What You Need to Know about Diabetes and the Coronavirus

Expert advice on preparing for the coronavirus: prescription refills, sick day kits, and general precautions. Updated 3/17/20

Wash your hands. Don’t touch your face. If you’re sick, stay home. And like everything else with diabetes, it’s best to be prepared.

By now, you’re probably aware of the novel coronavirus, the global infection named COVID-19. While it originated in China, it has now spread to different countries around the world, including the United States. The news about COVID-19 changes daily; stay up-to-date with factual, science-based information available from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).

But what should you do specifically if you or a loved one has diabetes? Melissa Young, Pharm.D., board certified in advanced diabetes management, and a CDCES (certified diabetes care and education specialist, formerly called CDE, or certified diabetes educator), also urges self-education and preparation. “We want everyone to be prepared, but to ask for help if they need it,” she said. “There may be a point where we are asked to stay home, so we need to do our best to follow the guidelines but to seek medical care if needed.”

Pay Attention to Prescriptions

Young cited the American Diabetes Association’s COVID-19 page report, which gives tips specific to people with diabetes. In general, she says, “Definitely make sure your medications are refilled. This is not the time to get behind on medications.” This includes any oral drugs you take to manage blood sugar, insulin, and any related supplies such as syringes or pens, insulin pump supplies, pen needles, glucose strips, lancets, alcohol swabs, ketone strips, glucagon and whatever else you use to manage your diabetes.

Several factors – including your specific insurance plan, laws, and the type of medication – determine the amount of prescriptions and supplies you can fill at a time. If filled at a local pharmacy, this often means a 30-day or sometimes a 90-day supply. “It’s likely you will not be able to fill your prescription again if you’ve just refilled it,” Young said. “Usually, it can be refilled once 80 to 90 percent of your supply from the last prescription has been used.” (Though this doesn’t apply to controlled substances such as opioids, Young notes.) If you can use a mail-order pharmacy with your insurance, you can typically receive a 90-day supply with a healthcare professional’s prescription. But as the COVID-19 situation progresses, “check your insurer’s website or ask your local pharmacist to see if they will make allowances to refill prescriptions earlier than usual,” Young said.

With all the uncertainty of this epidemic, new information is coming out about prescription refill allowances:

• BlueCross BlueShield has announced a national COVID-19 coverage plan, including "waiving early medication refill limits on 30-day prescriptions [...] and/or encouraging members to use their 90-day mail order benefit."

• Aetna is providing 90-day prescription medications to members and people on Medicare insurance.

• Anthem is relaxing 30-day refill limits, and encouraging members to ask their doctors for 90-day prescriptions. 

• UnitedHealthcare members can fill prescriptions early (for a 90-day supply) at their pharmacy or through mail order. 

• Regence BlueCross BlueShield announced that they are easing refill restrictions for non-opioid medications, allowing 90-day prescription refills in Washington, Utah and Oregon.

• A Florida state statute allows people who live in counties experiencing a declared state of emergency to get an early refill of chronic medications for up to a 30-day supply.  

What is the risk of severe COVID-19 infection for people with well-managed diabetes?

Young couldn’t say. “Preliminary data show that the elderly and those with baseline chronic conditions, such as diabetes, heart disease and lung disease, appear to be at higher risk for experiencing severe illness with this virus. [High blood glucose levels challenge] the immune system, leaving the body vulnerable to severe outcomes with infections. Working with your diabetes care team to manage blood sugars would help the immune system to function properly and increase overall wellness. In addition, keep a careful eye on your blood sugar if you are sick; illness can cause blood sugars to spike, leading to severe complications that further weaken the body’s ability to fight the virus.”

She also urged people with diabetes to continue taking not just their diabetes medications, but related prescribed drugs such as those for lowering cholesterol and blood pressure levels, too. “The more chronic conditions you have, the more you are at a higher risk.” Keeping health conditions managed is vital for good health.

