“I was so out of it. Like so, so out of it.”
Alessandra Shah spent her Covid-19 nightmare zonked out of her mind, barely able to do a thing, totally isolated from family and with nobody to help her manage her Type 1 diabetes. She got through it okay, and she wanted to share her story with us, with the hope that it might help others.
“It was a rollercoaster ride having Type 1 and Covid.”
Diabetes can be a beast to manage even in the best of times, and blood sugars are especially volatile during illness. So, how about during Covid-19, an illness known to cause acute hyperglycemia and even diabetes itself in the previously healthy, a disease for which doctors have been instructed to intensify blood sugar control as a primary means of preventing the worst outcomes?
The Covid-19 pandemic is waning in some parts of the world, and still raging in others, and we’re still learning from the experiences of Covid patients with diabetes.
Alessandra Shah is 23 years old. Having grown up with Type 1—she was diagnosed at 18 months—Alessandra had gone through all of the growing pains.
2020 was the year that Alessandra really got her Type 1 diabetes under control. She was feeling ready to take her management to the next level, and she made three big changes:
- She committed to pre-bolus 15 minutes before every meal.
- She started eating fewer carbs – “Low-carb, high-protein breakfast, a heavier carb meal for lunch, and another lighter carb meal for dinner.”
- She started using Tandem’s t:slim X2 pump with Control-IQ , an advanced hybrid closed-loop system that automatically adjusts insulin levels based on Dexcom G6 continuous glucose monitoring (CGM) readings.*
The result of these changes was impressive. Her A1c, which had been as high as 10% during earlier years of apathy and burnout, improved all the way down to 5.9%.
But 2021 was a rude awakening. In early 2020, Alessandra had moved in with her grandmother in Tennessee. Anxious to keep grandma safe, she took social distancing very seriously. All it took was one slip-up:
“I went to visit one friend – just one friend! – and slept over at her house. That morning, she learned that someone at her job had contracted Covid, and she told me that she wasn’t feeling too well. I got it just a few days after.”
She had an early snafu with a false negative test, but a second test confirmed her diagnosis. That same day the symptoms really hit.
“I was extremely sick for the first five days, and there were times where I was just lying in bed the entire day. I had a fever, and I felt winded, as if I had just run a race. I couldn’t talk on the phone for more than five minutes without needing to hang up so I could catch my breath.”
Because she was living with her grandmother, Alessandra decided that she needed to self-isolate utterly. She stuck herself in the back half of the apartment, and the two did not see each other for days. Her grandmother would go shopping and drop a bag of snacks outside the back door, and Alessandra wouldn’t emerge to pick them up until the coast was clear. Grandma stayed safe, but there was nobody to tend to Alessandra, and she wasn’t up to the task herself.
“I just did not have the mental headspace or physical capability to take care of myself. I couldn’t even think about adjusting my basal rate.”
“The thing that kept my blood sugars regulated was my pump. Because without Control-IQ technology, truly, my blood sugars would have been running in the 300s and 400s the entire time. I required a lot more insulin, and I was passed out most of the time.”
The advanced hybrid closed-loop system worked in the background to adjust to her increased insulin needs, adjusting her basal rates and delivering correction doses, automatically.
“My mom was watching through the Dexcom app, and she was just mesmerized at how stable my blood sugars were.”
After the fifth day, Alessandra lost her appetite and her senses of taste and smell. That brought new challenges: she lost all interest in eating, but she also knew that her body wanted nutrients. Her blood sugar, which had threatened to go high, was now threatening to go low. Although the advanced hybrid closed-loop system can suspend insulin delivery to prevent hypoglycemia, Alessandra did need to chug Gatorade a few times to keep her blood sugars up, before she adjusted her pump settings. She also drank “gallons of water.”
Luckily, Alessandra got better, and put her intense illness behind her. We can’t know how much of a difference good blood sugar control made in her outcome, but the peace of mind that her insulin pump technology gave her (and her family) was irreplaceable.
Alessandra has been involved with a T1D nonprofit near her Florida home, Touched by Type 1, and will try to stay involved with the community if her career takes her elsewhere.
“I hope my story can help people with Type 1 diabetes better understand severe illness with diabetes, especially younger people considering using an insulin pump with automated delivery for the first time.”
* Dexcom CGM sold separately. Transmitter can only be paired with one medical device (either a Dexcom receiver or t:slim X2 insulin pump) and one consumer device (phone or tablet) at the same time.