T1D and Coronavirus: What You Need to Know
Worried about COVID-19? Don’t panic: Here is the latest information and recommendations for people with type 1 diabetes, from the experts.
News about the novel coronavirus—which causes a disease now named COVID-19 by the World Health Organization (WHO)–continues to dominate global headlines.
On March 11, 2020, WHO publicly characterized COVID-19 as a pandemic.The situation is evolving rapidly, and risk to Canadians is now considered to be high.
COVID-19 and other viral illnesses—such as the flu—can pose a serious risk for people with T1D.
Below are some fast facts about COVID-19, and what people with T1D need to know.
About the Coronavirus Disease (COVID-19)
What is COVID-19?
Coronaviruses are a family of viruses that cause respiratory illnesses. Most of them cause illness in animals, but seven known types of coronavirus cause illness in humans. SARS-CoV-2 is one of those viruses—it causes the illness COVID-19. SARS-CoV-2 is related to other coronaviruses that cause illness in humans such as those that cause SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome).
What are the symptoms?
People who are confirmed to have COVID-19 have exhibited mild to severe respiratory illness with fever, coughing and shortness of breath. According to the WHO, some people may experience aches and pains, nasal congestion, runny nose, sore throat or diarrhea—though these symptoms usually develop gradually after the onset of the illness.
How will someone know whether they have COVID-19?
Generally, the disease is spread from person to person. If you have not been within six feet of someone who has it, your chances of contracting it are low. Presently, only certain public health laboratories can test someone to see if they have COVID-19. People who think they have been exposed to COVID-19 should contact their health-care provider immediately.
What should I do to protect myself?
Everyone has a part to play in minimizing the impact of the COVID-19 outbreak in Canada: Good hygiene and social distancing are crucial at this time to protect yourself and others. The Public Health Agency of Canada has posted key recommendations, including: Wash your hands often with soap and water for at least 20 seconds; do not touch your eyes, nose and mouth with unwashed hands; disinfect frequently touched objects and surfaces; avoid crowded places and non-essential gatherings; remain at least 2M away from others if you must go out; limit contact with people at high risk, such as those who are older or in poor health. Since COVID-19 is so new, there is not yet a vaccine, nor are there medications to treat it, although hundreds of clinical trials are already planned, or in progress.
What Should Someone with T1D Know about Having a Viral Illness?
1. People with T1D are not more at risk of coming down with COVID-19.
- COVID-19 poses a serious health threwat, and risk to Canadians is currently high. While we lack specific evidence about T1D and COVID-19, leading medical experts say that individuals with well-managed type 1 diabetes are NOT at increased risk of developing COVID-19.
- Experts further say that if someone with well-managed T1D does develop COVID-19, they are not necessarily at higher risk of developing serious complications from the disease.
- Those at greatest risk are people with consistently elevated blood sugar levels and those with a second chronic disease (such as heart disease, renal disease or lung disease).
- For parents of a child with T1D, you may find recent information from the International Society for Pediatric and Adolescent Diabetes (ISPAD) of interest. Their summary of anecdotal evidence from China and Italy reassuringly concludes that “youth with diabetes are not more affected by COVID than peers.”
- For a detailed explanation, please view this video from leading endocrinologist, Dr. Anne L. Peters.
- If you have T1D and do become ill, with any virus, you must take special care of you and your T1D (see below).
2. Monitor your blood glucose and ketones more than usual.
- When you’re under the weather, you may not feel like eating or drinking much, and you may be taking medication to address symptoms such as fever and muscle aches.
- For all of those reasons, it is crucial to carefully monitor your blood glucose and ketones more often than usual, as often as every four hours. Check your continuous glucose monitor (CGM) or flash glucose monitor (FGM) if you have one, or frequently use finger sticks. It may be necessary to take extra insulin to bring down higher blood glucose levels.
- Be vigilant in checking for ketones, as very high levels could lead to diabetic ketoacidosis (DKA), a dangerous condition that demands immediate medical attention, and can be fatal if left untreated.
- Elevated ketone levels often occur when blood sugar readings are high. This can be a sign that the body is using fat and muscle for energy, instead of sugar.
