COVID-19 Q&A for Patients with Diabetes
Should I stop taking certain blood pressure medications because I’ve heard that these drugs may affect my risk of COVID-19 infection?
Blood pressure control is an essential part of managing (hypertension, heart and kidney diseases and) diabetes. In addition, certain blood pressure lowering medications [(a class of medications known as angiotensin converting enzyme inhibitors (ACE-i) or Angiotensin Receptor Blockers (ARBs)] are often recommended for people living with diabetes to protect them from kidney and heart-related complications, even in the absence of high blood pressure.
At the present time, there is no confirmed scientific link between these blood pressure medications and the risk of COVID-19 infection or its complications. Please do NOT stop or change any of your medications without discussing with your healthcare team.
Source: https://www.diabetes.ca/en-CA/resources/tools---resources/faq-about-covid-19-and-diabetes
How coronavirus can affect people with diabetes
Coronaviruses can cause more severe symptoms and complications in people with diabetes, as well as in older people and those with other long-term conditions, such as cancer or chronic lung disease.
Everyone with diabetes, including those with type 1 and type 2, is more at risk of severe complications if they get coronavirus, but the way it affects you can vary depending on what type of diabetes you have.
You’re more at risk of having serious blood sugar highs and lows, as well as longer-term problems with your eyes, feet and other areas of your body.
For most people, coronavirus is a mild illness, but some people develop a more serious form of the virus, and could die.
It is important that people with diabetes follow the sick day rules should they become ill from any illness. If you routinely check your blood sugar at home, you'll probably need to do it more often – at least every four hours, including during the night.
If your blood sugar is persistently high or low, or if you have symptoms of a hyper (hyperglycaemia) contact your GP practice or diabetes team by phone who will help you if you have any queries or if you are unsure about what to do regarding your diabetes.
Source: Diabetes UK https://www.diabetes.org.uk/about_us/news/coronavirus
What can people with diabetes and their loved ones do?
If you have diabetes, the International Diabetes Federation (IDF) recommends:
- Prepare in case you get ill.
- Make sure you have all relevant contact details to hand in case you need them.
- Pay extra attention to your glucose control.
- If you do show flu-like symptoms (raised temperature, cough, difficulty breathing), it is important to consult a healthcare professional. If you are coughing up phlegm, this may indicate an infection so you should seek medical support and treatment immediately.
- Any infection is going to raise your glucose levels and increase your need for fluids, so make sure you can access a sufficient supply of water.
- Make sure you have a good supply of the diabetes medications you need. Think what you would need if you had to quarantine yourself for a few weeks.
- Make sure you have access to enough food.
- Make sure you will be able to correct the situation if your blood glucose drops suddenly.
- If you live alone, make sure someone you can rely on knows you have diabetes as you may require assistance if you get ill.
Source: International Diabetes Federation https://diabetesvoice.org/en/news/covid-19-anddiabetes/
If you are pregnant and have diabetes, Diabetes UK recommends:
The same rules apply to you as for everyone with diabetes. If you’re pregnant and have diabetes, then you are more at risk of getting the virus. This is because you’re more vulnerable to getting infections and illnesses. It's really important you follow the rules on staying at home.
Source: Diabetes UK https://www.diabetes.org.uk/about_us/news/coronavirus
Are the risks similar for people with type 1 and type 2 diabetes?
In general, the American Diabetes Association does not know of any reason to think COVID-19 will pose a difference in risk between type 1 and type 2 diabetes. More important is that people with either type of diabetes vary in their age, complications and how well they have been managing their diabetes.
People who already have diabetes-related health problems are likely to have worse outcomes if they contract COVID-19 than people with diabetes who are otherwise healthy, whichever type of diabetes they have.
Source: American Diabetes Association. https://www.diabetes.org/diabetes/treatmentcare/planning-sick-days/coronavirus
If people with diabetes become unwell for any reason, it is important to follow ‘sick day’ rules. Sick Day Rules/guidance have been published by a number of professional organisations:
American Diabetes Association
https://www.diabetes.org/diabetes/treatment-care/planning-sick-days/coronavirus
Diabetes UK:
https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/illness
International Diabetes Federation
https://diabetesvoice.org/en/news/covid-19-and-diabetes/
Primary Care Diabetes Society
https://www.diabetesonthenet.com/resources/details/glance-factsheet-covid-19-anddiabetes
Is the virus more dangerous for me because of my kidney disease?
