COVID-19 Guide for People with Diabetes
Knowledge of COVID-19 (Coronavirus) and the right way to manage it continues to improve as scientists and health officials learn more. Please ensure you have the latest version of this guide, available from https://www.guidepost.net. This version was last updated on 21 March 2020. E&OE.
As a person with diabetes, you are more likely to develop severe symptoms if you contract COVID-191.
Don’t panic! There are simple steps you can take to remain safe at home and when you go out. Armed with the information below, you can monitor yourself for signs and symptoms and know when you should seek medical attention. If you are a member of Guidepost, please do call us if you have any questions.
What is COVID-19?
COVID-19/Coronavirus is a virus that causes various degrees of illness, typically starting with flu-like symptoms but may progress to more severe disease. There are many excellent sources of general information on COVID-19 which you can access from the World Health Organisation2 and the South African National Institute for Communicable Diseases3.
This guide is specifically for people with diabetes and presents you with practical steps you can take now.
Steps You Can Take
The virus is spread in two major ways. The first way is through aerosolised droplets spread from an infected person not following the appropriate cough etiquette while coughing or sneezing near you. Aerosolized viral particles would travel a distance of around 1.5 meters from them. If you are within this range you will be covered with viral particles. This is why you need to follow social distancing advice.
The second way is for viral particles that have come to rest on a surface for example a table, a computer, a phone or an eating utensil that can survive on these objects for 1-2 days. Touching them and then touching your face will transmit the virus to you. This is why you need careful hand washing and avoid touching your face.
As a person with diabetes, you need to protect yourself from acquiring the infection. The first step is to avoid getting into situations where you can contract the virus by avoiding contact with other people. Keep in mind that a person could have the virus and not show any symptoms in the first two weeks, so you could catch the virus even from someone who does not seem to be sick. Avoiding contact with other people will require isolation, potentially for a prolonged period of months and not days or weeks. Governments around the world, including South Africa, have imposed restrictions on travel, large gatherings and many other situations where many people come into contact with each other. Restrictions will be lifted once the peak of new cases is over and at a low enough level to allow re-integration with the general public.
You and your family will need to practice home, work and community isolation – also called social distancing. Specifically you should:
- Work from home if at all possible
- Avoid public transport and avoid making unnecessary trips out of the home
- Avoid gatherings where you could come into contact with infected people; this includes churches, synagogues, mosques, clubs, pubs, restaurants and shopping centres. If you need to go out to get groceries you should go at off-peak times and use hand sanitiser
- At home you should avoid contact with family members who could transmit the virus to you via hugs, kisses and close contact
- Consider the other things you do every day that are likely to place you in a situation where you can contract the virus and figure out how best to avoid these activities
You will still need to take your diabetes medication and your other medication. A simple and efficient way to still get your medication while isolating yourself is to use a courier pharmacy, where your medication is delivered to your home. Your medical aid may have a preferred courier and there may be no extra cost to you. Please contact your medical aid and find out what options they have for you. If you are a Guidepost member, please discuss this option with your Coach.
Monitor for signs and symptoms of developing COVID -19 infection. Most people develop mild to moderate symptoms and recover, so there is no need to panic. If you do develop symptoms, consider getting tested as below.
Testing and Diagnosis
Should I get tested now?
If you do not have the symptoms explained below there is no need for you to get tested. Unnecessary testing may delay testing for people who really need it as the testing kits are in limited supply.
What are the symptoms?
The most common symptoms of COVID 19 are: fever above 38 degrees C (~90%), cough (68%), excessive tiredness (38%), coughing up phlegm (34%), shortness of breath (19%), muscle or joint pain (15%), sore throat (14%), headache (13.6%) and chills (12%).
Symptoms of severe disease include shortness of breath, rapid breathing, difficulty breathing, air hunger, chest pain. Some people develop heart symptoms such as chest pain, swelling of the feet and ankles, as well as extreme tiredness.
