In the midst of coronavirus pandemic, experts advise people suffering from diabetes on preparing for what is to come: prescription refills, sick day kits, and general precautions.
So while there’s no cure, quick fix, or guaranteed way to prevent yourself from getting coronavirus, there are steps you can take to ensure your immune system is in peak condition.
Melissa Young, Pharm.D., board-certified in advanced diabetes management, and a CDCES (certified diabetes care and education specialist, formerly called CDE, or certified diabetes educator), also urges self-education and preparation. “We want everyone to be prepared, but to ask for help if they need it,” she said. “There may be a point where we are asked to stay home, so we need to do our best to follow the guidelines but to seek medical care if needed.”
In general, she says, “Definitely make sure your medications are refilled. This is not the time to get behind on medications.” This includes any oral drugs you take to manage blood sugar, insulin, and any related supplies such as syringes or pens, insulin pump supplies, pen needles, glucose strips, lancets, alcohol swabs, ketone strips, glucagon and whatever else you use to manage your diabetes.
With all the uncertainty of this pandemic, new information is coming out about prescription refill allowances:
- Regence BlueCross BlueShield announced that they are easing refill restrictions for non-opioid medications, allowing 90-day prescription refills in Washington, Utah, and Oregon.
- A Florida state statute allows people who live in counties experiencing a declared state of emergency to get an early refill of chronic medications for up to a 30-day supply.
What is the risk of severe COVID-19 infection for people with well-managed diabetes?
Young couldn’t say. “Preliminary data show that the elderly and those with baseline chronic conditions, such as diabetes, heart disease, and lung disease, appear to be at higher risk for experiencing severe illness with this virus. [High blood glucose levels challenge] the immune system, leaving the body vulnerable to severe outcomes with infections. Working with your diabetes care team to manage blood sugars would help the immune system to function properly and increase overall wellness. In addition, keep a careful eye on your blood sugar if you are sick; illness can cause blood sugars to spike, leading to severe complications that further weaken the body’s ability to fight the virus.”
She also urged people with diabetes to continue taking not just their diabetes medications, but related prescribed drugs such as those for lowering cholesterol and blood pressure levels, too. “The more chronic conditions you have, the more you are at a higher risk.” Keeping health conditions managed is vital for good health.
What you should do right now to prepare?
To be prepared, have a fully stocked sick-day kit at the ready. It should include the following:
- The name and phone number of your doctors, including a primary care physician and anyone on your diabetes care team, such as an endocrinologist or diabetes educator.
- A list of your active medications and doses, including supplements and vitamins.
- A card or piece of colored poster board that states you have diabetes, to keep in your wallet; a bracelet, necklace or other wearable tags that indicates you have diabetes.
- A source of simple carbohydrates to treat lows, kept separate from other food in the house. “Everyone thinks this is so simple, but what if someone else in the house drinks the soda from the refrigerator or eats the LifeSavers,” said Young. Keeping them separate ensures they will be available to you if needed.
- Alcohol swabs, extra hand sanitizer, ketone strips, glucagon.
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What can you do when the pharmacies won’t be an option?
Diabetes is a serious disease that can often be managed through physical activity, diet, use of insulin and oral medications to lower blood sugar levels. People with diabetes are at increased risk of additional serious health complications including vision loss, heart disease, stroke, kidney failure, amputation of toes, feet or legs, and premature death. As many as 2 out of 5 Americans are expected to develop type 2 diabetes in their lifetime.
According to The National Diabetes Statistics Report, 2017 analyzes health data through 2015, 30.3 million Americans, or 9.4% of the population, had diabetes. Approximately 1.25 million American children and adults have type 1 diabetes.
84.1 million Americans age 18 and older had prediabetes (a condition in which blood glucose levels are higher than normal but are not high enough for a diagnosis of diabetes. People with prediabetes are at increased risk for developing type 2 diabetes and for heart disease and stroke. Other names for pre-diabetes are impaired glucose tolerance and impaired fasting glucose.)
1.5 million Americans are diagnosed with diabetes every year and even with all the technologies, and treatments available, diabetes remains the 7th leading cause of death in the United States with 79,535 death certificates listing it as the underlying cause of death, and a total of 252,806 death certificates listing diabetes as an underlying or contributing cause of death.
What will people with diabetes do when the hospital and pharmacies won’t be an option anymore? When the SHTF, and it will, there will be enough things to worry about other than staying healthy.
