Preliminary data from China suggest that people with diabetes and other preexisting conditions are more likely to experience serious complications and death from COVID-19 than people without diabetes and other conditions.
But COVID-19 and the coronavirus that causes it are new, and researchers are still investigating how they impact immunity. We also know that if a person has diabetes and gets influenza or another infection, they can experience worse health outcomes. The question is why.
High blood sugars can interfere with white blood cells’ ability to fight infection. So there’s a possibility that people with high blood sugars may have a suppressed immune system, leaving them more susceptible to lung complications. There’s not enough data yet to know if there is a link between blood sugar control and COVID-19 outcomes.
Preparation and precautions are the best protection
Fortunately, we can still help protect people with diabetes with the information we do know. If you have type 1 or type 2 diabetes, take the following steps to prepare and reduce your risk of infection:
Wash your hands regularly. Take care to wash your hands frequently. You should be using soap and water, and scrubbing for at least 20 seconds. Wash your hands whenever you’re preparing or eating food, caring for a child or a sick person, using the toilet, or going out in public.
Wear a cloth mask in public. If you need to leave your home, for example to go to the grocery store or pharmacy, wear a cloth face mask. The CDC has instructions for making your own masks. They do not recommend wearing an N95 mask, as those should be reserved for health care professionals.
Practice social/physical distancing. Stay at least six feet away from other people, and avoid gathering in large groups. It can help to use mail-order delivery for prescriptions and a grocery delivery service. If you do get sick, stay home and isolate yourself from other people in your household.
Have up-to-date supplies and prescriptions of your diabetes devices and medications. Stock up on insulin supplies, glucose testing supplies, ketone test strips, glucose tablets, and up-to-date prescriptions.
Continue taking ACE inhibitors and ARBs as directed. If you take ACE inhibitors or ARBs for high blood pressure, heart disease, or diabetes, keep taking them unless your physician recommends otherwise. There was a controversial report saying that these drugs might make people more susceptible to COVID-19, but there is no evidence that this is true. In fact, the American Heart Association and other major associations recommend their continued use.
Be prepared if you do get sick. Keep a supply of fever-reducing medications, like acetaminophen (Tylenol), and cough syrup in your home.
Uncontrolled diabetes may make symptoms feel more intense, and it may be more challenging to manage a pre-existing condition when you become sick or fatigued. This could result in needing hospitalization.
“When diabetes isn’t well managed, you can have high blood sugar, which suppresses immune system function. When the immune system isn’t performing as well, it has a harder time fighting off infections, and viral symptoms can be worse,” says Soleimanpour.
If you have diabetes and get sick with COVID-19
It’s critically important for people with diabetes to understand that COVID-19 illness can raise their blood pressure levels, and high blood pressure can lead to dehydration. If you get sick, drink plenty of fluids and check your blood pressure regularly. Ask your doctor for instructions on how to watch your blood pressure and adjust for changes.
In addition, check your blood sugar more frequently (about every six hours) and contact your doctor if it stays above 250 mg/dL. If you have type 1 diabetes and your blood sugar rises above 250, you could be at risk for ketoacidosis, which occurs when the body burns fat for energy and creates high levels of blood acids, known as ketones. Eventually these ketones can poison the body. During the coronavirus outbreak, it’s especially important to keep your ketone levels down and avoid trips to the ER, when possible.
Overall, having diabetes does put you at risk for COVID-19 complications, including the need for hospitalization and a ventilator. Do your best to avoid getting sick and needing care at the hospital.
Prioritize your emotional well-being
It’s also important to prioritize your mental health, which can have a big impact on your diabetes and blood sugar levels. People with diabetes are two to three times more likely to have depression. Take extra care to do things that make you happy. Breathe in deeply and slowly when you feel anxious. Talk to loved ones regularly. Use technology to stay connected to friends and family; try an online meeting or call a friend.
It’s important to be proactive in diabetes management on a daily basis, but even more vital during this pandemic. Don’t let fear paralyze you from being proactive and making good decisions for your health, Soleimanpour says.
He adds, “my heart goes out to people with diabetes because I understand their concerns. I’m not immune to being worried myself. I try to take care of myself by doing things I can control. I can’t control this virus, but I can control my diabetes.”
Set yourself up for success by eating healthy meals and exercising 30 minutes a day. It’s good for your mental health, too. Even though gyms are closed, you can get your heart rate going with home workouts or a walk around the neighborhood.
Your routine has been disrupted, so it’s also important to continue to get enough sleep, eat healthy, and exercise within your ability.
And above all, remember that this is a unique season of life. It won’t always be this way.
Robert Gabbay, MD, PhD, FACPRobert Gabbay, MD, PhD, FACP