What to do if a family member has symptoms
What should you do if a family member living with you is infected? The family member must quarantine themselves away from you (e.g. move out of the house or stay in a different part of the house to you) and only lift the quarantine once they have been confirmed to be disease free – that is 2 confirmed negative tests 48 hours apart. This may take 7-20 days (average 14 days).
What to do if you have symptoms
If you have had potential contact with a person who may be infected and you are developing the symptoms of COVID-19 call your doctor, tell them that you might have caught the disease and request a referral for testing. You will need a lab request form and you must go to a designated testing centre/laboratory. Your doctor might be able to email you a lab request form or you might have to get one from your doctors’ office. Take the form to a laboratory close to you; each laboratory company has their own website and you can find the closest laboratory via their website (https://www.lancet.co.za/, https://www.pathcare.co.za/ or https://www.ampath.co.za/). You may also need a “Person under investigation form (PUI)” which includes a request for lab testing at a public health laboratory, a list of people you may have contacted, your travel history and many other details the government may need. You can get the form here: http://www.nicd.ac.za/wp-content/uploads/2020/02/COVID_19_PUI_Form_v3_Contact_list_v5_Elect.pdf
Once you have been tested, quarantine yourself until you get the results (which typically take 24-48 hours).
If your COVID-19 test is negative but your symptoms persist, you can request your doctor to retest, including a swab for alternative respiratory pathogens (known as a respiratory antigen panel) to identify what other condition you might have.
Continue to manage your diabetes closely. You should avoid hospitals and doctors’ rooms as far as possible as you could either contract COVID -19, additional infections or potentially spread COVID-19 to others. The approach you should take will be similar to managing previous episodes of flu. Most of your diabetes management can be performed by yourself at home.
- Check your blood glucose levels more often and try to keep them below 15 mmol/l. While sick you are likely to experience higher blood glucose readings and urinate more often.
- Stay hydrated by drinking more water than usual to replace the water you lose via urination.
- Monitor for diabetes deterioration such as abdominal pain, nausea or vomiting.
- Monitor your insulin needs in collaboration with your healthcare provider. Insulin needs may increase due to infection or decrease if you are eating significantly less. Take extra insulin if you are on insulin. Never stop or skip your insulin.
- Call your diabetes hotline (if available to you) should you need assistance.
What to do if you test positive for COVID-19
If you are COVID-19 positive but are medically well, or have been assessed by a clinician as having only mild disease (fever, cough , sore throat and body pains or completely asymptomatic disease) you can manage your condition at home. During this period you will stay at home and perform supportive management, fever control (preferably with paracetamol not ibuprofen, stay hydrated and rest). You will most likely recover in the next 7-21 days (average 14 days). When symptoms have resolved, you should get retested and when 2 tests 48 hours apart are negative you are clear of the virus.
While you are positive for the virus:
- You should quarantine yourself at home. Don’t go to work, avoid unnecessary travel, and as far as possible avoid close interactions with other people.
- You should clean your hands with soap and water frequently, washing them for at least 20 seconds. Alcohol-based sanitizers may also be used, provided they contain at least 60% alcohol.
- Do not have visitors in your home. Only those who live in your home should be allowed to stay. If it is urgent to speak to someone who is not a member of your household, do this over the phone.
- You should wear a facemask when in the same room (or vehicle) as other people.
- At home, you should stay in a specific room and use your own bathroom (if possible). If you live in shared accommodation (university halls of residence or similar) with a communal kitchen, bathroom(s) and living area, you should stay in your room with the door closed, only coming out when necessary, wearing a facemask if one has been issued to you.
- You should practice good cough and sneeze hygiene by coughing or sneezing into a tissue, discarding the tissue immediately afterward in a lined trash can, and then wash your hands immediately. Alternatively, cough into the crook of your elbow. Do not sneeze or cough directly into your hands.