A quick trip to your local physician and you are back on track. So how should we prepare for when times are not so good and there is no doctor or emergency room? It is very important to understand that knowing what to do when medical care is needed may not only diminish the pain the injured party suffers—but make the difference between life and death.
What herbal therapies are available for diabetes and pre-diabetes?
Blood glucose and blood sugar are interchangeable terms, and both are crucial to the health of the body; especially for people with diabetes.
Most diabetics will be familiar with the terms blood glucose, blood glucose test, blood glucose level and blood glucose meter, but what does blood glucose really mean? Why do blood sugar levels need to be controlled?
Blood sugar levels are literally the amount of glucose in the blood, sometimes called the serum glucose level. Usually, this amount is expressed as millimoles per liter (mmol/l) and stays stable amongst people without diabetes at around 4-8mmol/L.
Spikes in blood sugar will occur following meals, and levels will usually be at their lowest in the early mornings. When it comes to people with diabetes, blood sugar fluctuates more widely.
Many common herbs and spices are claimed to have a blood sugar lowering properties that make them useful for people with or at high risk of type 2 diabetes.
A number of clinical studies have been carried out in recent years that show potential links between herbal therapies and improved blood glucose control, which has led to an increase in people with diabetes using these more ‘natural’ ingredients to help manage their condition.
Plant-based therapies that have been shown in some studies to have anti-diabetic properties include:
Aloe Vera and Diabetes
Aloe vera is a product of the prickly but succulent aloe vera plant, which has been used in herbal medicine for thousands of years due to its healing, rejuvenating and soothing properties.
Native to the Caribbean, South Africa, and Latin America, the plant’s leaves contain a clear gel that is widely used in:
A bitter liquid is known as aloe latex, which can be derived from the skin of the leaves, is used in juice drinks, tablets, capsules and dental care items such as toothpaste and mouthwash.
Preliminary research suggests that intake of aloe vera juice can help improve blood glucose levels and may, therefore, be useful in treating people with diabetes. 
Aloe has also been linked with:
- Decreased blood lipids (fats) in patients with abnormally high levels of these molecules in the blood (e.g. some people with type 2 diabetes) and/or acute hepatitis (liver disease)
- Decreased swelling and faster healing of wound injuries. Leg wounds and ulcers are common complications of diabetes, and they typically take a longer time to heal than in healthy non-diabetic individuals.
These positive effects are thought to be due to the presence of compounds such as lectins, mannans, and anthraquinones.
What other health benefits does it have?
As well as being mainly used to help soothe and heal skin problems and irritations, aloe vera also:
- Supports digestive system health
- Helps treat constipation
- Helps the healing process in regards to both pain and inflammation
- Prevents scars after surgery
- Aids dental health
In addition, preliminary studies suggest that oral aloe vera gel may reduce symptoms and inflammation in patients with ulcerative colitis, which is a form of inflammatory bowel disease.
Bilberries (scientific name: Vaccinium myrtillus) are a dark blue fruit, similar in appearance to blueberries but are smaller, softer and darker.
Research studies indicate that a compound in bilberries, anthocyanosides, appears to promote blood vessel strength which could have protective properties against forms of retinal damage in people with diabetes.
What are anthocyanosides?
Anthocyanosides are a part of a class of nutrients called flavonoids that are found in a number of fruits and other plants.
Anthocyanosides are found abundantly in a number of purples, blue and red berries and also in purple colored vegetables.
Bilberry extract is not recognized as a treatment for diabetes but people with diabetes may notice that it helps in lowering blood glucose levels.
If you are on blood glucose-lowering medication that can bring on hypoglycemia, you may need to monitor your blood glucose levels and take precautions to ensure blood sugar levels don’t go too low.
What are the benefits of bilberry extract?
The following benefits have been observed from research studies into bilberries, bilberry extract or anthocyanosides:
- Strengthens blood vessels
- Improves circulation
- Treats diarrhea
- Prevent cell damage
- Could help in treating retinopathy
- May help lower blood glucose levels
Bilberry extract and retinopathy
Retinopathy and maculopathy are both conditions of the retina in the eye that are more likely to develop in people with diabetes.
Research has shown that people with retinopathy that took bilberry extract during the study showed signs of strengthening of blood vessels in the retina and reduced hemorrhaging.
The research that has been carried out to date has been small scale and so whilst bilberry extract shows promise, researchers are yet to find out how much bilberry extract may be of help in limiting the development of retinopathy.
Bitter Melon and Diabetes
Bitter melon, also known as bitter gourd or karela (in India), is a unique vegetable-fruit that can be used as food or medicine.
