Reviewed by Mariela Glandt, M.D.
Coronavirus (COVID-19) is still spreading quickly, and experts now fear that it will inevitably reach almost every corner of the world. Diabetes is a complicating factor that can make similar illnesses, like the flu, more intense and more dangerous. If you have diabetes, should you be especially worried? What do you need to know if coronavirus reaches your community? Here’s a round-up of the best information we could find.
The Risk of Coronavirus to People with Diabetes
Maybe you’ve already seen the numbers. In China, the overall case fatality rate has been 2.3%, but among people with diabetes it’s been reported as 7.3%. We don’t know how much of that increase is due to the unique characteristics of diabetes, and how much is due to overlap with other known risk factors. For example, the population of people with Type 2 diabetes skews older, and coronavirus is known to be most dangerous to the elderly.
Nevertheless, it’s clear that coronavirus is serious stuff. The most recent estimates suggest that coronavirus is more than three times as deadly as the common flu, which is already uniquely dangerous to people with diabetes. And diabetes has been found to significantly increase the risk of severe infection in other recent epidemics, such as the 2009 H1N1 scare.
General Advice from the CDC
First, general advice from the CDC. Coronavirus is a respiratory illness, spread from the nose and mouth, so the organization recommends common-sense measures to help reduce your risk of infection:
- Wash your hands frequently!
- Stay away from anyone coughing and sneezing: at least 3 feet distance
- Avoid touching your face
And it should go without saying that practicing good respiratory hygiene yourself, such as sneezing into your elbow, can also help prevent the spread of disease.
The Impact of Blood Sugar on Coronavirus
If you fear you may be infected, how important is it to maintain healthy blood sugars? Our friend Maria Muccioli over at Diabetes Daily reviewed the medical literature on the interactions between blood sugar and disease risk. She concluded that high blood sugar can definitely weaken the immune system:
“It follows that maintaining optimal blood glucose control is an important preventative strategy for avoiding serious related complications, such as a secondary bacterial infection (i.e., pneumonia) and is likely an important determinant in the patient prognosis for anyone who becomes infected.”
Coronavirus, just like the flu, may drive blood sugar up, necessitating increased insulin doses to bring blood sugar back down to a healthy level. Experts recommend caution in making such adjustments. The insulin resistance driven by illness can be unpredictable, and patients should keep emergency carbohydrates close at hand in case blood sugar unexpectedly drops.
The Risk of DKA
Conversely, reduced appetite and other symptoms may make it difficult to eat, prompting patients to use even less insulin than normal. This can also be dangerous due to the risk of Diabetic Ketoacidosis (DKA).
JDRF recommends that anyone with Type 1 diabetes who fears they may be infected should be monitoring both blood sugar and ketones much more frequently. Acute illnesses are known to cause the type of metabolic havoc that can lead to DKA, particularly when the symptoms of the illness cause you to eat and drink less than normal.
JDRF also details the surprising ways that some common medicines, such as ibuprofen and acetaminophen, can affect blood sugar: T1D and Coronavirus: What You Need to Know.
When Should You Call the Doctor?
Most cases of coronavirus are mild, and experts don’t want hordes of mildly sick people rushing to the emergency room, overwhelming health workers and hospital resources. If you can manage your illness at home, please do so. But patients with diabetes who are suspected of coronavirus infection need to monitor their own symptoms for signs of both pneumonia (shortness of breath, tenacious fever), one of the dangerous consequences of severe coronavirus infection, and for signs of DKA (nausea, vomiting, abdominal pain, excessive thirst and urination). If you fear that you may be developing either of these complications, it’s time to seek medical care.
Should You get Tested for Coronavirus?
Stay tuned. While South Korea has already set up drive-thru testing stations, the United States has lagged far behind most other affected countries, and is still scrambling to figure out its own standards and system. Updates from the CDC and the White House are coming fast and furious, and as the government pushes to ramp up testing capabilities, it is likely that the answer to this question will change from one day to the next.
Healthline wonders: should you be stockpiling diabetes supplies? The website quotes two experts that think it’s not a bad idea:
“[Dr. Jason] Baker encourages [people with diabetes] to have extra insulin on hand, preferably a month’s worth at least, along with extra glucose monitoring and diabetes supplies. He recognizes the built-in barriers of access and affordability, too often dictated by insurance companies. That’s why it’s important to research any local grassroots relief efforts in your area, and to talk with your doctor now about working through and around these barriers if and when needed.”
It’s not impossible that the global supply chain that provides us with insulin and other critical management tools gets interrupted to some extent. It may be prudent to stock up on your supplies, if you can.