The CDC has determined that COVID-19 is a serious public health threat—and older adults and people with serious chronic medical conditions, including diabetes, are at a higher risk of experiencing complications and getting very sick from it.
Here’s what you need to know:
People with diabetes are not more likely to get COVID-19 than the general population.
The problem people with diabetes face is primarily a problem of worse outcomes, not greater chance of contracting the virus.
In China, where most cases have occurred so far, people with diabetes had much higher rates of serious complications and death than people without diabetes—and generally we believe that the more health conditions someone has (for example, diabetes and heart disease), the higher their chance of getting serious complications from COVID-19.
We expect the death rate to decline over time as we get better at detecting and treating this specific virus.
People with diabetes do face a higher chance of experiencing serious complications from COVID-19.
In general, people with diabetes are more likely to experience severe symptoms and complications when infected with a virus.If diabetes is well-managed, the risk of getting severely sick from COVID-19 is about the same as the general population.
When people with diabetes do not manage their diabetes well and experience fluctuating blood sugars, they are generally at risk for a number of diabetes-related complications.
Having heart disease or other complications in addition to diabetes could worsen the chance of getting seriously ill from COVID-19, like other viral infections, because your body’s ability to fight off an infection is compromised.
Viral infections can also increase inflammation, or internal swelling, in people with diabetes. This is also caused by above-target blood sugars, and both could contribute to more severe complications.
When sick with a viral infection, people with diabetes do face an increased risk of DKA (diabetic ketoacidosis), commonly experienced by people with type 1 diabetes. DKA can make it challenging to manage your fluid intake and electrolyte levels—which is important in managing sepsis. Sepsis and septic shock are some of the more serious complications that some people with COVID-19 have experienced.
COVID-19 is different from the seasonal flu.
COVID-19 is proving to be a more serious illness than seasonal flu in everyone, including people with diabetes. All of the standard precautions to avoid infection that have been widely reported are even more important when dealing with this virus.
Recommended safety precautions are the same as for flu, such as frequent hand washing and covering coughs and sneezes with a tissue or your elbow. The CDC does not recommend the use of face masks by people who are not infected.
We encourage people with diabetes to follow the guidance of the CDC and to review how you manage sick days—preparing for a sick day can make it easier.
The risks are similar for people with type 1 and type 2 diabetes.
In general, we don’t know of any reason to think COVID-19 will pose a difference in risk between type 1 and type 2 diabetes. More important is that people with either type of diabetes vary in their age, complications and how well they have been managing their diabetes.
People who already have diabetes-related health problems are likely to have worse outcomes if they contract COVID-19 than people with diabetes who are otherwise healthy, whichever type of diabetes they have.
Manufacturers are not reporting that COVID-19 is impacting access to insulin and other supplies.
Leading manufacturers are reporting that COVID-19 is not having an impact on their current manufacturing and distribution capabilities for insulin and other supplies at this time. We are continuing to monitor the situation and will provide updates should anything change. If you are struggling to pay for insulin or know someone who is, the ADA has resources to help—visit InsulinHelp.org.
If COVID-19 is spreading in your community, take extra measures to put distance between yourself and other people to further reduce your risk of being exposed to this new virus. Stay home as much as possible.
Before you get sick, make a plan:
Gather your supplies:
- Phone numbers of your doctors and healthcare team, your pharmacy and your insurance provider
- List of medications and doses (including vitamins and supplements)
- Simple carbs like regular soda, honey, jam, Jell-O, hard candies or popsicles to help keep your blood sugar up if you are at risk for lows and too ill to eat
- If a state of emergency is declared, get extra refills on your prescriptions so you do not have to leave the house
- If you can’t get to the pharmacy, find out about having your medications delivered
- Always have enough insulin for the week ahead, in case you get sick or cannot refill
- If you are struggling to pay for insulin or know someone who is, the ADA has resources to help—visit InsulinHelp.org
- Extra supplies like rubbing alcohol and soap to wash your hands
- Glucagon and ketone strips, in case of lows and highs
- Have enough household items and groceries on hand so that you will be prepared to stay at home for a period of time
Talk to your health care team about the following:
- When to call your doctor’s office (for ketones, changes in food intake, medication adjustments, etc.)
