As 2022 begins, two years into the COVID-19 pandemic, everyone has started to develop their own feelings and behaviors around the coronavirus. 

Some people are avoiding all large gatherings, others are taking calculated risks, and others are ready to live life as they did pre-pandemic. But people with predisposing at-risk health conditions have had to approach the pandemic with more caution. 

This extra caution usually applies to people with type 1 or type 2 diabetes mellitus. Type 1 diabetes mellitus is a chronic illness from birth, which means that a person is born with the inability to produce insulin (a pancreatic hormone that breaks down carbohydrates and sugar). These people must rely on synthetic insulin for life. 

On the other hand, a person with type 2 diabetes mellitus has an inability to produce consistent insulin, leading to varying blood sugar levels, and symptomatic responses. A person with type 2 diabetes mellitus usually is diagnosed in their adulthood.

More than 34 million Americans have a form of diabetes mellitus today. Furthermore, about 88 million Americans have pre-diabetes, meaning they are at risk of insulin insufficiency soon.

So what does this mean for diabetics and pre-diabetics during COVID-19?

If you are looking to exert extra caution for yourself or your loved ones, you might benefit from 10 important tips to manage diabetes during COVID-19.

#1: Know Your Numbers. 

If you think you or a loved one might have undiagnosed diabetes mellitus, the first step to protecting yourself is a diagnosis. Diabetes is usually diagnosed with an A1C blood test, which can easily be conducted at a primary care or clinic appointment.

An A1C measures the varying levels of blood sugar over the past 3 months. The higher the percentage, the higher your blood sugars have been consistently. An A1C over 6.5% usually indicates diabetes that must be managed with diet, exercise, and/or medication. An A1C over 5.7% indicates pre-diabetes.

If you already have a confirmed diabetes diagnosis, knowing your daily blood sugar level is important. Sometimes diabetics must test their blood sugars before each meal (especially if they are Insulin dependent). Other times, diabetics check their sugar levels less often. 

A random blood sugar level should typically be below 160 mg/dl. A fasting blood sugar level should typically be 70-100 mg/dl. Typically, undiagnosed individuals don’t check their blood sugar on their own. You should learn more about monitoring your blood sugar numbers after an official diabetes diagnosis.

Woman measuring blood glucose levels with glucometer

#2: Adhere to Health Routines

One of the best ways to protect yourself and your loved ones during this time, is to do your best to adhere to healthy routines. This means eating a well-rounded, nutritious diet that includes fruits and vegetables. For many diabetics, this means limiting the amount of carbohydrates and sugars in their diets. 

If you check and your blood sugar is low, ensure you have a snack like fruit-juice gummies or peanut-butter crackers. Try to avoid sugar-y drinks unless your blood sugar is very low.

Furthermore, even mild to moderate exercise, such as walking the dog or going for a 30 minute bike ride/run, can help keep your body healthy. It is also important to continue basic hygiene, such as showering and performing body/nail care. Diabetics often have to provide extra care to their feet, since vascular disease can lead to foot ulcers or other skin issues. Make sure you regularly examine your feet and body for signs of damage. Also, examine your gums for signs of bleeding after brushing your teeth and go to your eye exam every 6 months, to prevent gum or optic disease.

Sticking to a physical health routine can be challenging, especially if you are working or isolating from home. However, by continuing to prioritize nutritious food, exercise, self-care, and careful inspections of your body, you will strengthen your immunity and health.

#3: Adhere to Your Medications

The most important advice that a diabetic person can follow is to adhere to their medications as prescribed. Sometimes illness or infection can cause variances in blood sugar, however, if you are diabetic, you will not change your medication dosage or routine on your own.

If you feel like your pre-meal and daily blood sugar checks are not normal, then you can contact your healthcare provider to request an appointment.

However, it is very important to adhere to Insulin or medication (Metformin, Glyburide, etc.) as usual during the pandemic. Abruptly stopping or switching your medication can lead to dangerous hypoglycemia or hyperglycemia. 

The next tip will discuss signs of these changes. 

Weekly Pill Organizer

#4: Monitor your Symptoms (Especially if you Get COVID-19)

There are two main adverse effects that a person who is diabetic can and will experience: high blood sugar (hyperglycemia) or low blood sugar (hypoglycemia).

Hyperglycemia is an adverse effect of diabetes when a person’s blood sugar is too high. This can be caused by illness, infection, lack of adherence to medication, extreme diet changes, or after a big surgery. A high blood sugar can usually cause symptoms when it reaches above 250 mg/dl. 

