This article was updated in December 2020 to include the latest information about COVID-19. Updates will continue as the pandemic situation progresses.

Healthline

The continuing COVID-19 pandemic remains a public health emergency worldwide, and those with underlying health conditions like diabetes remain at the top of the list for risks associated with the new coronavirus.

So, should we PWDs (people with diabetes) be especially concerned? And what can we do to prepare?

While scientific data varies on whether PWDs are more at risk, what is becoming clear is that more severe outcomes are more likely for those with type 1 and type 2 diabetes.

As a result, precaution and mitigation strategies are the most important tools our D-Community can practice in dealing with this continuing public health emergency.

Here’s what we know, based on information from health authorities including the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and credentialed medical professionals within and beyond the diabetes space.

First, the basics.

The CDC reports that coronaviruses are a large family of viruses common in animal species, and only rarely do they infect and spread among humans.

As it pertains to COVID-19, the disease that the new coronavirus, SARS-CoV-2, causes, some researchers believe it arose last year with an outbreak in Wuhan, China.

From there it’s gone global, and has been responsible for tens of millions of infections and more than 1.6 million deaths worldwide.

Importantly, the incubation period is 2 to 14 days, per the CDC. This means people can be exposed and transmit the virus for days or weeks before developing any symptoms, if they do even develop symptoms.

All U.S. states now have CDC approval for coronavirus tests that produce results in 1 to 4 days, and the number of testing sites continues to grow around the country.

The Food and Drug Administration (FDA) approved use of the first COVID-19 home testing kit in April. Using the cotton swab provided, people can collect a nasal sample and mail it to a designated laboratory for testing.

The FDA’s emergency use authorization specifies that the test kit is authorized for use by people who healthcare professionals have identified as having suspected COVID-19.

Several companies have made rapid progress on a vaccine for COVID-19. On Dec. 2, the United Kingdom became the first Western country to approve a new vaccine, made by U.S. pharma giant Pfizer and its German partner BioNTech.

More vaccines are on the way and expected to get approved, with healthcare workers and long-term care residents getting the first doses.

“In general, people with diabetes face greater risks of complications when dealing with viral infections like flu, and that is likely to be true with COVID-19,” the American Diabetes Association (ADA) said in a statement early in the year.

The ADA encourages people with diabetes to follow the guidance of the CDC and to review their diabetes sick day protocols in case they do contract an infection.

The fact is that people with diabetes are at higher risk when it comes to things like influenza (flu), pneumonia, and now COVID-19.

This is because when glucose levels are fluctuating or elevated consistently, we have a lower immune response (less protection against disease), so we risk getting sicker quicker.

There may also be an underlying risk of exacerbated illness simply due to having diabetes even if glucose levels are in range.

In a recent study published in December by Vanderbilt University Medical Center, researchers discovered PWDs with T1D and T2D who’ve tested positive for COVID-19 are three times more likely to have severe illness or require hospitalization compared to those without diabetes.

Investigators examined electronic health records of more than 6,000 patients across 137 Vanderbilt health clinics who had a COVID-19 diagnosis between mid-March and early August.

Researchers then reviewed those medical records and followed up by telephone to explore additional risk factors and gather more info on the COVID-19 impact on their health.

“People with type 1 diabetes don’t need to live in fear and have undue anxiety, but they need to be really diligent in doing the things we all should be doing,” said Dr. Justin Gregory, a pediatric endocrinologist at Vanderbilt Children’s Hospital and the study’s lead investigator.

“I’m not asking people with type 1 diabetes to do anything that all of us shouldn’t already be doing. I just think they need to be the most diligent about doing it day in and day out,” he said.

Of course, data throughout the year has contradicted those findings, and it’s still TBD on the actual impact for those living with T1D.

In particular, an October study that looked at the first 3 months of the pandemic in Belgium found that there’s no increased hospitalization due to COVID-19 for those with T1D.

Another clinical study at the Joslin Diabetes Center in Boston, Massachusetts, found that age and glycemic control didn’t differ significantly between adult T1s hospitalized for COVID-19 and those hospitalized for other reasons.

Those studies confirmed previous clinical research by T1D Exchange in May, showing that most PWDs who keep tabs on their diabetes management aren’t more likely to see worse outcomes or death from COVID-19.

At the European Association for the Study of Diabetes virtual meeting in late September, Dr. Catarina Limbert in Portugal pointed out that increased risk is largely limited to a smaller number of more vulnerable PWDs: those with A1Cs at 10 percent or higher, those older than 50 with long-term diabetes, and those with compromised immune systems.

The CDC’s recommendations for protecting against COVID-19 include:

It’s also critical to keep unwashed hands away from your eyes, nose, and mouth, because that can allow germs that cause respiratory infections to enter the body.

Official guidance has evolved throughout 2020, but the CDC updated its guidance in early November to indicate the importance of wearing a face mask — not only to protect others, but to protect yourself.

