COVID-19 and Diabetes

The COVID-19 outbreak has been declared an international public health emergency. People with diabetes may be more vulnerable to the severe effects of the virus

COVID-19 is a new and potentially serious coronavirus. There are many coronaviruses, ranging from the common cold to much more serious viruses such as as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). They are viruses that have been transmitted from animals to people. In severe cases, coronaviruses can cause infection in the lungs (pneumonia), kidney failure and even death. The World Health Organization (WHO) has declared the COVID-19 outbreak to be a global pandemic. At present there is no drugs or vaccine against COVID-19. Common signs are typical flu-like symptoms:
  • a fever,
  • cough,
  • breathing difficulties,
  • tiredness and muscle aches
Symptoms usually start within 3-7 days of exposure to the virus, but in some cases it has taken up to 14 days for symptoms to appear. People of all ages can be infected. For many (more than 80% of cases), COVID-19 is mild, with minimal flu-like symptoms. Some have not shown symptoms or only very mild symptoms, more like a common cold. The majority of people who have caught the virus did not need to be hospitalised for supportive care. However, in approaching 15% of cases COVID-19 has been severe and in around 5% of cases it has led to critical illness. The vast majority (around 98%) of people infected to date have survived. Older people and people with pre-existing medical conditions (such as diabetes, heart disease and asthma) appear to be more vulnerable to becoming severely ill with the COVID-19 virus. When people with diabetes develop a viral infection, it can be harder to treat due to fluctuations in blood glucose levels and, possibly, the presence of diabetes complications. There appear to be two reasons for this. Firstly, the immune system is compromised, making it harder to fight the virus and likely leading to a longer recovery period. Secondly, the virus may thrive in an environment of elevated blood glucose. Like any other respiratory disease, COVID-19 is spread through air-droplets that are dispersed when an infected person talks, sneezes or coughs. The virus can survive from a few hours up to a few days depending on the environmental conditions. It can be spread through close contact with an infected person or by contact with air droplets in the environment (on a surface for example) and then touching the mouth or nose (hence the common advice circulating on hand hygiene and social distancing).

What can people with diabetes and their loved ones do?

For people living with diabetes it is important to take precautions to avoid the virus if possible. The recommendations that are being widely issued to the general public are doubly important for people living with diabetes and anyone in close contact with people living with diabetes.

  • Wash hands thoroughly and regularly.
  • Try to avoid touching your face before you have washed and dried your hands.
  • Clean and disinfect any objects and surfaces that are touched frequently.
  • Don’t share food, glasses, towels, tools etc.
  • When you cough or sneeze, cover your mouth and nose with a tissue or use the crook of your arm if you don’t have a tissue to hand (dispose of the tissue appropriately after use).
  • Try to avoid contact with anyone showing symptoms of respiratory illness such as coughing.
  • Think whether you can make changes that will help protect yourself or loved ones. For example, can you avoid unnecessary business travel? Can you avoid large gatherings? Can you avoid public transport?
  • If you are ill with flu-like symptoms, stay at home.

If you have diabetes:

  • Prepare in case you get ill.
  • Make sure you have all relevant contact details to hand in case you need them.
  • Pay extra attention to your glucose control.
  • If you do show flu-like symptoms (raised temperature, cough, difficulty breathing), it is important to consult a healthcare professional. If you are coughing up phlegm, this may indicate an infection so you should seek medical support and treatment immediately.
  • Any infection is going to raise your glucose levels and increase your need for fluids, so make sure you can access a sufficient supply of water.
  • Make sure you have a good supply of the diabetes medications you need. Think what you would need if you had to quarantine yourself for a few weeks.
  • Make sure you have access to enough food.
  • Make sure you will be able to correct the situation if your blood glucose drops suddenly.
  • If you live alone, make sure someone you can rely on knows you have diabetes as you may require assistance if you get ill.

People with diabetes, one of the high-risk categories who could suffer more from COVID-19

By Diabetes Education Study Group (DESG)

One of the categories at high risk of being infected by coronavirus is people with diabetes. Here are some of the most frequently asked questions by people with diabetes.

