This information is based on current knowledge of COVID-19 and will be updated as additional scientific evidence is released.
We know you have questions. We have answers.
Q: Are people with diabetes more likely to get COVID-19?
A: People with diabetes are not more likely to get COVID-19 than the general population. The problem people with diabetes face is primarily a problem of worse outcomes, not greater chance of contracting the virus. In China, where most cases have occurred so far, people with diabetes had much higher rates of serious complications and death than people without diabetes—and generally we believe that the more health conditions someone has (for example, diabetes and heart disease), the higher their chance of getting serious complications from COVID-19. While the death toll is likely to rise as the virus spreads, we expect the death rate—the number of people who die from the virus as a percentage of the total number of people who contract the virus—to go down as we get better at detecting and treating this specific virus.
Everyone needs to be careful to avoid the coronavirus that causes COVID-19. If you have type 1 or type 2 diabetes, you should be even more cautious.
Your risk of catching the virus isn’t higher than anyone else’s. But you could have worse complications if you do get sick. That’s especially true if your diabetes isn’t well-controlled.
To reduce your chance of getting infected:
- Keep your distance from other people.
- Use good hygiene.
- Keep your blood sugar under control.
Q: Do people with diabetes have a higher chance of experiencing serious complications from COVID-19?
A: People with diabetes do face a higher chance of experiencing serious complications from COVID-19. In general, people with diabetes are more likely to experience severe symptoms and complications when infected with a virus.
Your risk of getting very sick from COVID-19 is likely to be lower if your diabetes is well-managed. When people with diabetes do not manage their diabetes well and experience fluctuating blood sugars, they are generally at risk for a number of diabetes-related complications. Having heart disease or other complications in addition to diabetes could worsen the chance of getting seriously ill from COVID-19, like other viral infections, because your body’s ability to fight off an infection is compromised.
Viral infections can also increase inflammation, or internal swelling, in people with diabetes. This is also caused by above-target blood sugars, and both could contribute to more severe complications.
Q: Do I need to worry about DKA (diabetic ketoacidosis)?
When sick with a viral infection, people with diabetes do face an increased risk of DKA (diabetic ketoacidosis), commonly experienced by people with type 1 diabetes.
DKA can make it challenging to manage your fluid intake and electrolyte levels—which is important in managing sepsis. Sepsis and septic shock are some of the more serious complications that some people with COVID-19 have experienced.
If your blood sugar has registered high (greater than 240 mg/dl) more than 2 times in a row, check for ketones to avoid DKA.
A: COVID-19 is proving to be a more serious illness than seasonal flu in everyone, including people with diabetes. All of the standard precautions to avoid infection that have been widely reported are even more important when dealing with this virus.
Recommended safety precautions are the same as for flu, such as frequent hand washing and covering coughs and sneezes with a tissue or your elbow.
We encourage people with diabetes to follow the guidance of the CDC and to review how you manage sick days—preparing for a sick day can make it easier.
Q: What are the symptoms and warning signs I should be watching out for—and what do I do if I think I’m developing them?
A: Pay attention for potential COVID-19 symptoms including fever, dry cough and shortness of breath. If you feel like you are developing symptoms, call your doctor.
When you call:
- Have your glucose reading available
- Have your ketone reading available
- Keep track of your fluid consumption (you can use a 1-liter water bottle) and report
- Be clear on your symptoms (for example: are you nauseated? Just a stuffy nose?)
- Ask your questions on how to manage your diabetes
Q: What are the emergency warning signs—and what should I do if I’m experiencing them?
A: If you develop emergency warning signs for COVID-19 get medical attention immediately. In adults, emergency warning signs include:
- Difficulty breathing or shortness of breath
- Persistent pain or pressure in the chest
- New confusion or inability to arouse
- Bluish lips or face
Q: Are the risks different for people with type 1 and type 2 diabetes?
A: In general, we don’t know of any reason to think COVID-19 will pose a difference in risk between type 1 and type 2 diabetes. More important is that people with either type of diabetes vary in their age, complications and how well they have been managing their diabetes.
People who already have diabetes-related health problems are likely to have worse outcomes if they contract COVID-19 than people with diabetes who are otherwise healthy, whichever type of diabetes they have.
