Coronavirus has taken over the world. Scientists are scrambling to research this viral infection as extensively and quickly as they can. Fortunately, they have done the work to see COVID’s effect on diabetes.
So even though COVID-19 is a new virus, we already know quite a lot about it. We know it has a greater impact on people with diabetes than those without diabetes. But as it turns out, COVID can actually worsen your juvenile diabetes or type 1 or type 2 diabetes.
We will discuss all this and more in the article below. First, we’ll clear up what coronavirus even is and how diabetes increases your risk of COVID. Then we’ll talk about COVID precautions, particularly if you have diabetes.
We will discuss the concept of stockpiling supplies for diabetes and the idea of “shielding.” Then we will go into what to do if you get sick from COVID and community resources to help you if that does happen.
What is coronavirus?
Coronavirus is a type of enterovirus RNA infection that causes a variety of diseases and conditions due to viral RNA, including the common cold. A coronavirus is actually a fairly common virus in general. The current pandemic is called COVID-19. The virus that causes COVID-19 is called SARS (Severe Acute Respiratory Syndrome) CoV-2 (Coronavirus 2).
This virus is zoonotic in origin (similar to LCMV), meaning it came from an animal. We know that COVID-19 originally came from a bat and was transmitted to humans, but the intermediary animals are still unknown to this day.
COVID-19 first emerged in Wuhan, China, in 2019. Within a few months of the first report, it spread across China and worldwide, reaching pandemic status. It is the third most highly pathogenic coronavirus infecting humans in the entire 21st century.
COVID is a respiratory infection that is transmitted by inhalation or contact with infected droplets. The incubation period can range from two to fourteen days. COVID is diagnosed by special molecular tests of respiratory secretions. A patient with COVID will also have low white blood cell counts, high C reactive protein, and abnormal Computed Tomography (CT) scans of the chest. The fatality rate is estimated to be around two to three percent.
Coronavirus symptoms can range from mild flu-like symptoms to acute respiratory distress syndrome, multiple organ failure, kidney disease, and even death. Milder symptoms include:
- Fever
- Cough
- Sore throat
- Breathlessness
- Fatigue
- Malaise
More severe outcomes can occur in at-risk populations and lead to pneumonia and lung failure. Susceptible populations include children, health care providers, the elderly, and diabetes patients.
COVID-19 has triggered an enormous amount of human casualties and severe economic loss, posing a global threat.
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Diabetes risk
Diabetes has been reported as a significant predictor of morbidity and mortality from COVID-19. There is evidence of increased incidence and severity of COVID-19 in patients with diabetes. Experts say that COVID-19 could affect the pathophysiology of diabetes.
Research on humans and nod mice says diabetes can affect COVID-19 due to the following factors:
- Chronic inflammation
- Increased coagulation activity
- Impairment of the immune system/immune response
- Direct damage to beta cell function of the pancreas
- Increased function of pancreatic islet autoantibodies/islet autoimmunity/autoantibody
- Reduced expression of Angiotensin-Converting Enzyme 2 (ACE 2)
- Use of renin-angiotensin-aldosterone system antagonists (heart disease medications)
One study looked at 174 patients with confirmed cases of COVID-19. Demographic data, medical history, signs, symptoms, lab findings, Computed Tomography of the chest, and treatment measures were collected and analyzed.
They found that COVID-19 patients without other comorbidities but with diabetes were at higher risk of the following:
- Severe pneumonia
- Release of tissue injury related enzymes
- Excessive uncontrolled inflammation responses
- Hypercoagulable state
They also found that levels of inflammation-related biomarkers in the blood were higher in people with diabetes than those without diabetes. These included the following:
- Interleukin 6
- C reactive protein
- Ferritin
- Coagulation index
- D-dimer
This suggests that patients with diabetes are more susceptible to inflammation, eventually leading to rapid deterioration once infected with COVID-19.
But diabetes doesn’t just increase the risk of morbidity and mortality of COVID. It also works the other way around. There is a two-way interaction between COVID and diabetes.
COVID leads to the worsening of dysglycemia and diabetes. Dysglycemia and diabetes exacerbate the severity of COVID. Research has shown that COVID worsens blood sugar dysregulation via the following mechanisms:
- Direct damage to beta cells of the pancreas (leading to increased beta-cell autoimmunity)
- Cytokine-induced insulin resistance
- Hypokalemia (low levels of potassium in the blood)
- Drugs used in the treatment of COVID-19 (corticosteroids, lopinavir, ritonavir)
Don’t forget that diabetes is related to autoimmunity. It is an autoimmune disease, after all. All this shows that diabetes should be considered a risk factor for rapid progression and poor prognosis of COVID-19.
General precautions
In general, it is essential to use proper hand hygiene. If you are ever out in public, it is important not to touch anything unnecessarily. If you do cough or sneeze, do so into a tissue and throw it away promptly.
If you do not have a tissue ready, sneeze, or cough into your elbow, avoid touching your face, particularly your eyes, nose, and mouth. This is how the virus can enter your body. Wash your hands frequently and for at least 20 seconds. If soap and water aren’t available to you, hand sanitizer is the next best choice.
Wear a mask. If you don’t have one, they are reasonably simple to make. The CDC has encouraged the general public to wear face masks, even if they are simply made of cloth. You can cut up an old T-shirt or use a bandana or ski mask. For extra protection, place a coffee filter inside. Wash your mask often, preferably after each use. If you are using a filter, change it out after 24 to 48 hours of use.
If you suspect that you may have COVID-19, you must stay home. Isolate yourself, and do not leave your home for 14 days. If you do not suspect you have COVID-19, still remain home as much as possible. If you do go out into public, be sure to stay a minimum of six feet away from other people at all times.