- How often to check your blood sugar
- When to check for ketones
- Medications you should use for colds, flu, virus, and infections
- Any changes to your diabetes medications when you are sick
Take everyday precautions:
- Avoid close contact with people who are sick
- Take preventive actions:
- Clean your hands often
- Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing, or having been in a public place.
- If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol.
- To the extent possible, avoid touching high-touch surfaces in public places–elevator buttons, door handles, handrails, handshaking with people, etc. Use a tissue or your sleeve to cover your hand or finger if you must touch something.
- Wash your hands after touching surfaces in public places.
- Avoid touching your face, nose, eyes, etc.
- Clean and disinfect your home to remove germs: practice routine cleaning of frequently touched surfaces (for example: tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks & cell phones)
- Avoid crowds, especially in poorly ventilated spaces. Your risk of exposure to respiratory viruses like COVID-19 may increase in crowded, closed-in settings with little air circulation if there are people in the crowd who are sick.
- Avoid all non-essential travel including plane trips, and especially avoid embarking on cruise ships.
Watch for emergency warning signs:
If you develop emergency warning signs for COVID-19 get medical attention immediately. In adults, emergency warning signs include:
- Difficulty breathing or shortness of breath
- Persistent pain or pressure in the chest
- New confusion or inability to arouse
- Bluish lips or face
If you feel like you are developing symptoms, call your doctor:
Pay attention for potential COVID-19 symptoms including fever, dry cough and shortness of breath. If you feel like you are developing symptoms, call your doctor.
When you call:
- Have your glucose reading available
- Have your ketone reading available
- Keep track of your fluid consumption (you can use a 1-liter water bottle) and report
- Be clear on your symptoms (for example: are you nauseated? Just a stuffy nose?)
- Ask your questions on how to manage your diabetes
If you do get sick, know what to do:
Here are some common tips, which may vary for each person:
- Drink lots of fluids. If you’re having trouble keeping water down, have small sips every 15 minutes or so throughout the day to avoid dehydration.
- If you are experiencing a low (blood sugar below 70 mg/dl or your target range), eat 15 grams of simple carbs that are easy to digest like honey, jam, Jell-O, hard candy, popsicles, juice or regular soda, and re-check your blood sugar in 15 minutes to make sure your levels are rising. Check your blood sugar extra times throughout the day and night (generally, every 2-3 hours; if using a CGM, monitor frequently).
- If your blood sugar has registered high (BG greater than 240mg/dl) more than 2 times in a row, check for ketones to avoid DKA.
- Call your doctor’s office immediately, if you have medium or large ketones (and if instructed to with trace or small ketones).
- Be aware that some CGM sensors (Dexcom G5, Medtronic Enlite, and Guardian) are impacted by Acetaminophen (Tylenol). Check with finger sticks to ensure accuracy.
- Wash your hands and clean your injection/infusion and finger-stick sites with soap and water or rubbing alcohol.
Know your rights:
A reminder: If you have diabetes, you have legal rights that do not go away during a health crisis like COVID-19.
- Even in a pandemic, you have the right to reasonable accommodations at work, which could include medical leave or alternate work arrangements.
- Your child’s Section 504 Plan should include accommodation for extra sick days without penalty. This would apply if your child is sick or if you choose to keep him or her home from school to avoid contagion with COVID-19.
- People with diabetes who are incarcerated or in police custody are entitled to appropriate and adequate medical care, and their medical needs may change during infectious disease outbreaks.
If you are concerned you are being treated unfairly because of your diabetes, contact us to seek help from our Legal Advocacy team.
For more information, please call 1-800-DIABETES (800-342-2383)
Source: American Diabetes Association
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