Diabetes and Coronavirus
Early studies have shown that about 25% of people who went to the hospital with severe COVID-19 infections had diabetes. Those with diabetes were more likely to have serious complications and to die from the virus. One reason is that high blood sugar weakens the immune system and makes it less able to fight off infections.
Your risk of severe coronavirus infection is even higher if you also have another condition, like heart or lung disease.
If you do get COVID-19, the infection could put you at greater risk for diabetes complications like diabetic ketoacidosis (DKA). DKA happens when high levels of acids called ketones build up in your blood. It can be very serious.
Some people who catch the new coronavirus have a dangerous body-wide response to it, called sepsis. To treat sepsis, doctors need to manage your body’s fluid and electrolyte levels. DKA causes you to lose electrolytes, which can make sepsis harder to control.
Q: What should I do to prevent the spread of COVID-19 in my home—and what do I do if someone in my household has the virus?
A: For people with underlying health conditions, including diabetes, healthy family members in the household should conduct themselves as if they were a significant risk to them. For example, they should be sure to wash their hands before feeding or caring for them. If possible, a protected space should be made available for vulnerable household members, and all utensils and surfaces should be cleaned regularly.
If a member of your household is sick, be sure to give them their own room, if possible, and keep the door closed. Have only one family member care for them, and consider providing additional protections or more intensive care for household members over 65 years old or with underlying health conditions.
Q: Will COVID-19 impact my access to insulin and other diabetes supplies?
A: Leading manufacturers are reporting that COVID-19 is not having an impact on their current manufacturing and distribution capabilities for insulin and other supplies at this time. We are continuing to monitor the situation and will provide updates should anything change. If you are struggling to pay for insulin or know someone who is, the ADA has resources to help—visit InsulinHelp.org.
Q: Do I have legal rights as a person with diabetes during the COVID-19 pandemic?
A: Yes, for more information, please visit https://www.diabetes.org/coronavirus-covid-19/know-your-rights-covid-19.
Q: Can disinfectants be ingested as a preventive measure?
A: No, people should not consume or misuse disinfectants. According to the CDC, household cleaners and disinfectants can cause health problems when not used properly. Follow the instructions on the product label to ensure safe and effective use.
Is COVID-19 Causing Diabetes?
When the prestigious medical journal The Lancet published a set of “practical recommendations for the management of diabetes in patients with COVID-19” (PDF), representing what must be the best up-to-the-minute consensus on the topic, the authors briefly noted one curious but potentially consequential aspect of treatment:
All patients without diabetes and particularly when at high risk for metabolic disease who have contracted the viral infection need to be monitored for new onset diabetes that might be triggered by the virus.
“New onset diabetes?”
Is the new coronavirus … giving people diabetes?
The answer appears to be yes. The mechanisms by which this may occur are not yet verified, and the prevailing theories are probably only truly comprehensible to those with graduate level biochemistry experience, but I’ll take a crack at it. You may have heard of ACE2, a receptor that the coronavirus “hijacks” in order to gain entry to the body’s cells and multiply. ACE2 is highly expressed in the pancreas and on the beta cells themselves, which means that when the coronavirus attacks, the beta cells are among the primary fields of battle. Direct damage to the beta cells impairs their ability to release insulin, leading to heightened glucose intolerance and, in a word, diabetes.
The theory that COVID-19 attacks the Beta cells is supported by “frequent” reports of patients suffering from diabetic ketoacidosis (DKA), a condition almost unknown outside of the presence of type 1 diabetes, attested to by Italian colleagues of the authors of the Lancet paper. The authors further go on to emphasize the “tremendous insulin requirements” of patients: “the extent of insulin resistance in patients with diabetes seems disproportionate compared with critical illness caused by other conditions.”
The day after the Lancet letter was published online, the same link was considered in a Chinese case study, in which COVID-19 was seen to “precipitate” a case of DKA.
Neither paper speculates on the duration of new onset diabetes, although the Lancet letter does note that “SARS-CoV-2 can induce long-term metabolic alterations in patients,” and that cardiometabolic monitoring during is called for during recovery.