'Everyone With Diabetes' Must Prepare for COVID-19

Anne L. Peters, MD


March 11, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

This transcript has been edited for clarity.

I've been getting many calls from my patients with diabetes who are understandably concerned about COVID-19 and their risk, so I thought this would be an important topic for us to discuss.

I'm not an infectious disease specialist, so I'm not going to talk specifically about the virus, though I do try to keep up on the literature so I can help our patients avoid infection. Every night, I look for primary studies that have been published and then I review the CDC recommendations. I want to understand what patients are hearing and I want to follow the recommendations to help my patients avoid becoming ill.

People commonly hear that diabetes is a risk factor for the worst outcomes for death. Understandably, this makes people with diabetes frightened. What do we know about infections in patients with diabetes?

No Clear Answers

The literature is a bit contradictory and we don't do randomized controlled studies in this area. Overall, the literature suggests that people with diabetes get infections at a somewhat higher rate than those who do not have diabetes and can often have poorer outcomes. We also know that being ill can make it more difficult to manage diabetes.

Illness itself can increase insulin resistance and raise blood glucose levels. If a patient is vomiting and is unable to eat and keep down fluids, that can cause glucose levels to fall and lead to all sorts of issues in regard to diabetes management. When we think about infections in people with diabetes, we want to both prevent them from getting the infection and then obviously help them if they run into issues with glycemic control if they do become infected.

There are many questions to which we don't have an answer. We don't know if there are differences in terms of infection rates between people with type 1 or type 2 diabetes, for example, or whether people with an A1c < 7% do better or worse than patients with an A1c of 10%.

From what we know of COVID-19, being older and having comorbidities, such as cardiovascular and pulmonary disease, worsens outcomes. What we don't know is the risk in a healthy, young person without comorbidities who has well-controlled disease.

How to Prepare for COVID-19

I try to be realistic and comforting where I can, and to help people be prepared so they can deal with their diabetes during times of illness. Everyone with diabetes needs to prepare. In addition to what we've all heard about social distancing, hand washing, and all the measures that everyone needs to follow, people with diabetes need to be sure that they have their medications available with as many refills as possible.

It would be ideal if patients could get extra so that they have an extra supply of medications, but for many, that is not possible. As healthcare providers, we need to be sure that as we're prescribing medications and renewing them, we give people as many refills as possible so they can continue getting their medications.

It's useful to have medications that are delivered by mail so patients can avoid going to the pharmacy in person. If there is a true epidemic and healthcare providers become overwhelmed with people who are sick, people with diabetes who take insulin need to remember that they can always get vials of NPH and regular insulin at Walmart without a prescription.

I don't want anybody to run out of insulin because they can't reach their healthcare provider during this phase. Ideally, everyone will be prepared so they won't run out of their supplies and their medications, but it's always good to have a backup plan.

In addition to medications, patients need to be sure that they have a blood glucose meter and test strips at home, even if they have a continuous glucose monitor, so they can test their blood glucose levels if they become ill.

Ideally, sick-day rules should be reviewed with each patient, but at a minimum, patients should be encouraged to have both nonsugary and sugary fluids at home, such as apple juice or sugary sodas. Electrolyte tablets and broth are good to have on hand. Patients need to have the option of consuming fluids, whether or not they have carbohydrates, as they need them. People also need to stock up on nonperishables such as canned goods, so that they can eat to maintain their glucose levels in a healthy range.

Patients with diabetes need to remember to look after themselves, knowing that changes in lifestyle, stress, and illness can impact glucose levels in all sorts of ways. Usually, glucose levels go up, but sometimes they go low. It's important to be mindful of glucose levels and to monitor and adjust as needed to stay in the normal range.

As healthcare providers, we need to be sure that our patients are well stocked with the medications they need, that they have adequate sources of simple carbohydrates available if they are on insulin and/or a sulfonylurea agent to avoid and treat lows, and that they have a sick-day plan to help them manage their diabetes when they are ill.

Finally, all patients should be current in regard to vaccinations for preventable diseases. Many are still undervaccinated, and we need to be sure to discuss this with patients as we are seeing them. This is an uncertain time, but we can make a difference in the lives of our patients by being calm, knowledgeable, and responsive to changing circumstances.

Anne L. Peters, MD, is a professor of medicine at the University of Southern California (USC) Keck School of Medicine and director of the USC clinical diabetes programs. She has published more than 200 articles, reviews, and abstracts and three books on diabetes, and has been an investigator for more than 40 research studies. She has spoken internationally at over 400 programs and serves on many committees of several professional organizations.

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