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Coronavirus: Specific guidance for people living with diabetes

If you live in Hammersmith and Fulham, Kensington and Chelsea, Westminster, Ealing, Hounslow, Brent, Hillingdon or Harrow and have diabetes or you are at risk of type 2 register your interest in the Know Diabetes service today.

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Coronavirus: Specific advice for people living with diabetes

Having diabetes does NOT mean you are more likely to catch coronavirus.  However, if you do catch coronavirus, it can cause more severe symptoms and complications in people with diabetes. It's important therefore to remain protected as much as possible.

The risk of developing more severe symptoms of coronavirus is thought to be increased in those whose HbA1c (average blood sugar) is higher, people in older age groups, people who are overweight, people from black, Asian and minority ethnic backgrounds, and those with other long-term conditions such as cancer or chronic lung disease.

Specific advice to lower your risk:

Type 2 Diabetes or Prediabetes (non-diabetic hyperglycaemia):

  • Many people who are overweight and have Type 2 diabetes or prediabetes (non-diabetic hyperglycemia) are focusing on losing weight as a way of improving their blood sugar and reducing the risk of more severe disease. Check out our resources on low carb and Type 2 diabetes remission to find out more - note that you should only stop medication on the advice of a doctor. We've also put together some information about healthy eating and healthy eating on a budget during COVID 
  • Ensure that you are taking your medication regularly as prescribed by your doctor
  • Check out the wellbeing advice in our Know Diabetes blog

Type 1 Diabetes:

  • You may find you have extra time to check blood glucose more often and to focus on getting your diabetes on target. Check out our Type 1 education courses or other Type 1 resources for help and ideas.

If you get sick, seek help. Read more below.

Latest updates

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. Only go out for:

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 (self-isolating)?

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.

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

Staying at home if you have symptoms (self-isolation)

If your symptoms are mild, NHS 111 will usually advise you and anyone you live with not to leave your home.  This is called self-isolation

  • Anyone with symptoms should self-isolate for 7 days from when their symptoms started
  • Anyone who does not have symptoms should self-isolate for 14 days from when the first person in your home started having symptoms

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 on multiple daily injections, type 1 on an insulin pump or type 2 and check your blood glucose frequently. A useful summary of these (courtesy of the Primary Care Diabetes Society) is shown below.

Sick Day Rules for Diabetes

Information for pregnant women and their families, please refer to this source. 

It’s important not to go to your GP surgery, hospital or pharmacy if you think you may have coronavirus, please use the NHS 111 online tool or dial NHS 111 for further medical advice.

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, but 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 which makes it harder for you to manage your diabetes. This can increase your 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. It is important that people with diabetes follow the sick day rules for type 1 and type 2 and use the NHS 111 online coronavirus tool or dial NHS 111 for further medical advice.

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 'clinically 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. In England, you can go outside once a day with the person you live with, or one person from another household if you live on your own. If you are shielding and do meet someone outside, make sure you follow stringent social distancing.

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.

People with diabetes are not in the clinically extremely vulnerable group (shielding group). People with diabetes are in the 'clinically vulnerable group'. This means you should still stay at home as much as possible and if you do go out, be really careful to avoid contact with people you don't live with.

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. 

Based on the latest data, the UK Government do not think that shielding is appropriate for all people with diabetes. But they do think that people with diabetes at higher risk – those over 70 or with other risk factors – should be contacted by their healthcare teams to talk about their support needs, including if shielding is right for them. If it’s appropriate, your healthcare team should be able to get a shielding letter issued so that you get the right support. 

Speak to your healthcare team if you’re very worried about your risk, or call the Diabetes UK helpline team to talk things through.

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. 

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 your 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 and pen needles 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 ketone testing strips if appropriate (if you have had 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. If you take a tablet called SGLT2 and you become unwell you may need to check your glucose and ketones.
  •  Make sure you have a good stock of your medications, orals tablets &/or injectable therapies:
  •  Be aware of your sick day rules provided by your diabetes educator team
  • Stay hydrated – have plenty of unsweetened drinks and eat little and often

Practical advice to help you right now

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 some areas of the UK, the government is starting a phased return of more children going back to school. This is happening in England first. Schools should be practising social distancing for your child. This is to prevent the virus from spreading between children and your home. Talk to the teaching staff if you don’t feel that social distancing is possible in your child’s school.

You may be worried about the safety of your child returning to school if they have diabetes. We recommend speaking to the school and to your child’s diabetes team about your concerns – they should be able to give you the information you need to help you make a decision.

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.

Travel and leisure

COVID-19 Exceptional Travel Advisory Notice

As countries respond to the coronavirus pandemic, including travel and border restrictions, the Foreign & Commonwealth Office advises British nationals against all but essential international travel.

Holiday homes and overnight stays

People with holiday homes and caravans are still not permitted to travel to their second home or to stay overnight. 

Leaving your home - the place you live - to stay at another home is not allowed.

Click the link here for more details on GOV.UK website.

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
  • Keep up to date with the advice from Diabetes UK which you can find here
  • All people with diabetes should self isolate.

Don't

  • Touch your eyes, nose or mouth if your hands are not clean
  • If you haven't stopped smoking, now is a good time to do so​. Most stop smoking support teams are still providing a remote service.

Some specific advice for healthcare professionals (HCPs) and people with diabetes:

  • Guidance for Health professionalsClinical guide for the management of people with diabetes during the coronavirus pandemic
  • Guidance for Primary Care, Secondary Care,  Community Health, Social Care and Ambulance services
  • People with diabetes are at elevated risk of acquiring the more severe disease
  • Keep up to date with the advice from Diabetes UK which you can find here
  • All diabetes consultations to be done virtually by HCPs to minimise the risk of exposure unless otherwise indicated
  • If people haven't stopped smoking, advise that now is a good time to do so
  • All people with diabetes should self isolate.
  • Guidance for healthcare professionals on coronavirus (COVID-19) infection in pregnancy, published by the RCOG.

For further Healthcare Professional COVID-19 guidance, please visit https://www.knowdiabetes.org.uk/professional/