It is the edible part of the plant Momordica Charantia, which is a vine of the Cucurbitaceae family and is considered the most bitter among all fruits and vegetables.
The plant thrives in tropical and subtropical regions, including:
- South America
- parts of Africa
- the Caribbean
The bitter melon itself grows off the vine as a green, oblong-shaped fruit with a distinct warty exterior – through its size, texture and bitterness vary between the different regions in which it grows – and is rich in vital vitamins and minerals.
How does it affect diabetes?
In addition to being a food ingredient, bitter melon has also long been used as a herbal remedy for a range of ailments, including type 2 diabetes.
The fruit contains at least three active substances with anti-diabetic properties, including charantin, which has been confirmed to have a blood glucose-lowering effect, vicine and an insulin-like compound known as polypeptide-p.
These substances either work individually or together to help reduce blood sugar levels.
It is also known that bitter melon contains a lectin that reduces blood glucose concentrations by acting on peripheral tissues and suppressing appetite – similar to the effects of insulin in the brain.
This lectin is thought to be a major factor behind the hypoglycemic effect that develops after eating bitter melon.
A number of clinical studies have been conducted to evaluate the efficacy of bitter melon in the treatment of diabetes.
In January 2011, the results of a four-week clinical trial were published in the Journal of Ethnopharmacology, which showed that a 2,000 mg daily dose of bitter melon significantly reduced blood glucose levels among patients with type 2 diabetes, although the hypoglycemic effect was less than a 1,000 mg/day dose of metformin. 
Other older studies have also suggested an association between bitter melon intake and improved glycemic control, while a report published in the March 2008 issue of Chemistry and Biology found that bitter melon increased cellular uptake of glucose and improved glucose tolerance. 
However, research published in the Journal of Clinical Epidemiology in 2007 failed to show any benefits of bitter melon for poorly controlled type 2 diabetes, while another clinical review published two years later in the British Journal of Nutrition stated that more, better-designed and clinical trials are required to confirm the fruit’s role in diabetes treatment. 
What other health benefits does it have?
Bitter melon is used in traditional medicine for:
- Chronic cough
- Painful menstruation
- Skin conditions
It is also used to heal wounds, assist childbirth and, in parts of Africa and Asia, prevent or treat malaria and viral diseases such as measles and chickenpox.
In addition, researchers from Saint Louis University in the US say they have shown that an extract from bitter melon can kill breast cancer cells and prevent them from growing and spreading.
Cinnamon and Diabetes
Cinnamon is a sweet but pungent spice that is derived from the inner bark of the branches of wild cinnamon trees, which grow in tropical areas across Southeast Asia, South America and the Caribbean.
The use of cinnamon dates back thousands of years and was highly prized among many ancient civilizations.
Cinnamon, often used in cooking and baking, is increasingly being linked to improvements in the treatment of conditions such as diabetes mellitus.
Research has suggested that cinnamon can help to improve blood glucose levels and increase insulin sensitivity.
How does cinnamon affect diabetes?
Results from a clinical study published in the Diabetes Care journal in 2003 suggest that cassia cinnamon (cinnamon bark) improves blood glucose and cholesterol levels in people with type 2 diabetes, and may reduce risk factors associated with diabetes and cardiovascular disease. 
A daily intake of just 1, 3, or 6 grams was shown to reduce serum glucose, triglyceride, LDL or bad cholesterol and total cholesterol after 40 days among 60 middle-aged diabetics.
Another study reported in the July 2000 edition of Agricultural Research Magazine found that consuming just 1g of cinnamon per day can increase insulin sensitivity and help manage or reverse type 2 diabetes.
In addition, a more recent analysis published in 2007 in The American Journal of Clinical Nutrition showed that 6g of cinnamon slows stomach emptying and significantly reduces hyperglycemia after meals (postprandial blood glucose) without affecting satiety.
As a result of the scientific evidence available, many health experts claim that cinnamon contains properties that are beneficial for blood sugar regulation and treatment of type 2 diabetes.
However, bear in mind that like many natural compounds cinnamon is yet to be medically approved for prevention or treatment of any disease.
In addition to regulating blood glucose and lowering cholesterol, cinnamon has been shown to:
- Have an anti-clotting effect on the blood
- Relieve pain in arthritis sufferers
- Boost the body’s immune system
- Stop medication-resistant yeast infections
- Help in relieving indigestion
- Reduce the proliferation of leukemia and lymphoma cancer cells
- Preserve food by inhibiting bacterial growth and food spoilage
- Be a great source of vital nutrients, including calcium, fiber, manganese, and iron
The majority of these health benefits are associated with the use of true cinnamon (also known as Ceylon cinnamon) and not cassia bark cinnamon, which is the species involved in most diabetes research.