- If you need to wash the laundry at home before your test results are available or if you have tested positive, then wash all laundry at the highest temperature compatible with the fabric using laundry detergent. This should be above 60° C. If possible, tumble dry and iron using the highest setting compatible with the fabric. Wear disposable gloves and a plastic apron when handling soiled materials if possible and clean all surfaces and the area around the washing machine. Do not take laundry to a laundrette. Wash your hands thoroughly with soap and water after handling dirty laundry (remove gloves first if used).
- Avoid sharing household items like dishes, cups, eating utensils and towels. After using any of these, the items should be thoroughly washed with soap and water.
All high-touch surfaces like table tops, counters, toilets, phones, computers, etc. that you may have touched should be appropriately and frequently cleaned.
What to do if your COVID-19 symptoms get much worse
Continue to monitor your symptoms daily for signs of deterioration to severe COVID -19 disease. Signs or symptoms of worsening disease include shortness of breath, air hunger (gasping for air), chest pain, difficulty breathing, fatigue or change in mental status (feeling confused or dazed).
If these become present you must visit an urgent care facility such as a hospital. Call ahead to inform the casualty and your treating doctor that your admission to hospital might be required. If you are on medical aid, you must also call your medical aid before you travel to request hospital admission approval.
Transport by family members or friends will place them at risk of infection. If possible, you or your family should instead arrange for ambulance transfer to hospital. Inform the ambulance personnel of your positive COVID-19 status.
Take all of your diabetes supplies with you to hospital. If you are admitted to hospital you may have to stay in hospital for a while and will need to continue with your diabetes treatment in hospital.
What do do if your diabetes control gets worse
It could happen that your COVID-19 symptoms remain the same but that your diabetes control gets worse (e.g. your blood sugar readings go up). In this case you should handle this as you would any other sick days. Monitor your blood glucose regularly and keep hydrated.
If you are only on oral diabetes medication and you have high blood glucose readings, you need to increase your fluid intake and monitor your blood glucose levels more frequently. If symptoms of dehydration develop, or diabetes ketoacidosis (DKA0 (abdominal pai, nausea or vomiting) or hyperglycaemic hyperosmolar non-ketotic coma (HONK) (confusion, lethargy) you will need to be referred for insulin therapy and supplemental fluid therapy.
If you have a low blood glucose reading (<4.0 mmol/l) eat 15 grams of rapid absorbing carbs, such as honey, jam, juice or regular soda, and re-check your blood sugar in 15 minutes to make sure your BG levels are rising. Check your blood sugar extra times throughout the day and night (generally, every 2-3 hours, over the next 12 hours). For members on the Guidepost program, call the hotline for further assistance.
Take additional insulin if needed (and as recommended to you by your doctor), to keep blood glucose levels below 15 mmol/l. Monitor for ketones especially when your blood glucose levels are above 15 mmol/l or if you have symptoms of DKA
How long does it take to recover?
If you are infected and your body successfully fights the infection, the virus may clear by day 7. If your symptoms have improved, get another test done seven days after your first test. If your symptoms have not improved, delay re-testing until you no longer have symptoms or your symptoms have improved.
If this test at day 7 is positive or if symptoms are still present, repeat the test at 14 days or when symptoms resolve, followed by a confirmatory test 48 hours later. 2 negative tests 48 hours apart indicate that you are all clear and you can come out of quarantine.
It is not year clear if you can get infected a second time so you should still exercise caution and keep up the good hygiene practices in the months to follow.
- Wang et al. (2020) “Timely blood glucose management for the outbreak of 2019 novel coronavirus disease (COVID-19) is urgently needed” Diabetes Research and Clinical Practice, March 2020 [Online]. Available at: https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(20)30368-5/fulltext
- World Health Organisation (2019) ‘Coronavirus disease (COVID-19) advice for the public’ [Online] at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
- National Institute for Communicable Diseases (2020) ‘COVID-19’ [Online]. Available at: http://www.nicd.ac.za/diseases-a-z-index/covid-19/