Spotlight: Diabetes and COVID-19

TRACY BLITZER

DIABETES EDUCATION COORDINATOR

We're posting this article on the eve of Halloween — a spooky, silly night that is fun for kids of all ages. But for diabetics, Halloween can be a day of over-indulgence, with sugary treats at every turn. Hey, at least there's a walk around the neighborhood with the kids, right? Not this year? Oof.

Diabetics, let's get focused! It's important to keep your blood sugar under control at all times, but it's especially important right now in the COVID-19 pandemic. Halloween, or not.

Let me be clear: Diabetes does not increase your risk of catching COVID-19. But, there's good reason to consider yourself, or the diabetic in your life, to have some extra COVID risks: diabetics can have worse complications if they do get sick, especially if their diabetes is not well-controlled. Studies have shown that people with diabetes who have severe COVID-19 infections were more likely to have serious complications, due to several factors:

High blood sugar weakens the immune system, and makes it less able to fight off infections.
Risk of severe infection is greater if you have any other conditions such as heart or lung disease.
Infections lead to an increased risk for diabetes complications like hyperglycemic hyperosmolar syndrome (HHS), or diabetes ketoacidosis (DKA). DKA happens when high levels of ketones build up in your blood, which can be very serious and can happen quickly. HHS happens when your body does not have enough insulin, and usually takes days to occur.

So what is a diabetic to do? First, we've got to keep you healthy.

Avoiding infection

Just like everyone else, you must:

Stay home as much as possible and avoid crowds.
Keep at least 6 feet away from other people, and wear a face mask.
Wash your hands with hot soapy water for 20 seconds, or use hand sanitizer with 60-70% or higher alcohol often while you are out and when you get home. Avoid touching your eyes, nose, and mouth.

But you should also:

Wash your hands before performing a finger stick or giving yourself a shot. Clean each site first with soap and water or rubbing alcohol.
To protect you, everyone in your house should wash their hands often, especially before they cook. Don’t share utensils or other personal items. If anyone in your house is sick, they should stay in their own room, as far as possible from you. They should wear a mask when they have to be in the same room with you.
Be diligent with your other health measures. Take your medications, make healthy eating choices, stay hydrated, and include movement or exercise in your daily routine. Get your flu shot so you are less likely to battle flu this year. Ask your provider about an MMR booster or Vitamin D supplement, which have both been linked to positive COVID-19 outcomes.

Next, all patients with diabetes know: preparedness is key. So, let's make a plan.

Your COVID-19 Diabetes Plan

1) Gather supplies to manage your diabetes at home in case you get sick. If you have COVID-19 you'll be sheltered-in-place or quarantining from others, so there will be no running to the pharmacy or store. Make sure you have:

Enough food, especially healthy carbs. Arrange for a home food delivery now, while you're healthy, to try this in advance! Use the app for your favorite store like Giant or Wegmans, or use Instacart to pick from a variety of stores. Trying it in advance before you're sick is a good way to work out any difficulty using the app, which you won't want to deal with when you're ill.
Blood sugar testing supplies
Ketone testing strips
Continuous glucose monitor sensors (if you use CGM) and back-up blood glucose meter & testing supplies
Fast-acting carbs to treat low blood sugar (glucose tabs, fruit juice, or hard candies)
Severe low blood sugar emergency kit (glucagon)
Extra medicine. During a state of emergency, you may be able to refill a prescription before it’s due (30- or 90-day supply).
- If you can’t get to a pharmacy, try home delivery or mail-order.
- If you use an insulin pump, talk to your health care provider about a back-up plan, which may include having long-acting insulin and knowing your pump settings.

2) Gather information. A conversation with your provider can shed a lot of light on how best to manage being sick. Medicare and some private insurance companies now cover the cost of telehealth (Zoom) visits if you are not comfortable going into the office. Make sure you ask your provider:

How often to check your blood sugar and test for ketones when you're ill
How to adjust your medicines if you become sick
What cold and flu remedies are safe for you to take

But what happens if you do get sick?

What to Do if You Get Sick

Call your provider for an appointment.
Check your blood sugar often (every 2-3 hours). Aim for levels between 70-180mg/dL. If you have low blood sugar (less than 70 mg/dL), eat 15-20 grams of fast-acting carbs and re-check blood sugar in 15 minutes. Repeat if needed until blood sugar is at least 80 mg/dL, then have a snack that contains carbs and protein.
Do not stop taking your insulin. If you have a fever, insulin needs are usually higher.
Drink lots of fluids to stay hydrated.
Test for ketones every 4 to 6 hours, or if blood sugar is higher than 240 mg/dL more than 2 times in a row. DKA is serious. Contact your health care provider immediately if you have symptoms of DKA:
- High levels of ketones
- High blood sugar levels (250-300 mg/dL)
- Difficulty breathing
- Fruity odor on breath
- Feeling drowsy, confused, or disoriented
- Frequent urination, increased thirst
- Nausea, vomiting, stomach pain
HHS has many of the same symptoms as DKA, but blood sugar is even higher and you'll have just a trace or NO ketones. If blood sugar remains above 300-400 mg/dL over a few hours, call your provider.
Treat underlying illness or symptoms as instructed by your provider.
Some over-the-counter cold medicines can affect blood sugar levels! Syrups that contain sugar and decongestants can raise blood sugar (pills that contain the same ingredients as syrups, without the sugar, may be a better choice). Acetaminophen (Tylenol) can cause false readings in some CGMs (check blood sugar with finger sticks to make sure it is accurate).
Get Medical Help Immediately if you have:
- Severe Shortness of Breath
- Persistent pain or pressure in chest

Don’t Forget: Take it easy on yourself.

Well-controlled blood sugar is an outcome of four variables: food, exercise, medicine, and emotion. Not only is the COVID-19 pandemic distracting from our normal diabetes self-management, but it has created many unique emotional challenges we have never faced before in this context: uncertainty, fear, isolation... and even income loss (which can perpetuate the other three). These new feelings may lead to emotional eating, less exercise, not taking medicines or not making healthy food choices due to cost, and many other personal challenges. We need to remind ourselves that the pandemic should be a daily reminder of the value of self-care, compassion, and patience. We are all doing the best we can, and that is okay. If you have questions about your diabetes, or are searching for strategies to keep it under control, don't hesitate to reach out. I'm here to help.