Coronavirus and Type 1 Diabetes:
What You Need to Know

Worried about COVID-19? Don’t panic: Get the latest information and recommendations from the experts for people living with type 1 diabetes (T1D).

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News about the novel coronavirus disease—named COVID-19 by the World Health Organization (WHO)—continues to dominate global headlines. The WHO publicly characterized COVID-19 as a pandemic, and many Americans are understandably concerned.

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 Should Someone with T1D Know about Having a Viral Illness?

  • Having T1D does NOT make you more susceptible to contracting COVID-19.
    • Current evidence suggests that individuals with 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 compared to people without T1D (however, see the section on hospital care for COVID-19 for further information). 
    • 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).
    • 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):
    • 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 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).

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.

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.

Back-to-School and COVID-19 Resources 

Download our one pager for easy access to your most frequently asked questions about Back to School + COVID

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.  

Additional Information

For additional information about diabetes and COVID-19, consult  Coronavirus + Diabetes, a resource from the JDRF and Beyond Type 1 Alliance. 

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

National Institutes of Health (NIH) treatment guidelines for healthcare providers.

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: July 15, 2020, 1:30 pm EST

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