Worried about COVID-19? Don’t panic: Here is the latest information and recommendations for people with type 1 diabetes, from the experts at the Juvenile Diabetes Research Foundation (JDRF).
COVID-19 — and similar viral illnesses, such as the flu — can pose a serious risk for people with T1D. Below you can find a few fast facts about T1D and COVID-19. If you still have concerns or questions, we strongly urge you to please contact your physician or healthcare provider. Your health and safety are of great importance.
What Should Someone with T1D Know about Having a Viral Illness?
Having Type 1 Diabetes (T1D) does NOT make you more susceptible to contracting COVID-19.
- Current evidence suggests that individuals with well-managed T1D are NOT at higher risk of contracting COVID-19.
- Experts further say that if someone with well-managed T1D does contract COVID-19, they are not necessarily at higher risk of developing serious complications from the disease.
- Those at greatest risk are people with consistently elevated blood sugar levels and those with a second chronic disease (such as heart disease or lung disease).
- For a detailed explanation, please read this blog or view this video from leading national endocrinologist, Dr. Anne L. Peters.
- If you have T1D and do become ill, with any virus, you must take special care of you and your T1D (see below).
Monitor your blood glucose and ketones more than usual.
- When you’re under the weather, you may not feel like eating or drinking much, and you may be taking medication to address symptoms such as fever and muscle aches.
- For all of those reasons, it is crucial to carefully monitor your blood glucose and ketones more often than usual, as often as every four hours. Check your continuous glucose monitor (CGM) if you have one, or frequently use finger sticks. It may be necessary to take extra insulin to bring down higher blood glucose levels.
- Be on the lookout for ketones, as very high levels could lead to diabetic ketoacidosis (DKA), a dangerous condition that demands immediate medical attention, and can be fatal if left untreated.
- Elevated ketone levels often occur when blood sugar readings are high. This can be a sign that the body is using fat and muscle for energy, instead of sugar.
- Other signs of DKA include flu-like symptoms (feeling tired, weak, aches, nausea or vomiting, abdominal pain), dehydration and also a fruity smell to the breath with more rapid breathing, which happens when the body is trying to eliminate the ketones and acid.
- If you have vomiting, moderate or large ketones, symptoms of DKA, contact your healthcare provider immediately.
It is more important than ever to continue a normal schedule of medications.
- This can be challenging when you feel sick, especially if you’re having a hard time keeping food and liquid down.
- Beyond insulin, many over-the-counter (OTC) medications also affect blood glucose levels. Though there are some sugar-free cough syrups on the market, many such syrups contain sugar, which only exacerbates already high blood glucose levels.
- Pills taken orally—that have the same ingredients as syrups—can be a better choice if they contain no carbohydrates.
- Other drugs like decongestants also raise blood glucose.
- Be aware of the effects of pain and fever reducers, too.
- Aspirin in large doses can lower blood glucose levels.
- Acetaminophen can cause false or no readings in CGMs, and can be toxic to the liver and kidneys. Anyone with kidney complications should be cautious about using these drugs with acetaminophen.
- Ibuprofen should also be handled with care as it increases the hypoglycemic effect of insulin.
Stock your cabinets with items that will help you keep up your carbohydrate intake in a healthy way.
- Foods like crackers, vegetable or noodle soups, unsweetened applesauce, or fruit-flavored yogurt are all easy-on-the-stomach selections.
- If those mild foods prove difficult to swallow, liquids can be a short-term solution.
- If blood sugars are in range, start with drinks that contain carbohydrates, and plan to consume something every three to four hours. Options include fruit juices such as orange or cranberry, sports drinks and regular soft drinks.
- It’s important to stay well hydrated, especially when ketones are present, to flush them out. Increase your intake of carb-free choices like water, broth, and sugar-free gelatin, popsicles or soft drinks.
Be prepared, just in case.
- It is vital to be ready for the worst, even if (hopefully) you never experience it.
- Ensure that you have diabetes medical supplies on hand and have access to refills in the event that you are quarantined.
- Have your doctor’s phone numbers (including how to reach them at night and on weekends or holidays) ready in case you encounter these symptoms: vomiting or diarrhea for more than six hours; shortness of breath; a fever that won’t go away after a couple of days; large levels of ketones; and inability to keep food or liquid down and are experiencing hypoglycemia.
- For children, call a doctor if they: have trouble breathing or exhibit blue lips; won’t eat or drink; experience severe ear pain (this may indicate an ear infection); and are much more sleepy than usual.
- If you end up at the emergency room, it is vital that you mention that you or your loved one has T1D, and have an ID bracelet prominently displayed.
Preparing for the Hospital
When should I go to the Hospital?
- If you are worried that you may be showing signs of diabetic ketoacidosis (DKA) seek help. Do not wait. If left untreated, DKA can lead to death.
- If you suspect someone you love may be showing signs of diabetes, seek help. We were devastated to hear of a recent death when T1D was thought to be the flu.
- With COVID-19, physicians urge you to seek help if you have trouble breathing, persistent pain or pressure in the chest, new confusion or inability to arouse or have bluish lips or face
What should I do before I go to the hospital?
- Contact your personal physician and have them call ahead of your arrival to ensure staff know that you have T1D, the medical issue you are going to the hospital for and your arrival time.
- Pack a bag with two weeks of T1D supplies.
Hospital Protocols vary and some may not allow the use of your own supplies and T1D technology, but experts advise that you bring your own supplies and be prepared to rely on them if possible.
- If you have one, take your continuous glucose monitor (CGM), as this allows medical staff to quickly and frequently check your levels. Know that hospital policies vary, but during the pandemic, many hospitals are welcoming personal CGMs.
- All insulin pens, needles and back-up pens
- Syringes are typically available, but, if permitted, you may feel more comfortable using what you are accustomed to
- Many hospitals do not carry all types of insulins, so if you would prefer not to change, bring your own
- If you use a pump: infusion sets, reservoirs and filling mechanism (or in the situation of OmniPod Pods), vial of rapid acting insulin (with a back-up vial), batteries and / or a charging cable
- Sensors, transmitter and back-up transmitter adhesives / tapes or pre-insertion wipes, batteries and / or charging device, plus cables
- Meter, lancet, lancing device and strips (you may need to use the hospital meter, but ask to use your own lancing devices as they are likely smaller gauge needles)
- Supply of treatments for lows
- Glucagon
- Piece of paper with your endocrinologist’s name and contact information
- Ketone strips (should be available, but good to take with you)
For more information about Type 1 Diabetes and COVID-19, visit JDRF’s Coronavirus page: www.jdrf.org/coronavirus
Source: www.jdrf.org.
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