Column: Diabetes During Covid-19 Part II

April 20, 2020

[Column written by Dr. Annabel Fountain]

This article is part 2 of my Living with Diabetes and Covid-19 Pandemic series. In the previous article, I discussed how persons living with diabetes and their families can reduce their chance of becoming infected with the virus. This article will share a few tips on how to manage if you do happen to become infected. These are your sick day rules, and apply to any infection. But first, let’s discuss what we currently know about Covid-19.

As of April 13, 2020, 1,856,831 cases have been recorded worldwide. 428,277 people have recovered and 114,312 people have died. Most people [more than 80%] have a mild illness of Covid-19. This is great news. However, about 14% are severe and one in 20 people will develop critical illness such as pneumonia. This is more common in people who have other health problems, but not always. We know that many people around the world who probably had the virus have not been tested, so the true number of cases is probably higher, which means that the death rate is probably not as high as these statistics make it appear.

The incubation period for the Covid-19 virus is between 2-14 days but many people may have only very mild symptoms or none at all and never realise they had it. These people may transmit the virus to others and never even know it. This is why social distancing is so important.

The first symptoms of Covid-19 virus may include cough, nasal congestion, fever, body aches and sore throat, just like any respiratory virus like the common cold or flu. Indigestion and diarrhea are also possible. These symptoms are your body’s response to the virus, not actually the virus itself. When a virus invades your body, the immune system acts to kill it. White blood cells are recruited to destroy the virus and hormones, enzymes and other chemicals are released. These chemicals are what cause the fever and runny nose, aches and pains. In later stages of the illness a person may develop shortness of breath, pneumonia and respiratory distress.

If you think you may have Covid-19 call your doctor, stay home, limit contact with other people and wash your hands well and often. When we recommend that people just stay home and ride it out, that can be really scary for a person with diabetes, who may need more support. Be in close contact with your doctor if you don’t feel well.

  • Don’t panic – contact your diabetes team if you need help to manage your sugars.
  • Do not go to a GP surgery, pharmacy or hospital unless you have severe illness [see below].
  • If you or someone you live with has symptoms of coronavirus, then all household members must stay at home and not leave the house for 14 days or until 3 days after the last symptoms have resolved.

Sick day rules.
Any stress can make diabetes more unpredictable and difficult to manage. This is true for illness, including the Covid-19 virus. If you’re not monitoring your blood sugars, you won’t know if they’re high.

  • 1] If you’re unwell, you need to be testing more often.
  • 2] If you take medications for your diabetes, you may need higher doses when you’re unwell. Some medicines, such as insulin, cause low blood sugars if you’re not eating properly or vomiting. Close monitoring of your glucose levels allows you to make adjustments to your medications. Call for help if you don’t know how to do this.
  • 3] Keep eating and drinking – if you can’t keep food down, try snacks or drinks with carbohydrates in to give you energy. Try to sip sugary drinks [such as fruit juice or non-diet cola or lemonade] or suck on glucose tablets or sweets like jelly beans. Letting fizzy drinks go flat may help keep them down. If you’re vomiting, or not able to keep fluids down, get medical help as soon as possible.
  • 4] If you routinely check your blood sugar at home you’ll probably need to do it more often.
  • 5] If you don’t test your blood sugar levels at home, be aware of the signs of high blood sugar levels, which include passing more urine than normal [especially at night], being very thirsty, headaches, blurred vision, tiredness and lethargy. Call your diabetes team if you’re experiencing this.
  • 6] If you have type 1 diabetes, check your blood sugar at least every four hours, including during the night, and check your ketones if your blood sugar level is high [>250mg/dL]. If ketones are present, contact your diabetes team.
  • 7] If your sugars are high, avoid carbohydrates and sugars.
  • 8] Make sure you stay well-hydrated. Drink plenty of water or sugar free drinks.
  • 9] Get plenty of rest
  • 10] Remember that some glucose sensors [not regular meters] can be less accurate if you take Tylenol.
  • 11] If measures you’re taking to keep your sugars under control aren’t working, call your diabetes team. When you call them be prepared:
    • Have your glucose readings available and if you check ketones, have that ready too;
    • 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.

When to seek medical attention?

If you develop 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

If you’re having trouble breathing; if you’re not able to keep fluids down or you’re becoming dehydrated [dizzy, lightheaded, faint, very dark urine]

If you feel you cannot cope with your symptoms at home, your condition gets worse, or your symptoms do not get better after 7 days, then call your GP or the Bermuda Hospitals Board support line. 444 2498, available 9:00am to 9:00pm daily. If you are encountering a medical emergency call 911.

- Dr Annabel Fountain is a Bermudian physician who is board certified in Endocrinology, Diabetes and Internal Medicine. She is the Owner/Medical Director of Fountain Medical Group. Dr Fountain offers the following Endocrinology services, Diabetes Prevention, Education and Management, Thyroid Disease – Hypothyroidism, Hyperthyroidism, Nodules and Cancer, Obesity and Weight management, Disorders of Calcium and Bone including Osteoporosis, Hypertension and Cholesterol disorders, Adrenal and Pituitary Disease, Infertility and Menopause, Other glandular disorders.


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