Coronavirus (COVID-19) Information for TPIAT Patients

After TPIAT, do children & adolescents have a higher risk of COVID-19?

After a TPIAT (total pancreatectomy with islet cell auto-transplantation), children & adolescents have similar risks to otherwise healthy individuals as long as their diabetes is well-managed. While adults with diabetes are at increased risk for severe illness from COVID-19, it does not appear that children with diabetes are at the same risk. Their immune systems are otherwise normal and most reports show that children with diabetes do not have a significantly higher risk than other children.

What if their diabetes isn’t well-managed?

For children & adolescents who have Hgb A1C greater than 9%, please contact your diabetes team. In this situation, they will likely be advised to limit exposure to COVID-19 as much as possible due to the increased risk of developing Diabetic Ketoacidosis (DKA) with a viral infection.

What if there has been exposure to COVID-19?

If the patient or family member has been exposed to COVID-19, it is important that they contact the Diabetes Center for support. If the patient is currently on insulin, the team can support insulin management & review sick day guidelines. If the patient is not currently on insulin, it will be important to start monitoring blood glucose five times a day. Please report any blood glucoses over 150mg/dL. In addition to contacting the Diabetes Center, please contact the patient’s primary care provider

What if the patient has a fever?

Although having the spleen removed does not put someone at higher risk for COVID-19, there is a higher risk for certain bacterial infections. It is important to contact your primary care provider immediately and go to the emergency room if there is a fever of 100.4 or greater. Please also let the Pancreas Care Center know. In the emergency room, the patient should get IV antibiotics after blood cultures are sent. Please refer to the emergency care plan your nurse prepared for you at your last visit.

TPIAT Patients and COVID-19 Vaccines

Many of our post-TPIAT families have asked for advice regarding the COVID-19 vaccine for their child. The Pancreas Care Center is always working together, to keep you well informed and your child safe. We are closely monitoring the development of the different COVID-19 vaccines and will continue to do so.

Currently, COVID-19 vaccines are routinely available for the pediatric population aged 5 years and older. Check the CDC website for updated vaccine recommendations.

If your child meets vaccine criteria, we are comfortable with its use in the post-TPIAT population.

Taking Care of Your Mental Health During COVID-19

It is important to acknowledge that patients who have undergone TPIAT (total pancreatectomy with islet cell auto-transplantation) do not face increased risk from coronavirus (COVID-19) due to spleen removal. Of note, patients still on insulin who experience worsening blood sugar control may be at higher risk. Recognizing this, we are providing our parents and patients with the following tips and strategies to help them cope with their unique concerns.

Ways that TPIAT Patients Can Support their own Well-Being

• Step away from electronics. Breaks from watching, reading, or listening to news stories, including social media, are very important during this time. Hearing about COVID-19 repeatedly can be upsetting, especially as information changes rapidly. This can be confusing for anyone.
• Take care of your body. Breathe. Stretch. Take time to be still and quiet. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep, avoid alcohol and drugs, take all your medications as prescribed and on-time, and stay in communication with your medical team by phone or MyChart.
• Make time for fun! Engage in activities you’ve always enjoyed that can be done while still honoring social distancing.
• Social connection remains important. Connect VIRTUALLY with others as much as possible. Talk with people about your concerns and how you are feeling.

Ways Caregivers Can Help

Children and adolescents tend to follow the lead of the trusted adults around them. Caregivers will provide the best support for their children when they deal with COVID-19 calmly and confidently themselves. Be open and engage in discussion, while remaining supportive and reassuring. This is a hard task! Seek support for yourselves so that you can be present emotionally for your children. All children and adolescents respond to stressful times differently. Keep an eye out for some of these common changes:

• Increased crying or irritability
• Return to behaviors previously outgrown (e.g., toileting accidents, bedwetting)
• Excessive worry (e.g., asking similar questions repeatedly, clinginess)
• Unhealthy eating or sleeping habits
• “Acting out” behaviors or struggling to follow directions
• Difficulty with attention and concentration
• Avoidance of activities they have previously enjoyed
• Increased report of unexplained physical symptoms (e.g., headaches, pain)
• Use of alcohol, tobacco, or other drugs

Ways to Support Your Child

• Spend time together. Take time to talk with your child or adolescent about COVID-19 and its impact on your life. Answer questions and share facts about COVID-19 in a way that your child or adolescent can understand. Be honest.
• Validate concerns and reassure your child that you and their healthcare team are doing everything they can to help them be safe. Help them understand areas where they have some control and things they can do to keep themselves safe, such as: hand washing, follow social distancing, staying away from restaurants or public places, not touching unnecessary things, eating healthy, well-balanced meals, exercise regularly, get plenty of sleep, avoid alcohol and drugs, take all your medications as prescribed and on-time, and stay in communication with your medical team by phone or MyChart.
• Set limits on your family’s exposure to news coverage, including social media. Information is changing rapidly, can be highly confusing, and easily misinterpreted. This can be frightening if they do not understand. Have discussions about what they hear and let them know it is ok if they feel upset. Share with them ways that you cope with your own stress so that they can learn from you.
• Try to keep up with regular routines. Children like to know what will happen next. While schools are closed, create a schedule for learning activities and relaxing or fun activities.
• Be a role model. Engage in your own selfcare -- take breaks, get plenty of sleep, exercise, and eat well. Connect VIRTUALLY with your friends and family members for support.
• Important: If you feel you or your child needs to speak with someone regarding these issues, please contact your mental healthcare provider or your TPIAT care team.

Back to School Safety Tips

TPIAT patients may feel scared to go back to school during an ongoing pandemic. Here are the most important tips for students K-12. Everyone is different, so TPIAT patients are encouraged to consult their care team if they have any concerns.

• Monitor your temperature - Having the spleen removed does not put someone at higher risk for COVID-19 virus or other viruses. However, there is a higher risk for certain bacterial infections. It is important to go to the emergency room immediately & contact your primary care physician if there is a fever of 100.4 or greater. Please let the Pancreas Care Center know.
• Know which mask to wear - Cloth masks are okay to wear if all other students and staff are wearing masks or face coverings.
• Clean your hands frequently - Hand hygiene is very important. Wash your hands with soap and water for 20 seconds or use hand gel with at least 60% ethanol.
• Keep a safe distance - Stay 6 feet apart from other students and teachers
• Understanding your diabetes management - For children & adolescents who have Hgb A1C greater than 9%, please contact your diabetes team. In this situation, they will likely be advised to limit exposure to COVID-19 as much as possible due to the increased risk of developing Diabetic Ketoacidosis (DKA) with a viral infection.

Additional Resources

• More information from the CDC about COVID-19 and type 1 diabetes
• The free app “Stop, Breathe, and Think” is a great resource that provides tools to help you practice mindfulness and meditation. It also has a specific section dedicated to coronavirus.

Contact Information:

Diabetes Center: 513-636-2444
Pancreas Care Center: 513-803-2123