Diabetes and COVID-19

Be prepared for COVID-19 – tips for those living with diabetes

Daily case numbers of COVID-19 are in the thousands, and when you are living with diabetes, these numbers can be daunting. Many people feel it is inevitable they will either catch COVID-19 or be a close contact and in either situation, you would be required to immediately isolate once you are notified. People living with diabetes need to continue to safely manage their diabetes while in isolation and proper planning and preparation can make this easier. Be prepared with an at-home COVID management kit and personalised diabetes sick day management kit and plan.

How might COVID-19 affect my diabetes?

COVID-19 is a viral illness, and viral illness are most likely associated with increased blood glucose levels, also known as hyperglycaemia, particularly in the presence of a fever. Your body releases hormones to help fight the infection. These same hormones increase the amount of glucose produced by your liver and impair insulin action resulting in hyperglycaemia. Hyperglycaemia can occur a few days before the onset of illness, during, and persist for a few days after the illness has passed. If blood glucose levels (BGLs) are not managed appropriately, hyperglycaemia may lead to diabetes ketoacidosis (DKA) in type 1 diabetes and hyperosmolar hyperglycaemic state (HHS) in type 2 diabetes.

COVID-19 can also cause gastrointestinal symptoms, including nausea, vomiting and diarrhoea. These symptoms may result in low BGLs, also known as hypoglycaemia due to reduced carbohydrate-containing food intake, increased output and a mismatch of insulin to carbohydrates. For people taking certain medications for type 2 diabetes, these symptoms may result in euglycaemic (blood glucose levels with range) DKA. For pregnant women experiencing vomiting, they are at a higher risk of hypoglycaemia and ketosis.

The severity of COVID-19 varies between people, and some people living with diabetes may experience no significant effect on their blood glucose levels. However, any illness can impact a person’s ability to self-manage their diabetes. Some people may require increased support from a carer or family member, which can be difficult in isolation. Personalised sick day management plans and kits are an integral part of diabetes care and can help you to continue to self-manage your diabetes, even when you aren’t feeling your best.

How does a sick day management plan help me?

When you are unwell it can be difficult to manage your diabetes. You may need to make changes to your usual diabetes management to prevent hypo- or hyper-glycaemia until you are well again. A sick day management plan will provide you with information and guidance on what to look for and how to make changes safely, empowering you to live well with diabetes during illness. The aim is to minimise the effects of the illness on your glucose levels and reduce the risk of acute deterioration of glucose levels leading to hospitalisation.

What should my sick day management plan contain?

Every person’s experience living with, and management of, diabetes is individual. A sick day management plan will be different for people living with type 1 diabetes and those with type 2 diabetes. It will also contain different information for those with type 1 diabetes managed by insulin injections or an insulin pump. It will be different within the population of people with type 2 diabetes depending on their management, for example those managed with insulin, other glucose lowering medication or diet alone. For women with gestational diabetes or diabetes in pregnancy, a sick day management plan will be individualised to keep both mum and future baby safe. Any changes to your usual diabetes care during illness are only needed until you are well again.

Independent of your type of diabetes or management, each sick day management plan should contain several important concepts and strategies:

  • Guidance on when to commence and cease your sick day management plan.
  • Recommended frequency and amount of fluids to reduce the risk of dehydration.
  • Recommended frequency and amount of carbohydrate-containing foods and fluids to reduce risk of hypoglycaemia and the development of ketones.
  • The frequency of blood glucose monitoring and, if appropriate, blood or urine ketone testing.
  • Advice on ceasing, adjusting and recommencing diabetes medications, including supplemental insulin doses, insulin pump adjustments and insulin dose adjustments.
  • Recommended additional medications which can be useful to address clinical symptoms of illness e.g., antiemetic (anti-nausea) and anti-diarrhoeal agents.
  • The criteria to trigger contact with your diabetes care team.
  • Names and phone numbers for your relevant diabetes health care professionals and/or the diabetes department. Include contacts for outside office hours, weekends and public holidays.
  • Medical facility to which to present or phone if your sick day management plan is not effective, your condition further deteriorates, or your usual health care team is not contactable. Include when to call for an ambulance (000).
  • Contents of a sick day management kit.
  • Regular checking of sick day management kit to ensure all items are within their expiry dates.

If you don’t have a sick day management plan, or haven’t had yours reviewed for a while, now is a great time to book in and see your Credentialled Diabetes Educator (CDE) or General Practitioner (GP). If you are having difficulty seeing your regular health care professionals, or don’t have a CDE, the Diabetes SA Health Services team includes six CDEs who can see you in person or by telehealth. For examples of what a sick day management plan may look like, visit the Australian Diabetes Educator Association Clinical Guidelines website https://www.adea.com.au/resources/standards-position-statements-and-other-resources/adea-clinical-guidelines/.

Please note that the templates vary depending on the type of diabetes you have and how you are managing you diabetes.

What is a sick day management kit?

In addition to your sick day management plan, you should have a sick day management kit. This is everything you need, ready to go, to manage your diabetes well the moment you fall ill. It is recommended to check your kit every three months to ensure it is fully stocked and everything is within its expiry.

What should a sick day management kit contain?

