Diabetes Precautions

Much is still unknown about the COVID-19 virus, but we are learning more every day. Here's what to do if you get sick. Furthermore, there are important recommendations we can now make to you, our patients, in an effort to inform you on how best to prevent, prepare for, and manage this illness based on what we know now. Additional detailed information is available on the CDC, JDRF, and ADA websites.

While we all face the threat of COVID-19, people living with diabetes have additional concerns. Numerous medical experts and authorities have identified individuals with diabetes as being at “high risk” for contracting the virus. Listen, as endocrinologist Linda Gaudiani, MD, FACE, FACP reviews the additional risks, and offers advice on how you can stay well during the COVID-19 pandemic.

The Risks for those with Diabetes
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 as far as we now know. Younger individuals appear to be at lower risk than older ones.

In T2DM, the situation is different. These individuals are on average older, often over 65, and frequently have other complications of heart, lung or kidney and other diseases. These patients are often on multiple drugs that may increase infection risks or alter outcomes. They may face more serious complications and worse outcomes from COVID-19. Both T1DM and T2DM patients who have inadequate resources, food, medical care or medicines may also be at increased risk. Additionally, any patient with prior poor glucose control may also be at increased risk for infection.

However, for most patients with any type of diabetes despite degree of risk, any serious infection can make blood sugars 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 to maintain safe glucose targets. 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 people do become infected or sick.

Although it is not yet known to what extent any given individual with diabetes has a greater chance of getting COVID-19 or recovering from it, patients with diabetes and their health professionals should all be prepared for the unique considerations of a patient with diabetes dealing with the reality of COVID-19.

PREPARING FOR COVID-19
Preparing helps reduce stress and fear as well as insuring access to best care during illness. Individuals with diabetes should:

  • Stock up on all necessary medication, supplies and food for a minimum of 14 days in case of quarantine.
  • Make sure you 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. 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 your meds, supplies and food delivered to avoid unnecessary exposure.
  • For those who require insulin, be aware 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. This is not likely to happen but it’s good to know about. Your doctors or BDC practitioners can help adjust your insulin regimen if necessary in that situation.
  • Make sure you 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 over the counter medications such as Tylenol available, as well as other meds for fever control and pain relief, non-sugar containing cough syrups and lozenges for respiratory symptoms. Anti-nausea meds can also be very helpful to stabilize caloric intake and prevent dehydration. Stay tuned on recommendations regarding 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 with COVID-19.
  • Inquire about having your medical appointments by telehealth if possible to avoid exposure to others who may be ill with COVID-19 or anything else. 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.
  • Don’t change your medications without the advice of your prescribing MD or NP/practitioner.
  • Consider postponing any unnecessary surgical or other procedures and discuss that with your practitioners.