People with diabetes are no more at risk or likely at risk of COVID-19 than anyone else. However,  just as with the flu, living with diabetes puts you at greater risk of experiencing more severe symptoms and developing complications.

When it comes to living with diabetes and viral infections, like COVID-19, the most important thing to remember is to be prepared before you get sick.

People living with diabetes should have a personalised sick day action plan and a sick day management kit ready to use at the earliest sign of illness.  If you don’t have one already, your diabetes healthcare team can help you put this together.

Check out our factsheets on sick day management:

Type 1

Type 2

We recommend that you download a copy now, so that you don’t have to go looking for it later and have it at hand if you need it.

What are the risks for people living with diabetes?

Being unwell can make it more difficult to manage your diabetes. This is because your body releases stress hormones by when you are sick. These hormones make your liver increase the amount of glucose in your bloodstream, and make it difficult for your insulin to do its job. These hormones increase insulin resistance.

This can cause your blood glucose levels to rise and therefore it is important to monitor blood glucose levels more often when you are unwell.

If you are sick and have high blood glucose levels, you may be at risk of severe dehydration. This can leave you feeling drowsy and confused, and result in the need for urgent medical attention. Dehydration can affect the interstitial cell fluid balance and hence, if you are using continuous glucose monitoring it is a good idea to double check your blood glucose level with a finger prick from time to time.

It’s very important to keep up your fluid and carbohydrate intake when you are feeling unwell, to avoid dehydration and low blood glucose levels, known as hypoglycaemia or aor hypo.

Medications

It is important that you continue a normal schedule of your medications. Be aware that some over-the-counter medications, such as cough mixtures and decongestants, contain sugar which can make your BGLs even higher.

If you are taking insulin, you may need extra insulin when you are unwell, even when you are not eating much, are vomiting or have diarrhoea. Your blood glucose levels will determine if you need extra insulin. Your diabetes health professional can give you advice on what changes you need to make to your insulin dose or type of insulin when you are sick.

Check for ketones

If you have type 1 diabetes you should also check for ketones if your blood glucose levels rise above 15 or you have symptoms that may suggest you have or are developing a condition called Diabetic Ketoacidosis (DKA).

People who have type 2 diabetes and take an SGLT-2 inhibitor are also at higher risk of developing DKA. SGLT-2 inhibitors include:

• Forxiga (dapagliflozin),
• Jardiance (empagliflozin),
• Xigduo (dapagliflozine with metformin) or
• JardiaMet (empagliflozin with metformin),

Diabetic Ketoacidosis (DKA)

Diabetic Ketoacidosis (DKA)  is a serious condition that occurs when the levels of glucose and ketones in the blood are too high. The build-up of ketones makes the blood too acidic and leads to a loss of body salts and fluids. If you have large amounts of ketones in your blood or urine, you may have DKA and could need urgent medical attention.

The symptoms of DKA include:

• having a dry mouth,
• decreased urination,
• increased thirst,
• abdominal pain,
• vomiting and nausea,
• rapid-breathing,
• drowsiness,
• weakness or confusion.

You can help prevent DKA by following your sick day action plan. This should include information about managing your diabetes when you are unwell, which you have discussed with your GP or diabetes healthcare team.

Ask for help

Let a friend or family member know that you are unwell. Tell them about your sick day action plan in case you need any help. If required, have someone stay with you or check on you frequently.

Seek medical help to treat the illness. Contact your GP early to avoid becoming even more unwell and needing emergency care.

You may also need to contact your diabetes healthcare team for advice about adjusting your insulin dose or medications during periods of illness, especially if your glucose levels stay above 15mmol/L or below 4mmol/L.

Tips to stay healthy

• Get immunised for flu and pneumonia.
• Take care with personal hygiene to avoid the spread of germs.
• Keep your blood glucose levels within your target range to help reduce the risk of illness and infections

Sick day checklist

• Follow your sick day action plan and use your sick day kit
• Let someone know you are unwell
• If you are on insulin or self monitor check your BGLs more often
• Keep taking your insulin or diabetes medications
• Drink plenty of fluids and keep eating
• See your doctor or diabetes healthcare team
• Seek urgent medical care if needed