Coronavirus and Type 1 Diabetes:
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.

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News about the novel coronavirus disease—named COVID-19 by the World Health Organization (WHO)—continues to dominate global headlines. Many Americans are understandably concerned. 

On January 31, 2020, Health and Human Services Secretary Alex M. Azar II declared a public health emergency (PHE) for the United States to aid the nation’s healthcare community in responding to COVID-19. On March 11, 2020, the WHO publicly characterized COVID-19 as a pandemic.

COVID-19 and similar viral illnesses—such as the flu—can pose a serious risk for people with T1D. 

Below, 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)

  • 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 coronaviruses 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. People who think they have been exposed to COVID-19 should contact their health-care provider immediately.

  • What should I do to protect myself?
    Since COVID-19 is so new, there is not yet a vaccine, nor are there medications to treat it. The CDC has posted key recommendations for preventing the spread of all respiratory illnesses. Wash your hands often with soap and water for at least 20 seconds; do not touch your eyes, nose and mouth with unwashed hands; avoid close contact with people who are sick; stay home when you are sick; and disinfect frequently touched objects and surfaces.

What Should Someone with T1D Know about Having a Viral Illness?

  1. Having T1D does NOT make you more susceptible to contracting COVID-19.
  • Current evidence suggests that individuals with well-managed T1D are NOT at higher risk of contracting COVID-19.
  • Experts further say that if someone with well-managed T1D does contract 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 or lung disease).
  • For a detailed explanation, please read this blog or  view this video from leading national 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).  

 

  1. 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) 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 on the lookout 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, moderate or large ketones, symptoms of DKA, contact your healthcare provider immediately.

 

  1. It is more important than ever to continue a normal schedule of medications.
  • This can be challenging when you feel sick, especially if you’re having a hard time keeping food and liquid down.
  • Beyond insulin, many over-the-counter (OTC) medications also affect blood glucose levels. Though there are some sugar-free cough syrups on the market, many such syrups contain sugar, which only exacerbates 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 also 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 in CGMs, and can be toxic to the liver and kidneys. Anyone kidney complications should be cautious about using these drugs with acetaminophen.
    • Ibuprofen should also be handled with care as it increases the hypoglycemic effect of insulin.

 

  1. 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 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 such as orange or cranberry, sports drinks and regular soft drinks.
  • It’s important to stay 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.

 

  1. 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 that won’t go away after a couple of days; large levels of ketones; and inability to keep food or liquid down and are experiencing hypoglycemia.
  • 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.

Stock of Supplies 

JDRF has been, and will remain, in close contact with the leading manufacturers of insulin and type one diabetes (T1D) supplies. Each leading manufacturer has shared with us that COVID-19 is not having an impact on their current manufacturing and distribution capabilities. We will continue to monitor the situation and update the T1D community should anything change. 

Because of increased orders in recent weeks, some suppliers are telling T1D customers that they may be delayed in immediately refilling orders. We are told that these are delays, not longer-term issues and not due to shortages in the supply chain.

All members of the T1D community should ensure prescriptions are current, and that you have received the maximum number of refills available. Also, consider contacting your pharmacy to see if you are able to refill your prescription even if it is before the typical 30-day time window, as some state and/or health insurance companies are waiving refill restrictions because of COVID-19. 

  • Can I get insulin without going to a physical pharmacy?

We know some insurers are taking action to make it easier for people to get their insulin through home delivery. We encourage you to reach out to your insurance company or pharmacy to see what options are available to you.

  • Help with costs

There are a few ways you can lower your prescription and insulin costs: through state and nonprofit programs; diabetes patient assistance programs offered by pharmaceutical companies; medication discount cards and more. Learn more about them at jdrf.org/costs.

  • What are the major suppliers saying?

Numerous companies have distributed public statements about their supply chains (listed below). We will provide updates as we receive new information.

Information on State-Level Emergency Orders and Prescription Refill Waivers

When a state 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, Healthcare Ready advises people to follow their local health department on social media for postings on waivers. You can check your local Board of Pharmacy website for more information, and call your local pharmacy and health insurer for updates. Healthcare Ready also provides a list of current state-level emergency orders with details on the status of waivers in addition to COVID-19 screening and testing.

Additional Information

For detailed information about COVID-19, visit the Centers for Disease Control (CDC) 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? CDC provides recommendations on postponing or canceling travel

Do you have questions about insulin access and need information in dealing with health insurance? Visit the JDRF Health Insurance Guide to learn more.

 

Updated: March 27, 2020 9:00 am EST