cost of insulin, an essential medicine for diabetes management. A study found that one in four people with diabetes rationed theirinsulin use, which can have dire health consequences. The House voted to cap the price of the drug at $35 a month. The Senate has yet to consider the measure.
Betty Angeles sees the challenges of managing diabetes for the farmhands, busboys and other low- wage laborers in and around Santa Barbara, Calif. Ms. Angeles is a house cleaner, a pastry chef and a community health worker at Sansum Diabetes Research Institute, where she helps Spanish-speaking clients navigate the complexity of diabetes treatment.
Ms. Angeles, who has managed her own diabetes for nearly three decades, said that it is difficult to see a doctor when you are uninsured and working two or three jobs.
Sansum makes it easier for patients to stay healthy. It means regularly testing their blood sugar levels, jogging in place for 15 minutes between jobs, and teaching them to prepare meals that favor fresh produce over bread, rice and tortillas.
Ms. Angeles and other outreach workers with community roots are the key to the success of the institute's type 2 diabetes program. She believes that the especialistas, as they are known in Spanish, deserve some credit for the fact that none of Sansum's 400 clients have died of Covid.
Building trusted relationships and creating culturally relevant information has real-world implications.
Well-funded public education campaigns are needed to drive home the importance of exercise and healthy eating, as are seismic changes to a food system geared to cheap, processed food.
State and local governments can make a difference through programs that subsidize fresh produce for low-income workers and measures to lure supermarkets to so-called food deserts, according to researchers.
Instead of telling poor people they are lazy for not being physically active, why not make their neighborhoods safer so they can go outside and exercise?
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