The American Diabetes Association (ADA) states on its web site that people with either type 1 or type 2 diabetes mellitus (DM) are not necessarily at greater risk of becoming infected with COVID-19 than people without DM; they are, however, far more likely to experience severe symptoms and complications, thus to experience worse outcomes.The ADA has prepared a list of suggestions for persons with DM to protect themselves from the virus and to manage their diabetes in the event they do become infected. We summarize it below as a check list of topics for primary care physicians to discuss with their DM patients.
Make your diabetes patients aware. Patients with diabetes are more likely to experience severe symptoms & complications of viral infection.
Remind patients of general protection precautions. CDC does NOT recommend use of face masks by people who are not infected. CDC does recommend the same precautions used to prevent/limit influenza infection including frequent handwashing, covering coughs/sneezes with tissue or elbow, and limiting social contact.
Urge extra caution for patients with DM complications. People with DM vary in age, complications, and how well they manage their DM. People who already have DM-related health problems are likely to have worse outcomes if infected.
Suggest that patients make plans ahead in case of illness. The ADA recommends: ADA recommends collecting contacts, supplies: Phone #s of doctors, healthcare team, pharmacy, insurance provider ** List of medications/doses (include vitamins, etc) ** Supply of simple carbs (eg, soda, honey, jam, hard candy) ** Always have enough insulin available for the week ahead ** If state of emergency is declared, get extra refills on meds to avoid leaving the house; arrange for delivery, if available.
More supplies to have on hand to ensure self care. Glucagon, ketone strips, rubbing alcohol, soap; enough household items/groceries in prepration tp stay home for an extended period.
Talk to your diabetes patients about: When to call the doctor's office (for ketones, changes in food intake, medication adjustments, etc) ** How often to check blood sugar ** When to check for ketones ** Medications to use for colds, flu, virus, and infections ** Any changes to diabetes medications when sick.
Educate diabetes patients on emergency warning signs of infection. Difficulty breathing or shortness of breath ** Persistent pain or pressure in the chest ** New confusion or inability to arouse ** Bluish lips or face.
Educate diabetes patients on COVID-19 symptoms, when to call MD. Fever, dry cough, dyspnea ** Prepare for a call with the doctor: Have ketone reading available ** Keep track of fluid consumption and report (use a 1-L water bottle) ** Be clear on symptoms (eg, nausea? Just a stuffy nose?) ** Ask questions on how to manage diabetes.
Tips to help sick patients with diabetes manage during illness. Drink lots of fluids ** If BG is low (ie, <70 mg/dL or target range), eat 15 g simple, easily digested carbs, re-check BG in15 mins to ensure it is rising ** Check BG extra times throughout the day/night (ie, every 2-3 h; if using CGM, monitor frequently.
More tips to help sick patients with diabetes manage during illness. If BG is high more than 2x in a row (ie, >240mg/dL), check for ketones to avoid DKA ** Call doctor's office immediately, if medium or large ketones are detected (and if instructed to with trace or small ketones) ** Wash hands and clean injection/infusion and finger-stick sites with soap and water or rubbing alcohol.
VERY IMPORTANT REMINDER. some CGM sensors are impacted by acetaminophen: Dexcom G5, Medtronic Enlite, Guardian. Check with finger sticks to ensure accuracy.
