Controlling blood sugar even more crucial with increased COVID 19 risks

As research points to diabetes patients being at increased risk for severe illness with COVID-19, experts say keeping blood sugar under control, maintaining good communication with your health care professional and seeking medical attention when needed is more important than ever.

Diabetes is the second most common underlying health condition associated with severe outcomes in COVID-19 patients, surpassed only by cardiovascular disease, according to the Centers for Disease Control and Prevention. People with diabetes are six times more likely to be hospitalized and 12 times more likely to die than those without pre-existing, underlying conditions.

Research shows keeping diabetes under control may play an important role in outcomes. COVID-19 patients who had better-controlled glucose had a lower death rate than those with poorly controlled glucose, according to a study from China published in the journal Cell Metabolism.

Unfortunately, emergency room visits for blood glucose problems have fallen 10% since March, as people seem to be avoiding trips to the ER since the pandemic began.

But avoiding needed emergency care can set them up for a worse case of COVID-19 – "the very thing they are trying to avoid," said Dr. Prakash Deedwania, professor of medicine at the University of California, San Francisco.

Blood glucose levels that remain high for too long can lead to long-term complications such as heart disease, stroke, kidney disease, nerve damage and amputations, as well as eye and vision problems, including blindness. Uncontrolled blood glucose levels also weaken the immune system, Deedwania said.

"One should not fear going to whatever place of care they need to go to get blood glucose under control," he said. "All of those places are open and functioning and well aware of how to make the environment safe."

Dr. Joshua Joseph, assistant professor of medicine in the Division of Endocrinology, Diabetes and Metabolism at Ohio State University Wexner Medical Center in Columbus, said people with high blood sugar should stay in touch with their health care professionals to closely manage their hyperglycemia.

In some cases, a trip to the ER may not be needed. Many doctors have increased use of telemedicine during the pandemic. Joseph said patients should work closely with their health care professional to determine the best approach, adding that his practice works with the patient to determine if the problem can be controlled at home through insulin adjustments or in an outpatient setting.

In cases where blood sugar is extremely high, patients are asked to come to the hospital, where precautions are taken to keep COVID-19 patients isolated and away from those being seen for other health care issues.

Deedwania and Joseph provided some tips for keeping blood sugar under control:

Take your medications as prescribed and make sure you have enough on hand so you don’t miss any doses.  While some misinformation early in the pandemic led to confusion about the role of certain drugs, including ACE inhibitors and angiotensin receptor blockers, often used by people with diabetes to prevent heart disease, the American College of Cardiology, the American Heart Association and the Heart Failure Society of America issued a statement in March saying patients taking the drugs should continue treatment unless otherwise advised by their doctor.

Closely monitor your blood sugar and adjust your insulin and diet as needed. "Pay attention to what you are eating and don't eat a lot of takeout food," Deedwania said. "Eat what you can cook at home so you know what's in it."

Keep stress levels at bay. "As stress increases, it can make blood glucose go out of control," Deedwania said.
“Maintaining strong social support networks and healthy relationships are important for managing stress,” Joseph said. Other important factors are getting at least 150 minutes of physical activity per week and getting enough sleep. Using mindfulness and meditation, deep breathing or listening to music can also help, he said.

Minimize COVID-19 exposure by “staying at least six feet apart from other people in public, or from anyone outside immediate family who enters your home,” Deedwania said. And "always wear a mask (in public), especially if you have diabetes."