by Christel Oerum, DiabeteStrong
The COVID-19 virus has turned everyone's life upside down, and with people living with diabetes being told that they are a “high-risk group” and to take extra precautions to stay safe, it’s no wonder that anxiety levels are rising in the diabetes community.
Because there is a lot of (sometimes conflicting) information about diabetes and COVID-19 circulating on social media, many people living with diabetes are confused about what to believe. Consequently, many will seek support and guidance on how to navigate the current situation from their diabetes care and education specialist and the Association of Diabetes Care & Education Specialists.
As the owner of DiabetesStrong.com, I experience the confusion, frustration and anxiety firsthand from our readers and on our social media platforms.
I surveyed the Diabetes Strong community and asked them about their most burning COVID-19 questions and what misconceptions they saw most often when it comes to diabetes and COVID-19. After reading through the many replies, I distilled them down to 10 questions that I discussed with leading endocrinologist Dr. Anne L. Peters.
Diabetes care and education specialists can have a strong role in guiding people living with diabetes through the facts of diabetes and COVID-19.
If your blood sugar is consistently above 200 mg/dl, it will impact how well you will be able to fight the virus if infected. Hyperglycemia is an issue for healing as it makes the immune fighting cells less effective.
Are people with diabetes more likely to get COVID-19?
The short answer is no, people living with diabetes are not immune-compromised, and there is no evidence that people living with type 1 or type 2 diabetes are more likely to get infected with COVID-19.
The caveat is that we don’t have any clear data about diabetes and COVID-19 yet. The data from China has people of all ages and types of diabetes lumped together.
Are you at a higher risk of getting COVID-19 if your diabetes isn’t well managed?
No, for the reasons listed to in the previous question.
However, if your blood sugar is consistently above 200 mg/dl, it will impact how well you will be able to fight the virus if infected. Hyperglycemia is an issue for healing as it makes the immune fighting cells less effective.
What complications increase the risk?
If someone lives with cardiovascular disease or kidney disease, they are at higher risk should they get infected with COVID-19.
Other factors such as age and asthma can also increase the risk should someone get infected.
What symptoms should we look for if we think we may have COVID-19? Is that different for people living with diabetes than for other people?
The symptoms of COVID-19 are not different for people living with diabetes, and still include fever, cough and shortness of breath. Many of Dr. Peters patients measure their temperature daily to check for a fever.
If someone living with diabetes has a fever, they might also notice that their blood sugars start to run higher than normal.
Can some diabetes medications amplify the immune response to COVID-19?
At this time, we don’t know of any diabetes medications that amplify the immune response to COVID-19. No one should stop taking their medication unless they’re guided to do so by a medical professional. However, if someone is on an SGLT-2 Inhibitor (like Jardiance or Farixga or Invokana) they should probably stop it if they become ill.
Should we be concerned about the availability of diabetes medication and supply?
No, the leading diabetes medication and supply companies have ensured us that there won’t be an impact on their manufacturing and distribution. The only potential bottleneck could be your ability to see a doctor, to get your prescriptions renewed.
Dr. Peters encourages everyone to make sure that they have a year's refills on their important prescriptions. The concern is that, as more people get sick, it will become harder to reach your doctor for a new prescription, so getting that done now should be a priority.
People with type 2 diabetes who are not dependent on insulin might need to reduce their diabetes medication if they start to get too many hypoglycemic episodes. Especially Sulfonylureas and insulin increase the risk of hypoglycemia and might need to be adjusted.
What should we do if we contract COVID-19?
Everyone living with diabetes should have a sick-day plan. The plan will differ depending on how the individual's diabetes is managed.
Dr. Peters recommends having Tylenol at hand for muscle pain (contrary to what many think, Tylenol does not interfere with the Dexcom G6 readings), cough syrup and an anti-nausea medication, like Zofran for nausea. Also, all people with type 1 diabetes should have ketone test strips available.
For those dependent on insulin, the risk of DKA increases when sick. Often when people are nauseated, they can’t or won’t eat and then stop taking their insulin. Dr. Peters suggests having liquid carbohydrates as well as electrolytes to prevent people from becoming ketotoic. Everyone should also have a supply of both long-acting and rapid-acting insulin as well.
People with type 2 diabetes who are not dependent on insulin might need to reduce their diabetes medication if they start to get too many hypoglycemic episodes. Especially Sulfonylureas and insulin increase the risk of hypoglycemia and might need to be adjusted. SGLT-2 inhibitors should also be considered as they can lead to dehydration. Finally, GLP-1 RA’s and metformin may need to be held if individuals are anorexic or nauseated.
Dr. Peters points out that getting to a doctor can become increasingly difficult going forward, so diabetes care and education specialists can help you understand your self-adjustments and care.
If we had the virus and recovered, can we get it again or are we now immune?
We don’t know. As of today, there’s no cure and no vaccination for COVID-19. Just as with influenza, we might see COVID-19 mutate and be a reoccurring virus, but we don’t know yet.
If you work in an essential job and cannot practice social distancing, how can you protect yourself – do you have the right to take leave?
Dr. Peters suggests discussing your situation with your HR department. Although people living with diabetes aren’t at a higher risk of getting infected with COVID-19, some get so anxious that it’s hard for them to function in the workplace.
According to the American Diabetes Association (ADA), people living with diabetes are covered by the Americans with Disability Act which requires covered employers to provide reasonable accommodations for employees with disabilities, such as diabetes. This applies to everyone, not just people working “essential” jobs.
The most common accommodations for people with diabetes are:
- Temporary reassignment of certain job functions to allow for physical distancing
- Temporary reassignment to another position that is vacant
- Provision of parking so that employee may avoid public transit
- Permission to use personal protective equipment such as gloves/masks
If your doctor asks you to stay home (regardless of job), are you entitled to paid leave?
There doesn’t seem to be a clearcut answer to this question at the time of writing this article, and it may vary from state to state.
According to the ADA website, certain employees are entitled to protection under the Family Medical Leave Act (FMLA). This law provides 12 weeks of leave for employees who themselves have, or have a family member with, a serious health condition.
Others might have rights under the new Families First Coronavirus Response Act or other state and local laws.
Christel is a Los Angeles based speaker, writer, diabetes coach and diabetes advocate. She has been living with type 1 diabetes since 1997 and is the founder of www.DiabetesStrong.com, a free diabetes website with information on all subjects related to exercise, health and general diabetes management for people living with any type of diabetes.
ADCES Perspectives on Diabetes Care
The Association of Diabetes Care & Education Specialists Perspectives on Diabetes Care covers diabetes, prediabetes and other cardiometabolic conditions. Not all views expressed reflect the official position of the Association of Diabetes Care & Education Specialists.
Copyright is owned or held by the Association of Diabetes Care & Education Specialists and all rights are reserved. Permission is granted, at no cost and without need for further request, to link to, quote, excerpt or reprint from these stories in any medium as long as no text is altered, and proper attribution is made to the Association of Diabetes Care & Education Specialists.
HEALTHCARE DISCLAIMER: This site and its services do not constitute the practice of medical advice, diagnosis or treatment. Always talk to your diabetes care and education specialist or healthcare provider for diagnosis and treatment, including your specific medical needs. If you have or suspect that you have a medical problem or condition, please contact a qualified health care professional immediately. To find a diabetes care and education specialist near you, visit DiabetesEducator.org/Find.