Free Resources - COVID-19 Related Info for Asian people with Diabetes
The AADI/Asian Clinic has put together resources as well as created FAQs on self care and put together some resources that are relevant to Asian communities (patients, their caregivers, family, and community members). Information in different Asian languages are available under “3. National and Local resources”.
According to Centers for Disease and Prevention (CDC), those at high-risk for severe illness from Coronavirus Disease 2019 (COVID-19) are:
People aged 65 years and olderPeople who live in a nursing home or long-term care facility
- People of all ages with underlying medical conditions, particularly if not well controlled, including:
People with diabetesPeople with chronic lung disease or moderate to severe asthma
- People who have serious heart conditions
- People who are immunocompromised
- Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications
- People with obesity
- People with chronic kidney disease undergoing dialysis
- People with liver disease
- People who are pregnant should be monitored since they are known to be at risk with severe viral illness, however, to date data on COVID-19 has not shown increased risk
1. Information about Coronavirus Disease 2019 (COVID-19)
2. AADI/Asian Clinic FAQ on self care FAQs on self care, what to eat, how to stay active, stress management, sleep, etc.
3. National and local resources
4. Resources from Asia
5. Other resources
1. Information about Coronavirus Disease 2019 (COVID-19)
2. AADI/Asian Clinic FAQs on self care
- What should I do if I have flu-like symptoms?
- Do I need to stock up on my diabetes medications and supplies?
- I am experiencing financial difficulty due to this pandemic, and is struggling to pay for my medication and food, what should I do?
- I have diabetes, how should I take care of myself?
- What food shall I eat to help me stay healthy?
- How can I stay active while staying at home?
- I am feeling really worried, what should I do?
1. What should I do if I have flu-like symptoms?
Call your primary care doctor if you think you have been exposed to COVID-19, and develop symptoms such as fever, cough, or difficulty breathing. Stay at home except to get medical care. If you have developed any emergency warning signs, seek medical attention immediately. Emergency warning signs include trouble breathing, persistent pain or pressure in the chest, new confusion or inability to arouse, bluish lips or face. Please refer to the CDC page for the up-to-date guideline.
Illness may increase your glucose, even if you are not having much appetite. Check your glucose more frequent than usual.
If you have type 2 diabetes and on oral pills, GLP-1 agonist injection (such as Adlyxin, Bydureon, Byetta, Ozempic, Trulicity or Victoza): Check your glucose after you wake up, before you go to bed and at times when you feel you are having low or high glucose. Call your healthcare provider for medication adjustment if you see your glucose is consistently low (<70 mg/dL) or much higher than usual
If you are taking a pill, called SGLT2 inhibitor (Jardiance, Invokana, Farxiga, Steglatro), stop the pill if you are not able to drink enough fluids (dehydration) or feel stomach ache, call your healthcare provider without delay
If you have type 1 diabetes, or use multiple insulin injections each day: Check your glucose after you wake up, before each meal, and before you go to bed. Also check for your ketones. If your glucose is consistently low (<70 mg/dL), much higher than usual or have ketones, call your healthcare provider for treatment and for medication adjustment
If you need to be hospitalized for treatment, bring your medication, and/or medication list to the hospital and let your provider know. Follow the medication instructions from your doctor during your hospital stay; it may be different from what you usually take at home. Contact your diabetes care team as soon as possible after you are discharged to discuss the medication regimen at home. If you are a patient at Joslin, schedule for a visit within 1-2 weeks after your hospital discharge. An urgent visit can be made 1-4 days post-discharge.
2. Do I need to stock up on my diabetes medications and supplies?
Currently (as of 4/10/2020), there is no report of shortage for insulin or other diabetes medications and supplies. However, if possible, it is good to have the supplies a few weeks ahead. If you are sick and cannot refill your prescriptions, you will still have some medications ready to use. Here is a checklist of items you may want to keep at home.
4. I have diabetes, how should I take care of myself?
CDC has identified those who have diabetes are at higher risk for severe illness from COVID-19. Here are few things that you may do:
5. What food shall I eat to help me stay healthy during this pandemic?
Try to keep to the same eating habit as much as possible. Continue your healthy eating behavior that you have been doing. This presentation (Cantonese) on 5 Simple Steps to Healthy Eating for diabetes will be a good refresher.
