Coronavirus: specific advice for people with diabetes

Having diabetes does NOT mean you are more likely to catch Coronavirus.  However, if you do catch Coronaviruses, it can cause more severe symptoms and complications in people with diabetes. More severe symptoms are also likely in older people, and those with other long-term conditions such as cancer or chronic lung disease.

The Government advice is for everybody to stay at home as much as possible but there have been some changes to lockdown for people in England

While the UK government has recently eased some lockdown restrictions in England, the advice for people with diabetes across the UK is still to stay at home as much as possible and to minimise contact with people outside your household.

You can only leave your house for the following reasons:

• Basic necessities such as food and medicine.
• Exercise - In England only, you can now drive somewhere to exercise for activities such as tennis, golf and angling.
• Any medical needs – to visit a pharmacy or deliver supplies to a vulnerable person.
• Going to and from work if you cannot work at home.

Do not leave home if you or anyone in your household has symptoms.

If you have to leave your home for any of the reasons above, you need to wash your hands as soon as you get home and still follow strict social distancing measures. You should also ensure you stay 2 metres (6 ft) apart from anyone outside your household when doing these activities.

If you live in England, you can sit and rest outside. You can also meet up with one person from outside your household, as long as you still follow the social distancing guidelines and keep 2 metres apart at all times. 

Keep up to date with the latest guidance from the UK government about staying alert and safe here.

What should I do if I have symptoms?

Do not leave home if you or someone you live with has any of the following: A high temperature, a new, continuous cough, a loss of, or change to, your sense of smell or taste.

Most people with coronavirus have at least one of these symptoms.

Phone your GP if your symptoms:

• are severe or you have shortness of breath
• worsen during home isolation
• have not improved after 7 days

If your GP is closed, use the NHS 111 online coronavirus service or phone NHS 24 (111). In addition, it is now recommended that all individuals living in the same household as an asymptomatic person should self-isolate for 14 days (household isolation). Information on COVID-19, including “stay at home” advice for people who are self-isolating and their households, can be found on the NHS website. 

If you have diabetes and start to feel unwell you need to follow the sick day rules for type 1 or type 2 and check your blood glucose frequently.

You can find help on HM GOV website if you’re struggling because of coronavirus, for example with paying bills, being out of work or taking care of your mental health. You can also sign up to get emails when they change any coronavirus information on the GOV.UK websites

How coronavirus can affect people with diabetes

Everybody that has diabetes, no matter whether type 1, type 2 or gestational, is at risk of developing a severe illness if they get coronavirus, but the way it can affect you varies from person to person.

When you are ill and have diabetes, your blood glucose levels can be unstable as your body is trying to fight the illness. Your body starts releasing stored glucose into your bloodstream to give you energy. As a person with diabetes, your body either cannot produce insulin or the insulin you produce doesn't work as well. This causes your blood glucose levels to rise further. There is a risk of both high and low blood glucose levels as your body is working overtime to fight the illness.

For most people, the coronavirus causes a mild illness, but some people can develop a more serious form of the virus which can be life-threatening.

SGLT2i medication

If you have type 1 diabetes and you take SGLT2i tablets (medication that ends in 'flozin'), your doctor may want you to stop taking these for just now. This is because SGLT2i tablets can mask the symptoms of DKA (diabetic ketoacidosis) which can be caused by coronavirus.

If you have type 2 diabetes and take SGLT2i tablets, you can keep taking these unless you become unwell. If you are unwell, these tablets could increase your risk of developing diabetic ketoacidosis. 

There are lots of different types of SGLT2i tablets so have a look at Diabetes UK for the full list of brand names.

Shielding advice

Shielding is a way to protect those that are extremely vulnerable and at a very high risk of severe illness from coronavirus. This involves staying at home and avoiding all face-to-face contact for at least 12 weeks. Those that are classed as extremely vulnerable are people with certain types of cancer and severe respiratory conditions. To find out more about shielding and who should be following this advice, please check the UK Government website.

Some people with diabetes may also need to follow this shielding advice if they have other medical conditions, for example, those with kidney disease or cystic fibrosis-related diabetes. However, under the current advice, most people with diabetes do not need to shield. If you have not had any instructions from the NHS to shield then you should follow the stay at home guidance.

Other TIPS to keep safe and well 

If you have type 1 diabetes:

• Ensure you have enough glucose and ketone testing equipment
• Be aware of you sick day rules provided by your diabetes educator team
• Make sure you have a good stock of insulin pens, needles and any other medications you are prescribed
• Stay hydrated – have plenty of unsweetened drinks and eat little and often
• If you are an insulin pump user you should have insulin pens as a backup and a good supply of insulin pump consumables
• Make sure your diabetes technical device  (insulin pump /continuous glucose monitor/Freestyle Libre device is in good working order and if you have any concerns phone the company who supplies your device directly to troubleshoot and arrange a replacement if necessary.

If you have type 2 diabetes:

• Ensure you have enough glucose testing equipment and if appropriate ketone testing strips (this might be if you have had your diabetes for a long time or have had ketones in the past). Ketones are uncommon in type 2 but remain a risk if glucose is high for a significant time &/or during illness.
•  Make sure you have a good stock of your medications, orals tablets &/or injectable therapies.
•  Be aware of you sick day rules provided by your diabetes educator team
• Stay hydrated – have plenty of unsweetened drinks and eat little and often

This advice is likely to be in place for some weeks.

For the most up-to-date advice then keep checking the UK government and NHS websites.

Additional JDRF advice for Type 1 diabetes can be found here.

To avoid catching or spreading Coronavirus:

Do:

• Wash your hands with soap and water frequently – wash for at least 20 seconds
• Always wash your hands when you get home or into work
• Use hand sanitiser gel if soap and water isn’t available
• Cover your mouth and nose with a tissue when you cough or sneeze
• Put used tissues in the bin straight away and wash your hands
• Try to avoid close contact with people that are unwell

Don't

• Touch your eyes, nose or mouth if your hands are not clean
• Do not use pocket-handkerchiefs as these are unhygienic, instead use single-use tissues.

If you have hospital and GP appointments

Do not go to the GP surgery, pharmacy or hospital if you have coronavirus symptoms. If you are having treatment for something such as an eye or foot problem and you do not have coronavirus symptoms, then your appointments should still carry on unless you have been contacted to cancel it. If you are in any doubt then phone the number on your appointment letter.

Most routine appointments such as your annual diabetes review have been cancelled for just now. These will be rescheduled once the situation returns to normal. In the meantime keep up your routine of checking your feet, keeping to a healthy diet and doing some physical activity.

If you notice something different that you are concerned about such as a cut or blister to your foot, call your GP and let them know. If you cannot get through then call 111 for advice. If you have a change in your vision you should get in touch with your local screening service or optometrist. 

Children and school

Everyone, including children, can get coronavirus. All of the guidance regarding social distancing and staying at home as much as possible apply to children with diabetes too.

In England, the government has plans for a phased return of some children to school, with an ambition that some pupils will go back to school from early June. There will be more up-to-date guidance from the government about this soon so this page will be updated as soon as it is published. You can find all of the latest news from the government about coronavirus on their website.