Diabetes? Your 5-Step Plan to Stay Safe During the COVID-19 Outbreak

Living with diabetes can be difficult under normal circumstances. The new coronavirus makes it all the more challenging, because it’s proving to be especially dangerous to those with diabetes.

Looking at currently available data in the United States, roughly one-third of patients who are hospitalized with COVID-19 (the respiratory illness caused by the new coronavirus) have diabetes, says Robert Eckel, M.D., president of medicine and science for the American Diabetes Association (ADA) and professor of medicine emeritus at the University of Colorado School of Medicine. For comparison, about 10 percent of Americans have diabetes.

“We know that people with diabetes are more likely to be hospitalized once they become infected, and also the outcomes look less favorable,” says Dr. Eckel, explaining that in patients with diabetes, the infection causes blood glucose (aka sugar) to rise, which can set off an intense inflammatory response in the respiratory tract.

“How much of this is because of their diabetes alone, or because of additional pre-existing conditions, like high blood pressure or heart disease, is less than clear,” says Dr. Eckel. “But we do know that the immune response in patients with diabetes is impaired.”

But the outlook isn’t all gloom. With the right precautions, you can stay on the right side—the far side—of the coronavirus.

“As someone who’s had diabetes for 35 years, I practice what I preach, which is control what you can control,” says endocrinologist Scott A. Soleimanpour, M.D., assistant professor of internal medicine at the University of Michigan School of Medicine, where he is also director of both type 1 diabetes basic research and the type 1 diabetes transition program.

With that in mind, here’s your five-step plan to stay in control of your diabetes right now. 

Step #1: Keep Your Blood Sugar Levels on Target
By now you have heard the CDC recommendations to prevent catching the coronavirus—wash your hands regularly and stay 6 feet away from others. You should also be appropriately masked any time you’ll be with people outside your household, which, according to the CDC’s latest guidance means layering a disposable surgical mask underneath a snug fitting cloth mask or placing a mask fitter over your cloth mask to ensure a tight fit. But as someone living with diabetes, the best thing you can do for yourself today is to make sure your blood sugar stays in the target range outlined for you by your doctor.

“I’m most concerned about individuals with uncontrolled blood sugar developing COVID-19, as they’ll have a harder time fighting off the infection,” says Dr. Soleimanpour, who also practices at the VA Ann Arbor Healthcare System. 

Here, he says he’s looking at people who have elevated hemoglobin A1C levels, as well as those who have known complications of their diabetes, such as skin infections, nerve damage, high blood pressure, or kidney disease. Those problems generally spawn from poor blood sugar control.

“Just because we’re in the middle of the outbreak, don’t hesitate to get in touch with your doctor if you need help tightening your blood sugar levels,” he says. “Even if they can’t see you in person right now, you can do a telemedicine visit or a phone call.”

Keep up with your current treatment plan, including taking your medications as prescribed, and ask your doctor if you should monitor your blood sugar or ketones more than usual.

Step #2: Stock Up on Your Diabetes Supplies
Good news: There have been no reports of shortages or supply chain issues with diabetes medications or insulin at this time.

Still, you’re wise to make sure that all of your prescriptions are up to date and that you have a minimum two-week supply of your necessities. “Be proactive, so that you don’t get into a situation where you’re in a bind and have to leave the house,” says Dr. Soleimanpour. 

Things you’ll need:

• Glucose meter (with extra batteries and test strips)
• Insulin
• Extra refills of prescriptions
• Ketone test strips
• Backup supplies for your pump or continuous glucose monitor 
• Glucose tablets or gels
• Glucagon kit

Step #3: Refine Your Grocery List and Make Time to Move
Current physical distancing practices are a double-edged sword: Staying home and limiting contact with others helps stop the spread of the coronavirus, but it also makes it hard for anyone with diabetes to practice the self-care measures that are so important in managing blood sugar levels.

“Even if you’re trying to stay indoors more to protect yourself from the virus, you really need to do the good habits,” says Dr. Soleimanpour. “I know it’s hard when you’re inside—some people become more sedentary, they stop exercising, they may eat a little more poorly. But being active and eating right still apply.”

If your normal fitness routine isn’t possible, get creative. The popular fitness program for seniors, SilverSneakers, is hosting Facebook Live workouts. Or if you’re a Broadway buff, try some choreographed cardio and strength training to your favorite show tunes, courtesy of 567Broadway! on YouTube.

When you’re making your grocery list, think about shelf-stable essentials—along with an assortment of frozen fruits, vegetables, and meats—that will allow you to eat balanced meals for two or more weeks. 

A good rule of thumb is to build your meals around lean protein, complex carbohydrates (think whole grains, broccoli, beans, and sweet potatoes), and healthy fats (such as olive oil, nuts, or avocadoes). Having the right mix of foods on hand will make it easier to keep your blood sugar in your goal range while sticking close to home. 

