Coronavirus & Diabetes: What to Look Out for & Tips to Be Prepared

Like many others, people with diabetes are concerned about being infected with COVID-19, or coronavirus. During times like these, extra care should be taken for those with diabetes since managing blood sugar during illness is difficult and can lead to an increased risk of complications.

COVID-19 and diabetes can be well managed in children who are otherwise healthy by following sick day guidelines and staying in close touch with their diabetes care team. Older people with diabetes who get coronavirus may have other health conditions to manage, which can increase the risk of complications with the virus.

How can people with diabetes prevent getting COVID-19?

Your risk for catching coronavirus is the same as everyone else, but the more underlying health conditions a person has the more potential that the virus can cause serious complications. The best defense against a COVID-19 infection is to keep your blood sugar in range and well under 200 mg/dL.

Maintain your health

Pay extra close attention to your treatment plan for diabetes, including monitoring blood sugar levels and taking medications or insulin as prescribed. Carefully manage other diseases such as high blood pressure, as recommended by your healthcare provider. Exercise 15 minutes a day if able, and make sure to get rest and stay hydrated with sugar free beverages.

Practice good hygiene and social distancing

The entire family should practice the COVID-19 safety precautions outlined by the Centers for Disease Control and Prevention (CDC), including:

• Wash hands often for at least 20 seconds, with soap and water
• Avoid touching your face (eyes, nose, mouth) with unwashed hands
• Clean and disinfect high-touch surfaces like doorknobs, keyboards, phones, countertops, tables, light switches, faucets, toilets, and sinks, daily
• Keep 6 feet between yourself and other people
• Avoid contact with people who are sick

Take vitamin supplements if advised

In addition to taking your normal medications, some healthcare providers are recommending to take a Vitamin D supplement as recent studies have shown that Vitamin D supplementation may help prevent COVID-19 and other respiratory tract infections. Discuss your Vitamin D level with your healthcare provider and whether or not a supplement is recommended.

What should you do at home to be prepared?

It is safer for people with diabetes to stay home, so explore which local pharmacies or grocery stores deliver, or ask a friend or family member to go out for you if there are essentials you need from the store. Below we outline key items to make your stay at home safer.

Stock extra diabetes supplies and medications

Keep extra supplies for managing diabetes on hand, including:

• Test strips
• Lancets
• Pen needles
• Syringes
• Alcohol swabs
• CGM sensors or pump supplies
• Ketone strips
• Extra refills of prescriptions (oral medications, insulin, etc.) as your insurance allows

Check with your pharmacist, supplier, or insulin manufacturer if you have questions about refilling prescriptions or insulin access.

Keep your pantry stocked with essentials

• Make sure to stock a 14-day supply of carbohydrate containing foods (in addition to lean proteins and healthy fats) in the event of a quarantine. Shelf stable sources of carbohydrate include:
  • Oatmeal, brown rice, black beans, cold cereal (look for high fiber), soups that contain pasta, rice and/or beans, canned corn, peas or potatoes, whole wheat pancake and biscuit mixes, and canned fruits.
• Create a pantry sick day box that is stocked with essentials if you do get sick:
  • Regular soda (not diet) or Gatorade, canned soup, broths, soda crackers, unsweetened applesauce, instant hot cereal, gelatin, pudding, and fruit juice.
• If everyone in your family is staying at home, be sure to keep supplies for low blood sugar in a separate cabinet or area from your family’s snacks, so that you have access to a quick-acting source of carbohydrate (hard candies, juice boxes, etc.) if needed.

Discuss ways to minimize exposure

Create a plan with your family to take extra precautions around those with diabetes, such as washing hands frequently, cleaning all surfaces and shared cooking items regularly, and as needed, dedicating a protected space for this family member. If possible, have another family member run out to the grocery store or pick up items for the family to further reduce your time out and about.

What are the risks for people with diabetes if they get coronavirus?

When managing diabetes, health-related problems can arise when blood sugar levels are chronically high. This includes heart disease, kidney disease, nerve damage, and other serious complications. The American Diabetes Association (ADA) notes that people with diabetes who have complications like these can be at an increased risk of severe illness with COVID-19.

