As a nurse, Julia Schulman already is at higher risk for contracting the coronavirus. As a nurse with diabetes, she has a greater chance of getting severely ill or dying from the disease.
"I’ve been very nervous throughout the entire time" of the pandemic, said Schulman, who works with diabetes patients as a nurse manager at Northwell Physician Partners Endocrinology at Great Neck.
Diabetes is the second most common underlying medical condition for New Yorkers who have died of COVID-19, and the most common for those under 40, according to New York State Department of Health data.
Experts say people with diabetes are especially susceptible to severe COVID-19, largely because the coronavirus can cause dangerous inflammation of the blood vessels. Most people with diabetes already have inflammation, creating a potentially deadly combination.
Schulman said many of her diabetes patients are frightened about their increased vulnerability to the virus, so part of her job is to reassure them and help them reduce their risk.
Of the 34,407 New Yorkers who had died of COVID-19 as of Monday, more than 91% had one or more underlying medical conditions, according to the health department. More than 37% of those with an underlying condition had diabetes, and nearly 12% had kidney disease, which often is caused by diabetes. Some people had multiple underlying conditions.
The only underlying condition more common than diabetes was hypertension, or high blood pressure, which 58% of those who died of COVID-19 had. About two-thirds of people with diabetes also have hypertension or take medicine to lower their blood pressure, according to the American Diabetes Association.
Gov. Andrew M. Cuomo said Jan. 12 that immunocompromised people would be next to be eligible for vaccines but has not said when they will be added.
The health department did not directly respond to questions about the timetable, instead sending a statement from senior Cuomo adviser Rich Azzopardi that blamed the federal government for recommending people with underlying conditions be made eligible for vaccinations without supplying enough vaccines.
Cuomo said the state is studying which medical conditions would qualify for the list.
A Centers for Disease Control and Prevention list of those with underlying medical conditions that put them at higher risk for severe COVID-19 includes Type 2 diabetes. Type 1 diabetes is listed with hypertension, asthma and other conditions that "might" put people at higher risk for severe COVID-19. The CDC said there is insufficient data to be sure.
As a health care worker, Schulman, who has Type 1 diabetes, qualified for a vaccine, and she got her first of two shots nearly three weeks ago.
"I think it will give me some peace of mind for sure," she said.
As many as 95% of adults with diabetes have Type 2, which means the body doesn’t make insulin or use it well, according to the National Institute of Diabetes and Digestive and Kidney Diseases. The bodies of those with Type 1 diabetes do not make insulin and need insulin shots to survive.
The body breaks down certain foods into blood sugar, and insulin is needed to transfer that sugar into cells, where they’re converted into energy. In people with diabetes, too much of that sugar remains in the blood.
The frequent spikes and drops in blood sugar that many people with diabetes experience lead to inflammation, said Dr. Joshua Miller, medical director of diabetes care at Stony Brook Medicine and assistant dean at the Renaissance School of Medicine at Stony Brook University.
"Their blood vessels and organs have suffered years and years of damage from that increased burden of inflammation," said Miller, who has Type 1 diabetes. "So when you take someone with long-standing diabetes, with uncontrolled diabetes, with blood sugars that are very high … and you put on top of that person a deadly virus that in and of itself causes marked inflammation, it’s a recipe for disaster."
Miller said people who have had diabetes for longer, and those whose diabetes is less controlled, likely are at higher risk for severe COVID-19 than younger people with controlled diabetes.
In addition to endangering the lives of people with diabetes, COVID-19 also appears to help cause diabetes. Miller said he has seen people who had no history of diabetes, or who had prediabetes, enter the hospital "and their blood sugar goes through the roof because of COVID. There’s something about the virus that renders them unable to make enough insulin."
They then leave the hospital with a diabetes diagnosis that they did not have when they arrived, he said.
Some people with diabetes will need dialysis, typically three to four hours, three times a week, said Dr. Susana Hong, a nephrologist with North Shore University Hospital in Manhasset.
Dialysis centers have instituted precautions such as mandatory mask-wearing, a prohibition on eating to keep masks on, and health screenings and temperature checks before each visit, she said.
Schulman said she has stressed to her patients the critical importance of general COVID-19 precautions, as well as measures to control their diabetes.
"I tell them during this period it’s more important than ever to keep blood sugars tightly controlled, that we make sure they’re following their regimens and keeping in touch with us if their blood sugars are elevated, so we can do something about it," she said.
People with disease are at higher risk for severe or fatal cases of COVID-19.
Number of New Yorkers who died of COVID-19: 34,407
Percent of those who died of COVID-19 who had at least one underlying condition: 91.2%
Percent of those who died of COVID-19 with an underlying condition who had diabetes: 37.3%
Number of Americans with diabetes: More than 34 million
SOURCES: New York State Department of Health, Centers for Disease Control and Prevention