Be Savvy About Sick Days

As of this writing, more than 167,000 people around the world have been diagnosed with COVID-19, and the number changes daily. People with chronic conditions, such as diabetes, are at a higher risk for getting sicker if they do show symptoms, Young said.

To be prepared, have a fully stocked sick-day kit at the ready. It should include the following, per Young and the ADCES:

• The name and phone number of your doctors, including a primary care physician and anyone on your diabetes care team, such as an endocrinologist or diabetes educator.

• A list of your active medications and doses, including supplements and vitamins.

• A card or piece of colored poster board that states you have diabetes, to keep in your wallet; a bracelet, necklace or other wearable tag that indicates you have diabetes.

• A source of simple carbohydrates to treat lows, kept separate from other food in the house. “Everyone thinks this is so simple, but what if someone else in the house drinks the soda from the refrigerator or eats the LifeSavers,” said Young. Keeping them separate ensures they will be available to you if needed.

• Alcohol swabs, extra hand sanitizer, ketone strips, glucagon.

It’s a good idea to know ahead of getting sick how to treat symptoms, which can include a fever, cough, shortness of breath, and gastrointestinal symptoms such as diarrhea. They appear 2-14 days after exposure, according to the CDC. “Know what medications you can take over-the-counter if you have a fever or cough,” said Young. “It’s important to read labels on over-the-counter medications because it is easy to duplicate ingredients, and some medications can affect blood sugars.” Also, Tylenol (acetaminophen) is known to affect readings of some continuous glucose monitors (CGM), such as the Dexcom G5, Medtronic Enlite, and Guardian, notes the ADA website.

COVID-19 symptoms are similar to those of influenza (the flu). If you haven’t already, Young urges people to get a flu shot. While it won’t prevent against COVID-19, it will lessen the severity of flu symptoms and help keep you healthier, which can help you if you do get COVID-19.

General Precautions for All

• Whether you have diabetes or do not, everyone should be washing hands with soap and water for at least 20 seconds before eating, after using the bathroom, and after coming home from being out in public. Use hand sanitizer when handwashing isn’t possible.

• Face masks are not helpful if you aren’t already sick.

• Stay educated by looking up daily updates from the CDC, WHO, ADA and from fact-based news sources.

“There are so many resources about this,” said Young. “We don’t want people to have questions that are unanswered, as that leads to fear.”

What if you think you might have the coronavirus?

• Call your healthcare team. Do not go to the doctor’s office or emergency room without first calling, to help protect others. If you do not have a doctor, call your state or local health department. 

• Your healthcare professional will ask questions: do you have a cough? Shortness of breath? A high fever? Have you traveled recently? If they think you may have the virus, you will probably be advised to self-quarantine at home. 

• Wear a mask if you are around others. Avoid close contact, do not share personal items, and disinfect all common surfaces frequently. 

• Currently there is no treatment for coronavirus. At this time, testing is very limited in the United States; you may not receive a test for a mild case.

When should you go to the doctor or the emergency room?

• If you are experiencing more and more shortness of breath  – especially if you are unable to complete a sentence without taking a breath.

• Older people with other health conditions are at higher risk for severe infection, so should consider getting immediate care.

To read more COVID-19 preparation strategies from diaTribe, click here.

About Cheryl

Cheryl Alkon is a seasoned writer and the author of the book Balancing Pregnancy With Pre-Existing Diabetes: Healthy Mom, Healthy Baby. The book has been called “Hands down, the best book on type 1 diabetes and pregnancy, covering all the major issues that women with type 1 face. It provides excellent tips and secrets for achieving the best management” by Gary Scheiner, the author of Think Like A Pancreas. Since 2010, the book has helped countless women around the world conceive, grow and deliver healthy babies while also dealing with diabetes.

Cheryl covers diabetes and other health and medical topics for various print and online clients. She lives in Massachusetts with her family and holds an undergraduate degree from Brandeis University and a graduate degree from the Columbia University Graduate School of Journalism.

She has lived with type 1 diabetes for more than four decades, since being diagnosed in 1977 at age seven.