High or uncontrolled blood sugar levels cause the immune system to not function as optimally, making your body more vulnerable to serious illness. Having tight control of your blood sugar can help prevent COVID-19 and will help with good health in the future.

In general, sickness tends to drive up blood sugar levels. Check for ketones if you have two consecutive readings above 240 mg/dL, as viral infections can increase the risk of DKA (diabetic ketoacidosis) especially in those with type 1 diabetes.

How should you manage your symptoms if you start feeling sick?

If you are having symptoms of fever, aches and cough, call your healthcare provider or a local hospital right away to discuss your symptoms and determine if you need to be tested. Do not go directly to the doctor’s office or hospital.

If you do contact a healthcare provider to discuss symptoms, make sure to remind them that you have diabetes when you call. If you live alone, make sure to notify a friend or family member that you are not feeling well so that they can stay in close touch with you to help you stay safe.

Take medications as recommended by your healthcare team

Do not make changes to your medication care plan without talking to your healthcare team. Take all prescriptions according to your healthcare provider’s instructions.

If your healthcare provider recommends using any over-the-counter medicines to alleviate symptoms, only use those that are approved by your healthcare provider. Be aware that some fever-reducing medications may interfere with blood sugar readings on certain continuous glucose monitors, so check the manufacturer’s instructions to see if this applies to your system.

Stay hydrated and eat small meals if you’re not feeling well

Stay hydrated by aiming for 6-8 ounces of fluid every hour. Eat small meals to prevent a low blood sugar if you are taking glucose-lowering medications. If you do not feel well enough to eat, choose 15-gram carbohydrate portions of juice, regular soda, Gatorade, soup, regular gelatin, or hot cereal, to consume about 45 grams of carbohydrate every 3-4 hours.

Make sure to partner with your healthcare team as soon as you start to have symptoms. If you suspect that you may have COVID-19, do not treat it like you would a common cold. Stay in constant touch with your care team.

Keep tabs on your blood sugar

If you have been diagnosed with COVID-19 and are caring for it at home, check your blood sugar regularly to monitor for any out of range readings. Record your blood sugar tests in a written glucose log or diabetes app, so that you can easily provide this information to a healthcare provider.

When should you seek emergency help?

According to the ADA, it’s important to seek help immediately if you experience:

• Shortness of breath or difficulty breathing
• Chest pain or pressure
• Confusion or difficulty being alert
• Blue tint to lips or face

It’s also important to seek medical attention for symptoms of DKA such as:

• Ketone levels in your urine that in the moderate to high range
• Excessive thirst and frequent urination
• High blood sugar level
• Weakness or abdominal pain
• Nausea and vomiting

You should consult a medical professional for any other symptoms not listed that are unusual, concerning, or severe.

How can I prevent spreading coronavirus in my household?

Keep any members of your household who are sick with COVID-19 in a separate room away from the family, with the door closed. If possible, have them use a separate bathroom. Dedicate one person to care for them and avoid any unnecessary contact with the person who is sick. Only clean the room or bathroom of the person who is sick if they are a child or someone who is unable to do so for themselves.

To prevent the spread of the virus, wash hands frequently and do not touch your face (eyes, nose, mouth) with unwashed hands. Do not share items with the person who is sick, like food, utensils, or drinks. Follow CDC guidelines to thoroughly wash laundry and clean other household surfaces that are “high-touch.”

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For people with diabetes, the best defense against COVID-19 is to keep blood sugar in tight control. It’s also important to control other health issues that you might have. If possible, exercise for at least 15 minutes daily, get rest, and stay well hydrated by consuming sugar-free drinks. Practice good social distancing and find creative distractions to have fun and decrease stress levels. Stay home as much as you can, and send friends or family out for appropriate foods to stock your pantry or any needed diabetes supplies.

If you begin to experience cough, fever and body aches, call your healthcare provider or local hospital immediately for guidance. We will all get through this together.