Be Vigilant for Signs of Diabetes During COVID-19 Lockdown

Becky McCall

April 23, 2020

As concerns about coronavirus deter people from seeking hospital care, endocrinologists and a leading UK charity are calling for general practitioners (GPs) and the public to be aware of the signs and symptoms of type 1 diabetes.

Diabetes UK say they have heard anecdotally from clinicians that disproportionate numbers of young people are arriving for urgent care already in diabetic ketoacidosis (DKA) while the country is in lockdown.

And May Ng, MBBS, PhD, a pediatric endocrinologist and associate medical director at Southport & Ormskirk Hospital NHS Trust, UK, told Medscape Medical News that in her area they have already seen two presentations of severe DKA prior to type 1 diabetes diagnosis in the past 4 weeks, which she believes reflects the picture countrywide.

There have been similar reports from clinicians in Italy and China at the peak of their outbreaks, as previously reported by Medscape Medical News.

"We have been concerned about the delayed presentation of cases where children have attended accident and emergency [A&E] very unwell as they have not been seen earlier," Ng said.

"Many families are worried about COVID-19 and the risks of infection. And while they have done the right thing by keeping minor illnesses at home, the message must go out that if your child is unwell and you are worried, do not wait — seek help early with the GP and go to [the emergency room]."

But Simon Heller, MD, professor of clinical diabetes at the University of Sheffield, UK, isn't so sure this is the case.

"I'm aware of new cases of type 1 diabetes but they've been seen promptly by children's admissions, so I think it is a theoretical risk," he commented.

He said that, at least in the case of children with undiagnosed type 1 diabetes, pediatric emergency departments are relatively protected from COVID-19. So if a parent recognizes a child is ill, "they should be able to be seen by the GP in the normal way and be sent to A&E."

Nevertheless, he says it will be important to systematically gather findings on this issue and examine the impact of COVID-19 on new diagnoses of type 1 diabetes.

Remember the 4Ts: Don't Confuse Diabetes Symptoms With Those of Virus

Diabetes UK stress that the early signs and symptoms of type 1 diabetes are easy to mistake for a viral infection or other illness, which is why it is so important to be 4T aware. 4T refers to toilet, thirsty, tired, and thinner. 

  • Toilet: Going to the toilet a lot, bed wetting by a previously dry child, or heavier nappies in babies.

  • Thirsty: Being really thirsty and not being able to quench thirst.

  • Tired: Feeling more tired than usual.

  • Thinner: Losing weight or looking thinner than usual.

"It is vital that parents are aware of the early signs of type 1 diabetes and seek help if they need it," said Dan Howarth, head of care at Diabetes UK. 

"DKA can be a life-threatening complication of diabetes. If a child or young person does not receive immediate treatment for DKA, it can lead to coma, or even death," he stressed.

"The quicker children are diagnosed the less likely they are to become seriously ill," Howarth noted.

And he also urged GPs not to forget about possible diabetes symptoms.

"When patients call or visit the practice, try to ensure that the tell-tale symptoms of type 1 diabetes are not overlooked — especially as the 4Ts may not be all present at the same time," he said.

"Signs of type 1 diabetes need to be addressed as soon as possible, because if not, it will lead to further risks for the patient and can potentially lead to an acute admission to hospital."

These concerns echo comments made last week by Stephen Powis, BM BCh, PhD, national medical director of NHS England, when he highlighted the need to ensure medical attention for non-COVID-19 diseases is sought in a timely way.

"If you have any emergency condition, whether it's a sick child, whether it's a mother or a pregnant should be seeking emergency services, just as you always have done — they are there for you. And although we are focusing on coronavirus, it's important that we also continue to focus on other emergency conditions," Powis said.

Even prior to the coronavirus pandemic, it's estimated that around 600 children and young people in the UK each year receive a type 1 diabetes diagnosis only after they develop DKA, based on National Paediatric Diabetes Audit Hospital admissions and complications reports (2012-2015, 2017).

Ng and Heller have reported no relevant financial relationships. Heller is on the advisory board of Medscape Diabetes & Endocrinology.

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