- Other signs of DKA include flu-like symptoms (feeling tired, weak, aches, nausea or vomiting, abdominal pain), dehydration and also a fruity smell to the breath with more rapid breathing, which happens when the body is trying to eliminate the ketones and acid.
- If you have vomiting, high ketones or symptoms of DKA, contact your healthcare provider immediately.
3. It is more important than ever to continue a normal schedule of medications
- This can be challenging when you feel unwell, especially if you’re having a hard time keeping food and liquid down.
- Beyond insulin, many over-the-counter medications also affect blood glucose levels. Although there are some sugar-free cough syrups on the market, many such syrups contain sugar, which can exacerbate already high blood glucose levels.
- Pills taken orally—that have the same ingredients as syrups—can be a better choice if they contain no carbohydrates.
- Other drugs like decongestants can raise blood glucose.
- Be aware of the effects of pain and fever reducers, too.
- Aspirin in large doses can lower blood glucose levels.
- Acetaminophen can cause false or no readings with certain CGMs, and can be toxic to the liver and kidneys. Anyone with kidney complications should be cautious about using drugs containing acetaminophen.
- Ibuprofen should also be handled with care as it increases the hypoglycemic effect of insulin.
4. Stock your cabinets with items that will help you keep up your carbohydrate intake in a healthy way
- Foods like crackers, vegetable or noodle soups, unsweetened applesauce, or fruit-flavored yogurt are all easy-on-the-stomach selections.
- If those mild foods prove too difficult to swallow, liquids can be a short-term solution.
- If blood sugars are in range, start with drinks that contain carbohydrates, and plan to consume something every three to four hours. Options include fruit juices, sports drinks and regular soft drinks.
- It's important to say well hydrated, especially when ketones are present, to flush them out. Increase your intake of carb-free choices like water, broth, and sugar-free gelatin, popsicles or soft drinks.
5. Be prepared, just in case
- It is vital to be ready for the worst, even if (hopefully) you never experience it.
- Ensure that you have diabetes medical supplies on hand and have access to refills in the event that you are quarantined.
- Have your doctor’s phone numbers (including how to reach them at night and on weekends or holidays) ready in case you encounter these symptoms: vomiting or diarrhea for more than six hours; shortness of breath; a fever for more than a couple of days; high levels of ketones; or an inability to keep food or liquid down.
- For children, call a doctor if they: have trouble breathing or exhibit blue lips; won’t eat or drink; experience severe ear pain (this may indicate an ear infection); and are much more sleepy than usual.
- If you end up at the emergency room, it is vital that you mention that you or your loved one has T1D and have an ID bracelet prominently displayed.
Stocks of Supplies
People with T1D should prepare for any emergency by assessing their medication and supply needs.
- Contact your physician, and make sure all your prescriptions are current and have a maximal number of refills available.
- Consider and check expiry of all back-up medications and supplies including:
- - Extra rapid-acting insulin
- - Long actin insulin if you are a pump user (in case of problems with your pump), with pens and syringes
- - Ketone strips and/or meter
- - Back-up method for monitoring blood glucose (if you usually use a CGM or Flash monitor), including meter, strips and lancets.
Numerous companies have distributed public statements about their supply chains (listed below). We will provide updates as we receive new information.
- Eli Lilly
- Insulet (Omnipod)
- Novo Nordisk
- Abbott Canada
- AMG Medical (Dex4)
- BD Medical
Information on Emergency orders and Prescription Refill Waivers
When a province issues an emergency order in response to the COVID-19 outbreak, the declaration may trigger a prescription refill waiver. These waivers allow pharmacists to refill prescriptions early if they deem a medication, such as insulin, critical to saving a person’s life or maintaining their treatment plan.
For further details, follow your local health department on social media for postings on waivers. You can call your local pharmacy and health insurer for updates.
- British Columbia
- New Brunswick
- Nova Scotia
- Prince Edward Island
- Newfoundland and Labrador
- Northwest Territories
- Yukon Territory
- For detailed information about COVID-19, visit the Public Health Agency of Canada and World Health Organization (WHO).
- For up to date information on the spread of COVID-19, visit the Johns Hopkins Global Cases Dashboard.
- Travel concerns? Health Canada provides recommendations on postponing or canceling travel.
- We have set up an email address to provide community support on issues related to T1D and COVID-19: [email protected]