The CDC’s new November guidance cites a number of studies showing that masks reduce the risk of transmitting or contracting the virus by more than 70 percent.

Along with wearing cloth face coverings in public settings where other physical distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), the CDC emphasizes it’s especially importantin areas of “significant community-based transmission.”

This is now deemed critical to slow the spread of the virus and help people who may have an infection and not know it from transmitting it to others.

In case you’re wondering how diligent handwashing really can slow down an epidemic, this piece from Medical News Today explains, “if 60% rather than 20% of air travelers maintained clean hands, it could slow down the spread of infections by almost 70%,” according to researchers at Massachusetts Institute of Technology in Cambridge.

The CDC and other authorities also continue to state that if you think you might be sick, stay home from work or school.

That recommendation isn’t without criticism, however.

An article in The Atlantic explores how difficult it can be for working adults to stay home in the event of any illness in the United States.

For that reason, many businesses have now issued their own updated work from home (WFH) policies, and have canceled most business travel and in-person events.

Most medical professionals who treat diabetes are emphasizing basic hygiene and illness precautions, as well as doubling down on efforts to achieve good glucose control.

Endocrinologist Dr. Jennifer Dyer in Ohio tells DiabetesMine that she’s received a barrage of calls from patients concerned about COVID-19. Her advice?

“Bottom line: Make sure you get a flu shot. If you or your loved ones get sick with a flu-like or cold-like illness, first make sure it’s not the flu, which is treatable. If there is any progression to pneumonia, get support and treatment fast as this is what typically makes these viruses dangerous,” she says.

Well-known Philadelphia-area diabetes education and care specialist Gary Scheiner reminds us that PWDs can also be more prone to dehydration, especially when blood sugars rise, so it’s important to stay hydrated.

This may mean stocking up on bottled water, or even sugar-containing liquids like Gatorade, which can also provide electrolytes and energy in the event of emergency situations.

In an interview on the “Diabetes Connections” podcast, Scheiner explains that if a person with diabetes contracts an infection with the new coronavirus, “it’ll affect them just like it affects a person without diabetes, but in a PWD it’s gonna cause the glucose levels to rise as well… You’re going to see some intense inflammation of the respiratory tract.

“One of the unique things about it compared to some other viruses like the flu is it can cause some severe shortness of breath, which we don’t always see with other communicable common illnesses. So that’s something to watch for,” he said.

Scheiner also shared some specific reminders for people with diabetes:

  • “I tell patients to be a bit OCD about handwashing — be very compulsive about that.”
  • “Get a flu shot, because you can prevent any form of the flu, and that’s always beneficial.”
  • “Be very careful around people who have signs of respiratory illnesses who are coughing, sneezing, etc. Keep your distance, or just try to be very cautious about physical contact with them.”
  • “A humid environment is also beneficial. If your house is dry, especially in the wintertime, use a humidifier. The first place where germs can penetrate into the body is the nasal passages, and if they dry out due to dry air, you’re kind of opening the door and marshaling germs into your system.”

Regarding glucose control, Scheiner said, “We see the risk of these types of problems almost go up exponentially when the A1C starts getting up into the 9 or 10 range. And with an A1C in the 6 or 7s, the risk is slightly increased. I wouldn’t say it’s dramatically higher than in someone without diabetes, but there is some increased risk.

“The other issue is managing the glucose if you do get sick, which becomes more challenging, but even more important, because when glucose levels are elevated, you’re sort of aiding and abetting the infection that virus or bacteria has a lot of fuel to grow off of.

“So you’re feeding the enemy in a way if your blood sugar is poorly controlled. When you’re sick, running a lot of high blood sugars is going to extend your recovery time and cause your symptoms to become that much worse,” he explained.

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Image via DiabetesDietBlog.com

No doubt, emergency and disaster planning is a critical component to all of this.

“In general, I think this virus is bringing up the question of disaster preparedness, and is reminding many in the diabetes community about how poorly we are prepared for disaster scenarios,” says endocrinologist Dr. Jason Baker in New York, who also lives with type 1 diabetes himself.

“We are indeed reminded right now of how vulnerable we are living with diabetes, how reliant we are on the uninterrupted manufacture and distribution of our life-sustaining insulin and glucose monitoring supplies; we are indeed naked without them,” he says.

Baker encourages PWDs to have extra insulin on hand, preferably a month’s worth at least, along with extra glucose monitoring and diabetes supplies.

He recognizes the built-in barriers of access and affordability, too often dictated by insurance companies.

That’s why it’s important to research any local grassroots relief efforts in your area, and to talk with your doctor now about working through and around these barriers if and when needed.

In Colorado, diabetes education and care specialist Jane Dickinson says she’s had conversations with people trying to stockpile insulin and supplies.