People with diabetes are part of the high-risk population. However, just being a person with diabetes doesn’t mean you’re at high risk. A person who is 20 or 30 years old has almost the same risk as the rest of the population. The problem rises more for people over 70 who have diabetes, hypertension, heart disease or other chronic conditions. In diabetes, the situation is further complicated. Everything depends on the general situation, the more health problems you have, the more likely you are to be affected. Of course, the elderly are also at a higher risk of being affected.

No, the signs are the same. The peculiarity of this viral infection is that it is not characterized by a very high temperature from the beginning. Therefore, some of those infected are diagnosed late. The main sign is excessive fatigue, the infected person feels great unexplained fatigue, while the temperature is not very high. On the other hand, cough is present from the beginning. The difference from a common flu is that there is no secretion from the nose. These signs should be kept in mind. So, if you have a high fever at the beginning, with secretion from the nose, the probability that you are infected with coronavirus is lower. There are no specific signs in people with diabetes other than these. The problem is that those with diabetes are mostly older people. They also have other concomitant diseases, that aggravate or worsen the situation. Especially if they also have respiratory problems. But people with diabetes certainly belong to the population at risk, even if they are affected by common flu.

One of the tips we want to give, even for the years to come, is vaccination (the flu vaccine) for people with diabetes, they should be vaccinated when the vaccination period begins in September-October. If vaccinated, respiratory problems are also less likely.

It is highly recommended and important for people with diabetes to have adequate stocks of the medicines they use as we do not know how long this situation will last. They should also have extra test-strips to increase the frequency of self-monitoring, as even common flu can worsen glycemic control.

The general advice is definitely hygiene, frequently washing hands with soap and water and bathing, keeping distance from other people, avoiding physical contact. If someone at home has the flu, stay away. Give up visits to relatives, even unnecessary visits for consultations, or appointments that can be postponed to a better time. Avoid crowded environments. All the measures that are taken are very necessary, as the awareness of this situation is not enough. Adherence to these seemingly simple measures will greatly prevent the spread of the virus. And staying at home, you must apply the sick day rules that you can find on the DESG website, in education in 5 minutes leaflets.

In terms of food, fruits are the key. But people with diabetes, given their high sugar content, can consume two to three portions of fruit a day.

During this time, we recommend consuming fruits rich in vitamin C, like citrus, lemon, oranges, tangerines. We would also mention kiwi, which is rich in vitamin C. Good sources of vitamin C are also broccoli, tomatoes, red and green pepper, white cabbage. They are low in carbohydrates and high in fibers as well.

The virus in nature, especially in high temperatures, will not survive. But temperatures are not that yet at these levels. If we are in places where there are not many people, we may go out.In crowded environments such as lakes, parks, or in places with many people the risk of spreading is great. Older people with diabetes are recommended to stay at home.

It is very important, and worth repeating, to keep the social distance recommended. Unless absolutely necessary, going out should be programmed at times when there is less movement of people. If it’s not an emergency please just phone your doctor, your pharmacist, or your diabetes specialist for an advice, or opinion for the moment. We must all realize how important it is to stay home. We should be aware that the epidemic in some countries has not yet reached its maximum level. Everyone should make their contribution to keep this level as low as possible and stay home. 

The problem is that we are facing an unknown phenomenon. And what remains to be seen is what changes this virus will bring to the human body. This type of virus lowers immune capabilities. Will this be long term? It’s too early to say. It is important that everyone is responsible and respects the rules. With time, we’ll have more answers and a better understanding of this virus.

  • diaTribe Learn: The Latest on COVID-19: Staying Safe as The Pandemic Surges – As COVID-19 restrictions and recommendations shift, what do we know about staying safe with diabetes? How can we protect each other and make careful decisions about risk? View the new COVID and diabetes infographic.

COVID-19 is a new coronavirus. Keep informed of the latest developments. Look out for updates and advice from your government, national diabetes association and other reliable sources.