Here are a few tips for eating healthy during the pandemic:
Try to cook more at home, as this will allow you to have more control on what to put into your recipes. Here are some recipes that you may try out.
Choose foods that help you to fight inflammation
Increase your vegetables intake (half of your meal should have vegetables!)
Have 2 servings of fruits each day. Berries and citrus fruits are good choices.
Eat nuts as your snacks which gives you healthy oil you need.
Eat fatty fish (tuna, salmon), seafood or tofu in place of meat (e.g. beef, pork, or lamb)
Include a non-starchy vegetable dish. Try to choose a variety of vegetables and include different colors of vegetables if possible - e.g. yellow onions, red onions, mushrooms, eggplant, yellow/orange/red bell peppers, carrots. Half of your meal should consist of vegetables.
Buy vegetables or fruits that can last longer, such as cabbage, broccoli, oranges.
If fresh vegetables choices are limited, try frozen vegetables. Frozen vegetables may be more nutritious than fresh produce, as they are picked at their peak ripeness and frozen to keep the nutrients. You may also try canned vegetables. Pour out the liquid and rinsing the vegetables under water will help to lower the salt content.
If you cannot get fresh fruits, unsweetened frozen fruits will be a good alternative. You may also try canned fruits that are soaked in fruit juice. Eat the fruits, and leave the juice in the can for cooking, such as making sauces or salad dressings.
If you are not able to buy fresh fish or other protein (e.g. chicken) below are some good alternatives:
Frozen unprocessed seafood or chicken, fish, scallops are among some of the available frozen and healthy meat options. This chart shows you how long can foods be kept safely in the fridge or freezer
Canned fish or chicken - the ones that are soaked in water with less salt are the best option. Pour out the liquid and rinsing the chicken or fish under water will help to further reduce the salt content.
Try making beans - they are high in protein and fiber, a very nutritious and inexpensive alternative.
Tofu - they are nutritious and inexpensive. If you cannot finish all of them at one time, put them in the freezer. Tofu can be kept in the freezer for a few months. Some brands carry shelf stable types as well.
If you are not able to find eggs, try using egg substitute. Egg substitute also has a longer shelf life than eggs.
These tips for eating out will also be helpful for you if you are ordering takeout or delivery.
6. How can I stay active while staying at home?
20-30 min per day of moderate exercise has anti-inflammatory effects, and if done regularly, would increase cardiorespiratory fitness, which tends to be lower in people with diabetes. The improvements in oxygen exchange, lung/heart function that occur with increased cardiorespiratory fitness could potentially reduce the need for hospitalization and ventilator use. Exercises that strengthen muscles used for breathing might also help.
- Stay active at home by doing these aerobic exercises:
- Walking from one end of your home to another end
- Walking up and down the stairs
- Jogging on the spot
- Jumping jacks
- Biking in the air - you can do this by sitting in a chair or lying down on a bed
- Swimming in the air - you can move your arms like you are swimming while sitting on a chair
- Indoor activities - this handout provides links to indoor exercise videos conducted in Cantonese
- Doing strength training to build your muscles is also very important. Here are some suggestions:
- Resistance bands are great for training your muscles. Create your own weights for training if you do not have a resistance band - fill a bottle with water, rice or beans
- Simply using your body weight for resistance training is also very good
- Check out Joslin’s AADI YouTube Channel to find examples of resistance training
You may find yourself having more screen-time or sitting more than usual. For every 30 minutes of sitting down, stand up and move around for 5 minutes. Breaking out the sedentary time period is important.
Here are some home activities that you may try to incorporate. Choose the activities that are higher in activity level for greater calorie-burning effect.
How to build physical activity into your life
Calories burned by 30 minute activities
After all the physical activities, do not forget to stretch!
7. I am feeling really worried, what should I do?
This is an unprecedented time, many people are feeling concerned. Here are some stress management tips that you may find helpful. Stay in touch with your family and friends through phone calls or video calls. Seek out professional help if needed.
