Diabetes & Covid-19: risks and measures against it
Updated: May 4, 2020
Here at DUET diabetes, we have been following the coronavirus outbreak closely. As the momentum continues to grow, we wanted to help you understand what the risk is for people living with diabetes and how we can be best prepared.
It has been more than 4 months since the World Health Organisation (WHO) first reported Coronavirus (COVID-19) on December 31st 2019 in Wuhan, China. In this time, the virus has spread at an alarming rate and has now become a global pandemic. We have all heard the news and read the papers on the importance of transparency in dealing with the virus, so based on this philosophy, we want to outline some facts relating to diabetes.
Are people living with diabetes at a higher risk?
Coronavirus can affect anyone, but according to the Scientific Advisory Group for Emergencies (SAGE) and WHO some people appear to be at a higher risk of developing the virus. These include older adults and people living with serious, chronic medial conditions such as cardiovascular conditions (heart disease), diabetes, kidney conditions, and lung disease such as COPD.
Professor Chris Whitty, the Government’s Chief Medical Advisor and Epidemiologist explained on BBC News: “the lungs are the common risk factor because the Coronavirus causes an infection of the lungs, and when this happens the airspaces fill up with fluid caused by inflammation, which makes the heart work harder. He adds “patients with diabetes often have complications involving the heart, but also the kidneys, and in the same way any strain on the body from infection can cause secondary problems in those organs.”
The leading UK Diabetes charity, Diabetes UK, further states, “When you have diabetes being ill can make your blood sugar go all over the place. Your body tries to fight the illness by releasing stored glucose (sugar) into your blood stream to give you energy. But your body cannot produce insulin to cope with this, so your blood sugars rise.
Your body is working overtime to fight the illness, making it harder to manage your diabetes. This means you’re more at risk of having serious blood sugar highs and lows, as well as longer-term problems with your eyes, feet and other areas of your body. This is why individuals with consistently high blood glucose levels are particularly at higher risk.
However, if you are generally in good health and stay in top of your diabetes management, the risk is similar to someone without diabetes.”
So, it appears that there could be a silver lining!
What steps can you take for prevention?
There is currently no vaccine to prevent the coronavirus, however trials have recently begun to assess the safety and effectiveness in this country of a proposed vaccine. Research into the development of a vaccine against this new virus and treatments for Covid-19 is taking place globally and as more is being learnt about this virus we are constantly being updated. The following guidelines have been issued by the Government, The IDDT (The Independent Diabetes Trust) and Diabetes UK:
The primary method of prevention is to wash your hands frequently and thoroughly, for a minimum of 20 seconds.
[graphic from www.bbc.co.uk]
In addition, the InDependent Diabetes Trust (IDDT) urges those living with diabetes, to review how they manage their time in isolation. It is important to keep your immune system in good shape and not to overlook everyday habits such as:
Getting good quality sleep
Eating a healthy balanced diet consisting of vegetables and staying hydrated. Further information on this can be found at https://www.diabetes.org.uk/Guide-to-diabetes/Enjoy-food/Eating-with-diabetes/The-Eatwell-Guide
Move your body and get at least 30 minutes of activity in accordance with your own physical capabilities. This can include chair-based exercises, which can be found on https://movingmedicine.ac.uk/wp-content/uploads/2019/07/Chair-exercise-programme-v.3-final.pdf as well as cardio workouts. Further information to tailor your activity levels to your diabetes can be found on https://www.leicesterdiabetescentre.org.uk/covid19-blog/2020/3/30/infographic-pa
Most importantly, don’t panic! Stress can have an impact on your blood sugar levels. Connecting with people via video chats such as Zoom, Skype or WhatsApp can really help with mental wellbeing. The following page https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/staying-home has some useful advice on managing your emotions, including stress.
https://www.mind.org.uk/information-support/coronavirus/coronavirus-and-your-wellbeing/ also has some useful tips on taking care of your mental health.
Take your prescribed medication as instructed (if you become unwell you may be told to alter doses or temporarily stop certain medications).
We all have a responsibility, during this time, to follow the advice that has been given to us. By managing your diabetes, you are reducing the need for medical attention, protecting the NHS and ultimately, saving lives.
As a reminder, other protective measures released by SAGE and Public Health England:
Stay at home - no unnecessary journeys or social contact
Necessary journeys have been highlighted as the following:
Essential Food shopping
Exercise once a day following social distancing rules (2 meters from any individual)
[graphic from bbc.co.uk]
[graphic from bbc.co.uk]
[graphic from bbc.co.uk]
What steps should you take if infected or suspect an infection?
For a person living with diabetes, it is important that you take the infection seriously. The number one thing to do is:
isolate yourself and your family
STAY AT HOME FOR AT LEAST 7 DAYS IF YOU START SHOWING SYMPTOMS – If you feel that you cannot cope with your symptoms or if your illness gets worse, or your symptoms are no better after 7 days, use the online 111 coronavirus service https://111.nhs.uk/covid-19 in the first instance. If you do not have internet access, call NHS 111. If you are struggling with breathing, please seek emergency medical attention. For a medical emergency, dial 999.
