 Hi guys, today I want to give you a quick update on coronavirus, COVID-19, diabetes, whatever you name it, and I want to tell you about not just the risk but how to manage diabetes during this time period. I get a lot of questions from my patients about like okay what am I gonna do, how bad is my risk, some people are really so scared they get stuck in the house and they cannot go anywhere, they cannot do anything. And what ends up happening is that their diabetes gets worse, their cholesterol gets worse, and then you know their risk is still there and it actually may increase the risk of having significant complications from diabetes. So I want to clarify a few topics based on the recent research that came out. In my initial videos I was talking about increased risk but we were not 100% sure what was the exact risk associated with diabetes and COVID-19. But today we have more data, more research, I'll talk about this. Now of course as you all know the risk of diabetes, I'm sorry, the risk of coronavirus death is higher in diabetics. Now how much it is based on the recent study in China and in the United States as well. So the 2.3% is the general population risk right now. Now the patients with diabetes overall has a risk of around 7.5% which appears to be three times higher risk of death from coronavirus pandemic. Now of course the 7.5% is a general number that pretty much includes everybody with diabetes. Now what we know about coronavirus is actually is much more riskier as you get older. So when they did studies actually, patients with diabetes age of above 40 versus age of patients with diabetes below 40, there is a significant differentiation in the risk. So that tells you that even if you have diabetes, if you are less than 40 years of age, your chances of or risk of death is not high or not even near compared to patients above age 40. Again when I say above age 40, your risk will dramatically increase every decade. So if you are 50 versus 60 versus 70 and then the worst case scenario is about age 80. So if you are about age 80 and you have diabetes and it's uncontrolled, then you are really, really looking at very high risk. So you may be as high as actually the risk of death from coronavirus even without significant comorbidities is around 14% for patients above age 80. Now if you multiply this by age, you know, the risk of age 80 plus the risk with diabetes, you are really, really going up there. So you may be risking more than 50%. If you are diabetic about age 50 and you're uncontrolled, then that is a really, really high risk factor. Now it is very difficult to say, you know, some people will ask me, hey, I'm 65, my avanzee is 8%. What is my risk? We don't have a tool or a calculator to say what your risk is because there are other things that actually increases your risk. So what are they? The more comorbidities, which means that the more chronic conditions you have, the higher risk you have. So you may have diabetes with, for example, chronic kidney disease, right? That puts you at significant risk. Now chronic kidney disease also is not just one thing, right? So there may be different stages. So if you are stage four or stage five chronic kidney disease, that is even much higher risk than a stage three kidney disease. Now you're going to, for example, look at your lab now and your lab values, your doctor may tell you you have stage three kidney disease, but that's certainly common in diabetics. Stage four and stage five, what really puts you at risk? So that's one. Another big risk with coronavirus guys is the heart disease. So if you have underlying coronary artery disease, that puts you at significant, significant risk. Because basically the primary mechanism of dying from coronavirus is hypercoagulable state, which means that increase in the risk of coagulation or clotting. So basically when you have coronavirus, your clotting factors go up significantly. Now as a result, if you already have a heart disease, which is like, you know, partially or almost fully clogged arteries, you are going to put yourself at significant risk of developing a heart attack, which kills most people in that situation. So chronic kidney disease is another state, again, that is hypercoagulable, which means that the chronic kidney disease increases your risk of clotting as well. Diabetes does the same thing. So if you have diabetes, you have chronic kidney disease and you have heart disease, you are basically just very prone to getting this clotting in your arteries and veins. It can occasionally lead to pulmonary embolism, or it can lead to heart attacks or stroke, which is detrimental in patients with coronavirus. Now, of course, you want to talk about what medications you should be on during this time and what you should not be on. That's another important question, right? So the medication, so if you have coronavirus, I would definitely recommend you to stop metformin. Okay, so that is one of the things that you don't want to be on if you have coronavirus. If you don't have it, of course, don't stop it because your blood sugars may go high. So the reason for that is metformin, especially if you develop acute kidney failure, can put you in significant trouble due to the accumulation in your system. Another class is SGLT2 inhibitors. These are like your Jardins, your Farsiga, your Stiglato, your Invokana, because these medications tend to produce a ketogenic state. So a ketogenic state is not necessarily a great state when