Signs of hyperglycemia include frequent urination (polyuria), excess thirst (polydipsia), dry mouth, nausea, vomiting, shortness of breath/shallow breathing, abdominal pain, muscle weakness, confusion, and fruity-smelling breath and urine.

Hypoglycemia is an adverse effect of diabetes when a person’s blood sugar is too low. This can happen if a person takes excess diabetes medication, fasts or forgets to eat often, drinks excessive alcohol, or changes their exercise routine drastically.

Signs of hypoglycemia include feeling extremely hungry, shaky, weak, irritable, anxious, or tired, as well as pale skin, sweating/clammy skin, tremors, and fast or irregular heartbeats. 

Symptoms of COVID-19 are changing with each variant, however, they often resemble symptoms of a cold or the flu. Look for signs of cough, loss of smell, loss of taste, nasal congestion, sneezing, fever, shortness of breath, chest pain with breathing, or fatigue. 

If you suspect you have COVID-19, you can get tested at an urgent care, clinic, primary care office, hospital, or most drug stores (CVS, Walgreens, etc.). Contact your doctor if you have worsening shortness of breath, confusion, or are concerned about any health change.

If you get COVID-19, it is important to monitor signs of hyperglycemia and hypoglycemia extra closely, since illness can affect blood sugar.

#5: Know the highest-risk situations for catching COVID-19

COVID-19 is a virus that spreads from person-to-person on microscopic droplets in the air, every time a person sneezes or coughs, or even when a person talks. This means that your best protection from getting COVID-19 is to limit close contact with people. Whenever you can, ensure you & the person you are talking to are wearing masks, to reduce the spread of droplets. And of course, keep 6+ feet away from people when you can. 

Avoid extremely crowded public places, such as bars/clubs, very busy restaurants, crowded public transportation, concerts, events, or large gatherings. These are the highest-risk situations for catching COVID-19.

Do not share drinks or utensils with other people. Limit touching your face, especially if you are touching door handles, railings, or other public areas. And try to wash your hands often, for 20 seconds with soap & water, or with alcohol-based hand sanitizer. 

You can get COVID-19 anywhere, but the highest-risk situations are when you are in crowded areas or close to many people without masks. This increases the likelihood that COVID-19 can be spread by droplets and on surfaces.

#6: Some Over-the-Counter Medications Affect Blood Sugar

If you do get COVID-19, you might want to use some medications to ease your sick symptoms. However, it is important to know all of the possible drug interactions with your blood sugar or diabetes medications.

What not to use (or consult with your doctor first):

  • Cough syrups, even sugar-free cough syrup
  • Decongestants (phenylephrine & pseudoephedrine)
  • Advil (ibuprofen) and NSAIDs — these can sometimes lead to hypoglycemia with Insulin
  • Cough suppressant pills
  • Aspirin
  • Niacin (vitamin B supplement)

Alternatives for controlling COVID-19 symptoms include acetaminophen (Tylenol), increasing your fluids/water intake, taking hot showers and baths, sitting in a steam-filled bathroom, and resting often. 

While there may be some over-the-counter medications that you can take, it is important to consult with your doctor first. And even if you do take medication, monitor for symptoms of hypoglycemia, hyperglycemia, and worsening COVID-19. 

If you ever feel chest pain or severe shortness of breath, call 911 immediately. 

#7: Seek Out Evidence-Based Sources on the Risk for Diabetic Individuals who get COVID-19

Nowadays, there is an endless amount of information on the internet regarding both diabetes management and COVID-19 management. Not all of the information online is accurate, and not everything will work best for your body.

Make sure you keep track of what advice works for managing diabetes. 

The best sources to find evidence-based information are “.org” or “.gov” websites. 

These websites are run by official organizations, healthcare researchers, and governments, whose jobs are to share accurate information. 

Furthermore, you can find peer-reviewed medical journals on “Google Scholar”, “PubMed”, “CINAHL”, “APA”, “EBSCO”, or “JSTOR”. Peer-reviewed articles are always scientific-method based and follow many guidelines for testing the veracity of linking health conditions to certain causes and effects.

And if you have reservations or fears about the pandemic, you are not alone. People with at-risk conditions often feel more lonely and isolated during COVID-19 than their peers. 

Reach out to a support system, whether that is family, friends, neighbors, community members, healthcare workers, or other people online who have diabetes.