A Message from the AADI / Asian Clinic Regarding COVID-19

Dear patients of the Joslin's Asian Clinic and friends of the AADI,

We hope that wherever you are, you and your loved ones are staying safe during this challenging time with the COVID-19 viral pandemic. As with many hospitals and service providers, we are taking extra measurements to ensure the safety of our patients, caregivers, and staff.

People with diabetes are severely affected by COVID-19, 30-40 % of hospitalized people with COVID-19 infection have diabetes. This increased risk is even higher if you have high blood pressure and are overweight, as reported both in China, Europe, and US. It is crucial for you to take extra efforts for diabetes management in order to avoid contracting the infection and for your body to fight the infection if you are exposed by doing the following:

Follow the recommendations for safe practices strictly: Stay away from others by 6 ft or 1.5 meters. Wash your hands frequently and wear masks when going outside.

Additionally, take care of your diabetes very very carefully:

  • Check your glucose at least 2 times a day
  • Take all your medications, eat anti-inflammatory foods such as vegetables, fish and avoid red meat
  • Exercise for 20-30 min each day. Make your heart rate go up and allow you to breathe deeply when you do the activities
  • Decrease stress by mediations and sleep at least 7-8 hours/day.
  • Contact us  if you have questions about your diabetes  care (see below for more information

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 is available under the National and Local resources section below.

Additional free educational resources and information relevant to diabetes management for Asian communities from AADI is available here: https://aadi.joslin.org/en/educational-materials

You can download and read the AADI Message in Simplified Chinese, Traditional Chinese, Japanese, Korean, and Vietnamese.

AADI/Asian Clinic FAQs on self-care

According to the 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 older
  • People 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 diabetes
    • People 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 a severe viral illness, however, to date data on COVID-19 has not shown an increased risk

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 frequently 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), 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.

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.

We are very sorry you are going through this tough time. The American Diabetes Association provides information on affordable medications, particularly insulin. The Association of Diabetes Care and Education Specialists provides additional cost-saving resources for non-insulin diabetes medications. If your insurance plan has changed and certain prescriptions are no longer covered, talk to your healthcare team to look for alternatives. For Joslin’s Asian Clinic patients, please contact the julia.li [at] joslin.harvard.edu (Asian Clinic Coordinator)target="_blank". You may also find help from your local food bank through Feeding AmericaAsian Community Development Corporation (ACDC) also has emergency funds to support families who are out of work due to this pandemic. 

CDC has identified those who have diabetes are at higher risk for severe illness from COVID-19. Here are a few things that you may do:

  • Keep your regular daily routine

    • It is very easy to change your daily routine as you are now mostly staying home. Try to wake up, eat, and sleep at the usual time. This will help you to follow your medication regimen and lifestyle easier, and better manage your glucose

    • Check glucose frequently and keep a record

      • With changes in lifestyle, your glucose may fluctuate, it is important to check your glucose more frequently. Check your glucose at least two times a day (one in the morning and one after dinner).  If you are on multiple daily insulin injections, check at least four times a day. This helps you to be more aware of your glucose level, and able to make adjustments to your lifestyle and/or medications sooner. If you see your glucose is consistently much higher or have low glucose frequently (<70 mg/dL), talk to your healthcare team. You may use this form to help you in recording your glucose and medication use. You may find more information on treating low glucose here.

    • Take all your medications as prescribed by your providers.
      • It is very important for you to manage your diabetes well during this time. Take the medications as you were told by your doctors.
    • Have diabetes medical supplies

      • Make sure to have supplies for medications, and glucose checking (at least 2-4 times per day) for a few weeks ahead. Ask your doctor to write a prescription for a 90-day supply if possible. If you have type 1 diabetes or use multiple daily insulin injections, also have supplies of ketone strips. Also, create or update the list of medications that you are currently taking. Here is a checklist of items you may want to keep at home.

    •  Protect yourself

      • Do what you can when running essential errands

      • Use soap and water to wash your hands for at least 20 seconds often.

      • Wear a mask when you must out and keep a 6 feet distance with others.

      • Stay at your home as much as possible and avoid visiting friends or family members.

      • You may find the latest suggestions on the CDC website helpful

Try to keep the same eating habit as much as possible. Continue the 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 over 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 vegetable 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 vegetable 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 rinse the vegetables underwater 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 underwater 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.

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 a 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!

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”

National and Local Resources

Resources from Asia

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)

Other Resources

Along with all the clinic services provided at Joslin, the Asian Clinic has shifted to a remote model of patient care with very limited in-person, “urgent care” appointments. If you need to reach Joslin's Asian Clinic for medication refills or questions regarding your blood sugar, please call 617-309-3444 and leave a message with your name and phone number or reach us via email Asian Clinic Coordinator: julia.li [at] joslin.harvard.edutarget="_blank"

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If you need to reach Joslin's Asian Clinic for medication refills or questions regarding your blood sugar, please call 617-309-3444 and leave a message with your name and phone number or reach us via email Asian Clinic Coordinator: julia.li [at] joslin.harvard.edutarget="_blank"