Managing Diabetes Amid a Pandemic

Chronic conditions like diabetes don’t take a vacation because of COVID-19. Those with the disease still need to monitor their glucose, take insulin and check in with their healthcare providers. Overlake endocrinologist Maria Mercado, MD and certified diabetes educator Lisa Levinson, RN answer questions related to how to manage diabetes during the COVID-19 pandemic, how to communicate with your care team and more.

How can I manage my diabetes during the stay-at-home order?

Levinson: When glucose values may become harder to control, it is important to have a plan in place as to when to be checking glucose, which values merit following up with provider, plan for medication dosing and which foods to eat.

• Make sure you have medications and any necessary supplies such as test strips to monitor glucose levels. Take medications as prescribed. Do not attempt to adjust dosing of medications without first consulting with your provider.
• Take precautions as advised. Use a face covering when necessary, practice social distancing. Limit trips outside the home.
• Stay hydrated.
• Continue to monitor glucose values. Know parameters as to when to contact your provider for glucose values above or below specific targets.
• Know which foods may be best when ill.

What are some ways I can communicate with my provider?

Levinson: Firstly, do not avoid medical care. Keep your regular appointments and ask your provider what options may be available to you. Most of our clinics are now offering virtual visits.

It is important to contact your provider if you are ill and to report low/high glucose values.  You can do this by phone or MyChart, when appropriate, to communicate with your healthcare team.

Am I able to share my glucose values with my provider remotely?

Levinson: Yes. Continuous glucose monitoring, insulin pump data may be shared remotely with your provider. These devices may have a share feature that allow for loved ones to receive glucose data in real time via phone apps. Meter data may be uploaded at home and shared with your provider via fax or MyChart.

Will COVID-19 impact my access to insulin and other diabetes supplies?

Mercado: Leading manufacturers are reporting that COVID-19 is not having an impact on their current manufacturing and distribution capabilities for insulin and other supplies at this time. If you are having trouble affording insulin or other diabetes medications, drug manufacturers offer patient assistance programs and physician offices sometimes carry samples that can help in the short term, or the American Diabetes Association has a program called InsulinHelp.com.

Are people with diabetes more likely to get COVID-19?

Levinson: No. Having diabetes does not mean one is at greater risk of acquiring COVID-19; it means they are at a greater risk of severe illness if exposed to COVID-19. This is because elevated blood glucose may contribute to worsening infections and hinder the immune response by the body. Diabetes can create a state of inflammation, which may slow the healing response of the body.

Mercado: Your risk of getting very sick from COVID-19 is likely to be lower if your diabetes is well-managed. Per American Diabetes Association guidelines, we strive to keep your hemoglobin A1c (blood sugar) under 7%.

Do I need to worry about DKA (diabetic ketoacidosis) if I have a viral infection?

Mercado: When ill with a viral infection, people with diabetes do face an increased risk of DKA (diabetic ketoacidosis), commonly experienced by people with type 1 diabetes. If your blood sugar has registered high (greater than 240 mg/dl) more than twice in a row, check for ketones to avoid DKA. If you have a virus, be sure to call your provider for further guidance and increase your fluid intake.

What are the symptoms and warning signs I should be watching out for—and what should I do if I develop them?

Mercado: Pay attention to potential COVID-19 symptoms, including fever, dry cough, shortness of breath, loss of taste or diarrhea. If you feel like you are developing symptoms, call your provider.

When you call, be sure to:

• Have at least three days of glucose readings available.  
• Know your medication/insulin dosages and when you last took your medication.
• Know if you need refills and where your provider can send the refills.
• Be clear with your symptoms, when they started and the severity of symptoms.

How can I cope with managing diabetes while social distancing?

Levinson: Make use of resources available to you; understand how to communicate with your care team and ask them questions/relay concerns; keep in contact with family and friends remotely; and exercise!

Lisa Levinson is a registered nurse and certified diabetes educator with Overlake Medical Center’s Diabetes Education Services.

Maria Mercado, MD is a board-certified endocrinologist who practices at Overlake Clinics – Endocrinology.

Watch the full-length interview with Dr. Mercado and Lisa in the video below: