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 or difficulty breathing. According to the CDC, additional symptoms include fever or chills, fatigue, muscle or body aches, headache, sore throat, new loss of taste or smell, congestion or runny nose and possibly gastrointestinal symptoms like nausea, vomiting or diarrhea. Symptoms may appear 2–14 days after exposure to the virus. For people with T1D, according the preliminary findings from the T1D Exchange (who received co-funding from JDRF), the most prevalent presenting symptom was high blood sugar, followed by elevated temperature, dry cough, excess fatigue, vomiting, shortness of breath, nausea and body/headaches.

• What should I do to protect myself and others?
  The CDC has posted key recommendations for preventing the spread of all respiratory illnesses. Wear a mask when in public; maintain at least a 6 feet distance between yourself and others; wash your hands often with soap and water for at least 20 seconds or using an alcohol-based hand rub; do not touch your eyes, nose and mouth with unwashed hands; and stay home when you are sick.

• What are my legal rights as someone with T1D concerning the COVID-19 pandemic? If you have questions about legal rights, the American Diabetes Association (ADA) has prepared and collected information and resources to assist people with diabetes during the COVID-19 pandemic.

Does COVID-19 Cause T1D?

• JDRF has been monitoring the impact of COVID-19 on the health of people living with T1D and now recommends, along with the ADA, that T1D be given a priority status for vaccination because of the strong correlation between high blood sugar and more severe COVID-19 infection. People with T1D or T2D have worse outcomes than people without them if they contract COVID-19.  
• JDRF has also been monitoring the number of new T1D diagnoses seen during the COVID-19 pandemic and praises the groups who have established registries to quantify this situation in the US, UK, the EU, and elsewhere.  

• Right now, the data do not clearly indicate that the rates of T1D diagnoses are changing during COVID-19, but we are continuing to evaluate the situation as more data becomes available.

• It is possible that COVID-19 could have a direct effect on the insulin-producing beta cells or could be a trigger for underlying autoimmunity leading to T1D-like disease. Right now, researchers are working hard to determine if either of these cases is true. Some scientists suggest that viral infections, in particular rotavirus and coxsackie infections, can trigger underlying autoimmunity leading to T1D. More research is needed to prove that SARS-CoV-2, the virus that causes COVID-19, to be a true T1D trigger.

• During COVID-19, many emergency physicians are seeing more people diagnosed with diabetes because of a serious complication of it, called diabetic ketoacidosis (DKA). Because of advisement not to visit hospitals with non-COVID problems and, potentially, fear of COVID exposure, people are delaying going to the hospital when they have signs and symptoms of T1D. This has led to the increased DKA rates being seen right now. 
• For that reason, JDRF advocates for people with T1D to get vaccinated as soon as possible. People with T1D and high blood sugar have a higher risk of experiencing more severe COVID symptoms. Consult our COVID-19 Vaccine Access Guide to learn more about the vaccine. 
• People should also know the signs and symptoms of T1D, including excessive thirst, frequent urination, and unexplained weight loss, and proceed to the emergency room immediately if they are experiencing these. 

