People with diabetes should exercise caution and good judgment in the midst of the COVID-19 pandemic. Because people with diabetes are more likely to both become infected and develop serious complications from this illness, we must understand the risks, take preventive measures and know what to do in case symptoms appear. The American Diabetes Association, CDC, medical groups and healthcare systems across the country have made recommendations for preventing and managing diabetes and coronavirus.
Diabetes and coronavirus risk
Is there really any strong evidence that people with diabetes have a weakened immune system and are more susceptible to illness?
The answer appears to be yes. In a study looking at the burden of infection of adults with diabetes compared to the general population, people with diabetes had higher rates for all infections, with the highest rates seen for bone and joint infections, sepsis, and skin infections. Of note, infections were more common in type 1 diabetes over type 2. Other studies have concluded that hyperglycemia leads to a weakened immune response, and that respiratory infections are responsible for a significant number of medical appointments for persons with diabetes compared to those without.
This is absolutely seen in clinical practice.
What we can confidently say is that being ill makes managing diabetes more difficult. Increased insulin resistance, less stable eating patterns, nausea, vomiting, diarrhea, and decreased fluid intake can all lead to uncontrolled blood glucose and difficulty in managing diabetes.
Because early reports of coronavirus in China affected those with underlying medical conditions more severely, the CDC has recommended people with diabetes take extra precautions for disease prevention.
Diabetes and coronavirus prevention
The best thing a person with diabetes can do now to prevent a viral infection is to keep your blood glucose in the target range. If your blood sugar has been uncontrolled, tightening up glucose levels and limiting episodes of hyperglycemia will help. It is believed that even improving glucose levels during the next few weeks can increase your body’s ability to fight infection. If you’ve been delaying a diabetes visit to address your A1C or determine if medication adjustments are needed, contact your physician to ask whether an office visit or telehealth visit is appropriate.
While the CDC recommendations for coronavirus prevention may seem extreme to some, these precautions must be followed to minimize your risk of contracting or spreading the disease.
The prevention guidelines for people at higher risk of getting sick from COVID-19 include:
- Following the everyday precautions to keep space between yourself and others
- Avoid crowds as much as possible
- When you are in public, stay away from those who are sick
- Wash your hands often
- Avoid cruise and non-essential air travel
- Stay home as much as possible if there’s an outbreak in your community
Preparation and diabetes sick day management
Now is a great time to review general sick day management rules for people with diabetes. Enlist the help of family members, friends or neighbors to be available should you need extra support or help to obtain supplies.
To specifically prepare during the coronavirus crisis, stock up on supplies. You’ll need to be sure you have several weeks’ worth of prescription and over-the-counter medications, glucose testing and pump supplies, sensors for continuous glucose monitors, carbohydrate sources for treating hypoglycemia, ketone test strips, and plenty of hand sanitizer, soap and alcohol wipes. If extra testing supplies are needed beyond what your insurance will cover, Walmart’s ReliOn brand is usually the most affordable. If you are unable to leave your home, many of these items can be ordered via Amazon for delivery.
A bit of good news is that glucose testing or injecting insulin does not appear to contribute to spreading the virus, but if you’ve become a bit relaxed about washing your hands before doing these tasks, this is the time to change that. If you are in public while using glucose testing supplies, an extra measure of precaution would include disinfecting the glucometer, CGM reader, insulin pens and other supplies with a solution of at least 70% alcohol before and after using them.
If you become sick, increasing blood sugar monitoring and drinking fluids throughout the day can help lower the risk of diabetic ketoacidosis (DKA) which can be a life-threatening medical emergency. Becoming dehydrated and/or a lack of insulin increases the risk of DKA. Have a discussion with your healthcare provider about their specific recommendations regarding the frequency of glucose and ketone monitoring when sick, medication changes, and any other individual advice they may have for you.
Be aware of the early and more advanced signs of DKA so that you can seek treatment as soon as possible.
Early signs of DKA include:
- Thirst or very dry mouth
- Frequent urination
- High blood sugar levels
- High levels of ketones in the urine
Later and more serious signs include:
- Constant fatigue
- Dry or flushed skin
- Nausea, vomiting, or abdominal pain
- Difficulty breathing
- Fruity odor on breath
- Mental confusion
What to do if you have coronavirus symptoms
The main symptoms to be aware of are fever, cough and respiratory symptoms that can range from mild to severe. While your first instinct may be to head to the closest emergency room to get checked out, the medical community is recommending that you call your primary care physician first.
By reserving emergency room space for those who truly need it, you will also limit your exposure to other germs and viruses and minimize the spread of coronavirus if you test positive. Many offices have telehealth visits set up to see you remotely. Once the initial evaluation is done, you’ll be given direction on whether a higher level of care or more testing is needed.
For symptoms that are more severe such as difficulty breathing, chest pressure, new confusion or inability to arouse, bluish lips or face, you should seek emergency treatment immediately.
Clinical management of diabetes and coronavirus
Patients who test positive for COVID-19 and have underlying chronic illnesses including diabetes will be monitored closely. The mainstay of treatment is managing symptoms and controlling other health conditions to prevent them from worsening in a time of weakened immunity. Elevated blood pressure, heart and lung conditions, and other problems will be carefully tracked and treated.
Those with mild symptoms may not be hospitalized, but the decision to treat someone as an inpatient or outpatient will be made on a case by case basis. The CDC and World Health Organization are providing daily guidance to medical providers on treatment and isolation protocols.
Resources for staying up to date
While this is not a time for fear, it is wise to be informed by reliable sources. Agencies providing information for the public include:
CDC’s Coronavirus Information – This is truly the go-to resource for both healthcare providers and the public. Guidance for the community, schools, businesses and travel are addressed here. Latest updates on cases in the United States are made daily.
American Diabetes Association Coronavirus Advice – This resource has checklists and recommendations for sick day management for people with diabetes.
Want some quick and easy diabetes-friendly snacks?
With this list, you won't have to wonder what to eat in between meals!
Download it to your phone or tablet and keep it handy, or print it off and keep it by your fridge.