Updated: Mar 19, 2020
The recent media coverage surrounding the novel coronavirus (COVID-19) has left many people with type 1 wondering about their level of risk and how they should act. In this Clinic Chat, we take an in-depth look at COVID-19, and how you can keep yourself safe.
Coronaviruses are a group of viruses that spread via person-to-person contact. This may be through droplets spread by coughing or sneezing, or contact with contaminated hands, surfaces or objects. COVID-19 was first reported in December 2019 in Wuhan City in China. Other coronaviruses that have received media attention include Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). Symptoms may be mild, including fever, coughing and fatigue, or more severe such as pneumonia.
Shortness of breath is a key symptom of COVID-19 that has been highlighted as one to look out for. Many affected people recover quickly, however, some people may become very ill.
Type 1 diabetes doesn't directly hamper the day-to-day activity of your immune system, especially if your blood glucose levels are well-managed. However, elevated blood glucose levels can impair the body’s defence capabilities so generally, people with higher HbA1Cs may be more vulnerable to infections (bacterial and viral) than people who have in-target HbA1Cs.
When people with type 1 get an infection, the infection itself can cause elevated blood glucose levels. If this happens and is not managed effectively, the infection may become harder to resolve, and the person may develop other issues associated with elevated blood glucose levels like diabetic ketoacidosis.
Current advice notes that children are not likely to be seriously affected by COVID-19; the virus impacts adults, especially older adults, more severely than children. Current evidence shows that children with type 1 are not more susceptible to COVID-19 than children who do not have diabetes. We do know that adults, particularly elderly adults, with diabetes and other chronic health conditions, or complications such as heart disease or renal failure, are at the greatest risk of serious illness should they contract the virus.
Reducing your risk
The COVID-19 situation is changing rapidly, and so it’s vital that you receive information about how to reduce your risk from trusted sources as it is issued. For general information follow the updates from the Australian Government Department of Health and WA Health.
The World Health Organization advises the same preventative strategies used to avoid any common virus, which include:
Practise social distancing (don’t shake hands, hug, kiss cheeks);
Use alcohol-based hand sanitisers, and wash your hands regularly using soap. Hands should be washed for at least 20 seconds – about the time it takes to sing Happy Birthday;
Insist that the people around you cover their noses and mouths with a tissue when coughing and sneezing, or sneeze into a flexed elbow - and do the same yourself;
Avoid contact with anyone with cold or flu-like symptoms;
We also advise you:
Disinfect frequently-used surfaces including technology, devices, and appliances in your workplace;
Avoid unnecessary travel and events or places with large numbers of people, especially in poorly ventilated spaces;
Ensure you have one month to six weeks’ diabetes consumables and your sick-day management plan at hand;
Have enough food at home in the event you develop mild illness or are exposed to the COVID-19 virus and have to self-quarantine.
Focus on your glucose management
If there was ever a time to dial in your diabetes management, then this is it. The better your glucose management, the better equipped your body is to avoid or fight infection.
Test often, or fire up your CGM or Flash monitoring system. Keep a close eye on your levels and make more effort to be carb-conscious and eat healthy, nutrient-rich food. Make time for exercise if you can.
If you need some help, see your diabetes educator. As the COVID-19 virus situation advances, we understand that many people may need to go into self-quarantine because they have been exposed to the virus, or not to spend significant time in public spaces as a protection measure.
Although the Family Centre has stringent measures in place to screen people coming into our facility and keep it safe, if you need to stay at home it’s important that you can still access diabetes education and dietetic services. We’ve opened up phone clinic to all patients to make sure everyone has access to personalised diabetes care during this time.
If you would like to change your face-to-face appointment or make a phone appointment, please contact the Family Centre. Please note that Medicare will not offer a rebate for phone clinics, although the ADEA has written the Medicare to request this.
Just in case
If you become unwell, it’s important to monitor your blood glucose and possibly your ketones much more closely. You should have a ‘sick-day’ management plan from your diabetes clinic or educator, which gives instructions if you become unwell and your insulin needs change.
Your diabetes educator can help you develop your management plan, and determine a strategy for managing diabetes when you are unwell. If you don't have a sick-day management plan, use this Baker Heart and Diabetes Institute resource as a guide until you can make an appointment with your educator about one.
Check you have a month to six weeks' of diabetes supplies at hand, both consumables and insulin. Use this checklist to help:
Fill scripts for both long-acting basal and rapid-acting bolus insulins and have back-up scripts on hand. Pump users should have back up insulin pens
Have at least one month's supply of syringes, pen needles and pump consumables
Have a back-up blood glucose meter and a good supply of strips
Have a month’s supply of CGM/Flash sensors
Have an extra supply of glucose tablets/liquids/gels and an in-date glucagon pen
The Family Centre is aware that many people in the diabetes community have acted already to fill their scripts and their consumables orders, and the sudden spike in demand has caused a short-term shortage in diabetes supplies at pharmacy level. As pump and CGM companies work with distributors to rectify the issue, the Family Centre is facilitating vital product exchange through its online communities. If you need something, please post in the Family Centre’s online groups; we are confident that our amazing type 1 community will help you get what you need.
