Thanks COVID

After being hospitalized with the virus, Matt Femrite learned he was facing another equally serious health issue.

By Steve Sullivan

Matt Femrite knew he had COVID-19.

It was when his symptoms landed him in Mary Greeley’s Emergency Department that he received a diagnosis that would change his life.

“How are you managing your diabetes?” asked Dr. Andrew Boyko, the McFarland Clinic emergency medicine physician who treated him.

“What?” thought Femrite. “Diabetes?”

Dealing with a severe case of COVID-19 was tough enough, and now Femrite had to face managing life with diabetes. Mary Greeley’s highly skilled and coordinated inpatient and outpatient diabetes care team was ready to help.

A Possibility

The news wasn’t a total surprise, Femrite admits. Two decades earlier, his father had been diagnosed with diabetes, and he recently learned that the disease has been present in several generations of his family.

“I’m a poster child for bad genetics,” said Femrite, who was diagnosed with type 2 diabetes, meaning his body doesn’t produce enough insulin to manage the glucose in his bloodstream.

“There were things that made me wonder, but at the same time, ignorance is bliss,” he added. “If I don’t have a diagnosis, I don’t have to deal with it. How bad could it be? Dealing with it has made all the difference.”

Femrite had been living with what Sarah Haveman calls “deniabetes.” A registered dietitian and diabetes educator with Mary Greeley’s Diabetes and Nutrition Education Center, Haveman has seen a lot of this.

“Deniabetes refers to someone choosing to deny they have diabetes rather than face the diagnosis and make changes to manage it,” she said. “Matt had been living with deniabetes, but since getting an actual diagnosis, he has worked hard and so far successfully to turn things around.”

COVID

Femrite came down with COVID-19 symptoms—fever, cough, fatigue—in early September. Both he and his wife ended up testing positive for the virus. A legal analyst for the state of Iowa, Femrite works from home. His wife, Stephanie, is an Iowa State student.

“We took all the precautions,” he said. “When I run errands, I wear a mask and social distance. My wife attends classes on campus, but she had never been contacted by a contact tracer.”

Not long after the initial diagnosis, his symptoms got worse.

“The first time we went to the hospital, his oxygen levels weren’t low enough to keep him, so they gave him a list of symptoms to watch for in case he needed to come back. He had been feeling better for a couple of days, and then on that Friday he got worse,” said Stephanie. “Toward the end of the day, Matt was trying to talk to me about something and he couldn’t say more than a few words at a time without needing to breathe. The hospital said to bring him back if he couldn’t say more than four words together.”

Femrite was admitted to Mary Greeley’s COVID-19 unit. He spent five days in the hospital, including several on oxygen. Because of visitor policies related to COVID-19, Stephanie couldn’t visit her husband.

“We did video calls, which was helpful. The sense of isolation was hard, though. Even when people came in, they wore masks and face shields,” Femrite said. “I remember joking that my wife has COVID anyway, why can’t she visit? I’m already paying for the room. She could sleep on the couch.”

While he was able to joke at times, Femrite was dealing with a lot of emotions. He was in the hospital with COVID-19. He was worried about Stephanie, who was home alone, coping with the virus herself and keeping up with school.

“It was a nightmare scenario,” he said. “We were both sick and I wasn’t there with her.”

And then there was that question that still needed attention: “How are you managing your diabetes?”

Coordinated Diabetes Care

On an average day, Mary Greeley has 100–105 admitted patients. Typically, 30–35 of these patients have a diabetes diagnosis. This creates a significant need for inpatient diabetes care services. Enter Kimberly Case, a family care nurse practitioner who collaborates with doctors and hospital staff on inpatient diabetes care.

Case met with Femrite while he was in the hospital—via iPad due to COVID-19 safety measures.

“Each patient is individual, but he was very motivated to get his diabetes under control,” she said.

“He needed basic education on his new diagnosis, as well as education on insulin administration and insulin adjustment,” she said. “We want them to be successful when they go home, so helping with these topics while they are an inpatient is very beneficial.”

Case made sure he knew how to give himself an insulin shot. COVID-19 treatment ironically provided an opportunity to educate about insulin adjustment. Steroids used to treat virus symptoms can cause higher levels of glucose in the blood. This meant adjustments were needed for his insulin dosage while on virus-fighting steroids.

To further ensure Femrite’s post-discharge success, Case connected him with Haveman (who also met with Femrite via iPad), helping him understand diabetes management, including insulin administration and checking blood sugars. He continued to have meetings with Haveman as an outpatient, covering such topics as good nutrition and tracking grams of carbohydrates per meal.

Gadgets

Femrite went home, checking his glucose levels four times a day with a glucose monitor and giving himself insulin injections four times a day. He did some research on insulin pumps and opted to get one not long after his discharge.

An admitted tech nerd, Femrite did a deep diabetes dive and has embraced all the diabetes management tools now available. He even made a spreadsheet of diabetes symptoms, tracking when he first recalled experiencing them over the years. Frequent urination? Check. Slow healing? Check. Hunger? Check. Sticky urine? Check. (That’s because of the sugar in the urine. An early test for diabetes, dating back to ancient times, involved tasting urine for sweetness. Medicine has come a long way since then.)

“He likes the toys, the technology,” said Haveman.

Femrite now uses a glucose monitor that sends glucose data to his insulin pump and can increase or decrease the drip of insulin as needed. An app enables Femrite to view his data on his phone. The app also uploads Femrite’s stats to his MyChart records, where Haveman can review them if needed.

“These tools I use to manage my diabetes allow me to have more control over it with greater precision, convenience, and safety,” he said. “For example, my CGM (continuous glucose monitor) allows me to see if I’m experiencing an unexpected high or low. This allows me to treat blood glucose variations as they happen, which helps me keep my blood glucose within a tighter range. Similarly, my insulin pump lets me directly manage my glucose levels in real time. However, my pump also automatically varies my basal insulin based on my glucose levels. This feature has all but eliminated episodes of hypoglycemia and hyperglycemia with less intervention on my part.”

His enthusiasm and commitment have paid off. When diagnosed, his A1C (a measurement of glucose in the bloodstream) was 12.6 percent. Three months later, it was 6.3 percent. The normal range is just under 7 percent.

“That is a crazy good drop. It indicates huge glucose management improvement,” said Haveman.

“I feel better than I have in a long time,” he said.

Diabetes for 2

Femrite is eating better these days and paying particular attention to portions. It’s all about moderation, more than denial. Still, he admits to missing those beloved hungry-man helpings of macaroni and cheese.

He also plans to get back on his bike. He was an avid cyclist, but law school derailed that pastime. He plans to get back on the bike now, knowing that exercise is also a key element of diabetes management.

Remember how Femrite and his wife both had COVID? They both now have diabetes as well. She was diagnosed early last year with type 2 diabetes and manages it with medication, diet, and exercise. But sharing a similar diagnosis has brought them closer together.

“Obviously, neither of us being diabetic would be optimal, but it’s less lonely that we both share the same condition. We get to act as each other’s support system. It’s much easier to plan meals since we have the same restrictions. It’s easier to stay on track both with diet and exercise when there’s someone else who understands the temptations to just let things go. It’s great to have that extra level of both support and accountability.”