People with diabetes have been recognised as a “high-risk” group during the COVID-19 pandemic.

This risk is not related to an increased chance of becoming infected with COVID-19 compared to those without diabetes. Rather, it refers to the increased risk of having severe symptoms, needing to be hospitalised and death if they do become infected. This is based on evidence from the Wuhan province in China1.

It is therefore important for people with diabetes to avoid becoming infected.

Here we provide some simple steps that can help prevent infection, followed by a guide for what to do should infection occur2.

 

How can people with diabetes prevent COVID-19 infection?

1. Follow the physical distancing restrictions in your state

For people with diabetes, it is important to take advice about physical distancing seriously and follow the advice and restrictions in your state. This is because the virus spreads from person to person and can survive on surfaces where an infected person has been.

The restrictions for each state can be found here.

It is also important to restrict letting people who do not live with you into your home. These people may not even know they have COVID-19, as symptoms can be mild and may not appear for up to 2 weeks. Even so, they can still share the virus during this time.

Following the government guidelines is the best way to avoid becoming infected and prevent the potentially serious consequences.

2. Maintain good hygiene

Washing your hands with soap and water, covering coughs and sneezes with your elbow, using alcohol-based sanitisers and avoiding touching your face, eyes, nose and mouth will all reduce the risk of the coronavirus spreading.

3. Continue to actively manage your diabetes to avoid becoming unwell

As always, it is important to control your blood sugar levels by sticking to your normal health maintenance routine (diet, exercise and regular blood monitoring). This will help reduce the risk of becoming unwell.

If you do need to see someone, it is a good idea to ring the surgery or clinic beforehand to find out how they are managing appointments. It may be possible to talk over the phone or use videoconferencing on your phone, tablet or computer to speak to your doctor. This will help avoid contact with other people in waiting rooms.

Ensure you have enough blood glucose monitoring supplies and medications at home to avoid having to leave the house.

  • Keeping a good stock of (in-date) medication (including insulin and oral hypoglycaemic medications) and monitoring supplies at home will mean you can control your blood glucose levels at home without needing extra visits to the pharmacy. This will minimise your contact with others during the pandemic.
  • If you do need supplies, your pharmacy may be able to deliver these to your home to avoid you having to leave the house unnecessarily. Contact your local pharmacy or NDSS Access point to see whether they are offering this service.

Know your “sick day” action plan

It can become difficult to manage your blood glucose levels when you get sick or have an infection.

If you become unwell, it is important to follow your “sick day” action plan that your doctor, diabetes educator, or diabetes team member has probably given you. This will include monitoring your glucose more frequently, testing your ketone levels (for people with type 1 diabetes), taking normal medication, drinking plenty of fluids and letting a friend or family member know that you are unwell in case you need help.

If you are unsure of your sick day plans, contact your diabetes health team or doctor for advice. And if you become worse or cannot control your blood sugar levels, seek urgent medical care.

 

What should people with diabetes do if they become infected by COVID-19?

1. Follow your “sick day” action plan

COVID-19, like any illness or infection, is likely to lead to worsening or hard-to-control blood sugar levels. It is therefore important to follow your sick day rules. This will help avoid your blood glucose becoming too high, possibly leading to serious health complications.

2. Seek medical attention

Call the National Coronavirus Hotline if you are seeking information or want to discuss your symptoms and get advice. National Coronavirus Helpline: Phone 1800 020 080.

If you are sick and think you may have COVID-19, seek medical attention. Depending on your symptoms, this may be a phone call to your normal doctor or your diabetes health care team. You may be able to have a consultation over the phone, or by video conferencing through your phone or computer.

If you become seriously unwell, seek emergency care (call 000) or go to the Emergency Department of the hospital. If you are going to the Emergency Department, it is a good idea to let them know you are coming and that you may have COVID-19.

 

Key message

If you have diabetes, follow your normal blood glucose maintenance plan and continue monitoring as usual. If you become unwell, follow your sick day action plan. If your symptoms get worse, seek medical attention.

For more information about COVID-19 and diabetes, see the Diabetes Australia site.

Expert review

The medical content in this article has been reviewed by A/Professor Shane Hamblin. A/Prof Hamblin is Head of Endocrinology & Diabetes at Western Health, Melbourne and a consultant endocrinologist at The Alfred, Melbourne. He also holds honorary positions at both The University of Melbourne and Monash University and is a Council member of the Endocrine Society of Australia.

 

The content in this article was updated on 11 May to acknowledge the difference in restrictions imposed by different states and territories.

References

  1. Guan W, et al (2020) China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. https://doi.org/10.1056/NEJMoa2002032
  2. Puig-Domingo M, Marazuela M & Giustina A (2020). COVID-19 and endocrine diseases. A statement from the European Society of Endocrinology. Endocrine https://doi.org/10.1007/s12020-020-02294-5