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COVID-19 and Diabetes: What to Do

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COVID-19 and Diabetes: What to Do
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Nobody wants to get the novel coronavirus, but COVID-19 is an even bigger threat for people with diabetes. Although people with diabetes do not appear to be more likely to catch COVID-19 based on current research, they are more likely to be hospitalized, develop complications and die from the virus. Fortunately, we can do a lot to prevent it and to minimize its severity.

Risk of COVID-19 complications

A study published online April 17 in the Journal of Diabetes Science and Technology found that among patients with COVID-19 at U.S. hospitals between March 1 and April 6, 2020, those with diabetes died at four times the rate of those without diabetes or hyperglycemia (high blood glucose).

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The researchers advise doctors to treat high blood sugars in COVID-19 patients, treatment that often gets too little attention because patients have so much else going on. “In the absence of evidence to the contrary,” they wrote, “clinicians should treat hyperglycemia to achieve [blood glucose] targets <180 mg/dl for most patients. This would [mean] basal-bolus insulin therapy in most non-ICU patients and continuous insulin infusion in the critically ill as directed by national guidelines.”

Preventing COVID-19 in diabetes

An international expert panel writing in The Lancet advises uninfected people with diabetes to intensify their metabolic control. They call good control a way of preventing COVID-19 disease. “This includes continuation and strict abidance with adequate control of blood pressure and lipids,” they write. So, now is not a good time to cheat on your diet.

EndocrineWeb points out the importance of reducing stress, which might be a tall order at this time. High stress levels damage immune function. Stress also causes mental health symptoms like anxiety, depression and confusion, which can interfere with self-care.

I wrote about ways of keeping the immune system strong in this article. Eat healthy foods such as citrus fruits, red bell peppers, spinach, broccoli, nuts and seeds. Use spices like garlic, turmeric and ginger. Drink a lot of water. Relax. Get more sleep, physical contact (where possible), sunshine and exercise. COVID-19 shutdowns make some of this harder, but many are still possible.

Everyone should follow officials’ advice about frequent hand washing, wearing masks in public, and keeping at least six feet of distance from other people. If you have respiratory symptoms or a temperature, stay inside! You might want to use gloves when touching common surfaces like elevator buttons, and you should avoid skin-to-skin contact with people other than your immediate family. Taking additional precautions can help for necessary outings such as grocery shopping and pharmacy trips. Since they are in the high-risk category, people with diabetes additionally might want to stay inside whenever possible.

Preparing for COVID-19

The time to prepare for a possible COVID-19 infection is now. The first step is to update your sick-day plan and talk it over with someone in your doctor’s office. You will need to be able to stay in touch with your healthcare team if you get sick. If your provider has no such service, or if you have no provider, you can consult with a doctor by phone or computer. This telemedicine option is clearly a second choice, because the provider may not know you and may or may not be expert in care of diabetes patients, but it can still help.

The American Association of Clinical Endocrinologists recommends that insulin users have a 90-day supply of insulin on hand, in case they can’t get out or supply problems develop. Also, buy a stock of diabetes-friendly shelf-stable food as described here.

During COVID illness, kidney function should be carefully monitored because of the high risk of chronic kidney disease or acute kidney injury. Home tests for kidney function are now available in some areas, or you might be able to arrange pick-up, drop-off or delivery of a specimen.

About the use of diabetes drugs, the expert panel writing in The Lancet has a number of recommendations for people with type 2 diabetes:

Metformin might lead to lactic acidosis if people are dehydrated, so if patients can’t drink adequate fluids, they should consult with their doctors regarding stopping the drug and follow sick-day rules.

• SGLT2 inhibitors, such as canagliflozin (brand name Invokana), dapagliflozin (Farxiga) and empagliflozin (Jardiance) also increase risk of dehydration and diabetic ketoacidosis during illness. The panel advises patients to consult with their doctors regarding stopping the drugs. (That said, scientists are currently studying Farxiga as a possible treatment to protect the kidneys and heart in those with COVID-19.)

Insulin therapy should not be stopped. Regular self-monitoring of blood-glucose every two to four hours or continuous glucose monitoring should be encouraged for insulin users, they say.

• According to the panel, GLP-1 agonists like albiglutide (Tanzeum), dulaglutide (Trulicity), exenatide-extended release (Bydureon), liraglutide (Victoza), lixisenatide (Adlyxin) and semaglutide (Ozempic) may be continued with close monitoring (and adequate intake of fluids), and DPP-4 inhibitors like alogliptin (Nesina), linagliptin (Tradjenta), saxagliptin (Onglyza) and sitagliptin (Januvia) can probably be continued as usual.

• Patients taking ACE inhibitors or sulfonylurea drugs should consult with their doctors about what to do, according to the panel. Diabetes.org.uk advises all people with diabetes to check their glucose at home more often. If you don’t check at home, be aware of symptoms of high sugar, such as excessive urination, hunger, thirst, headache, unusually dry skin, blurry vision, fatigue and irritability.

If you are hospitalized, the experts writing in The Lancet advise hospital clinicians to adjust therapy to keep glucose at less than 180 mg/dl. If a patient or a family member can learn what the therapeutic goals and treatment plan are, they might be able to help make the plan work. Be aware that you might need more insulin than usual. Keeping glucose in reasonable control may help you get home safe.

Want to learn more about coronavirus and diabetes? Read “Coronavirus and Diabetes: What You Need to Know,” “Healthy Eating During Hard Times” and “Avoiding Coronavirus With Diabetes: Stock Up and Stay Home, CDC Says.”

David Spero, BSN, RN

David Spero, BSN, RN

David Spero, BSN, RN on social media

A nurse for 25 years at University of California San Francisco and Kaiser hospitals, and one of the first professional health coaches. Nurse Spero is author of Diabetes: Sugar-Coated Crisis and The Art of Getting Well: Maximizing Health When You Have a Chronic Illness, as well as co-author of Diabetes Heroes and the diabetes chapter in Where There is No Doctor. He writes for Diabetes Self-Management, Pain-Free Living, and Everyday Health.

 

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