Fenugreek and Diabetes
Fenugreek is an aromatic plant that has many uses, both culinary – fenugreek is a key ingredient of curries and other Indian recipes – and medicinal.
The plant, which is widely grown in South Asia, North Africa and parts of the Mediterranean, has small round leaves and also produces long pods that contain distinctive bitter-tasting seeds.
The leaves are either sold as a vegetable (fresh leaves, sprouts, and microgreens) commonly known as methi or as an herb (dried leaves), while the seeds are used both whole and in powdered form as a spice.
As well as being a popular cooking ingredient, fenugreek has a number of health benefits and is used in both Ayurvedic and traditional Chinese medicine.
How does it affect diabetes?
Fenugreek seeds (Trigonella foenum graecum) are high in soluble fiber, which helps lower blood sugar by slowing down digestion and absorption of carbohydrates. This suggests they may be effective in treating people with diabetes.
Multiple studies have been carried out to investigate the potential anti-diabetic benefits of fenugreek.
Of these, several clinical trials showed that fenugreek seeds can improve most metabolic symptoms associated with both type 1 and type 2 diabetes in humans by lowering blood glucose levels and improving glucose tolerance.
In one study, researchers in India found that adding 100 grams of defatted fenugreek seed powder to the daily diet of patients with insulin-dependent (type 1) diabetes significantly reduced their fasting blood glucose levels, improved glucose tolerance and also lowered total cholesterol, LDL or ‘bad’ cholesterol and triglycerides.
In another controlled trial, incorporating 15 grams of powdered fenugreek seed into a meal eaten by people with type 2 diabetes reduced the rise in post-meal blood glucose, while a separate study found that taking 2.5 grams of fenugreek twice a day for three months lowered blood sugar levels in people with mild, but not severe, type 2 diabetes.
What other health benefits does it have?
Fenugreek seeds are a rich source of vitamins, minerals, and antioxidants, which help protect the body’s cells from damage caused by unstable molecules known as free radicals.
For centuries they have been (and are still) used by nursing mothers to help stimulate the production of breast milk during pregnancy and following childbirth. Due to their powerful antiviral properties, they are also commonly used as an herbal remedy for colds and sore throats.
In addition, researchers believe fenugreek seeds may be effective in the treatment of arthritis, high cholesterol, skin problems (wounds, rashes and boils), bronchitis, abscesses, hair loss, constipation, upset stomach, kidney ailments, heartburn, male impotence and other types of sexual dysfunction.
Ginger and Diabetes
Ginger is the thick knotted underground stem (rhizome) of the plant Zingiber officinale that has been used for centuries in Asian cuisine and medicine.
Native to Africa, India, China, Australia, and Jamaica, it is commonly used as a spice or flavoring agent in cooking, as an alternative ‘herbal’ treatment for various ailments such as nausea and indigestion, and for fragrance in soaps and cosmetics.
The ginger rhizome can be used fresh, dried and powdered, or as a juice or oil. It has a pungent and sharp aroma and adds a strong spicy flavor to the food and drink.
Effect on diabetes
A study published in the August 2012 edition of the natural product journal Planta Medica suggested that ginger may improve long-term blood sugar control for people with type 2 diabetes.
Researchers from the University of Sydney, Australia, found that extracts from Buderim Ginger (Australian grown ginger) rich in gingerols – the major active component of the ginger rhizome – can increase uptake of glucose into muscle cells without using insulin, and may, therefore, assist in the management of high blood sugar levels.
In the December 2009 issue of the European Journal of Pharmacology, researchers reported that two different ginger extracts, spissum, and an oily extract, interact with serotonin receptors to reveres their effect on insulin secretion.
Treatment with the extracts led to a 35 percent drop in blood glucose levels and a 10 percent increase in plasma insulin levels.
A study published in the August 2010 edition of Molecular Vision revealed that a small daily dose of ginger helped delay the onset and progression of cataracts – one of the sight-related complications of long-term diabetes – in diabetic rats.
It’s also worth noting that ginger has a very low glycemic index (GI). Low GI foods break down slowly to form glucose and therefore do not trigger a spike in blood sugar levels as high GI foods do.
Other health benefits
Ginger has been used as an herbal therapy in Chinese, Indian, and Arabic medicine for centuries to aid digestion, combat the common cold and relieve pain.