Don’t forget to include foods that are part of your sick-day plan—things like Jell-O and 100-percent fruit juice to deal with low blood glucose, and low-sodium soup and meal-replacement beverages (like Boost or Glucerna) to keep you nourished and hydrated. 

“If you can do things like get the groceries delivered to your home, or do pick-ups rather than walking around a crowded store, that’s another safety measure that you can control right now,” says Dr. Soleimanpour.

Step #4: Map Out Problem-Solving Strategies
It’s well-known that stress can lead to blood sugar spikes, says Dr. Eckel. Well, hello, living in the middle of a pandemic is certainly stressful!

Now’s the time to take a beat and check in with yourself. Feeling anxious, sad, frustrated, and stuck are all perfectly normal responses to our new normal. Give yourself permission to have all of those feelings. But then take the next step, which is to think about the effective problem-solving strategies that have worked for you in the past.

Some suggestions from the ADA:

• Unplug from nonstop coronavirus updates—too much media exposure can be a negative emotional stimulation
• Create a new routine to help you regain a sense of control over your surroundings—this includes setting regular eating and sleeping patterns
• Make a point of getting some type of exercise every day
• Give yourself credit for the active adaptation that you’re engaged in

If you’re having trouble getting a grip on these emotions, reach out to your diabetes doctor.

“Sometimes diabetes is overwhelming, and it can be a really emotional condition,” says Dr. Soleimanpour. “But social distancing doesn’t mean disconnection with everybody. We can help.”

Step #5: Make a COVID-19 Sick Plan
When you were first diagnosed with diabetes, your doctor came up with a sick day plan for you to follow under any kind of illness or condition. Whatever your plan is, know it and be ready to follow it during this outbreak. 

However, because there’s no proven treatment, cure, or vaccine for COVID-19, it’s important to have additional plans in place should you—or someone you live with—become infected. 

First, know the signs: Fever, shortness of breath, dry cough, chills, repeated shaking with chills, muscle pain, headaches, sore throat, and new loss of smell or taste are the leading symptoms of COVID-19. Some patients are also reporting flu-like symptoms, including body aches, diarrhea, and nausea. If you spot any of these symptoms, call your doctor.

“Generally, when people with diabetes get a virus of any kind, the diabetes becomes more challenging to control,” Dr. Soleimanpour says. “You’ll often notice your blood sugars are starting to run higher because you have this infection. So it’s important to know that and be ready to do something about it.”

What to do if you develop COVID-19: Be prepared to temporarily bump up the doses of your medicines during your infection. 

“This is really where these connections, either by phone or by a telemedicine visit, with your diabetes specialist are important,” says Dr. Soleimanpour. “We can look at your [blood glucose] numbers and decide how much extra insulin or medication you need while you’re going through this.”

COVID-19 increases the amount of inflammation in the body. This can lead to an increased risk of diabetic ketoacidosis (DKA), which can be life-threatening if not quickly treated. Signs of DKA often include high levels of ketones in your urine, nausea and vomiting, thirst, and frequent urination. 

Get medical attention immediately if you start to experience any of these advanced-stage COVID-19 symptoms: 

• Difficulty breathing or shortness of breath
• Persistent pain or pressure in the chest
• New confusion or inability to arouse
• Bluish lips or face

Dr. Eckel adds that the hospitalized COVID-19 patients with diabetes who require intensive care are requiring much more insulin than they needed prior to becoming ill.

“Once infected, if you’re admitted to the hospital, we need to be more zealous in getting patients’ glucose within an acceptable range,” says Dr. Eckel, adding that an appropriate blood sugar level range would be between 110 and 180 milligrams per deciliter. 

If you go to the hospital, try to remember to bring your own diabetes supplies, especially if you’re on a pump or glucose sensor, advises Dr. Soleimanpour. Also, because you won’t be allowed to have family visitors in the hospital, don’t be afraid to speak up and “be your own advocate for your diabetes” care once you’re admitted, he adds.

What to do if a roommate develops COVID-19: If there’s someone in your home that you suspect might have COVID-19, you need to act fast to put some distance between you. 

“Sometimes that’s hard, but that’s really important,” says Dr. Soleimanpour. “Assign them their own room, or if that’s not possible, is there someplace else that you can stay while they recover? You want to do everything that you can to make sure that you don’t get it.”

The information in this story is accurate as of press time and posting. To limit the spread of the coronavirus, it’s important to continue practicing social distancing (keeping at least 6 feet away from people outside your household) and washing your hands frequently. You should also be appropriately masked any time you’ll be in public. According to the CDC’s latest guidance means layering a disposable surgical mask underneath a snug-fitting cloth mask or placing a mask fitter over your cloth mask to ensure a tight fit. Because the situation surrounding COVID-19 continues to evolve, we encourage readers to follow the news and recommendations for their own communities by using the resources from the CDC, WHO, and their local public health department.