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

• Having T1D does NOT make you more susceptible to contracting COVID-19.
  • Based on current scientific literature, there is no evidence that people with T1D are at higher risk for contracting COVID-19.
  • Although children with T1D can catch the virus, they usually have mild symptoms. However, the virus could make it harder to manage blood glucose levels and therefore create a risk for diabetic ketoacidosis (DKA). 
  • Two new studies show that adults with T1D, who are diagnosed with COVID-19, are at an increased risk of severe COVID-19 illness. Details on each of these studies are below. These add to an October 2020 UK population-based registry publication showing that people with type 1 diabetes have more than 3-fold level of increased risk of mortality when hospitalized due to COVID-19.
    • A December 2020 U.S.-based study shows that adults who get COVID-19 and have diabetes, whether T1D or T2D, have three to four times higher risk of severe illness and hospitalization.
      • Specifically, the study found “after adjustment for age, race, and other risk factors, the odds of a COVID-19–related hospitalization and greater illness severity for patients with type 1 diabetes are three- to four-fold higher than patients without diabetes. This increased risk is approximately the same for patients with type 2 diabetes.”
      • Per this study, “hypertension, race, recent diabetic ketoacidosis, health insurance status, and less diabetes technology use were significantly associated with illness severity.”
      • Those at greatest risk are people with consistently elevated blood-sugar levels and those with a second comorbidity (such as obesity or heart, kidney, or lung disease).
    • A December 2020 study published out of Scotland shows that the risk of serious outcomes among adults with T1D and T2D were significantly higher than compared to a baseline of the general population.
      • Specifically, the study found that the risk of severe COVID-19 for adults with diabetes compared to the general population when adjusted for age and sex was 2–4 times higher for T1D and 1–4 times higher for T2D.
      • The report indicates that greater elevation in T1D “is probably accounted for by longer duration of diabetes because in the older age bands, cumulative incidence was higher in type 1 than type 2 diabetes…”.
      • The study found that the “risk of fatal or critical care unit-treated COVID-19 in diabetes rose steeply with age and was higher in males…”.
  • Given the higher risks of severe illness and hospitalization from COVID-19 found in these studies, JDRF calls for people T1D and T2D to have prioritized access to the COVID-19 vaccine. Consult our COVID-19 Vaccine Access Guide for more information.
  • 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).

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.
    • 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.
    • Very high levels of ketones could lead to diabetic ketoacidosis (DKA), a dangerous condition that demands immediate medical attention, and can be fatal if left untreated.
    • Preliminary findings from the T1D Exchange suggest that one-third of people with T1D experience DKA if they have confirmed or suspected COVID-19, so be aware of any signs that DKA is occurring, such as 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—the symptoms of DKA—contact your healthcare provider immediately.

• 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 active 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 with kidney complications should be cautious about using acetaminophen.
    • Ibuprofen should also be handled with care as it increases the hypoglycemic effect of insulin.

• 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.

• 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.

Preparing for the Hospital

• When should I go to the hospital?
  • For Diabetic Ketoacidosis (DKA):
    • 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.
  • For COVID-19:
    • With COVID-19, physicians urge you to 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.
    • The overall risk of dying in the hospital from COVID-19 among people with T1D is very low, however, one study found that this risk is higher for people with T1D (3.5 times higher) compared to people without diabetes. So be vigilant about keeping your blood-sugar levels in a normal range, as increased blood-sugar levels correspond with poorer health outcomes for those who contract COVID-19.

• What should I do before I go to the hospital?
  • 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.
  • Ensure they know if you are on a continuous glucose monitor (CGM), insulin pump and/or hybrid closed-loop system.
  • Pack a bag with two weeks of T1D supplies.

• Hospital Protocols for supplies vary and some 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 rely on them if possible.
  • If you have one, take your CGM, as this allows medical staff to quickly and frequently check your levels. Know that hospital policies vary, but during the pandemic, many hospitals are welcoming personal CGMs.
  • All insulin pens, needles and back-up pens.
  • Syringes are typically available, but, if permitted, you may feel more comfortable using what you are accustomed to.
  • Many hospitals do not carry all types of insulin, so if you would prefer not to change, bring your own.
  • If you use a pump: infusion sets, reservoirs and filling mechanism (or in the situation of OmniPod, Pods), vial of rapid-acting insulin (with a back-up vial), batteries and/or a charging cable.
  • Sensors, transmitter and back-up transmitter adhesives/tapes or pre-insertion wipes, batteries and/or charging device, plus cables.
  • Meter, lancet, lancing device and strips (you may need to use the hospital meter, but ask to use your own lancing devices as they are likely smaller gauge needles).
  • Supply of treatments for lows
  • Glucagon
  • Piece of paper with your endocrinologist’s name and contact information.
  • Ketone strips (should be available, but good to take with you).

Hospital Protocols for visitors vary from hospital to hospital, but there are steps you can take to help enable a caregiver to assist with your diabetes management in the event you are hospitalized.

