COVID-19 has the potential to increase health complications in people with diabetes, whether type 1 or type 2. Here’s what these individuals need to know.
If you’ve been keeping up with federal guidance on who’s at higher risk for complications from COVID-19, you know that people with diabetes are among the affected groups. People older than 60, along with those who have respiratory problems, high blood pressure, and heart disease are, too, notes the Centers for Disease Control and Prevention (CDC).
That said, if you have diabetes, the disease doesn’t appear to increase your risk of being infected, according to the American Diabetes Association (ADA). This is apparently true even though research, including a review published in the Indian Journal of Endocrinology and Metabolism, shows that the immune systems of people with persistent hyperglycemia function less well. With COVID-19 — the disease caused by the coronavirus — the real problem is that people with diabetes are more vulnerable to complications and getting seriously ill from the virus once they are infected, says the ADA.
It had been clear early on in China, where the first cases of the disease were reported, that people with diabetes had much higher rates of serious complications and death than people without this condition, the organization explains in its online guide to COVID-19. That’s because people who already have diabetes-related health problems are likely to fare worse if infected simply because of those problems. A person with diabetes who is otherwise healthy doesn’t carry the same level of risk.
A small, preliminary study of 174 people in Wuhan, China, suggested that people with COVID-19 and diabetes but without other comorbidities were at a higher risk for severe pneumonia and inflammation that contributes to an accelerated progression of COVID-19 and a worse prognosis. Researchers published their findings in the March 2020 issue of Diabetes Metabolism Research and Reviews.
Another study, which was published in April 2020 the Journal of Diabetes Science and Technology (PDF), analyzed 1,122 people at 88 hospitals in 11 U.S. states, and drew a link between having diabetes and a fourfold increased risk of dying from COVID-19. Glytec, a provider of insulin software management, funded the research.
Other, more recent research, published online in May 2020 in Cell Metabolism, supports these findings. For this cohort study, researchers analyzed the health data of 7,337 people in Wuhan with and without type 2 diabetes. They observed an association between having diabetes and an increased risk of dying from COVID-19. However, those with stable blood sugar levels had a better prognosis than those with diabetes whose blood sugar control was poor.
In fact, the survival rate for those with good blood sugar control was nearly 99 percent, compared with an 11 percent death rate among those whose control was considered poor.
Participants’ blood sugar levels were measured using postprandial and fasting blood glucose tests. The authors defined poor blood sugar control as tending to exceed 180 milligrams per deciliter (mg/dL), and well-controlled blood sugar as ranging from 70 to 180 mg/dL.
It also doesn’t appear to matter what type of diabetes you have. “We tell our patients with either type 1 or type 2 diabetes that as of today there is no information saying whether patients with type 1 have a higher risk in comparison with type 2, or vice versa,” says Katherine Araque, MD, the director of endocrinology at the Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, California.
RELATED: The Latest News on COVID-19
Understanding COVID-19 and Its Symptoms
According to the World Health Organization (WHO), coronaviruses are a large family of viruses that cause diseases including the common cold, but also more severe illnesses such as Middle East respiratory syndrome (MERS); severe acute respiratory syndrome (SARS); and COVID-19, which first became known at the end of 2019 during an outbreak in the city of Wuhan in China’s Hubei province and has since developed into a pandemic. As of now, there is no vaccine or cure for the coronavirus that causes COVID-19.
Common symptoms of COVID-19 include fever, tiredness, dry cough, aches and pains, nasal congestion, runny nose, sore throat, and diarrhea, the WHO reports. Some infected people have no symptoms at all, but they can still spread the virus.
A mysterious rash on the toes, dubbed “COVID toes,” may also be a sign of COVID-19, suggested an early study published in May 2020 in Pediatric Dermatology. Typically though, this is a natural immune response in healthy people, and may signal that the individual is recovering or has recovered from the disease.
For most people the disease is mild, and about 80 percent of those infected recover from COVID-19 without needing hospitalization or special treatment. Yet around 1 out of every 5 infected people do become seriously ill, develop difficulty breathing, and require hospital care. While estimates for the death rate vary, even at a low-end estimate of 1 percent, COVID-19 is 10 times more deadly than the seasonal flu, says Anthony Fauci, MD, the director of the National Institute of Allergy and Infectious Diseases, as reported by CNBC.com.
If you have fever, cough, and difficulty breathing, WHO advises you to seek medical attention. Stay at home and call your doctor. Don’t go to an emergency room unless you are having a medical emergency, in which case you should call 911, advises the CDC. The agency describes the emergency warning signs for COVID-19 in adults as difficulty breathing or shortness of breath; persistent pain or pressure in the chest; new confusion or inability to arouse; and bluish lips or face.