“I think there’s a feeling that people on pumps need to not only have pump supplies on hand, but also MDI (multiple daily injection) supplies as a backup,” she says. She adds that this is a wise thing to do.

Thankfully, dozens of medtech and pharma companies are proactively tackling awareness and disease preparation as it relates to COVID-19 — notably Johnson & Johnson, Medtronic, and Roche.

Industry trade group AdvaMed notes that by the end of February, nearly three dozen member companies had already donated a collective total of $26.8 million worth of medical products to the China Red Cross (since COVID-19 originated in that country) as well as other health institutions and clinics globally.

The group has also formed a Coronavirus Task Force focusing on personnel, transportation, supply, etc., that’s meeting regularly to coordinate the industry response.

While there was a concern about this issue early on during the pandemic, it didn’t materialize into a large concern for most companies or PWDs.

Spokeswoman Stephanie Caccomo with the FDA’s Center for Devices and Radiological Health, which regulates and oversees diabetes devices, told DiabetesMine in early November that they hadn’t received any reports of diabetes products being directly affected by the COVID-19 crisis to date.

The Association of Diabetes Care and Education Specialists has compiled a comprehensive list of drugmakers’ responses about product and supply availability during COVID-19.

Among the 18 companies listed, no significant shortages are noted.

The midyear mail delays at the U.S. Postal Service and the shipping delays with big third-party companies like Amazon, FedEx, and UPS turned out to be more of an issue than supply shortages.

Since most of the home deliveries for 2020 went smoothly, the advice for PWDs going into the holidays and beyond has simply been to prepare in advance, and ensure they have enough diabetes supplies and medications on hand, just in case.

This BMJ opinion article published in early November highlights some interesting global patient perspectives on the implications of COVID-19 on those with T1D.

Importantly, it notes that aside from practical and logistical worries, there’s also an impact on mental health.

“In addition to individual country and region-specific challenges, there has also been an increased mental health burden because of the pandemic, especially for people living alone. People with T1D are struggling to balance the need to leave the house for work or necessary hospital visits with the desire to self-isolate and self-protect. Self-managing T1D already causes a high cognitive load and mental health burden, and the current pandemic is adding to that,” the authors state.

Interestingly, we’ve seen PWDs online taking various stances on this, from heightened concern to brushing it aside as nothing more than typical flu season preparedness.

In one Twitter thread, advocate and former ADA magazine editor Kelly Rawlings shared her diabetes-centric #COVID19 strategy and welcomed others to share theirs:

  1. Refill insulin & key supplies prescriptions ASAP.
  2. Update my primary care doctor contact info.
  3. Review basal/bolus rates; convert to multiple daily injection plan, JIC I can’t operate pump.
  4. Wash hands.
    And you?

Back in spring, Dana Lewis and her husband, Scott Leibrand, the entrepreneurs behind the first homemade Artificial Pancreas technology, were sharing early on what they had been doing to stay safe.

In this remarkable Twitter thread, Lewis announced: “I’ve been personally watching the information about #COVID19 for over a month and a half, and expecting it to come to my doorstep. It’s now here, as predicted, so I wanted to share some of what I’m personally able to choose to do & why, with regards to individual protection.”

She then explains which diabetes tools she’s using, and how she’s keeping herself safe inside and outside their home.

The couple lives in the Seattle area, and Scott had traveled to Silicon Valley in mid-February — an area that subsequently reported high numbers of COVID-19 cases.

As a result, aside from taking general health precautions, Scott put himself into “self-isolation” at home for a time.

Lewis and Leibrand are also behind the push by the #WeAreNotWaiting community of diabetes DIY technology enthusiasts to do more than just wearing masks, washing hands, and staying home.

They’re working to generate a DIY tool for self-reporting of health factors related to virus monitoring.

Collaborating with health professionals, infectious disease experts, and others, they’re creating what is known as CoEpi (Community Epidemiology into Action), a mobile tracking app.

It will allow anyone to easily and privately track who they’ve been in contact with, and anonymously share reports and updates on their own symptoms and likely contagiousness — whether that be a cold, flu, COVID-19, or any other contagious disease.

A beta version of CoEpi is available as of mid-November, though Leibrand points out they’re still “jumping through hoops” trying to get it into the Apple App Store.

Anyone interested in testing the beta version can download it using the links at the bottom of CoEpi.org.

Leibrand also notes that some parts of the United States now have an official Exposure Notification app, or the ability to turn it on via their smartphone settings.

He highly recommends everyone enable that, if possible.

And for anyone who’s not locked down tight in a tiny bubble, the Novid app is also very useful for your own contact tracing: It has a feature showing how many degrees of separation you have from someone who’s tested positive for COVID-19.

“Yeah, this pandemic is scary, but it’s exciting that there’s something we personally can all do to help protect ourselves, our loved ones, our social networks, and our communities,” Leibrand told DiabetesMine.