The rollout of COVID-19 vaccines in the United States has been, so far, slow and sometimes chaotic. Only a fraction of the available doses have actually been given, and some states and healthcare providers have disregarded guidance from the U.S. Centers for Disease Control and Prevention (CDC) about high-priority groups that should be vaccinated first.
So it’s understandable that many people with diabetes may be confused about when they’ll be able to get vaccinated, or whether they could even make getting the vaccine a priority. To help answer these potential questions, we spoke to two doctors — a virologist and an endocrinologist — about what people with diabetes should know about the COVID-19 vaccines.
Right now, the CDC officially lists people with type 2 diabetes — but not type 1 — as being at high risk for severe illness if they get COVID-19, stating that people with type 1 “might be” at higher risk. But the situation is actually more nuanced than this, says Irl B. Hirsch, MD, an endocrinologist at the UW Diabetes Institute in Seattle.
“Where it appears we are right now with type 1 diabetes is, it does not appear to be an independent risk factor for an increased risk of mortality,” says Hirsch. “But what we do know about type 1 diabetes is that we’re seeing this tremendous increased risk of diabetic ketoacidosis, and that in itself has mortality associated with it.”
Even if it doesn’t lead to a statistically significant increase in deaths, diabetic ketoacidosis — in which a lack of adequate insulin forces your body to break down stored fat for fuel, releasing dangerous byproducts called ketones into your blood — is a medical crisis that requires urgent treatment, and often hospitalization. COVID-19 is now a major cause of ketoacidosis in people with type 1, according to Hirsch.
“We see patients who need 20 to 25 units of IV insulin an hour while they’re in the ICU,” Hirsch notes, in people with type 1 who develop COVID-19 and are hospitalized for ketoacidosis. “When you have type 1 diabetes, especially if you’re at home, that population is not used to giving these very, very large insulin doses that they need. So they’re ending up in the hospital extremely sick.”
So even though the overall death risk from COVID-19 may not be as high for people with type 1 diabetes as it is for type 2, “You put all of this together, and it seems to me — and I’m not a public health expert — that people with either type 1 or type 2 diabetes should be vaccinated earlier in the queue,” says Hirsch. He adds that it would be very difficult to ask pharmacists or nurses administering vaccines to determine what type of diabetes someone has, since this isn’t even easy to determine when administering clinical trials that are specific to diabetes.
Overall, the available evidence shows that the two currently approved COVID-19 vaccines in the United States are remarkably safe and effective, with few serious reactions and about 95% efficacy, says Douglas S. Paauw, MD, a virologist at UW Medicine in Seattle.
“The thing that has led to concern for some people is the anaphylaxis that has been reported, but it’s still rare,” says Paauw. “The good news is that no one has died because of this vaccine. All those reactions have been treatable with epinephrine.” That’s in stark contrast, he adds, to the over 380,000 people who have died from COVID-19 in the United States so far.
But Paauw sees the ever-changing guidance on who should get vaccinated first as unnecessarily confusing, and wishes that doctors could have more discretion in prescribing the vaccine to people who are at high risk for poor outcomes if they get COVID-19, based on the doctor’s judgment. “We have so much trouble agreeing on any guidelines” in medicine, he laments. “I just hope that our patients at higher risk are given the vaccine, that we look at risk, not just age.”
As for people with diabetes who may be hesitant to get a COVID-19 vaccine, “These folks are not good at math,” says Paauw. “And we worry about not just deaths from COVID,” but also strokes, heart inflammation, and heart attacks. “These are the same issues affecting people with diabetes. Especially when you already have some risk, we want to protect you.”
Hirsch notes that just because you get sick after receiving a vaccine doesn’t mean the two events are related. One patient of a colleague developed a fever, chills, vomiting, diarrhea and shortness of breath within a day after getting their first-ever flu shot — symptoms that lasted for three to four days. “The patient comes back a month later and says, there’s no way I’m going to get a COVID shot after that bad reaction to the flu shot,” Hirsch recounts. The doctor ordered a blood test for COVID-19 antibodies, and found that the patient had actually developed COVID-19 right after getting a flu shot.
People with diabetes who are concerned about vaccine risks should remember that early versions of insulin weren’t purified and frequently caused severe reactions, says Hirsch — but that insulin was still considered a miraculous treatment, since if they didn’t receive it, children with diabetes would die. With any medical treatment or vaccine, “It’s risk versus benefit, and that’s the bottom line” people should consider, he urges.
Want to learn more about coronavirus and diabetes? Read “Coronavirus and Diabetes: A COVID-19 Update,” “Healthy Eating During Hard Times” and “COVID-19: Staying Safe at Work.”
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