Are people with diabetes more likely to get the COVID-19 infection than others?
There is no evidence, as of now, that people with diabetes are at higher risk of catching the COVID-19 infection compared to those without diabetes. However, people with consistently high blood glucose are more likely to get infections, in general; and it is likely that the same concept applies to the risk of getting infected with the COVID-19 virus.
Are people with diabetes at a higher risk for having severe illness if they get infected with COVID-19?
Though data have been limited thus far, it is true that some studies have linked diabetes to a more severe illness and higher risk of dying of COVID-19. However, it is important to note that most of the patients with diabetes who died of COVID-19 in those studies were older people who also had other medical conditions that are considered risk factors of death such as heart disease, obesity, hypertension, and underlying lung disease. Each of these underlying medical conditions, on its own, increases the risk of having severe illness and dying from COVID-19. Therefore, we still cannot say that people with diabetes who have good glucose levels and do not have other risk factors are at higher risk of dying of COVID-19. That said, it is essential not to underestimate the importance of maintaining good glucose management especially during this time.
How can people with diabetes protect themselves during the COVID-19 pandemic?
Like anyone else, people with diabetes are recommended to follow the general guidelines provided by the Center for Disease Control and Prevention (CDC). There are no additional precautionary measures that people with diabetes should take to protect themselves from catching the COVID-19 virus. The updated recommendations can be found on the CDC website https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html which include:
- Clean your hands with soap and water for at least 20 seconds, especially after being in a public place or after coughing or sneezing.
- Avoid touching your eyes, nose, and mouth with unwashed hands
- Avoid close contacts with people, especially those who are sick
- Stay home as much as possible
Is there any special advice that you give to people with diabetes?
Yes, I strongly encourage all people with diabetes to make sure that they have enough supply of insulin and all the tools they typically use to manage their glucose (e.g. glucose meter strips, ketone strips, lancets, needles, and the supply needed for CGMs and pumps if they are using those). In our clinic, we have automatically provided all of our patients with a 90-day supply of their medications unless they already had those refilled within a month. This, however, is not the case for many people with diabetes around the world; and they are encouraged to talk to their health care providers to make sure that they are prescribed at least a 60-day supply of their medications and diabetes supply, if possible. I also encourage people with diabetes to avoid going to the clinics or pharmacies unless it is for urgent matters. Many clinics and pharmacies can ship the medications and supply to your home.
When should a person with diabetes get tested for COVID-19 or seek medical care?
As of now, not everyone needs to be tested for COVID-19; though the guidelines on who should be tested are frequently updated and vary from one state to another. You can check the CDC website for the most updated information on this: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html.
The majority of people with COVID-19 have mild symptoms or no symptoms and may not need to be tested or seek medical care. They, however, should isolate themselves so they do not spread the disease to others. It is the minority of people who become severely ill and should seek medical advice.
What should people with diabetes expect if they get infected with COVID-19?
Remember the sick-day rule. For people with diabetes, it is expected that your glucose will start rising when you have any infection; and COVID-19 is not an exception. If you have type 1 diabetes and see your glucose is rising and you are requiring multiple correctional doses of insulin that do not seem to be working, you should check the ketones and contact your health care provider for advice. If you start feeling ill or vomiting you should go to the hospital or call 911. It is understandable and advisable to self-manage your hyperglycemia or hypoglycemia at home if you are able but you also do not want to wait until you are very sick or develop diabetic ketoacidosis to seek medical care.
How can people with diabetes cope with the current situation?
It is understandable to be anxious or nervous during this period of uncertainty. The fear of getting sick, inability to leave home, and may be the loss of your job are all enough reasons to feel down. It is essential that we all make sure to practice good self-care. This includes getting enough sleep at night, eating healthy diet, and maintaining virtual social interactions. Exercise is also an essential component of good mental health that we should not ignore. Always remember, people with diabetes do not seem to be at a higher risk of catching the COVID-19 virus as long as they are following the precautionary measures listed above.
By Mohammed Al-Sofiani, MBBS MSc