Given all that, if you have diabetes and wish to stay in the best health possible during this pandemic, Dr. Araque and other experts have some advice.
1. Follow the CDC Guidelines for Everyone
“We know that we should follow the CDC guidelines with regard to symptoms and when to test, regardless of the underlying diagnosis of diabetes,” says Araque.
Those guidelines include:
- Clean your hands often with soap and hot water or sanitizer that is at least 60 percent alcohol.
- Avoid touching your eyes, nose, and mouth with unwashed hands.
- Avoid close contact and practice social distancing (staying at least 6 feet apart).
- Cover coughs and sneezes with a tissue (then clean your hands!).
- Clean and disinfect frequently touched surfaces daily, and dirty ones immediately.
- Stay home if you’re sick.
- Separate yourself from others if you have been diagnosed with COVID-19 or think you have it.
- Wear a face mask outdoors.
- Call ahead about medical attention unless you are having a medical emergency.
Of course, in this fast-moving pandemic, local, state, and federal regulations and guidelines are constantly shifting regarding meetings, gatherings, travel, working, and when you should stay at home. Follow the latest ones, as they are meant to slow the spread of the virus.
2. Keep Your Diabetes Treatment Supplies and Equipment Clean and Disinfected
“We advise our patients to please keep up hygiene at home, to keep washing their hands,” says Araque. “For patients with diabetes, it is important to wash their hands thoroughly before administering insulin or injectable medications.” They should also use soap and water to clean the areas on their body where they inject their medications. She further cautions patients not to share needles or pens, and to dispose of needles safely.
3. Keep Your Prescriptions Filled and Stock Up on Extra Supplies
“We want to ensure that those patients have all their medications — not only the medications to treat diabetes but the medications to treat hypoglycemia,” says Araque. She advises having extra glucagon or glucose tablets in case your blood sugar drops too low. People who take insulin should have backup insulin pens (or syringes and vials) if needed, and extra ketone strips.
“Contact your insurer or diabetes supplier about increasing your allotment of supplies,” advises Melissa Young, PharmD, CDCES, a pharmacist at University of Utah School of Medicine in Salt Lake City and a spokesperson for the Association of Diabetes Care and Education Specialists. “You do not want to run out of continuous glucose monitoring sensors or pump tubing. If your pump malfunctions, calling the manufacturer will usually be the first step. If a glucometer malfunctions, there is an 800 number on the back of the glucometer, try that first. Typically, manufacturer support is available to assist with glucometer questions.”
As for how much you should stock up on: “The CDC recommends a 14-day self-quarantine period for anyone exposed to the coronavirus, so to be safe, at least several weeks’ to a month’s supply of medications on hand is recommended,” says Dr. Young.
4. Check for Measures That Make It Easier to Get Those Extra Supplies
If you are worried about the possibility that your prescription coverage won’t allow early refills, check with your pharmacy benefit provider or insurance provider. “Now that a national emergency has been declared, many insurers have increased allowances for [number of] days’ supplies or early refills for chronic care, noncontrolled — such as nonopioid — medications for underlying medical conditions such as diabetes and high blood pressure,” says Young.
For instance, the large pharmacy benefit manager CVS Caremark announced on March 12 that it is working with its clients to waive early refill limits on 30-day prescription maintenance medications, and that furthermore, Aetna will offer 90-day maintenance medication prescriptions for insured and Medicare members.
“Contact your regular pharmacy or diabetes supplier as soon as possible,” Young advises. “Your prescription information is on file, and they are aware of your insurance plan allowances on medications and supplies to be received per prescription.” Call the toll-free number on the back of your health insurance card for benefit details, she says. Take advantage of mail-order delivery if you are instructed to stay at home or are taking self-isolation measures.
If you are worried about the cost of extra medication and lack adequate coverage, check the JDRF resource page for help with diabetes medication costs. JDRF is a nonprofit dedicated to type 1 diabetes advocacy and research.
In general, know that several pharmaceutical companies have patient assistance programs (PAPs) that are designed to help people with diabetes better afford their insulin and oral medication. For example, Novo Nordisk and Dexcom have announced PAPs to serve individuals affected by job loss or insurance coverage related to COVID-19. Other pharmaceutical companies have existing PAPs that may help you in your specific situation. Ask your healthcare team if a PAP can help you better afford, and thus adhere to, your diabetes treatment plan.
5. Don’t Worry Yet About the Medication or Insulin Supply Chain
You may be wondering if measures to slow the spread of the coronavirus behind COVID-19 will affect your ability to get your medications and medical supplies on time.
