In the past weeks we have all been asking ourselves whether or not we are in the risk group more vulnerable to COVID-19 and its potential complications. Patients suffering from comorbidities are particularly concerned about their health. The Polish Society of Diabetology (PTD – Polskie Towarzystwo Diabetologiczne) dispels any doubts regarding the increased vulnerability of patients with diabetes in developing COVID-19.

The vast majority of patients suffering from COVID-19 caused by the SARS-CoV-2 coronavirus experience mild symptoms, and some of them are even asymptomatic. However, in some cases, COVID-19 may have a severe course and may even lead to death. The leading factors of the increased risk of developing serious complications with the SARS CoV 2 virus are underlying medical conditions. We can observe increased illness severity and adverse outcomes in patients who were infected with the novel coronavirus and simultaneously suffer from other diseases (including diabetes). It is not surprising that patients with diabetes are anxiously observing the spread of the coronavirus and are afraid of the complications associated with their potential infection.

The symptoms of COVID-19 are more severe than those of seasonal flu, so it is essential to follow all recommended precautions. In the face of widely available access to mass media, that increasingly broadcast contradictory or false information regarding the prevention and strategy for fighting the coronavirus, the Polish Society of Diabetology has decided to clarify patients’ doubts and take a stand on these matters by publishing key information and guidelines for patients with diabetes.

The PTD informs that “patients with diabetes are not more prone to contract COVID-19 than the general population.” However, “patients with diabetes are at a higher risk of developing severe COVID-19 complications”, which might be much more difficult to overcome. We must remember that patients suffering from diabetes are more susceptible to developing severe symptoms and complications caused by virus infections (not only the SARS CoV-2 virus), which may lead to increased blood glucose levels. From the very beginning of their illness, insulin-treated patients are educated to adjust insulin doses to their lifestyle, which allows them to manage their diabetes and avoid complications. According to the PTD, if diabetes is well-controlled, the risk of developing a severe COVID-19 infection is similar to that observed in healthy persons. However, the risk of developing diabetes complications rises in patients with poorly controlled diabetes, who experience variable blood glucose levels. The body’s impaired ability to fight viruses may in such cases lead to the development of a severe form of COVID-19, which is why it is essential for patients to strictly follow health care professionals’ recommendations.

Considering the currently available information, the PTD shares the views of the European Society of Cardiology and declares that “there is no evidence supporting the need to modify or discontinue treatment with angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs, or sartan medicines) despite media reports questioning whether drugs from this class should be used in the period of the pandemic. There is one more positive information in PTD’s article: “manufacturers of drugs do not report COVID-19 pandemic-related shortages of insulin preparations or other resources”. Therefore, the current situation related to the spread of the SARS CoV 2 virus does not impact the production and supply of diabetes medications in any way.

The PTD also provides a detailed list of guidelines which patients with diabetes potentially suffering from COVID-19 should follow to minimise the risk of developing complications. We present it below:

“Make sure you have the following things at hand:

  • The phone numbers of your doctors and healthcare team, pharmacy and insurance provider.
  • A list of medications you take and their dosages (including vitamins and dietary supplements).
  • An emergency set of products containing simple carbs, such as sweetened soda drinks, honey, jam, jelly or fruit hard candies – in case you experience hypoglycaemia or have trouble eating normally because of the illness.
  • Enough insulin for the week ahead, in case you get ill or cannot fill your next prescription.
  • Extra supplies such as alcohol-based sanitiser and hand soap.
  • Glucagon and strip tests for measuring urine ketone levels, if you are insulin-treated.
  • Enough household products and groceries in case you need to stay at home for a longer period of time.

Talk to a member of healthcare team about:

  • When to contact the doctor’s office (regarding urine ketone levels, dietary modifications, medication adjustments, etc.)
  • How often to check your blood sugar levels.
  • When to check urine ketone levels.
  • Medications you should use for colds, flu, and virus infections.
  • How to adjust diabetes treatment when you are ill.

Take appropriate everyday precautions:

  • Avoid close contact with people who are ill.
  • Take preventive actions: wash your hands often with soap and water for minimum 20 seconds, especially after sneezing, coughing or visiting public places.
  • If water and soap are unavailable, use a sanitiser with an alcohol concentration of at least 60%.
  • To the extent possible, avoid high-touch surfaces in public places – elevator buttons, door handles, handrails; avoid shaking hands with people, etc. Use a tissue or your sleeve to cover your hand or finger if you must touch something.
  • Wash your hands after touching the abovementioned surfaces.
  • Avoid touching your face, nose, eyes, etc.
  • Wash and disinfect surfaces and items in your house to remove germs: regularly clean frequently touched surfaces (e.g. tables, doorknobs, light switches, handles and bars, desks, toilets, sinks and mobile phones).
  • Avoid crowded and poorly ventilated spaces. Exposure to respiratory viruses such as COVID-19 increases in crowded and closed-in settings with poor air circulation where ill people are present.
  • Cancel all non-essential travel, including planned trips.

Observe if you haven’t developed COVID-19 symptoms that may require immediate medical attention:
If you experience any of the symptoms below, call your doctor immediately. In adult patients, symptoms requiring immediate medical attention include:

  • Trouble breathing or shortness of breath.
  • Persistent pain or pressure in the chest.
  • Confusion or trouble waking up.
  • Blue lips or face.

If you feel that you are developing the symptoms of an infection, call your doctor:
Take note of potential COVID-19 symptoms such as high fever, dry cough and shortness of breath.
Before speaking to the doctor you should prepare:

  • Your blood sugar level results.
  • Your urine ketone level result.
  • Notes on the amount of your fluid intake (you can use a 1-litre bottle for reference).
  • A list of symptoms you are experiencing (for example: Are you nauseous? Do you only have a clogged nose?).
  • Ask how to manage your diabetes in such a situation.

Learn what to do when you are ill:
Here’s some useful advice:

  • Drink plenty of fluids. If you are vomiting, have small sips of water every 15 minutes to avoid dehydration.
  • If your blood sugar level is low (below 70 mg/dl or your target), intake 15 grams of simple carbs: honey, jam, jelly, juice or a soda such as Coca-Cola, and re-check your blood sugar in 15 minutes to make sure its level is rising. Check your blood sugar more frequently throughout the day and night (generally, every 2-3 hours; if using a CGM, monitor frequently).
  • If your blood sugar level is high (over 250 mg/dl) more than 2 times in a row, check for ketones to avoid diabetic ketoacidosis (DKA).
  • Call your doctor’s office immediately, if you have moderate or large ketones (or, if instructed, trace or small ketones).
  • Be aware that some CGM sensors (Dexcom G5, Medtronic Enlite, and Guardian) are impacted by Acetaminophen (Paracetamol). Check with finger stick test to ensure accuracy.
  • Wash your hands and clean the injection/infusion and finger-stick sites with soap and water or alcohol-based sanitiser.”

Source text:
Polskie Towarzystwo Diabetologiczne, Nowy koronawirus SARS-Cov-2, COVID-19 a Cukrzyca (Polish Society of Diabetology, The Novel Coronavirus SARS-Cov-2, COVID-19 and Diabetes)