Precautions to take for diabetes
Chloroquine is currently being used in the treatment of COVID-19. If you have diabetes and test positive for COVID-19, it is crucial to be aware that chloroquine can potentially lead to hypoglycemic events.
It is important that you received treatment that is tailored specifically to you. Be aware that there are potential drug interactions that could lead to adverse outcomes.
Rigorous glucose monitoring is essential when you are developing type 1 diabetes, but especially in these times. Take all necessary precautions to ensure good glycemic control. This can help reduce your risk of contracting or suffering from COVID.
Stockpiling supplies
If you have type 1 diabetes, you should have about a month’s worth of extra insulin on hand. It is recommended that you do not stockpile more than this.
One month’s worth should be enough insulin. This is because if everyone stockpiles diabetes supplies, this could lead to shortages and other patients at increased risk. Your pharmacy may not even allow you to get more insulin than this. Pharmacies have been instructed not to support patients trying to stockpile supplies.
Governments are indeed taking action to make sure that there are enough medical supplies for everyone. In the United Kingdom, the government has been working with industry and partners to monitor the virus’s impact on the supply chain.
They have put in place measures to help protect patients. One of these measures is banning companies from buying insulin from the United Kingdom and selling it in countries at a higher price. This helps to ensure an uninterrupted supply of crucial medication for hospitals treating patients with COVID-19.
Shielding advice
Shielding is a method of protecting clinically extremely vulnerable people. These people are at very high risk of severe illness. If someone who is extremely vulnerable contracts coronavirus, they will certainly need to go to the hospital for treatment.
In order to “shield” or protect these extremely vulnerable people, it is important to stay home and avoid all face to face contact.
So who is considered to be clinically extremely vulnerable? Thankfully, people with diabetes don’t fall into this category. However, people with certain types of cancer and severe respiratory conditions do.
People with diabetes fall into the clinically vulnerable group. This means that you should follow social distancing rules closely. If you have comorbidity such as cystic fibrosis-related diabetes, you should be protected as part of the extremely vulnerable group.
If you have received a message from National Health Services telling you to shield, you must follow these guidelines. If not, then you still do need to follow the rules to stay home.
If you get sick
Step one is to give your doctor a call.
Make sure you drink lots of water. If you are having difficulty drinking enough water, just have small sips every 15 minutes or so. This will help to prevent dehydration.
If you have COVID and experience a drop in blood glucose levels (below 70 mg/dL or your target range), consume 15 grams of simple carbs. These should be foods or candies that are easy to digest, such as:
- Popsicles
- Hard candies
- Juice
- Honey
- Jam
- Jell-O
- Soda
Recheck your blood sugar level 15 minutes later to make sure they are going back up again. You will likely need to check your blood sugar more frequently than you normally would. Be sure to check it every two to three hours throughout the day and night.
But what if your blood sugar levels are high? If they are more than 240 mg/dL three times in a row, check for ketones. This is to check for diabetic ketoacidosis.
If you test positive for ketones, call your doctor’s office immediately. Managing diabetes effectively will help to reduce your risk of COVID.
If you are taking Tylenol as part of your COVID-19 management, just know that this drug impacts certain CGM sensors. These include Dexcom G5, Medtronic Enlite, and Guardian. Try checking your levels with finger sticks instead of an accurate reading if you are taking Tylenol and using one of these CGM sensors.
Wash your hands and clean your injection, infusion, and finger stick sites with soap and water or rubbing alcohol often.
Community
Social media is great for getting a community feel while physically distancing yourself from others. Twitter is an excellent resource for this. You will find people tweeting their diabetics-centric COVID strategies, and welcome you to share yours as well.
One example is Dana Lewis, the entrepreneur behind the first homemade artificial pancreas technology. She shared on Twitter what she is doing to keep herself safe. She even suggests which diabetes tools to use and ways to keep yourself safe at home and out in public.
Lewis has also started a community hashtag “#WeAreNotWaiting” for diabetes technology enthusiasts. This group of people is working to create a Do It Yourself tool for self-reporting health factors related to COVID. She is collaborating with health professionals and infectious disease experts to develop an app called CoEpi.
This stands for Community Epidemiology into Action. It will let anyone track who they have been in contact with, share reports on their symptoms, and include information on contagiousness. This is all anonymous and private, of course. Tools that are created by the community, such as CoEpi, help people to feel empowered. This is something that we can all do to help protect ourselves, our loved ones, and our communities.
There are resources you can use if you find yourself in isolation without friends or family. If you are located in the United Kingdom, there is the National Health Services Volunteer Responders in England.
They can help with your shopping, pick up medication for you, and set up phone calls to help if you are feeling lonely. If you are alone at home and have diabetes, this is a service that you may use. Call 0808 196 3646 or visit their website here.
If you are located in the United States and on Medicare, you should know that Medicare has expanded its telehealth coverage. This means that you have access to more places than usual, including your home.
There is also a wider range of communication tools available to use this service, including smartphones. This means you can have a doctor’s appointment from your home, rather than going to a clinic or hospital where you put yourself and others at risk. To learn more, visit their website here.
If you are located in the United States and are struggling to pay for insulin, the American Diabetes Association has resources that may help you. Check them out here.
COVID-19 pandemic is a scary time for a lot of people. If you have diabetes, you are indeed at higher risk, but there are things you can do to mitigate that risk. Stay home, wash your hands, don’t touch your face, and keep vigilant track of your blood sugar levels. Don’t be afraid to reach out to any of the resources above if you are in need. We can get through this together.
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