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.
JDRF provides this information in the interest of helping members of the T1D community make informed decisions regarding their health and well-being. If you still have concerns or questions, we strongly urge you to please contact your physician or healthcare provider. Your health and safety are of great importance.
- About the Coronavirus Disease (COVID-19)
- T1D and returning to work and school in the wake of the COVID-19 outbreak
- What Should Someone with T1D Know about Having a Viral Illness?
- Preparing for the Hospital
- Stock of Supplies
- Information on Emergency Orders and Prescription Refill Waivers
- COVID-19 Vaccine Provincial Rollout Plans
- Additional Information
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.
1. Having T1D does NOT make you more susceptible to developing COVID-19.
- COVID-19 poses a serious health threat, 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
- Canadian endocrinologist, Dr. Remi-Rabasa-Lhoret here.
- 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.
Is it safe to go to the hospital?
- If you are worried that you may be showing signs of diabetic ketoacidosis (DKA), seek help. Do not wait. If left untreated, DKA can lead to death.
- If you suspect someone you love may be showing signs of diabetes, seek help. We were devastated to hear of a recent death in the US that occurred when T1D was thought to be the flu.
- With COVID-19, physicians urge you seek help if you have trouble breathing, persistent pain or pressure in the chest, new confusion or inability to arouse or have bluish lips or face in light-skinned patients, gray or whitish skin around the mouth in dark-skinned patients, or grayish-greenish skin tone in patients with yellowish skin.
- Contact your personal physician and have them call ahead of your arrival to ensure staff know that you have T1D, the medical issue you are going to the hospital for and your arrival time.
- Pack a bag with two weeks of T1D supplies.
What T1D supplies should I bring to the hospital?
Protocols vary by hospital, and some facilities may not allow the use of your own supplies and T1D technology, but experts advise that you bring your own supplies and be prepared to use them if possible.
1. Blood glucose monitoring equipment
- If you have one, take your CGM and a sufficient supply of sensors, transmitter and back-up transmitter, adhesives/tapes, pre-insertion wipes, batteries and/or charging device, cables.
- Standard blood glucose monitoring supplies: glucose meter, lancing device and a sufficient supply of lancets and strips. You may need to use the hospital’s meter, but could ask to use your own lancing device as it likely has smaller gauge needles.
2. Insulin and injection or pump supplies
- If you use a pump: sufficient supplies (including reservoirs and filling mechanism (or pods if you use OmniPod), infusion sets, inserter devices), charging cable and/or battery
- If you use pens or syringes: a sufficient supply of pens and pentips, or syringes. Syringes are typically available, but, if permitted, you may feel more comfortable using what you are accustomed to
3. Vials of all insulins used, with back-up vials. Many hospitals do not carry all types of insulins, so if you would prefer not to change, bring your own.
4. Supply of treatments for non-severe lows (glucose tablets, juice etc.)
5. Glucagon (if available)
6. Ketone test strips (should be available, but good to take with you)
7. Copies of your healthcare team’s contact information
8. If possible, a copy of your last prescription
9. Details of your insulin regimen to share with medical staff: if medical staff need to manage your T1D on your behalf, this is information that they need communicated clearly and quickly. For example, if you use an insulin pump, try to download and bring a printout of the device settings, showing the basal profile, the profile of your carbohydrate-to-insulin ratios, the profile of your insulin sensitivity factor, targets for correction doses and active insulin time. Also include your typical total daily dose of insulin.
JDRF has been, and will remain, in close contact with the leading manufacturers of insulin and T1D supplies. Each leading manufacturer has communicated to us that COVID-19 is not having an impact on their current manufacturing and distribution capabilities. Some pharmacies in Canada are low on stock as they adjust to rapidly increasing demand, a situation that we have been informed is temporary and localized, and not related to an overall shortage We will continue to monitor the situation and update the T1D community should anything change.
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
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
- British Columbia
- Update: May 3, 2021: Children aged 12 -15 with type 1 diabetes are no longer required to present a doctor’s note when booking a vaccine. Anyone over 16 with type 1 diabetes is also eligible for a vaccine.
- Update: April 27, 2021
- We have received many questions about vaccination for children and adolescents with T1D. Below is the latest recommendation from the National Advisory Council on Immunization (NACI)
- 9. NACI recommends that COVID-19 vaccines should not be offered routinely to individuals who are not in the authorized age group. (Strong NACI Recommendation)
- a. However, a complete vaccine series with a Pfizer-BioNTech may be offered to individuals 12-15 years of age who are at very high risk of severe outcomes of COVID-19 (e.g., due to a pre-existing medical condition known to be associated with increased risk of hospitalization or mortality) or are at increased risk of exposure (e.g., due to living in a congregate care facility), if a risk assessment deems that the benefits outweigh the potential risks for the individual, and if informed consent with the individual and the parent or guardian includes discussion about the insufficiency of evidence on the use of COVID-19 vaccines in this population. (Discretionary NACI Recommendation)
- Alberta is currently offering vaccines to individuals in the age group with T1D. We will keep monitoring the rest of Canada and provide updates accordingly once the provincial recommendations on children and adolescents are revised.
- Update: May 3, 2021: As of May 10, 2021 anyone over 16 with type 1 diabetes can book a vaccine throughout the province.
- People with type 1 diabetes who are 16 years or older can now book a vaccine in the province of Quebec. To book, please click here.
- New Brunswick
- Nova Scotia
- Prince Edward Island
- Newfoundland and Labrador
- Northwest Territories
- Yukon Territory
If you want to voice any concerns you may have related to the vaccine roll out with your provincial or territorial government, consider writing to your province’s Chief Medical Officer, the Minister of Health, your MLA/MPP or all three.
At the municipal level you can also connect with your city/town’s– Chief Medical Officer/ Chief Public Health Officer – or your local representative (Councillor/ Alderman.)
Please find attached this letter that you can fill out and email or mail to your provincial or local health authority to make your voice heard.
- We are hosting regular online events so you can ask experts your questions about T1D and COVID-19.
- The JDRF-Beyond Type 1 Alliance has joined diabetes organizations across the world in a simple goal: tap in to the power of the global diabetes community to save lives. Together, we can lead the way in stopping the spread of COVID-19. Learn more about the #BigLittleChanges you can make to save lives at CoronavirusDiabetes.org
- To support and inform the T1D community, JDRF Canada consulted a panel of Canadian endocrinologists to provide answers to some of your most frequently asked questions. Read our blog here.
- 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]