As of May 12, a JDRF webpage on type 1 diabetes and COVID-19 stated that the organization is in touch with drug and diabetes supply manufacturers and is also unaware of any disruptions. “Each leading manufacturer has shared with us that COVID-19 is not having an impact on their current manufacturing and distribution capabilities. We will continue to monitor the situation and update the T1D community should anything change,” according to the JDRF. The page links to statements by several major manufacturers who say they don’t foresee any supply shortages or disruptions. The JDRF advises people to keep checking this page for the latest developments.
6. Know That Some Over-the-Counter Medication Can Affect Blood Glucose
Some over-the-counter medications used to treat cold and flu symptoms may affect your blood sugar levels, the JDRF warns. These include:
- Cough syrups, except those that are labeled sugar-free
- Pills that contain the same ingredients as syrups and do not have carbohydrates
- Decongestants such as phenylephrine and pseudoephedrine
- Aspirin in large doses
- Advil (ibuprofen), which can increase the hypoglycemic effect of insulin
Ask your healthcare provider if you are not sure about the effects of an over-the-counter medication.
7. Be Vigilant for Signs of Unstable Blood Sugar or DKA, Especially if Insulin or Other Drugs Run Low
People with type 1 diabetes, and, in rare cases, long-standing type 2 diabetes, are vulnerable to developing a potentially life-threatening condition known as diabetic ketoacidosis (DKA), notes Araque. When the body doesn’t have enough insulin to convert glucose into energy, it begins to break down fat to use as fuel. The result is a buildup of acids in the bloodstream known as ketones.
“We advise patients to check their ketones at home if they are experiencing persistent hyperglycemia to make sure they don’t go into DKA, regardless of whether they have any symptoms. This can happen in patients that miss injections or that have failures in their pumps or any problems getting access to insulin. They need to go to the hospital, separate of any symptoms of COVID-19.”
Given how the COVID-19 pandemic has changed daily life and increased stress for many people, you may also need to be checking your blood sugar more regularly, note new guidelines released by the JDRF–Beyond Type 1 Alliance. Ask your doctor about the right frequency for you.
8. Maintain a Healthy Lifestyle by Prioritizing Diet, Exercise, and Sleep
With gyms closed and many sports activities postponed, it can be a challenge to stay on the healthy regimen you established before the pandemic. “In my experience, some patients become sedentary when they stay at home,” notes Araque. If you are not under quarantine or otherwise advised to stay at home, go for a walk outside in the park (while maintaining social distancing guidelines). If you are homebound, pop in an exercise video or hit the Peloton. There are plenty of free resources to help you exercise online, as well. Also make sure you are stocking up on food that helps you consume carbohydrates in a healthy way, the JDRF advises. Also, continue to manage stress and prioritize sleep — two other essentials for managing your blood sugar.
9. Lean on Peers With Diabetes for Support
In its guidelines, the JDRF–Beyond Type 1 Alliance recommends reaching out to others living with diabetes for support. “None of these behaviors are easy, and we all need support,” the organizations write in their guidelines.
A study published in October 2018 in Diabetes Caresuggests that people with type 2 diabetes who participate in peer support programs are able to better manage depression and their blood sugar than those who don’t. These results may lower overall healthcare costs, researchers say.
Meanwhile, participation in a diabetes online community is associated with increased self-care habits, notes a study published in July 2018 in Future Science OA. These habits include eating a healthy diet, exercising, and sticking to your medication regimen.
There are plenty of online resources for finding peer support, including Facebook groups and the ADA’s peer support directory.
10. If You Call the Doctor, Keep Both COVID-19 and Diabetes in Mind
If you are sick, don’t hesitate to reach out to your healthcare team, according to the JDRF–Beyond Type 1 Alliance guidelines. But be sure to call first and have your health information ready.
“When people with diabetes call their doctor’s office for advice, they should be prepared to report blood sugar values, medication doses taken or missed, severity of respiratory symptoms, any nausea or vomiting, and how much they are able to eat or drink,” says Julie Adkison, PharmD, CDCES, a pharmacist and certified diabetes educator in Houston, who runs the blog My Diabetes Village. “Be aware of the signs and symptoms of DKA so that you know when to check for ketones, and seek care immediately if needed.”
And don’t be afraid to voice your concerns to your healthcare team. “This is not the time to not ask questions,” says Araque. “This is the time to ask questions and call your provider. It’s better to ask them than to delay care.”
For more information on how COVID-19 is affecting those living with diabetes, check out a recent study from Diabetes Daily.