Every sick day management kit will be slightly different. This is because every person’s sick day management plan will be different. In general, your sick day management kit should include:

  • Telephone numbers to call – e.g., support people, General Practitioner, local hospital, diabetes clinic, Credentialled Diabetes Educator, Endocrinologist.
  • Food and fluids for sick days (carbohydrate-containing and carbohydrate-free).
  • A range of rapid-acting carbohydrate foods and fluids for treatment of hypoglycaemia (for those at risk).
  • Pain relief medications (speak to your GP, CDE or pharmacist about potential interactions with other medications and continuous glucose monitoring devices).
  • Rapid-acting insulin (if prescribed) – this should be stored in the fridge until the expiry date on the box. Once used, it can be stored at room temperature for 28 days and then discarded.
  • Insulin syringes or insulin pen plus an adequate number of pen needles (if insulin is prescribed).
  • Spare insulin pump consumables, continuous glucose monitoring or flash glucose monitoring devices.
  • A blood glucose meter and in-date (non-expired) blood glucose testing strips (if sick day plan dictates blood glucose monitoring is necessary).
  • Thermometer.
  • Blood ketone testing meter and in-date ketone blood test strips or in-date urine ketone testing strips for those with type 1 diabetes and type 2 diabetes on certain medication.
  • Glucagon injection (in those at risk of severe hypoglycaemia).
  • Scripts for any medications that may need to be commenced in accordance with the persons sick day plan.

Do I need also need a COVID-19 management kit?

COVID-19 is circulating widely through the community, and it is a great idea to be prepared with a COVID-19 management kit. There is slight overlap between the content of a diabetes sick day management kit and a COVID-19 management kit and some important differences. Having both a sick day kit and COVID-19 kit is important to manage your diabetes well if you are diagnosed with COVID-19.

What does a COVID-19 management kit contain?

Isolation and quarantine periods currently vary from seven, 10 and 14 days depending on your situation. Doctors have advised have a minimum of two weeks supply of the following:

  • RACGP My Daily Symptom Diary
  • RACGP My COVID-19 action plan  – much of this information overlaps with a diabetes sick day management plan. You may wish to discuss with your doctor incorporating elements of your COVID-19 action plan into your diabetes sick day management plan.
  • Pain relief medications (speak to your GP, CDE or pharmacist about potential interactions with other medications and continuous glucose monitoring devices).
  • Electrolyte drinks (carbohydrate-containing and carbohydrate-free)
  • Prescription medication – Minimum two-weeks supply
  • Thermometer
  • Pulse oximeter
  • Hand soap
  • Face masks
  • Sanitiser
  • Disinfectant
  • Rapid Antigen Tests – at least two per person for those who need to quarantine from being a close contact
  • Contact details for medical support or assistance
  • Activities to keep you entertained

Can I manage my diabetes and COVID-19 at home?

Many people who contract COVID-19 will have no or mild to moderate symptoms and may be able to isolate and manage their symptoms at home. Having a diabetes sick day management plan +/- a COVID-19 action plan will provide you with the necessary information to keep you safe while managing at home. If you can manage at home, you will be in regular contact with either your GP, nurse, Aboriginal and Torres Strait Islander health practitioner or the local public health unit. Symptoms of COVID-19 can change overtime, so it is important to know when it’s time to go to hospital. For more information about managing COVID-19 at home, speak to your GP, CDE or see the RACGP Managing COVID-19 at home online interactive resource.

What else should I be prepared for?

Healthy food and medication are critical in times of illness. If you do run short on food most leading supermarkets have the option of online shopping and offer contactless delivery. Having frozen meals prepared can also be a great alternative, especially when fatigue sets in. If you have pets, ensure you have enough food and entertainment for them also.

If you run short on medication or diabetes supplies, call your local community pharmacy, have your NDSS card ready and explain the situation. If your prescriptions are not on file at the pharmacy, most community pharmacies can provide an emergency supply of your prescription medication, diabetes supplies and offer contactless delivery.

Discuss your isolation plan with family and friends. Talk about who can look after your dependents you test positive for COVID and can’t safely isolate in the same household. Also discuss who might look after your dependents or pets in the unlikely event you must go to hospital.

These are difficult times for many people. From mental health support relating to COVID-19 visit SA Health COVID-19 Mental Health Support page. This page contains information on a range of support services and other resources for adults, children, and culturally and linguistically diverse communities.

Useful links

You can also access COVID-19 assistance in your language by calling the National Coronavirus Helpline on 1800 020 080 and selecting option 5 for interpreter services. For people who test positive for COVID-19 or are a close contact the Department of Health has information in 63 languages.

Further resources for Aboriginal and Torres Strait Islander People include a COVID-19 Readiness Family Plan developed by the Queensland Aboriginal and Islander Health Council and Self-isolation and living with others developed by the Aboriginal Health and Medical Research Council of NSW.

If you would like to discuss the impact of COVID-19 on your diabetes management or be supported to develop a sick day management plan you can call Diabetes SA on 1300198 204 or email us at info@diabetessa.com.au. We are here to support you always.

The Royal Australian College of General Practitioners (RACGP) has developed an interactive online guide to help people with COVID-19 manage their symptoms at home.

The RACGP’s Managing COVID-19 at home with assistance from your general practice site is for for people who do not require additional support from their GP while self-managing their illness at home.

The online tool includes advice and information on:

  • what people need to do when isolating at home
  • how to manage symptoms
  • tips for taking care of mental health and wellbeing.

Information for people living with diabetes about COVID-19 (coronavirus)

We understand that COVID-19 is concerning for our diabetes community, so we have prepared the latest news to help you. The information is sourced from the Department of Health, NDSS and the World Health Organisation.

Managing sick days

COVID-19 and the National Diabetes Services Scheme (NDSS)

We recognise that people with diabetes and their families may be concerned about their risk, and also the availability of their diabetes medicines and NDSS products and supplies. Most people are continuing to order and receive their NDSS products and diabetes medicines as usual. This ensures enough products are available for everyone. For the latest information on COVID-19 and the NDSS, please visit the NDSS website at ndss.com.au/coronavirus-covid-19-information/. If you need a bit of extra support, or if you are struggling with your diabetes management during this time, please don’t hesitate to call the NDSS Helpline on 1800 637 700 to speak to a health professional.