Its powerful anti-inflammatory substances, gingerols, make it an effective pain reliever and it is commonly used to reduce pain and swelling in patients with arthritis and those suffering from other inflammation and muscle complaints.
In fact, ginger is said to be just as effective as nonsteroidal anti-inflammatory drugs, but without the gastrointestinal side effects.
Other medical uses of ginger include treatment of:
- Menstrual pain
- Nausea and vomiting
- Upset stomach
- Upper respiratory tract infections (URTI)
Okra is fast gaining a reputation as a so-called ‘superfood’ for people with or at risk of diabetes or cancer.
Commonly referred to as ladyfingers, or by its biological names Abelmoschus esculentus and Hibiscus esculentus, okra is known to have a positive effect on blood sugar control, among many other health benefits.
What is Okra?
Okra is a tall-growing vegetable that traces its origin from ancient Ethiopia (Abyssinia) through to Eastern Mediterranean, India, the Americas, and the Caribbean.
Parts of the plant (immature okra pods) are widely used vegetables in tropical countries and are typically used for making soups, stews or as a fried/boiled vegetable.
These tender pods are very low in calories, providing just 30 calories per 100 g, and contain no saturated fats or cholesterol. They are also rich in nutrients, completely non-toxic, and have no adverse side effects.
How can it help treat diabetes?
Evidence of okra having anti-diabetic properties has increased in recent years, with multiple Vitro (laboratory) and Vivo (animal) studies confirming okra as a potent blood glucose-lowering (or anti-diabetic) food.
In one study, published 2011 in the Journal of Pharmacy & BioAllied Sciences, researchers in India found that diabetic mice fed dried and ground okra peels and seeds experienced a reduction in their blood glucose levels, while others showed a gradual decrease in blood glucose following regular feeding of okra extract for about ten days.
Outside of scientific research, many people with diabetes have reported decreasing blood sugar levels after soaking cut-up okra pieces in water overnight and then drinking the juice in the morning, while in Turkey roasted okra seeds have been used as a traditional diabetes medicine for generations.
What’s behind this effect?
The superior insoluble fiber contained in okra is believed to help stabilize blood glucose by slowing the rate at which sugar is absorbed from the intestinal tract.
Other health benefits
Because okra is a rich source of dietary fiber, important vitamins and minerals, and powerful antioxidants, the vegetable is known to be beneficial for health in a number of ways.
- Preventing and improving constipation
- Lowering cholesterol
- Reducing the risk of some forms of cancer, especially colorectal cancer
- Improving energy levels and improving symptoms of depression
- Helping to treat sore throat, irritable bowel, ulcers, and lung inflammation
Allium sativum is more commonly known as garlic and is thought to offer antioxidant properties and micro-circulatory effects. Although few studies have directly linked allium with insulin and blood glucose levels, results have been positive.
Allium has been used safely since ancient times as both food and medicine in human populations, but studies of its efficacy in the management of diabetes have yielded conflicting results.
This study has evaluated the potential hypoglycemic effects of garlic in type 2 diabetic patients. The study was conducted in diagnosed type 2 diabetic patients (n=60) with fasting blood sugar level above 126 mg/dl to evaluate the effects of adding garlic tablets with standard antidiabetic therapy on blood sugar.
Patients were divided randomly into 2 groups. Group 1 (n=30) was given tablet Garlic (KWAI) 300 mg thrice daily + Metformin 500 mg twice daily and Group 2 (n=30) was given Placebo+Metformin 500 mg twice daily respectively for 24 weeks. Serum lipids and fasting blood glucose were measured at weeks 0, 12 and week 24. Group1 showed a significant reduction in fasting blood sugar at week 24 with a percentage decrease of (-3.12 percent) (P = <0.005) as compared to group 2 (0.59 percent).
At the end of week 24, GR1 group also showed considerable decrease in mean total cholesterol (6.2 mg/dl, -2.82%, P=<0.005), LDL-C (-3 mg/dl, 2.18% P=<0.005), triglycerides (-5.2 mg/dl, 3.12%, P<0.005) while HDL cholesterol was significantly increased (2.36 mg/dl, 6.72%, P<0.005) as compared to GR2 group. A combination of garlic with typical antidiabetic remedy has shown to improve glycemic control in addition to antihyperlipidemic activity. Garlic may be a good addition to the management of patients with diabetes and hyperlipidemia.
Allium may cause a reduction in blood glucose, increase secretion and slow the degradation of insulin. Limited data is available, however, and further trials are needed.
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