Individuals with diabetes are among those who could be at higher risk of complications from COVID-19, and this is the time for them to be extra vigilant in monitoring their blood sugar and managing their condition, say experts from Imperial College London Diabetes Centre (ICLDC), a Mubadala Healthcare provider.
ICLDC consultant endocrinologist and diabetologist Dr Sara Suliman says that people with diabetes need to be even more careful than the general public in following preventative advice such as handwashing and social distancing, but they also need to pay special attention to controlling their blood sugar levels.
Dr Suliman explains: “Fluctuating blood sugar levels generally increase the risk of other complications, and this could mean worse outcomes in the case of COVID-19, since the body’s ability to fight infection is compromised. In addition, above-target blood sugar levels can mean that viral infections cause increased inflammation, which could make the reaction worse.”
She says some experts believe that if blood sugar is well controlled and there are no other comorbidities – in other words, no other conditions associated with diabetes such as heart disease – then the effects of COVID-19 might be no different than those of individuals with no underlying medical conditions.
However, Dr Suliman cautions: “We cannot state this for certain yet, it is too early, but it makes sense and diabetes patients should be extra vigilant in monitoring their blood sugar levels and managing their condition during this pandemic.”
Her colleague, consultant diabetologist and endocrinologist Dr Mohgah El Sheikh, adds that blood sugar should be monitored regularly, and the rate increased to at least every four to six hours if people feel unwell or their blood sugar levels are too high (above 250mg/dl), or recurrently too low (less than 70 mg/dl).
“Telephone your doctor or diabetes nurse to ask for help in adjusting your medications, especially if you are unwell. Also, importantly, do not discontinue any medication unless you are advised to do so by your doctor,” Dr El Sheikh says.
Another aspect for people with diabetes to think about is a contingency plan in case they need to completely self-isolate.
Dr El Sheikh explains: “They should start thinking about how they would be able to keep their distance from other family members in the home and they should ensure that, in addition to food and other general items, they have a sufficient supply – and a safe plan for replenishing – all medication for diabetes and other health conditions, including insulin, blood-testing strips, lancets and sensors, rapid-action sugars and anything else they normally need.”
Dr El Shiekh says if someone with diabetes starts to feel unwell, he or she should follow the normal ‘sick day rules’, which are the instructions given to individuals with diabetes whenever they become ill. These include measures such as staying hydrated and continuing to take their medications.
She says if individuals suspect they have been infected, or if they show warning symptoms such high levels of ketones or persistently high or low glucose, they should phone the health authorities to arrange to see a doctor immediately.
Warning signs: When to call the health authorities
The doctors advise that if individuals with diabetes have any of the following signs, they should telephone their relevant health authority* to ask for about immediate medical care:
Shortness of breath
A fever that won’t go away after a couple of days, especially in the case of recent contact with someone who may have COVID-19
High levels of ketones (tested using ketostix)
Inability to keep food or liquid down for more than four to six hours
Persistently high (>250mg/dl) or low blood glucose (<60mg/dl), especially if insulin is used
Sleepiness, drowsiness or confusion