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COVID-19 and diabetes

COVID-19 is a new and potentially serious coronavirus. The World Health Organization (WHO) has declared the COVID-19 outbreak to be a public health emergency of international concern.

There are many coronaviruses, ranging from the common cold to much more serious viruses such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). They are viruses that have been transmitted from animals to people. In severe cases, coronaviruses can cause infection in the lungs (pneumonia), kidney failure and even death. At present there is no vaccine against COVID-19.

Common signs are typical flu-like symptoms: a fever, cough, breathing difficulties, tiredness and muscle aches. Symptoms usually start within 3-7 days of exposure to the virus, but in some cases it has taken up to 14 days for symptoms to appear.

People of all ages can be infected. For many (more than 80% of cases), COVID-19 is mild, with minimal flu-like symptoms. Some have not shown symptoms or only very mild symptoms, more like a common cold. The majority of people who have caught the virus did not need to be hospitalised for supportive care. However, in approaching 15% of cases COVID-19 has been severe and in around 5% of cases it has led to critical illness. The vast majority (around 98%) of people infected to date have survived.

Older people and people with pre-existing medical conditions (such as diabetes, heart disease and asthma) appear to be more vulnerable to becoming severely ill with the COVID-19 virus. When people with diabetes develop a viral infection, it can be harder to treat due to fluctuations in blood glucose levels and, possibly, the presence of diabetes complications. There appear to be two reasons for this. Firstly, the immune system is compromised, making it harder to fight the virus and likely leading to a longer recovery period. Secondly, the virus may thrive in an environment of elevated blood glucose.

Like any other respiratory disease, COVID-19 is spread through air-droplets that are dispersed when an infected person talks, sneezes or coughs. The virus can survive from a few hours up to a few days depending on the environmental conditions. It can be spread through close contact with an infected person or by contact with air droplets in the environment (on a surface for example) and then touching the mouth or nose (hence the common advice circulating on hand hygiene and social distancing).

Guidelines for managing diabetes during an illness

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What can people with diabetes and their loved ones do?

Wash hands thoroughly and regularly.
Try to avoid touching your face before you have washed and dried your hands.
Clean and disinfect any objects and surfaces that are touched frequently.
Don’t share food, glasses, towels, tools etc.
When you cough or sneeze, cover your mouth and nose with a tissue or use the crook of your arm if you don’t have a tissue to hand (dispose of the tissue appropriately after use).
Try to avoid contact with anyone showing symptoms of respiratory illness such as coughing.
Think whether you can make changes that will help protect yourself or loved ones. For example, can you avoid unnecessary business travel? Can you avoid large gatherings? Can you avoid public transport?
If you are ill with flu-like symptoms, stay at home.

If you have diabetes:

Prepare in case you get ill.
Make sure you have all relevant contact details to hand in case you need them.
Pay extra attention to your glucose control. Regular monitoring can help avoid complications caused by high or low blood glucose.
If you do show flu-like symptoms (raised temperature, cough, difficulty breathing), it is important to consult a healthcare professional. If you are coughing up phlegm, this may indicate an infection so you should seek medical support and treatment immediately.
Any infection is going to raise your glucose levels and increase your need for fluids, so make sure you can access a sufficient supply of water.
Make sure you have a good supply of the diabetes medications you need. Think what you would need if you had to quarantine yourself for a few weeks.
Make sure you have access to enough food.
Make sure you will be able to correct the situation if your blood glucose drops suddenly.
If you live alone, make sure someone you can rely on knows you have diabetes as you may require assistance if you get ill.Keep a regular schedule, avoiding overwork and having a good night's sleep.

Covid-19: perspective from people with diabetes

Healthy nutrition is an essential component of diabetes management. It is therefore important for people with diabetes to eat a varied and balanced diet to keep their blood glucose levels stable and enhance their immune system. It is recommended to:

Give priority to foods with a low glycaemic index (e.g. vegetables, whole wheat pasta/noodles).
Avoid excessive consumption of fried foods.
Limit consumption of foods high in sugar, carbohydrates and fat.
Choose lean proteins (eg. fish, meat, eggs, milk, beans after fully cooked).
Eat green, leafy vegetables.
Eat fruits in two or three servings.

In response to the COVID-19 pandemic, governments in many countries have restricted the movement of their citizens, confining them to the home environment. Regular physical activity is of great benefit to the general population and even more for people living with diabetes. View a series of daily exercises that can be performed at home.

In some countries, restrictions imposed to tackle the spread of the COVID-19 pandemic are disrupting the supply chain for insulin and other essential diabetes medicines. IDF is actively monitoring where issues are arising and helping to determine what assistance can be offered. Learn more.

IDF has also joined a global effort, together with the world’s leading diabetes organizations, to reduce risk for people with diabetes during the COVID-19 pandemic. Learn more.

COVID-19 is a new coronavirus. Keep informed of the latest developments by looking out for updates and advice from your government, national diabetes association and other reliable sources.

Home-based exercises for people with diabetes

Useful links:

WHO COVID-19 website
WHO COVID-19 situation dashboard
COVID-19: Guidance for people with diabetes (IDF Europe)
COVID-19 in children with diabetes (ISPAD)
COVID-19 and diabetes (JDRF, Beyond Type 1 Alliance)
Practical recommendations for the management of diabetes in patients with COVID-19 (Lancet Diabetes & Endocrinology)
COncise advice on Inpatient Diabetes (Diabetes UK)
Response Strategy COVID-19 Diabetes (Santé Diabète) EN | FR
COVID-19 and NCDs (NCD Alliance)
65+ years old and living with type 1 diabetes: What “higher risk” means and what you should do (JDRF)

Several IDF national members have published guidance and advice on managing and preventing COVID-19 for people with diabetes and health professionals in their countries. A selection of links is available below.

Articles in Diabetes Voice

Articles in Diabetes Research and Clinical Practice (DRCP)

IDF's official journal, Diabetes Research and Clinical Practice (DRCP), is committed to playing a positive role during the COVID-19 crisis. It aims to serve as a quick, trusted and authoritative platform for disseminating new diabetes research relating to the pandemic, with the aim of better serving people with diabetes all around the world. Articles currently published on the topic include:

Corona virus COVID-19 and Diabetes