Follow advice from your GP, practice nurse or diabetes team regarding your medication.
You may need to stop taking some medications during the period you are unwell, however…
NEVER STOP INSULIN!
Seek medical attention if you are continuously vomiting, if you have persistently high or low blood glucose levels despite altering your medication, or (if testing) ketone levels are not reducing despite following sick day rules (see below for links).
More information regarding ‘sick day rules’ for people living with diabetes who become unwell with coronavirus is available via the following links (from the London Clinical Networks and shared by Partha Kar):
Sick day rules Type 2 diabetes and coronavirus - https://bit.ly/3f9uxHC
Sick day rules Type 1 diabetes (multiple daily injections) and coronavirus - https://bit.ly/2VUz3lr
Sick day rules Type 1 diabetes (on an insulin pump) and coronavirus - https://bit.ly/2yZkUus
[graphic from bbc.co.uk]
1. Try and order your next prescription at least 14 days before it is due.
2. Check your insulin and/or oral medication supply at least once a week.
3. Have access to 1 month’s supply of all your medicines.
4. If you normally check your blood glucose levels at home, ensure you have 1 month’s supply of test strips and lancets (make sure that they haven’t expired).
5. If you use continuous or flash glucose monitoring systems, make sure you have access to a back up blood glucose meter and test strips.
6. If you test for ketones (urine or blood), make sure that you have sufficient supplies and that the ketone strips are ‘in date’ and not about to expire.
7. If unwell, follow the ‘sick day rules’ – if you are unable to do this or need further help contact your GP practice or diabetes team, particularly if you need advice regarding your medication.
8. If you are at risk of hypoglycaemia (‘hypos’ - low blood glucose), check you have some form of sugar-based snack/drink in the house.
9. When you are taking your daily exercise outdoors, don’t forget to take your hypo remedy food/drink with you.
10. If you routinely check your blood glucose levels at home, try and get into the habit of checking it more often. https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/testing offers advice including a video guide on how to do this safely.
11. If you don’t check your blood glucose levels at home, be aware of the signs of hyperglycaemia (high blood glucose) which include:
Passing more urine than normal
Tiredness, headaches and lethargy
PLEASE SEEK MEDICAL ADVICE IF YOU HAVE THESE SYMPTOMS
12. If you are using an insulin pump, a continuous glucose monitor or a flash glucose monitor (FreeStyle Libre) you will still be able to get these from your pharmacy. For those that use a blood glucose meter, Diabetes UK has negotiated with several companies to make certain test strips available through their online shop https://shop.diabetes.org.uk/
13. If you’re using insulin, you’ll need to know how to adjust your insulin doses to maintain healthy blood glucose levels. It is also a smart decision to get your refills arranged with your local pharmacy or arrange online repeat prescriptions via websites such as www.echo.co.uk or https://www.pharmacy2u.co.uk/ Prescriptions can be delivered to your home for free with some of these services. Please check on individual sites.
14. Check with your doctor to see if they can provide virtual consultations or other digital check-ins.
15. If you are already having treatment for a foot or eye problem, and you don’t have coronavirus symptoms, check with your clinic/hospital to see if the appointment is still going ahead. They will be able to offer advice.
16. Most routine appointments, like annual diabetes reviews, have been cancelled or postponed. But you will be able to reschedule once things return to normal. In the meantime, follow your current routine including checking your feet daily - advice on how to look after your feet is available at https://www.diabetes.org.uk/guide-to-diabetes/complications/feet/taking-care-of-your-feet
(&/or read our previous blog ‘how to look after your feet at home’).
17. If you spot something new that you’re concerned about, like a cut on your foot, contact your GP practice and explain the situation. If you can’t get through, call 111 for advice.
There has always been a wealth of information and support available for people living with diabetes and recently there is an increasing amount being shared regarding Covid-19 and diabetes. As time goes by experts and researchers will learn more and advise accordingly. In the meantime, we would like to share some interesting, uplifting and entertaining resources:
Bulletins from Professor Partha Kar (the National Specialty Advisor for Diabetes at NHS England):
Linkedin.com/in/parthakar or @parhtaskar (Twitter)
Partha's 'Sweet Talking' diabetes related podcasts can be accessed at https://anchor.fm/partha-kar
@_diabetes101 is a twitter account consisting of a group of healthcare professionals helping to signpost people with diabetes to accredited information and boost morale through fun interactions and challenges!
Looking towards the future of the virus
As we look towards the future, it is hard to predict what will happen. Regardless what happens, the important thing right now is to be vigilant in how we care for ourselves and ensure we take the necessary precautions to stay healthy.
By Gemma Andrews
HCPC Registered Podiatrist
Director, DUET diabetes Ltd
[The thumbnail photo linked to this blog 'washing hands to protect yourself and your family' was sourced from Unsplash - Dhaya Eddine Bentaleb]