The world’s first drone delivery of insulin may be a useful model in response to the COVID-19 pandemic.

For people in rural, remote and isolated urban areas, using a drone to deliver much-needed insulin supplies is an option under consideration. A test flight in Ireland used a drone to deliver insulin as a response to people who were stranded without insulin during Hurricane Ophelia and the post-winter storm Emma when people were snowed in.

“Drone delivery has endless possibilities and can help us connect with our patient communities even in the most remote areas during sentinel events such as hurricanes, earthquakes, and pandemics, which have unfortunately become more common,” Spyridoula Maraka, MD, MS told Healio/Endo.

Though drone delivery has endless possibilities, there are also significant regulatory challenges with “aviation, medication dispensing, pharmaceutical dispensing, and cold chain protocols,” that had to be accounted for during this test run. Markara explains that through each phase of the mission, they had to have backup procedures in place.

Even with the obstacles for drone delivery of insulin or life-saving medications, this is an innovative and exciting prospect for people living in remote or isolated areas.

During the current pandemic, endocrinologists and care providers encourage people that use insulin to have enough stores at home for prolonged “Stay At Home” orders. As stated in our recent Question of the Week people with diabetes are not necessarily at increased risk for contracting COVID-19, but are at risk for experiencing worse outcomes and series complications from the virus (click here to review ADA’s Treatment & Care Factsheet). People living with diabetes may also experience a compromised immune system if blood glucose levels are running above target for a prolonged amount of time.

For these reasons, it is of utmost importance to have the necessary supplies and insulin one needs for optimal glucose levels during periods of crisis, like a pandemic.

To read more, click here and here for more valuable information regarding staying prepared in the pandemic with your insulin and diabetes supplies.

Written by Catherine Cullinane RN, CDCES, our resident Tech Thursday Content Writer

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Disaster Preparedness Leader, Maryanne Strobel, RN, MSN, CDCES, believes that Certified Diabetes Education and Care Specialists (CDCES) have a lot to offer even if they are not reporting for their usual job. She has compiled a list of ways to get involved in virtual volunteering for those who are wanting to volunteer their time and expertise to their communities.

As Maryanne explains, “I am hearing from some of CDCES’s that they have been furloughed and are at home due to ‘stay-at-home’ orders or low hospital census days. Some are working reduced hours providing virtual medical visits or telephone consultation.

As professionals, we can continue to contribute and make a difference! Due to our unique inter-professional skill set, we have a lot to offer. We are in this profession out of a genuine desire to care for people, it is not in our character to sit back and watch as this pandemic unfolds.”

Maryanne Strobel

Here is list of ways to get involved in Virtual Volunteering:

• Connect with your colleagues:
  • Get the word that virtual volunteering is now an option and organize with your professional community.
  • Appoint someone to coordinate with everyone within your group who can organize and plan group ideas.
  • Create a “think tank” with your professional community to brainstorm ideas on how to become a virtual volunteer and address the needs of those in your community both throughout and after the pandemic. The challenges our community will face after this pandemic is over is known as the “second-wave” of a disaster event, which Maryanne suggests that how we deal with that is just as important.
• Check out your local communities organizations:
  • The www.allforgood.org organization and ww.pointsoflight.org are two organizations that you can learn and model from. 
  • Continue to keep in touch with your local organizations throughout and after the pandemic.
• Set up an After-Action review team:
  • This is a way to take what you learn from this event and “become better prepared to meet any future challenges.”
  • Continue to keep in contact with your local volunteer organizations.  

For more ways to get involved and learn about virtual volunteering, you can email Maryanne at: [email protected] 

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Our March 31st Question of the week was a question about COVID-19, sick days and diabetes. Although 40% of respondents chose the correct answer, 60% did not. We thought that this was an important topic to discuss further, so we can pass on correct info to people living with diabetes.

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

JR is 27 with Type 1 diabetes and is very worried about getting COVID-19 since they work in a local grocery store.  They ask you what they should do if they get COVID-19?

Which of the following statements is accurate regarding sick day management with COVID-19?

Answer Choices:

1. Seek immediate medical attention if lips or face become bluish.
2. Report to the emergency room if the temperature is 101 degrees or greater.
3. Reduce insulin intake by 10-20% if experiencing diarrhea.
4. Use glucose fingersticks instead of continuous glucose monitoring (CGM) when febrile to improve accuracy.

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As shown above, the most common choice was option 1, the second most common answer was option 4, then option 2, and finally option 3.

Only 39% of participants chose the correct answer number 3, which means there is a learning opportunity!

Answer 1 is Correct! Seek immediate medical attention if lips or face become bluish. Bluish lips or face indicates hypoxia and signals urgent medical care is needed.

From ADA Sick Day Information. If develop emergency warning signs for COVID-19 get medical attention immediately.

In adults, emergency warning signs include:

• Difficulty breathing or shortness of breath
• Persistent pain or pressure in the chest
• New confusion or inability to arouse
• Bluish lips or face

Option 2 is incorrect. One-fifth of respondents chose ” Report to the emergency room if the temperature is 101 degrees or greater.” In the case of fever, the next step would to be to contact your provider to evaluate presence of cough, shortness of breath and other symptoms to determine if urgent care is required.

Option 3 is also incorrect. “Reduce insulin intake by 10-20% if experiencing diarrhea.” During periods of illness, inflammation leads to insulin resistance and hyperglycemia. Most people will need to increase insulin dose during illness, including GI distress.

