COVID-19 : Guidance for people with diabetes

At the end of 2019, a novel coronavirus (a specific virus that causes human and animal disease) was identified as the cause of pneumonia cases in Wuhan, a city in the Hubei Province of China. It rapidly spread thereafter, resulting in an epidemic throughout China, with quick spread globally, affecting now nearly every continent. Understanding of this novel coronavirus is still evolving.

How do people get infected?
The virus can spread from infected animals but human-to-human transmission is also possible. It spreads like any other respiratory disease, through contaminated air-droplets that come out of the mouth of infected persons when talking, coughing or sneezing. The virus can survive in the environment from a few hours to a few days (depending on surfaces and environmental conditions) and touching affected surfaces and then the mouth or nose is thought to be the way of transmission. The virus is killed in the environment with alcohol-based solutions.

How severe can the infection be?
The good news is that COVID-19 is usually a mild disease and around 98% of people affected survive. The majority of cases (>80%) are mild (showing only minimal flu-like symptoms) and people can recover at home. Some cases (around 14%) are severe and very few (around 5%) can result in critical illness. Some people have no symptoms, or only the mild symptoms of a common cold. In others however, COVID-19 can lead to serious problems, like pneumonia or even death. This is more common in people who have other health problems, particularly the elderly, those with cardiovascular disease, chronic lung disease and hypertension. People with diabetes are among those high risk categories that can have serious illness (just like the flu) if they get the virus.

What are the possible symptoms of the illness?
People affected with COVID-19 can have fever, cough, shortness of breath (trouble breathing), feel tired and have muscle aches. Breathing problems occur when the infection affects the lungs and causes pneumonia. Symptoms usually start a few days after a person is infected with the virus, with most cases occurring approximately 3-7 days after exposure. In some people, it can take up to 14 days for symptoms to appear.

What to do if there is a chance of infection?
If a person has fever with cough or trouble breathing and may have been exposed to COVID-19 (if they live in or visited a country affected in the 14 days before they got sick, or if they had been around a person who may have had the virus), they should call their doctor or nurse for advice. It is best not to rush to the hospital, to avoid transmitting the virus to others and to allow priority arrangements to be made by medical personnel, if needed, instead of having to wait in line. If the person is advised to go to the clinic or hospital, they will need to put on a face mask. The medical staff may also have them wait away from other people, so that they can be examined properly and safely. Fluid samples taken from the nose or throat will show if the virus is present or not. There is currently no specific treatment for COVID-19, but since the majority of cases are mild, only a limited amount of people will require hospitalization for supportive care. However, it is essential that people affected and those that they have been in contact with are identified and isolated for a couple of weeks, to avoid the further spread of the virus.

What to do if instructed to stay at home?
Individuals and families affected that stay at home should practice proper measures for infection prevention and control. Management should focus on prevention of transmission to others and monitoring for clinical deterioration, which may prompt hospitalization. Affected persons should be placed in a well-ventilated single room while household members should stay in a different room or, if that is not possible, maintain a distance of at least one metre from the person affected(e.g. sleep in a separate bed) and perform hand hygiene (washing of hands with soap and water) after any type of contact with the affected person or their immediate environment. When washing hands, it is preferable to use disposable paper towels to dry them. If these are not available, clean cloth towels should be used and they should be replaced when they become wet. To contain respiratory secretions, a medical mask should be provided to the person affected and worn as much as possible. Individuals who cannot tolerate a medical mask should use rigorous respiratory hygiene − ie. the mouth and nose should be covered with a disposable paper tissue when coughing or sneezing. Caregivers should also wear a tightly fitted medical mask that covers their mouth and nose when in the same room as the person affected

What should people with diabetes do if they have the virus?
It is recommended that people with diabetes plan ahead of time what to do before they get ill. This includes having the contact information of their health care provider at hand and making sure to have an adequate stock of medications and supplies for monitoring blood glucose at home, so that they do not need to leave the house if they become ill. Peope with diabetes who are infected with the virus may see their glycaemic control deteriorate during the illness. They should practice the “Sick day rules” recommended for any stressful situation to improve their diabetes decompensation. They should also contact their health care provider immediately for advice on how to monitor their blood glucose, get adequate refills for medications (especially insulin) and what adjustments they may need to do in their medication or diet.

Sick day rules for people with diabetes
Keep hydrated
Monitor your blood glucose
Monitor your temperature
If you are on insulin, also monitor your ketone bodies
Follow your healthcare team recommendations
How can the virus be avoided?
Simple, sensible measures should be taken in every-day life in order to avoid infection from the virus:

Frequently wash hands with soap and water or use an alcohol-based solution, especially before eating and after being in public.
Don’t share food, tools, glasses and towels.
Avoid close contact with those who are ill. If someone is visibly ill, coughing or sneezing, keep away.
If you get ill with respiratory symptoms, stay at home and notify others and your health care provider of the illness.
When sneezing or coughing, cover the nose and mouth with a tissue or with the crook of the elbow. Throw the tissue in the bin.
Avoid unprotected contact with wildlife and farm animals.
The World Health Organization recommends that people without respiratory symptoms do not need to wear a medical mask in the community, even if COVID-19 is prevalent in the area. Wearing a mask does not decrease the importance of other general measures to prevent infection, and it may result in unnecessary cost and supply problems.

Home-based exercise for people with diabetes
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.