COVID-19: The impact on people with diabetes

Those with diabetes might have some very specific questions and concerns around how COVID-19 might impact them.

June, 2020

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As the COVID-19 pandemic continues to grip the world, scientists and researchers are learning more every day about the virus and its effects on the human body.

The diabetes community might have some very specific questions and concerns around how the virus might impact them. All these concerns are valid – and we will try to address some of them in this article, but remember to consult your healthcare professional with any specific questions.

This is a worrying time. However, it’s important to remember that the overall number of cases continues to decrease, and governments and healthcare professionals across the world are beginning to take control of this dangerous disease.

Diabetes and COVID-19: why are you more at risk?

It’s important to remember that if you have Type 1 or Type 2 diabetes you are no more likely to become infected with COVID-19 than anyone without the disease. However, having diabetes often means your immune system is not as strong at fighting infections as someone without the disease, which may mean you suffer more if you contract it. Many people living with diabetes face additional complications and have other risk factors relating to their heart and kidneys, and the virus can lead to additional problems arising with these organs, even in otherwise healthy adults.

In addition, being ill can make your blood sugar fluctuate as your body works overtime to try to fight the illness by releasing stored glucose (sugar) into your bloodstream. This means you’re more at risk of having serious blood sugar lows or highs, the latter potentially leading to diabetic ketoacidosis (DKA).

DKA is the process which occurs when the body lacks insulin and is unable to use blood sugar (otherwise known as blood glucose) for energy, and instead begins to use the stores of fat in the body. This process releases a chemical called ketones, which if left unchecked can increase the acidity of your bloodstream. Signs that DKA is occurring in your body include high blood sugar levels, an increase in thirst, confusion, an increase in tiredness and a feeling of being sick.

However, despite the dangers of COVID-19, it is important to remember that for many people COVID-19 is only a mild illness and shares many traits with the common flu, meaning it will pass after a few days. If you do become ill, then you should remember the Diabetes Sick Day Rules:

  • Don’t panic – contact your diabetes team who will help you if you have any queries.
  • Keep taking your diabetes medications – even if you don’t feel like eating. But there are some medicines that you shouldn’t take as much of or stop taking altogether. Make sure you talk to your diabetes team as soon as you’re feeling ill so they can give you the right advice.
  • If you take a certain type of diabetes tablet called SGLT2i and become unwell, you should stop taking these
  • If you check your blood sugar at home, you’ll probably need to do it more often – at least every four hours, including during the night.
  • Stay hydrated – have plenty of unsweetened drinks.
  • If you have type 1 diabetes, check your ketones if your blood sugar level is high (generally 15mmol/l or more, or 13mmol/l if you use an insulin pump, but your team may have given you different targets). If ketones are present, contact your diabetes team.
  • Keep eating or drinking – if you can’t keep food down, try snacks or drinks with carbohydrates in to give you energy.

What are the symptoms of coronavirus?

COVID-19 can be asymptomatic (show no symptoms) and most people who get it will only suffer from mild symptoms if any at all. However, some people can feel very unwell and require medical attention. The NHS and the UK Government have issued a checklist of symptoms to look out for:

  1. High Temperature
    This is one of the most common symptoms – this means you feel hot to the touch, particularly on your chest and back.
  2. Coughing
    Another common symptom is a new and continuous cough. This means that you are coughing for more than an hour or have three or more long coughing fits in a 24-hour period. If you are already suffering from a cough, then look out for this getting worse or the coughing fits lasting longer.
  3. Loss of taste and smell
    Recently, the government has highlighted that another symptom is a loss or change to your taste and smell. For some sufferers, they have not been able to smell or taste anything, whilst for others, they have noticed a change in the way things are tasting or smelling.

What to do if you have symptoms

If you have noticed any symptoms of the coronavirus, however mild they might be, it is important that you follow the UK guidelines. This means:

  • If you live alone, you should quarantine (stay at home) for at least seven days from when your symptoms started. If you live with others, all household members who remain well must stay at home and isolate for 14 days.
  • You do not need to call NHS 111 to go into self-isolation. If you feel you cannot cope with your symptoms at home, or your condition gets worse, or your symptoms do not get better after 7 days, then use the NHS 111 online service. If you do not have internet access, you should call NHS 111.
  • For a medical emergency dial 999.
  • If you have any symptoms of coronavirus (COVID-19), you should arrange a test within 3 days of symptoms starting by visiting https://www.nhs.uk or contact 111 via telephone if you do not have internet access.

Preventative measures you can take

There is currently no vaccine for the coronavirus, which means that for the moment the focus is on reducing the spread of the disease and keeping the ‘R’ rate below 1. This R-value is the average number of people that an infected person passes the disease on to. Keeping the R-value below one, therefore, reduces the spread and keeps it under control; ensuring our hospitals and medical services are not overwhelmed.

We can all help to reduce the spread. Even as some lockdown measures are eased, it is important that you continue to follow the social distancing measures that the government has outlined.

People with type 2 diabetes or those classed as ‘vulnerable’ should try to prevent themselves from coming into contact with the virus – by staying at home as much as possible and, if you do go out, take particular care to minimise contact with others outside your household. Currently, people living with diabetes are not on the list of vulnerable people. If you suffer from Type 1 or Type 2 diabetes (or gestational diabetes), then you should still try to reduce your exposure to the outside world as much as possible.

Additional advice

If you are someone living with diabetes, you should ensure that you have adequate supplies of your glucose testing equipment and ketone testing strips if needed. Many shops and chemists are unusually busy and so having a suitable level of supplies at home will ensure that you can reduce the number of times you need to go outside.

You should keep around a month’s worth of insulin and/or diabetes medicine, but there is no need to stockpile any more than that. The government and healthcare industry are working hard to maintain supplies and stockpiling unnecessary medicine and equipment will place additional pressure onto these supply chains and potentially prevent someone who really needs that medicine from receiving it.

Although hospitals are still operating as normal for emergencies, most of them have currently cancelled any routine appointments (such as your annual diabetes review). Things are slowly returning to normal, but until they do then regularly monitoring your blood glucose levels and sticking to a healthy diet, whilst undertaking regular exercise, can help to keep you in check.

The final word . . .

The current pandemic is a worrying time for many people, and it is entirely normal to feel anxious. But if you’re feeling overwhelmed, do not keep it to yourself – speak to your family and friends, your healthcare professional, or to the many charities and organisations available to help you.