you are sick in the ICU because ketogenic means that your body is really destroying a lot of your fat, your protein, et cetera. So you want to be in anabolic state to recover from a sickness instead of a catabolic state or ketogenic state. And SGLT2 inhibitors can also increase your risk of kidney failure during an acute illness or dehydration. So overall, they are good medications. Don't get me wrong. They're good medications for diabetes for stable patients and outpatient setting. But when you're sick, you should not be on these metformin and SGLT2 inhibitors. Also, another common misconception is patients with diabetes get really scared, right? So they end up staying at home and what ends up happening is that their A1C goes up, their blood sugars go up, but it's also a well-known fact that if your blood sugar is going up, okay, that is going to really, really create an environment for coronavirus to grow. So a lot of patients, for example, have asymptomatic coronavirus. But if you have diabetes that is uncontrolled, that can push you into that symptomatic or even critically ill state, and that's something that you don't want to be in. So what's the solution? Now you guys, I want to make sure that you don't get stuck at home. You can put your mask on if you're going to a place. I don't recommend really going to the gym, but you can go out in your neighborhood. You can go take walks. I mean, if unless you're getting really close to people, you're not going to catch virus just on a fresh air, okay? So don't be so scared. Now you can get up early in the morning, if it is hot during the day in summertime, and get up in the morning, do your workout, because if you are physically inactive, everything is going to work less. And another problem is that patients avoid going to doctors. Now guys, I want you to make sure that you go to the doctor, but not necessarily physically. So if you have diabetes and you are shining away from diabetes, there's something called telemedicine or telehealth, right? So a lot of doctors nowadays do that. I do that in my practice regularly as well. It's very easy. There are a lot of platforms. Most of the time, doctors will just call you on your on your FaceTime or whatever the app you're using or they want you to use. But it's really not that complicated. If you are not very tech savvy, you can just ask a family member to help you a little bit. Once you do it once, then it's easy. Now also, when you are from a distance, it's hard to really share your information. So as a result, I have been using a lot of CGM. What is a CGM? CGM is continuous glucose monitoring system, which means that you have a device such as Freestyle Libre, Freestyle Libre, or which Freestyle Libre came with a new one, which is called Freestyle Libre 2. And then you have Dexcom out there and you have Guardian from whatever. So they're different brands out there. What they do is you can monitor your blood sugars even without a finger stick, especially with Libre and Dexcom. And you can share this data remotely with your doctor and you can or with your loved ones. So multiple people including your doctor can see your numbers remotely. So when you see your doctor on a telemedicine visit, once you give a code or your doctor gives you a code, there are easy ways to share. Once you share the data, then your doctor can see your numbers from hundreds of miles away. So it's really no excuse to not to go to the doctor because we have telemedicine pretty much covered by every insurance. And you can also get Libre or Dexcom. And most insurances nowadays cover them a lot easier because they know that that is nowadays needed because patients need to really monitor their blood sugars more often. They need to have a better diabetes control due to COVID-19 and they need to share the data with their doctor. And these continuous glucose monitoring systems are very reliable. I have done another video that I tested actually. I put myself into low blood sugar situation by giving 30 units of fast acting insulin to myself just to see if they're really working, if they will catch the low range. Because we know that these devices sometimes can be wrong and if your blood sugars are super high or super low, these are the points that you really want to make sure that you're correct. And I put myself in a low sugar range and Libre II was extremely accurate compared to Libre I. And Dexcom was also very accurate. So the point is really I enjoyed using it. It taught me a lot about my own diet, about what really is spiking your blood sugar and what's not. But they're great teachers because you can monitor your blood sugars all the time without having to deal with finger sticks. And there are also some other meters that are very practical that most people don't know. I made a video recently about the Dario, which is a meter that's very practical. So anything that makes your life easy, guys, really go for it. Now, the bottom line is this is coronavirus time. It's a pandemic. You have diabetes. Your risk is high. Yes. But don't freak out. Make sure you control your diabetes. Make sure you see your doctor. Make sure you monitor your diabetes. Make sure you take your medications. And make sure you do not get stuck at home. Still go out, do your exercise. And I think you will be okay. Yes, the risk can be anywhere from three to 10 times higher depending on your age. But don't let that take you down. And I think you will be great. We'll see you in the next video, guys.