DIABETES & COVID-19
1. What should people with diabetes know?
• Pay extra attention to your glucose control. Regular monitoring can help avoid complications caused by high or low blood glucose.
• If you do show flu-like symptoms (raised temperature, cough, difficulty breathing), it is important to consult the doctor.
• Any infection is going to raise your glucose levels and increase your need for fluids, so have plenty of fluids.
2. Healthy nutrition and home-based exercise
• Give priority to foods with a low glycaemic index (e.g. vegetables, whole wheat) & lean proteins (eg. fish, meat, eggs, milk, beans)
• Avoid excessive consumption of fried foods
• Eat green, leafy vegetables and fruits.
3. Are people with diabetes more likely to get COVID-19?
• There is not enough evidence to show whether people with diabetes are more likely to get COVID-19 than the general population, however, like any other infections, they’re more likely to have worse complications if they get it.
4. Do people with diabetes have a higher chance of serious complications from COVID-19?
• Yes, people with diabetes are more likely to have serious complications from COVID-19, this is likely to be lower if diabetes is well-managed.
5. Are the risks different for people with type 1 and type 2 diabetes?
• People with any type of diabetes can be at increased risk of severe illness from COVID-19; however, those with type 1 might be at even higher risk for severe illness from COVID-19 and should exert extra caution from ending up with DKA.
6. Do I need to worry about DKA (diabetic ketoacidosis)?
• When sick with a viral infection, people with type 1 diabetes (and type 2 diabetes sometimes) do face an increased risk of diabetic ketoacidosis (DKA) and can make it challenging to manage fluid intake and electrolyte levels, let alone insulin dose adjustments.
7. Does COVID-19 and/or its treatment cause diabetes?
• Though there is no direct evidence linking COVID-19 to onset of diabetes, there is however definite role of hyperglycemia due to stress induced by the inflammatory state with COVID-19 infection. Another entity is steroid induced diabetes which is seen more commonly due to use of steroids for severe cases of COVID-19.
8. What should I do if I am Home managed for my COVID-19 infection?
• Keep in touch with your diabetes doctor through tele-consults, avoid physical visits to clinics/hospitals.
• Ensure you keep blood glucose meters and monitor your glucose readings as recommended by your doctor. Continuous glucose monitoring can be handy if you can access to one.
• Eat healthy, have plenty of fluids and try to keep fit mentally and physically while you are recovering at home.
9. How is COVID-19 managed in Hospital Settings?
• In the hospitals, you can still continue to take your usual medicines unless your doctor adjusts your medications or decides to initiate insulin. Insulin has much better outcomes when compared with oral medications during illnesses and hospitalization.
• Medications that are considered safe in Diabetes are INSULINS, METFORMIN, SULPHONYLUREA AND DPP4i. SGLT-2i and PIOGLITAZONES may be better avoided.
10. Some practical tips to manage Diabetes during COVID-19 infection?
1. Try to keep fasting around 100mg/dl and post meal readings below 180mg/dl.
2. Ensure patient do not get hypoglycaemic episodes (below 70mg/dl).
3. DPP4i like Galvusmet (50/500mg), Istamet (50/500mg) can be safely given for mild hyperglycemia as these do not cause hypoglycemia. The dose can be once or twice daily.
4. Combinations of SU + Metformins can be initiated (eg: GEMER 1, GEMER2, GEMER 3 etc, once or twice daily before food). Start with a small dose and titrate based on blood glucose readings.
5. For those who are familiar with insulins, the following options can be availed.
a) Basal insulins like LANTUS can be initiated at a dose of 10U and titrated to keep fasting around 100mg/dl.
b) For those with high post meal glucose readings, one option is to try MIXTARD 10U once or twice daily before breakfast and before dinner.
c) For patients with significantly high glucose readings, basal bolus regime with short acting before each meal and a basal at bed time can be more convenient to achieve decent control on glucose readings. (eg: Novorapid 4-6U before each meal with bedtime bolus like Lantus 10U)