Diabetes complicates COVID-19 risks — with or without vaccine

Dear Dr. Roach: I’m a 67-year-old male who was recently diagnosed with diabetes. I have had both Moderna doses for COVID-19. I have read all along that people with diabetes are at a much higher risk for complications with COVID-19, and I’ve read that the breakthrough infections, for the most part, are not nearly as severe as those for nonvaccinated people. For those who have been vaccinated, have there been any studies showing that breakthrough infections are very dangerous for those with diabetes? — D.S.

Dear D.S.: There are two ways I could answer this question. The first is to say that for people who are fully vaccinated, having diabetes makes you both more susceptible to a breakthrough infection and makes you more likely to have a more severe case. This is why it’s important, even for vaccinated people, to continue to take reasonable precautions as long as there is ongoing transmission in your community. This is especially true for all people with risk factors, such as older age and immune system disease. Both obesity and diabetes are additional risk factors.

The second way to answer this is to say that even with additional risk factors, the vaccine is still highly protective. The risk of severe disease (death or hospitalization) is still very low, even for people over 65 with diabetes, as long as they are fully vaccinated.

I’d advise you to get a third dose of vaccine when you are able to, usually six months after completing your second Moderna dose.

Dear Dr. Roach: Why do I feel colder after having breakfast? — J.S.B.

Dear J.S.B.: Eating sends your blood supply toward your stomach, intestines and bladder, and away from your extremities, which can lead to a cold sensation, especially in people who are a little predisposed to feel cold when others are comfortable. This is normal physiology.

People who feel cold more often might also have a medical condition. Low thyroid level is the first we usually think about, but people with diabetes and anemia may also feel colder, and have a larger than usual physiological effect after eating. Finally, people with blockages in the arteries often feel cold in the areas affected.

Dear Dr. Roach: Can Hashimoto’s thyroid disease be cured? — R.P.

Dear R.P.: Hashimoto’s thyroiditis is the most common cause of low thyroid levels in North America. It is an autoimmune disease where the body attacks the thyroid cells. Initially, there may be an increased level of thyroid hormone in the blood, but over months to years, the thyroid level decreases and people usually become symptomatically hypothyroid without replacement of thyroid hormone. Thyroid replacement, usually with thyroxine, the identical hormone made by the thyroid, is effective at returning blood hormone levels to normal and reversing any symptoms.

However, I wouldn’t call that a “cure.” It’s taking a medication every day to prevent symptoms and keep the many body tissues affected by the thyroid hormone healthy. Although some people who have taken thyroid replacement for years may be able to stop taking it under very close medical supervision, most people with Hashimoto’s who have become symptomatic from low thyroid will require treatment for life.