Coronavirus disease 2019 (COVID-19) is a new disease, and as scientists round the world gather information and data, we continue to learn more about the virus. Among the things we do know is that certain groups are at greater risk of developing serious complications if they contract SARS-CoV-2 (the virus that causes the COVID-19 disease). These include adults over the age of 65 and people with certain underlying medical conditions, such as chronic lung disease (e.g. COPD), serious heart conditions, severe obesity, and diabetes.
More than 34 million Americans have either type 1 diabetes or type 2 diabetes, making it one of the most prevalent diseases in the United States, according to the latest data from the Centers for Disease Control and Prevention (CDC). An estimated 6 million Americans take insulin as part of their diabetes treatment, with many more taking other oral medications to manage the condition.
As the nation grapples with the ongoing COVID-19 crisis, we have put together some straightforward answers to common questions related to diabetes and COVID-19...
Are you more likely to get COVID-19 if you have diabetes?
In short, no. There is no evidence to suggest that people with type 1 or type 2 diabetes are at a greater risk of contracting COVID-19 than the rest of the population. The risk of contracting the disease increases via exposure to someone with the virus, so continue to maintain social distancing and follow all hygiene and public health guidelines.
Are you more at risk from COVID-19 if you have diabetes?
Yes - people with diabetes who contract COVID-19 have a higher chance of experiencing complications than those with no underlying health conditions. The risk is increased in people whose diabetes and blood sugar levels are not well managed as this can hamper the immune system's ability to fight off infection.
Furthermore, people with diabetes are more prone to other serious health conditions, such as heart disease or hypertension, that increase the risk of COVID-19 complications. Viral infections can cause inflammation, something that may also be caused by high blood sugar levels. Consequently, maintaining stable and controlled blood sugar levels is more important than ever for people with diabetes, as inflammation may contribute to more severe complications in diabetic patients who get COVID-19.
Type 1 or type 2 diabetes - is the risk different?
Current evidence does not suggest people with type 1 diabetes are any more or less at risk that those with type 2 diabetes. The level of risk is more closely linked to factors such as the presence of underlying health conditions and how effectively a person manages their diabetes.
Is there a shortage of insulin or other diabetes supplies?
At the time of writing, the main manufacturers of insulin and diabetes supplies report that the COVID-19 pandemic has not adversely affected the manufacture and distribution of insulin and many states have introduced measures, such as reduced copays, to help people with diabetes who are struggling financially.
If you are concerned about paying for your insulin, visit the ADA's InsulinHelp.org or call 1-800-DIABETES for more information and resources. You can also use ModRN Health to search for the lowest price for your insulin at pharmacies in your area.
Managing diabetes during the pandemic
Speak to your healthcare team...
Even in the best of times, proper diabetes management is important, but during the coronavirus pandemic it is even more vital that you properly prepare and stay informed about how to look after your health. Speak to your healthcare team for specific advice on how to manage your diabetes. Make sure you are clear on:
- How often to check your blood sugar levels
- Which medications to use to manage any coronavirus symptoms
- Whether you need to change your medication regimen if you get sick
- When you need to call 911 or seek medical assistance if you develop symptoms
If you must go out, follow social distancing and hygiene guidelines...
Whether you have diabetes or not, the best way to minimize the chance you will contract the coronavirus is to minimize your potential exposure and maintain a high level of hygiene. If you need to leave your home, ensure you follow social distancing guidelines and stay at least 6ft from other people, wear a facemask at all times, and regularly wash your hands or use hand sanitizer.
Be organized at home and with your medication...
Try to minimize your potential exposure to the virus by staying home as much as possible. This may mean planning your regular grocery shop more carefully so you pick up all the supplies you need in one visit and avoid the need to take an extra trip.
Ensure you have a good supply of your insulin and any other medication, glucose testing kits and other supplies used to manage your diabetes. You may also be able to get a larger refill from your pharmacist to reduce the frequency of your trips to the pharmacy. Many major pharmacy chains and local pharmacies now offer free home delivery for medication, making it easier to stay safe and properly supplied with your medication.
Don't leave it until the last minute to get a refill and don't adjust your medication regimen without consulting with your physician.
What to do if you have diabetes and think you have COVID-19
If you think you are showing symptoms of COVID-19, call your doctor immediately. When you call, try to have the following information to hand:
- Glucose readings
- Ketone readings
- Information on your fluid consumption
When speaking to your healthcare provider or physician, be clear about your symptoms. COVID-19 symptoms usually appear 2-14 days after exposure and those with the disease usually exhibit dry cough and shortness of breath, or at least two of the following symptoms:
- Fever
- Chills
- Repeated shaking with chills
- Muscle pain
- Headache
- Sore throat
- New loss of taste or smell
What to do if you develop symptoms
- Stay hydrated - COVID-19 can raise blood pressure levels, which can lead to dehydration. If you struggle to keep water down, the ADA recommends trying small sips of water ever 15 minutes to avoid dehydration
- Maintain good hygiene - Always wash your hands and use soap and water, or rubbing alcohol to clean any injection, infusion or finger-stick sites.
- Check your blood sugar levels more regularly - If your blood sugar levels are low, eat a small quantity of simple carbohydrates and measure your levels 15 minutes after eating to check they are rising, then monitor your blood sugar more regularly (every two to three hours) through the day and night.
- If tests show you have high blood sugar levels more than twice in a row, check for ketones and contact your doctor immediately if you have medium or large ketone levels, or if your physician has instructed you to get in touch if small ketone levels are found.
- Continue taking your medication as directed unless your physician recommends otherwise.
A word on acetaminophen...
Tylenol (acetaminophen) can help alleviate fever, one of the symptoms of COVID-19. However, people with diabetes should bear in mind that some CGM sensors, notably the Dexcom G5, Medtronic Elite and Guardian, may be affected by acetaminophen. Consequently, the ADA recommends using finger-stick tests to ensure accurate readings if you are taking acetaminophen.
When to call 911 or seek medical attention
If you develop the emergency warning signs for COVID-19, you should seek medical attention immediately. These include, but are not limited to:
- Trouble breathing
- Persistent pressure or pain in the chest
- Confusion or an inability to arouse
- Bluish lips or face.
If you have any other symptoms that are severe or concerning, speak to your medical provider immediately. If you do need to call 911 with a medical emergency, don't forget to notify the operator that you have, or may have, COVID-19.
We will continue to provide you with updates and information during the ongoing coronavirus pandemic. Stay safe and stay healthy.
Other Resources
Useful links:
Know Your Rights: COVID-19 | ADA
Coronavirus Disease 2019 (COVID-19) | coronavirus.gov
Other articles:
COVID-19 (Coronavirus) - Key information and guidance
How to manage your medication during the COVID-19 pandemic
6 Tips for Good Mental Health During Coronavirus Lockdown