Healthy lifestyles, such as eating healthy and staying active, are helpful in keeping your mood and coping with stressors due to COVID-19. If you are having difficulties falling asleep, here are a few tips:
- Stay with your usual sleeping schedule even though you are staying at home
- Sleep for 7-8 hours to help you feel better emotionally
- Avoid screen-time at least 30 minutes before your sleeping time
- Stay physically active during the day
- Limit to 30 minutes of nap during the day
- Avoid caffeine (coffee or tea) in the afternoon
- Set the room temperature to 60 to 67 degrees
- If you wake up in the middle of the night and not able to fall asleep right away, avoid looking at the clock. Try reading a book, listening to light soothing music, or taking a slow walk at home
- Avoid reaching out to your phone or TV - the light from the screen will keep you awake!
- Try meditation to help you to relax - you may want to try “The Best Meditation Apps of 2019”
3. National and Local Resources
4. Resources from Asia
China: http://www.chinacdc.cn/jkzt/crb/zl/szkb_11803/ (also available in English)
Hong Kong: https://www.coronavirus.gov.hk/eng/index.html (available in English, Chinese and other Asian languages
https://www.covid19india.org (available in English)
https://www.mohfw.gov.in (available in English and Hindi) - Ministry of Health and Family Welfare
http://ncov.mohw.go.kr/en/ (available in English, Korean, Chinese)
Kumamoto association of Diabetes Education and Care http://kumamotoadec.p2.weblife.me
Dr. Elizabeth Paz-Pacheco’s slides (4/1/2020): Dr Elizabeth Paz-Pacheco 4_1_2020 Coping with DM during the COVID crisis.pdf
https://www.gov.sg/features/covid-19 (available in English)
https://www.cdc.gov.tw/En (available in English, Chinese)
5. Other Resources
Drs. George C. K. Liu and Bing Lu’s article (3/19/2020): “Empower America's neighborhood doctors: the first line of defense against COVID”
CDC - Travels (including travel recommendations by country) https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html?_ga=2.229371676.1283241030.1586279651-2084401465.1586279651
CDC - Travels (FAQs): https://faq.coronavirus.gov/travel/
Coronavirus Resource Center John Hopkins University & Medicine - Frequently Asked Questions: https://coronavirus.jhu.edu/covid-19-basics/faq
Coronavirus (COVID-19) Guidance for Harvard Chan Community https://www.hsph.harvard.edu/coronavirus/
The Journal of Clinical Endocrinology & Metabolism, Volume 105, Issue 5, May 2020, dgaa148 - "Our Response to COVID-19 as Endocrinologists and Diabetologists" https://academic.oup.com/jcem/article/105/5/dgaa148/5814115
JDRF (Juvenile Diabetes Research Foundation) FAQ - Understanding the risk https://www.jdrf.org/blog/2020/03/24/answering-your-questions-coronavirus/
JDRF (Juvenile Diabetes Research Foundation) FAQ - Stress, Kids, and supply chain
Harvard T. H. Chan School of Public Health Forum - Coronavirus Pandemic Series https://theforum.sph.harvard.edu/series/covid-19/
Harvard T. H. Chan School of Public Health - Food safety, nutrition, and wellness during COVID-19: https://www.hsph.harvard.edu/nutritionsource/2020/03/25/food-safety-nutrition-and-wellness-during-covid-19/
Podcast (4/3/2020): Dr. Mary Montgomery, an infectious disease physician at Brigham and Women’s Hospital, talks with Dr. Navin Kumar about the current COVID-19 pandemic. The two focus their discussion on inpatient diagnosis and management, covering the disease’s variable presentation, optimal time to test via nasopharyngeal swab, and current treatment paradigm from initial hospitalization to ICU. Possible therapeutic candidates, such as remdesivir, hydroxychloroquine, and IL-6 inhibitors, are also discussed https://www.runthelistpodcast.com/covid-19
BBC News - “What are social distancing and self-isolation?” https://www.bbc.com/news/uk-51506729
The Federation of Chinese American and Chinese Canadian Medical Societie http://fcmsmd.org
Ka Hei Karen Lau, MS, RDN, LDN, CDCES - "COVID-19 Care Tips for Asians with Diabetes" (6/13/2020)