Finally, Option 4 is incorrect. “Use glucose fingersticks instead of continuous glucose monitoring when febrile to improve accuracy.”
Fever by itself does not interfere with CGM accuracy. If a person is taking Tylenol, it can interfere with the accuracy certain CGMs. And, CGM use is not recommended in the Intensive Care setting. But, having a temperature by itself, does not interfere with CGM accuracy.

Here is a COVID and Sick Day Handout that you can share with your community. Thank you for helping us get the word out.

For more information on sick day management and when to seek medical care, please see this ADA Sick Day Information. 

We hope you appreciate this week’s rationale and keep studying hard! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

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“What do I do if I get sick or get COVID-19”?
This is a critical topic to discuss during our during telehealth visits or in-person meetings with people with diabetes. Infections, whether COVID-19 or the flu, can lead to a hyperglycemic crisis if not thoughtfully managed.

Sick Day Plans are crucial.

Free Sick Day and COVID-19 Handout

To help out, we have updated our Sick Day 2-Page handout, to include information of appropriate action in case of illness or COVID-19 infection.

Please feel free to print out or email this handout to colleagues and people living with diabetes.

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Virtual Diabetes Ed Specialist Program 2020

This virtual program includes:

10 two-hour live webinar courses (20 CEs) + enrollment in our Bonus Bundle (14.6 + CEs) from now through December 31st, 2020.

• Live Q & A Session with the instructor after each webinar
• Presentations by our team of experts
• Handouts and Resources for each session
• Post-test questions
• A sense of community
• If you can’t attend the live webinars, a recorded version will be posted later the same day for viewing
• Click here for more info on our Virtual Diabetes Ed Specialist Program

1. Seek immediate medical attention if lips or face become bluish
2. Report to the emergency room if temperature is 101 degrees or greater
3. Reduce insulin intake by 10-20% if experiencing diarrhea
4. Use glucose fingersticks instead of continuous glucose monitoring when febrile to improve accuracy.

Click here to test your knowledge!

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Dearest community,

I miss hanging out with you. But now is a time to be present with ourselves. This weekend, I considered finding my crochet hooks and making an afghan. I finished 2 books, made banana bread, mashed potatoes and put old books in a donate box. Our family has played dozens of games of Rook, even though our two teenage boys consistently outwit me and my husband.

I have found myself slowing down and observing more. I discovered two new birds nest during my daily walk. I paused to watch a curious quail poke its head into my succulents. I have delighted in the night time calls of the geese as they head home.

Last week, a narration appeared in my Facebook feed that I have kept going back to. The message has afforded me comfort and guidance during this time of reflection. I hope it resonates with you and I thank the Council of 13 Indigenous Grandmothers for sharing their wisdom.

A message from the Council of 13 Indigenous Grandmothers:

“As you move through these changing times… be easy on yourself and be easy on one another.

You are at the beginning of something new. You are learning a new way of being. You will find that you are working less in the yang modes that you are used to.

You will stop working so hard at getting from point A to point B the way you have in the past, but instead, will spend more time experiencing yourself in the whole, and your place in it.

Instead of traveling to a goal out there, you will voyage deeper into yourself. Your mother’s grandmother knew how to do this.

Your ancestors from long ago knew how to do this. They knew the power of the feminine principle… and because you carry their DNA in your body, this wisdom and this way of being is within you.

Call on it. Call it up. Invite your ancestors in.

As the yang based habits and the decaying institutions on our planet begin to crumble, look up. A breeze is stirring.

Feel the sun on your wings.”

Read more at the Council of 13 Indigenous Grandmothers:

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1. People with diabetes are at higher risk of getting COVID-19
2. People with diabetes have the same risk of getting COVID-19 as the general population
3. People with type 1 diabetes have a slightly higher risk of getting COVID-19 than those with type 2 diabetes
4. Regardless of the type of diabetes, COVID-19 rates are slightly lower

Click here to test your knowledge!

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COVID & Diabetes Update
Navigating a Crisis

Recorded & Ready for Viewing

Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM, has completely updated this critical presentation, to bring health care professionals up-to-date on the current state of COVID and its impact on diabetes care. She summarizes key information including critical teaching points and management strategies for people with diabetes who develop a COVID-19 infection.

Topics Include:

1. Discuss the current state of diabetes in the United States.
2. Describe the relationship between COVID and health care disparities 
3. Explore the impact of COVID infection on those with pre-existing diabetes.
4. Discuss treatment strategies for COVID and diabetes, including new vaccines.
5. List critical teaching points for people with diabetes and COVID.

Join us to learn critical information about Diabetes and COVID Management

Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF and Touro University and a nationally recognized diabetes expert.

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Mary Jane Oliver was an American poet who won the National Book Award and the Pulitzer Prize.

Her wisdom and candor offers readers the opportunity to see the world as it is and then slightly adjust their gaze to see the potential for hope and healing.

In this time of uncertainty, we can look to poetry, art and music to provide comfort, wisdom and a little beauty. We hope you enjoy this poem that Coach Beverly has chosen to share.

I WORRIED

I worried a lot. Will the garden grow, will the rivers

flow in the right direction, will the earth turn

as it was taught, and if not, how shall I correct it?

Was I right, was I wrong, will I be forgiven,

can I do better?

Will I ever be able to sing, even the sparrows

can do it and I am, well,

hopeless.

Is my eyesight fading or am I just imagining it,

am I going to get rheumatism,

lockjaw, dementia?

Finally I saw that worrying had come to nothing.

And gave it up. And took my old body

and went out into the morning,

and sang.

By Mary Jane Oliver, (September 10, 1935 – January 17, 2019) From Swan, 2010

Also read our blog 10 Mental Health Strategies while we Shelter-in-Place

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