• If you are over the age of 18, have an Advance Care Plan in place. This document will allow your medical team to communicate with your designated caregiver about your medical care. 
• Talk with your endocrinologist and primary care provider to develop a plan before you need to go to the hospital. Know who to call prior to heading to the hospital and make your desires known about your care, particularly if you want a caregiver to assist with your care and be present during your hospitalization.
• If you have a choice of hospitals, review their visitor policies and select the hospital that you feel best meets your needs. Revisit their policies prior to any hospitalization as they may change due to COVID-19.
• In the event you are hospitalized, you and/or your caregiver may contact the hospital risk manager, unit manager and/or your care team to discuss your desire to have your caregiver present to help with your diabetes management, which could ease some of the burden on healthcare providers and result in better outcomes.
• If hospital policies do not allow your caregiver to remain with you during your stay, you or your caregiver should ask how your caregiver can play an active role in helping to manage your diabetes.

Consult our hospital preparedness resources and our emergency preparedness resources for additional, general information. 

T1D Supply Chain and Availability 

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.

• • Medtronic
    • Medtronic Expands Diabetes Support Programs to Help Customers Losing Insurance Coverage
  • Dexcom
    • Dexcom Patient Assistance Program
  • Eli Lilly and Company
    • $35 Insulin Card
    • Lower-priced versions of Humalog® Mix75/25™ KwikPen® and Humalog® Junior KwikPen® now available
    • Insulin received through the Lilly Cares Foundation patient assistance program will now be delivered directly to the person’s home
  • Insulet (Omnipod)
  • Sanofi
    • New temporary access program provides eligible people with immediate access to a 30-day supply of medicine
    • Insulins Valyou Savings Program
  • MannKind (Afrezza) 
  • Novo Nordisk
    • Free 90-day insulin supply to people experiencing financial hardship
  • Senseonics 
    • Senseonics suspends US sales
  • Tandem Diabetes
  • Abbott
  • Xeris (Gvoke) 
    • Xeris Announces $0 Co-pay (Extended to May 31)

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.

Numerous companies have distributed statements about their policy changes (listed below). We will provide updates as we received new information.

• CVS Health Patient Access Resources

Community Resources

• JDRF Type 1 Nation
• Beyond Type 1
• DreaMed Virtual T1D Clinic

Back-to-School and COVID-19 Resources 

Find out what healthcare providers and educators are saying about going back to school for the 2020-2021 academic year. 

Three teachers with T1D share their thoughts about back-to-school during the pandemic, including their biggest concerns and what they want parents to know.

Back to school season during the coronavirus pandemic has been met with several challenges, but for college students, preparation is still key, whether on-campus or at home.

Social distancing is key in preventing the spread of COVID, but… what happens when school starts? From our partners at Beyond Type 1: Members of the Type 1 Diabetes Community from Spanish-speaking families share their perspectives.

Are teachers with T1D going back to school in Latin America? Find out what some teachers who live there told our partners at Beyond Type 1 about going back to school in the midst of this new reality–especially for people who live with diabetes.

Consult JDRF’s School and T1D Resources for additional information that parents, teachers and school healthcare providers need to know every academic year.  

Mental Wellness and Coping With Stress  

Editor’s note: This education made possible through the support of Anthem Foundation. 

Learn from an expert about what you can do to keep stress in check as part of type 1 diabetes management during the pandemic.

A few JDRF families share their approaches to managing the challenges of working from home while handling remote learning during the pandemic, and their messages of hope for the T1D community.

Learn what  parents can do to help children cope with the psychosocial challenges of living with T1D during quarantine.

A Licensed Professional Counselor who also lives with T1D shares her expert advice for coping with T1D during stressful and uncertain times. 

Hear from a member of the T1D community about how she learned to manage stress and embrace her mental health during the COVID-19 pandemic.

Partner support is essential when you’re living with T1D. JDRF sat down with Jose and Drew to talk stress, mental health, relationships and everything in between. Watch part I and part II.