Are You More at Risk of Coronavirus if You Are Diabetic?

NHS figures suggest that’s the case, and Diabetes UK has issued helpful advice

NHS figures providing a breakdown of specific pre-existing health conditions among those to have died with Covid-19 suggest that a quarter of patients suffered from diabetes.

The survey, of statistics from March 31st, showed that of the 22,332 patients who died, 5,873 were diabetic. The total death toll in the UK up to May 14th was 33,614 according to daily figures released by the Department for Health and Social Care.

Diabetes UK has updated its advice to emphasise that remind at-risk individuals of symptoms and procedures.

Particularly vulnerable

Everyone with diabetes, including those with type 1, type 2 and gestational, is vulnerable to developing a severe illness if they get coronavirus, but the way it affects them can vary from person to person.

People with diabetes are particularly vulnerable to becoming seriously ill with coronavirus because the virus can cause difficulties managing diabetes, potentially leading to DKA (diabetic ketoacidosis).

Diabetes causes variations in blood sugar levels, and the body tries to fight coronavirus by releasing stored glucose (sugar) into the blood stream to provide energy. But the diabetic body can’t produce insulin to cope with this, so blood sugars rise, causing a risk of serious blood sugar highs and lows, as well as longer-term problems with eyes, feet and other areas of your body.

If you have type 1 diabetes and take SGLT2i tablets, your doctor may want you to stop these for the time being. This is because SGLT2i tablets can mask the symptoms of DKA (diabetic ketoacidosis), which can be caused by coronavirus.

Coronavirus symptoms

If you have type 2 diabetes and you take SGLT2i tablets you can keep taking these unless you become unwell. If you are unwell, these tablets could increase your risk of developing diabetic ketoacidosis (DKA).

There are lots of different types of SGLT2i tablets so check information from Diabetes UK for the full list of brand names.

If you have coronavirus symptoms such as a new continuous cough and/or high temperature you should not go to a GP surgery, pharmacy or hospital.

If you live alone, stay at home for seven days from when your symptoms started. If you live with someone who has a continuous cough or a high temperature, you should stay at home for 14 days from the day the first person got symptoms. If you then develop symptoms, you should stay at home for seven days from the day your symptoms start, even if it means you’re at home for longer than 14 days.

Follow the advice of your GP practice, practice nurse or diabetes team regarding your diabetes and othet medication.

If you routinely check your blood sugar at home you’ll probably need to do it more often. If you don’t check your blood sugar levels at home, be aware of the signs of a ‘hyper’ (hyperglycaemia), which include passing more urine than normal (especially at night), being very thirsty, headaches, tiredness and lethargy. You should contact your GP practice if you have hyper symptoms.

Stay hydrated

Stay hydrated – have plenty of unsweetened drinks and eat little and often.
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 (generally 15mmol/l or more, or 13mmol/l if you use an insulin pump, but your team may have given you different targets) or if ketones are present, contact your diabetes team.

Keep eating or 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.

If you feel you cannot cope with your symptoms at home, or your condition gets worse, or your symptoms do not get better after seven days, then use the NHS 111 online coronavirus service. If you do not have internet access, call NHS 111. For a medical emergency, dial 999.

Shielding advice

Shielding is a way of protecting clinically extremely vulnerable people who are at a very high risk of severe illness and hospitalisation from coronavirus. It means staying at home and avoiding all face-to-face contact.

So what is meant by clinically extremely vulnerable? These include people with certain types of cancers and severe respiratory conditions. You can find the full list of people who should be shielding on the gov.uk website.

Government advice recognises that people with diabetes can be more vulnerable to becoming seriously ill with coronavirus. However it does not automatically place people with diabetes in the ‘extremely vulnerable’ or shielding group.

Diabetes UK says that some people with diabetes may become seriously ill with coronavirus and need to be hospitalised, but the available evidence does not show that all people with diabetes are at a significantly increased risk solely because of their diabetes.

There may be some people with diabetes who need to shield based on other conditions, for example those with cystic fibrosis-related diabetes. But under current guidance, most people with diabetes do not need to do this. If you haven’t had a message from the NHS yet, then you’re not being told to shield and you should follow the stay at home rules.

Hospital appointments

If you have hospital and GP appointments and don’t have coronavirus symptoms, then your appointments should still carry on, but you should check whether your appointment is still going ahead by calling the number on your appointment letter.

Most routine appointments like annual diabetes reviews, eye screening and foot checks will have been cancelled or postponed except for some people at higher risk such as pregnant women, but should be rescheduled once things go back to normal. You should continue with self-checking, keep to a healthy diet and try to keep active. All eye screening clinics should be using personal protective equipment (PPE).

Diabetes UK has some helpful information to help you cope with stress and other emotions, or you might like to the helpline to talk it through with someone. There is also a useful coronavirus thread on the online forum, where members are sharing information and experiences so you might find answers to any more questions.

Self-isolating

Diabetes UK has provided reassurance that users of insulin pumps, continuous glucose monitors or flash glucose monitor (FreeStyle Libre) will still be able to get them , whether through prescriptions or paying for yourself. However it advises that if you are self-isolating you should try to arrange for family, friends or neighbours to pick up your medication for you.