Patients with kidney disease have the same risk as the general population to get infected with coronavirus. However, because of your kidney disease, you are at higher risk of getting very sick from COVID-19. Therefore, it is extra important for you to take actions to reduce your risk of getting the coronavirus disease (COVID-19). This also accounts for patients older than 70 years and patients with other chronic diseases.
Source: European Renal Association – European Dialysis and Transplant Association https://www.era-edta.org/en/covid-19-news-and-information/#toggle-id-7
I am recovering at home. Can I use paracetamol when I don’t feel well?
The ERA - EDTA advises to discuss this with your doctor. In general, paracetamol has an established safety profile, as long as you do not take more than instructed on the package insert.
Although there is currently no evidence that nonsteroidal anti-inflammatory drugs (NSAIDs) worsen Covid disease (https://www.ema.europa.eu/en/news/ema-gives-advice-use-nonsteroidal-anti-inflammatories-covid-19), they are generally not advised for CKD patients because they can be harmful for your kidneys.
Source: European Renal Association – European Dialysis and Transplant Association https://www.era-edta.org/en/covid-19-news-and-information/#toggle-id-7
I use medication to suppress the immune system (immunosuppressive drugs). Should I stop taking these drugs?
No, it is very important that you continue taking these drugs. Your immune system will not improve directly when you stop taking these drugs, it will stay suppressed for a while. Moreover, you need these drugs to prevent rejection of the kidney transplant (patients living with a kidney transplant) or to prevent a kidney disease flare (patients with a kidney disease).
Source: European Renal Association – European Dialysis and Transplant Association https://www.era-edta.org/en/covid-19-news-and-information/#toggle-id-7
Can I still receive dialysis treatment when I am diagnosed with the Coronavirus Disease (COVID-19)?
Yes, dialysis treatment will continue as usual. If you have light symptoms and are permitted to stay at home whilst being infected, you can receive treatment in your own dialysis center. It is advised to contact them in advance to give notice of your situation. Make sure to use private transportation to your clinic and not use a taxi service that is shared with other patients. If you do not have private transportation available to you, in some countries (as for example The Netherlands) ambulance services (with the appropriate prevention measures) are offered. Upon arrival, you will be separated from other patients to limit the chances of spreading the virus to others. The medical professionals will wear protecting clothes and facemasks. These measures are called isolation measures.
In case you are experiencing severe symptoms due to the corona infection and have been admitted to a hospital, dialysis treatment will be done there.
Source: European Renal Association – European Dialisis and Transplant Association https://www.era-edta.org/en/covid-19-news-and-information/#toggle-id-7
Information for people with diabetes from professional organizations
American Association of Clinical Endocrinologists (AACE)
https://www.aace.com/recent-news-and-updates/aace-position-statement-coronavirus-covid-19and-people-diabetes-updated
American Diabetes Association
https://www.diabetes.org/diabetes/treatment-care/planning-sick-days/coronavirus
Diabetes Australia
https://www.diabetesaustralia.com.au/news/15720?type=articles
https://www.diabetes.ca/en-CA/resources/tools---resources/faq-about-covid-19-and-diabetes
Diabetes UK
https://www.diabetes.org.uk/about_us/news/coronavirus
International Diabetes Federation
https://diabetesvoice.org/en/news/covid-19-and-diabetes/
Primary Care Diabetes Society
https://www.diabetesonthenet.com/resources/details/glance-factsheet-covid-19-and-diabetes
Information for patients from other professional societies
American College of Cardiology
https://www.acc.org/latest-in-cardiology/features/accs-coronavirus-disease-2019-covid-19-hub
American Heart Association
https://www.heart.org/en/about-us/coronavirus-covid-19-resources
European Society of Cardiology
https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-theesc-council-on-hypertension-on-ace-inhibitors-and-ang
ERA-EDTA
https://www.era-edta.org/en/covid-19-news-and-information/#toggle-id-7
National Kidney Foundation
https://www.kidney.org/contents/be-prepared-kidney-patient-prep-coronavirus
Other:
Latest public health information from CDC: https://www.coronavirus.gov
Latest research from NIH: https://www.nih.gov/coronavirus
European Medicines Agency
https://www.ema.europa.eu/en/news/ema-gives-advice-use-non-steroidal-antiinflammatories-covid-19
Joslin Diabetes Center
https://www.joslin.org/about/news-media/joslin-updates-clinical-operations-and-covid-19