Cedars-Sinai Blog

Diabetes-Related Risks During COVID-19

A family exercising in their living room during the COVID-19 pandemic.

Diabetes affects more than 34 million Americans, and around 7 million people don't even know they have it, according to the Centers for Disease Control and Prevention (CDC). An additional 88 million people have prediabetes.

Those figures have been steadily climbing for years—and are projected to continue to grow. The COVID-19 pandemic may create an even further burden, however, putting more people in danger or at risk of reversing hard-won progress. Obesity, often co-occurring and a key contributor to diabetes, is also on the rise. 

"When you're given lemons, you have to make lemonade—in this case, sugar-free lemonade. We just have to do the best we can. There are simple changes we can make during this time that are safe and effective."

The widespread prevalence of these conditions has come into sharper focus during the pandemic. People with either of these diagnoses are more susceptible to developing severe illness from COVID-19, including death. 

Scientists are still researching the link but believe the problem is tied to older age and a higher presence of preexisting health complications in diabetic patients—such as hypertension and cardiovascular disease. Studies also suggest that the way diabetes and obesity increase inflammation, deregulate the immune system and thicken blood puts these patients at greater risk of organ failure and other severe outcomes.

In Discoveries: Diabetes Disparity

Dr. Ruchi Mathur

Meanwhile, pandemic conditions are ripe for exacerbating related risks such as weight gain. Those most vulnerable, such as minorities and the socioeconomically disadvantaged, may end up stuck in situations that make it more challenging to maintain their health. 

"It's a bit of a Catch-22," says Dr. Ruchi Mathur, director of the Cedars-Sinai Diabetes Outpatient Treatment and Education Center

Stay-at-home orders and sustained uncertainty are fueling changes that can worsen health, she notes. These include poor sleep quality, unhealthy dietary choices, stress-related overeating, excessive snacking and decreased physical activity.

So how can you protect your health while staying safe at home? Dr. Mathur suggests simple lifestyle strategies.

"When you're given lemons, you have to make lemonade—in this case, sugar-free lemonade," she says. "We just have to do the best we can. There are simple changes we can make during this time that are safe and effective."

Headshot for Ruchi Mathur, MD

Ruchi Mathur, MD

IM Endocrinology

Ruchi Mathur, MD

IM Endocrinology
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Understand risks

Obesity, defined by the CDC as having a body mass index of 30 or higher, increases diabetes risk and can worsen outcomes of diabetes and COVID-19 for those already diagnosed.

Dr. Mathur suggests speaking with your primary care provider about your weight during your annual physical or if you begin experiencing unusual symptoms such as frequent urination or thirst.

People with prediabetes have higher-than-average blood sugar levels but not high enough to be diagnosed with Type 2 diabetes. Like obesity, prediabetes makes you more prone to developing diabetes. But the vast majority of people with prediabetes—84%—don't know they have it, according to the CDC.

Both conditions are manageable and can be reversed or stalled with the right health interventions. Being overweight, over the age of 45 or belonging to certain ethnic groups (including of Black and Latino descent) can also raise the risk.

Eat a balanced diet

Some people are starting to see their weight tick up during the pandemic. Roughly 22% of adults reported pandemic weight gain in a May 2020 study.

It's easy to snack more often or eat more unhealthy foods when there are fewer barriers between you and the fridge and you're bored, anxious or stressed and stuck at home. 

Dr. Mathur recommends purchasing groceries on a weekly basis if at all possible so you have a balanced variety of fresh, health-conscious, low-fat and low-sodium foods always on hand. If you don't have an unhealthy snack available, you won't eat it.

She suggests limiting portion sizes, reducing fat content and carbohydrate content (especially important for diabetics), and opting for fresh food (even frozen vegetables and fruits) over cans whenever possible. Curbing the amount of preservatives, additives and salt in your diet is also recommended for everyone.

Follow your physical hunger cues to make sure you're not snacking out of boredom or as an emotional coping mechanism, she adds. For example, if you get a craving, you might try to occupy yourself, then come back to that sensation in 10-15 minutes. If it's hunger, it will still be there and you can act on it.

Keep moving

Inactive lifestyles are another concern, with so many people working from home and limiting time with people outside of their household, and indoor gyms and other recreational activities closed or altered. But it's dangerous for people trying to watch their weight and stave off diabetes—sedentary behavior is associated with a 112% greater risk of Type 2 diabetes, according to the National Institutes of Health

To combat this, Dr. Mathur suggests getting outside and moving your body as much as possible. The only caveat: Remember that if you are exercising outdoors, you should still wear a mask to protect yourself and others from COVID-19. Sometimes that can restrict exercise tolerance, so tailor your plan accordingly while wearing a mask.

If your circumstances limit your ability to go outside, there's a range of healthy fitness options you can do from your own home—from fitness apps to exercising virtually with friends on video calls. Those with physical disabilities and the elderly can find low-impact and seated options online such as chair exercises. 

"It takes a little bit of ingenuity, but it can be done," Dr. Mathur says.

When you are indoors, make sure you aren't just sitting down all day. Set a timer and take a break every 30-60 minutes to get up, walk around and stretch, she suggests. You can use the break to do household chores such as making your bed or doing the dishes. Standing desks might also help.

Practice sleep hygiene

While days and nights can blur together during quarantines, getting a consistent 8 hours of sleep every night is proven to benefit both the body and the brain. 

Dr. Mathur notes that an uptick in screen time during COVID-19 might be partly to blame for inadequate sleep. She suggests turning off your screen at least an hour, if not two, before bed and sticking to a relaxing or meditative bed routine to unwind.

Stress is a root cause of many of these challenges, Dr. Mathur adds. If it persists, it might be worthwhile to pursue a counselor or therapist to guide you.

Quit smoking

The CDC reports that smokers are 30-40% more likely than nonsmokers to develop Type 2 diabetes, with risk increasing depending on the amount of cigarettes you smoke. Smoking also puts diabetics at risk of losing control of disease management. 

On the flip side, quitting smoking for good can go a long way toward improving your health.

While the risks are real, diabetes doesn't have to be a cause for fear. You can stay on top of your health just by getting proactive.