Information on COVID-19 for Individuals with Diabetes
Currently we are all facing the crises of dealing with the threat of Covid-19 but patients with diabetes have additional concerns. Individuals with diabetes have been identified by numerous medical experts and authorities as “high risk individuals.” This raises valid questions about how we should approach helping advise our patients with diabetes at this time. The COVID-19 virus is new and much is still unknown but information is increasing rapidly. There are important recommendations we can now make to you, our patients, in an effort to inform you on how best to prevent and treat this illness in light of what we think we know. This needs to be an ongoing conversation with additions and modifications as we go along and more is learned. Additional detailed information is available on the JDRF.org, ADA.org and CDC.org. websites.
The risk of contracting COVID-19 does not increase with merely having diabetes in most individuals. Otherwise healthy patients with T1DM who have no other illnesses and whose diabetes is in good control probably have little increased risk of getting infection due to their diabetes. Younger individuals appear to be at lower risk than older ones.
For T2DM the situation is different as these individuals are on average older, often over 65, and frequently have other complications of heart, lung or kidney disease. Additionally these patients are often on multiple drugs that may increase infection risks. These patients especially if in poor glucose control may be at increased risk not only for infection but for more serious complications and poor outcomes including death from COVID-19 virus.
Both T1DM and T2DM patients who have inadequate resources, food, medical care or medicines may also be at increased risk. For all patients with any type of diabetes, any serious infection can complicate and destabilize diabetic control and make diabetes more difficult to control. Infection, stress and fever all cause insulin resistance, increasing insulin requirements and causing higher blood sugars. Fluctuations in dietary intake caused by illness, fever, nausea, vomiting or coughing can result in lower blood sugars as well. Medications and insulin must often be adjusted. So when we consider diabetes and COVID-19 infection, we first want to try to PREVENT infection, then to be PREPARED in case of illness and finally to address MANAGEMENT if persons do become infected or sick.
Although it is not known to what extent any given individual with diabetes has a greater chance of getting COVID-19, we should all be prepared for the sick patient with diabetes to be more complex to treat if they do get sick compared to patients without diabetes. So let’s get ready…
PREVENTION STRATEGIES for COVID-19 INFECTION
What has been learned about COVID is that it can be transmitted by individuals who do not appear to be sick. It is also thought to be quite infectious; therefore at this time and until we know more, have access to screening and testing and have better treatments or prevention we strongly recommend…
EVERYONE SHOULD BE PRACTICING THE RECOMMENDATIONS OF THE U.S. CENTERS for DISEASE CONTROL and PREVENTION (CDC) ON SOCIAL DISTANCING, AND PERSONAL HYGIENE THAT HAVE BEEN WIDELY PUBLICIZED. THIS CANNOT BE OVEREMPHASIZED!
Staying at home as much as possible, avoiding group gatherings, public places, and air travel or mass transit are good ideas until we know more. Limiting contacts to immediate family members if possible is also advised. Hand washing often for 20-30 seconds, not touching face, eyes, mouth, and nose with unwashed hands, disinfecting surfaces often including cell phones, washing clothes and linens frequently are all recommended strategies. The virus lives on surfaces for up to days!
Try to relieve stress and stay active. Taking walks in areas where there are few other people close by might be beneficial whereas going out to public gyms might pose increased infection risks. Stay social by calling, texting, using Facetime, Skype and other remote communications.
PREPARING FOR COVID-19
Preparing helps reduce stress and fear as well as insuring access to best care during illness so diabetic patients should:
- STOCK UP ON ALL NEEDED MEDS, SUPPLIES AND FOODS FOR MINIMUM OF 14 DAYS IN CASE OF QUARENTINE
- make sure they have adequate supply of all prescribed medications and insulins, even extra if possible on hand and for those patients on insulin, glucagon should be available to family members with instructions on use
- have adequate blood glucose testing supplies available and for patients on SGLT-2 inhibitors a testing kit for blood ketones might also be handy and helpful. Ask your doctor or practitioner
- try to have meds, supplies and food delivered to avoid unnecessary exposure
- note that for those who take insulin remember that if there is a true epidemic or prescriptive insulin shortage, vials of NPH and regular insulins can be purchased at Walmart without a prescription at low cost. Of course syringes would be necessary if you now use pens. Ideally this would not happen but it’s good to know about. Your doctors or BDC practitioners could help adjust your insulin regimen if necessary in that emergency situation
- make sure to have adequate supplies of non-perishable foods such as canned foods, beans, rice, broths, soups and fluids such as juices, electrolyte drinks, teas and waters on hand
- keep OTC meds available such as Tylenol and other meds for fever control and pain relief, non sugar containing cough syrups, lozenges for respiratory symptoms. Anti-nausea meds can also be very helpful to stabilize caloric intake and prevent dehydration. Stay tuned on recommendations re other fever meds such as ibuprofen (Advil) and naproxen (Aleve) and other drugs in the NSAIDS class as they fall into a group of drugs that is currently under investigation as possibly to be avoided in diabetics w COVID-19
- Inquire about having your medical appointments by Tele Health if possible to avoid exposure to others who may be ill with COVID or anything else. Again ask your health professional about medical follow-ups without face to face visits at least for now.
- Try to keep your blood sugars in your target range as much as possible as it may be that optimal glucose control will reduce infection and or complications. Eat well.
- Consider postponing any unnecessary surgical or other procedures and discuss with your practitioner
What If You Do Get Sick?
Start out by following recommendations for managing the flu. Isolate yourself until you are fully evaluated if you develop fever, flu-like symptoms, cough, sore throat
Call your primary care doctor to arrange for evaluation especially if you get more seriously ill or develop high fever or trouble breathing.
Avoid Emergency Rooms unless you have acute symptoms that you feel could be life threatening.
If your blood sugars are out of safe control, call your diabetes treating physicians/nurse practitioners or the BDC team if you have been seen at the BDC as a patient in the past. Medications and insulin may need to be adjusted, started or discontinued depending on the situation
We have faced difficult medical challenges in the past successfully and we will get through this one together as well if we communicate and continue to discover the best solutions possible. Stay in touch with your doctors and your entire medical health team. It’s our job to help!
Dr Linda M Gaudiani MD FACE FACP
Living life well with Diabetes