Home delivery of insulin and other medicines
The Australian Government has put in place a temporary at-home primary care home medicines service for people with chronic illness. You will be able to order Pharmaceutical Benefits Scheme (PBS) prescriptions remotely with ePrescribing and have medicines home delivered to reduce potential exposure to COVID-19. Note this applies to PBS medicines, not NDSS diabetes consumables. Read here for more information.
Tell your tribe
Let friends, family and co-workers know that as someone with type 1 diabetes you may be at increased risk in relation to COVID-19, and remind them that their choices and behaviour could impact your health.
If someone in your household becomes unwell, think through how you could isolate yourself from them. If you live alone and need to go into self-quarantine because you’ve been exposed to the virus, get a close family member or friend to check on you every day and get you any medications/diabetes supplies you need.
What should I do if I become unwell?
If you show have any flu-like symptoms – fever, cough, sneezing or runny nose – call your GP. You might not have been able to speak to your GP directly on the phone in the past, but that’s changed - the Australian Government has put temporary Medicare items in place to support GPs to do phone consults. Phoning is the safest way to get medical advice, and will ensure virus exposure and transmission is contained.
Your GP will ask you about recent contact with people who may have the virus, and symptoms, triage accordingly and give you some next steps. These may include staying at home if your illness is mild, or heading to a clinical services to be tested and treated.
Highs and lows
High blood glucose levels are common when the body is attacked by a virus. If you’re sick, your body will release stress hormones that trigger the release of stored glucose from the liver. When this happens, your insulin needs will increase. Without an adequate increase in insulin, both blood glucose and ketone levels can increase dramatically.
Alternatively, if your illness is causing nausea or gastrointestinal symptoms, you may find it hard to keep food and fluids down and your blood glucose levels may trend low. Although you may need to reduce your insulin doses, it is important continue to take insulin. If a person with type 1 is unable take on food or fluids at all for a period of more than a few hours, they should seek immediate medical attention.
Can I boost my immune system?
Lifestyle factors such as stress, inadequate sleep, diet and exercise can impact the body’s defence mechanisms. Unfortunately, there is no one fix when it comes to boosting your immune system but there are certainly ways you can give it the best fighting chance against a respiratory illness such as COVID-19. Here are a few tips to support your frontline defence:
Stress less – Your body will find it easier to fight off infections when it is not overrun by stress hormones that wreak havoc on blood glucose levels. Try dialling out of alarmist social media newsfeeds, and use the terrific SOS meditations on apps like Calm, Headspace or Insight Timer.
Sleep more – The more, the better. Sleep is time to rest and heal, and is proven to boost immunity. Go for eight hours a night if you can.
Eat well and drink less alcohol – Eating a healthy and varied diet will help meet your overall nutrient requirements, and staying carb-conscious will help you avoid high blood glucose levels which put you at greater risk. A number of studies have found a link between excessive alcohol consumption and impaired immune function, so avoid it - but if you do drink, stick to the guidelines.
Consider Vitamin C supplementation – Studies have shown that as a potent antioxidant, Vitamin C may play a key role in a number of components of the immune system’s functions, and may help prevent respiratory infections. You can find your recommended intake for age here.
Do you get enough Vitamin D? - Having sufficient levels of Vitamin D in the body could help your body fight off respiratory illness as Vitamin D plays a role in producing certain proteins that kill viruses. In WA, most of us get sufficient Vitamin D from sun exposure, but if you are indoors most of the day this may not be adequate. Vitamin D can be found in foods such as fatty fish, milk and fortified foods. Alternatively, consider a supplement.
Connect with community
Confronting media images, newsfeeds full of doom and gloom, cancelled events and stress about health can really get you down. Stay connected with your family, friends and the type 1 community. The Family Centre has online communities for parents of kids with type 1, adults with type 1, and mums with type 1 that are active 24 hours a day. The tribe is here to support you and you can connect from the safety and convenience of home.
We’re here to help
At the Family Centre, we're alert, but not alarmed. We are taking the COVID-19 outbreak seriously, we've been proactive in our policies and we are acting in every way possible to keep our community, team and facility safe. We’re here to help you with advice, support and information – please don't hesitate to contact the Family Centre if you need us.
Written by Bec Johnson MPH and Amy Rush APD CDE
Reviewed by Dr Natalie Sumich MBBS FRACGP