The challenges of managing diabetes and COVID-19 risk

UCHealth endocrinologist Dr. Cecilia Low Wang answers questions about the risks the COVID-19 pandemic presents for people with diabetes – and how they can protect themselves.
Nov. 25, 2020

A hard lesson of the pandemic unleashed by the novel coronavirus is that it can strike and sicken people unpredictably. The virus, which causes COVID-19, has claimed victims as young as two months old and infected young adults, many of them otherwise healthy, at rapidly increasing rates.

Still, COVID-19 strikes hardest at people of any age who already cope with certain preexisting medical conditions. They are most likely to require emergency care, hospitalization, respiratory support and sometimes extensive rehabilitation after they survive the disease. Evidence suggests that these underlying conditions significantly increase a person’s risk of dying from COVID-19.

Dr. Cecilia Low Wang
Dr. Cecilia Low Wang

One of these conditions is diabetes, which impairs or destroys the body’s ability to produce or use insulin, resulting in abnormally high blood sugar levels. People with diabetes are at increased risk of heart disease and strokes, as well as kidney, nerve, foot and eye problems and therefore must carefully manage their blood sugar levels with close attention to lifestyle and often with medications.

But how does COVID-19 complicate the lives of people with diabetes? What additional precautions should they take to protect themselves during the pandemic? For answers to these and other questions, UCHealth Today spoke with Dr. Cecilia Low Wang, Professor of Medicine in the Division of Endocrinology, Metabolism and Diabetes at the University of Colorado School of Medicine. Dr. Low Wang also directs the Glucose Management Team at UCHealth University of Colorado Hospital on the Anschutz Medical Campus.

The discussion comes at a challenging time for the nation, where numbers of COVID-19 infections, hospitalizations and deaths continue to soar. UCHealth is no exception. As of mid-November, the number of patients in its 12 hospitals with confirmed or suspected COVID-19 infections stood at 361, up more than tenfold from the number reported in September.

I have diabetes. Am I at increased risk of contracting COVID-19?

Before answering, Low Wang offered a cautionary note. “One of the important things to remember with any questions about COVID-19 is that we are still learning more,” she said. “Even though there is a lot of information, it’s being refined over time.”

That said, she noted, “People with diabetes don’t seem to be at higher risk of getting the infection. But if they do get it, they are more likely to be sick from it. That’s an important distinction.”

How does my diabetes increase my risk if I am infected with the virus that causes COVID-19?

Diabetes disrupts the body’s ability to regulate blood glucose levels. People can manage those levels with medications, healthy diets, exercise and other steps. Uncontrolled blood glucose levels put them at risk for a host of problems. The COVID-19 pandemic adds to the list.

Diabetes in general, and uncontrolled glucose levels in particular, weaken the body’s immune system, making people more vulnerable to infection eroding their ability to fight off an attack, Low Wang said.

A woman wearing a mask has her glucose checked, a vital management for diabetes and COVID-19 risks.
It is vital for people with diabetes to protect themselves against COVID-19 infection by managing their blood glucose levels. Photo: Getty Images.

The host of complications that many people with diabetes suffer also puts them at greater risk of contracting COVID-19. For example, chronic kidney disease, which affects roughly one-third of adults with diabetes, degrades the body’s ability to filter the blood and remove the byproducts of processing nutrients. This heightens the likelihood of infection of any kind.

Do my risks of complications from COVID-19 infection differ depending on whether I have Type 1 or Type 2 diabetes?

That’s “an unclear area,” Low Wang said. In people with Type 1 diabetes, the pancreas produces no or very little insulin to process blood sugar. In people with Type 2 diabetes, the pancreas doesn’t produce enough insulin to overcome the body’s resistance to it.

At this point, people with Type 1 diabetes who do not have other underlying conditions “don’t seem to be at increased risk for developing complications from COVID-19,” Low Wang said. But she added that they should continue to follow standard measures to remain safe – maintaining social distancing, wearing a face covering, and washing hands frequently – and carefully manage their glucose levels to guard against diabetic ketoacidosis, a potentially life-threatening state that occurs when the body doesn’t have enough insulin and produces excess acid in the blood.

Type 2 diabetes, however, is far more prevalent, and presents a wider range of risks, Low Wang said. For example, obesity, hypertension, heart disease and chronic kidney disease affect many people with Type 2 diabetes and all increase the danger of infection, she said.

I understand the risks my diabetes presents. How do I protect myself from COVID-19?

First, anyone with diabetes should follow the practices to protect themselves and others mentioned above. In addition, it’s vital to stay prepared to manage the disease. As we’ve seen, keeping glucose levels under control is key to warding off infection.

“Make sure you are stocked up on your supplies and medications,” she said.

But the pandemic is raging. Shouldn’t I stay at home if I have diabetes?

It’s wise to be conservative, Low Wang agreed.

“It is important to wear a face covering, stay physically distanced while indoors or outdoors, avoid contact with people who are coughing, sneezing, or otherwise seem ill, wash your hands often, and to stay home if you are sick,” she said.

However, “it’s also possible to become overly conservative or take caution to the extreme,” she added. With some planning, people can very often take care of necessary chores safely. For example, for necessary errands like grocery shopping or getting prescriptions, pick times when there will likely be fewer people in the stores.

In addition, many people with diabetes who are still employed will not have the option to work from home. That’s a big concern, but they have the right to pursue workplace accommodations to keep them safe, Dr. Low Wang noted. The American Diabetes Association provides a summary of Rights for Workers with Diabetes during the Coronavirus Pandemic.

Most importantly, people with diabetes should not be afraid to seek necessary medical care because they fear exposure to the coronavirus, Low Wang said. They might consider first a phone call or telehealth visit to review symptoms with a nurse or physician before leaving home. She also emphasized that UCHealth has put policies and practices in place to protect people who need to visit the hospital, emergency room or clinic.

“Don’t delay care if you feel that you need it,” Low Wang stressed.

What about the flu and diabetes? 

The overlapping of flu season with the surge of COVID-19 cases presents another health protection problem for all of us. It’s important for people with diabetes and everyone else to get a flu shot if they haven’t already.

Low Wang said the symptoms of flu and COVID-19, such as fever, cough and body aches, can be hard to distinguish. However, shortness of breath and loss of taste and smell are strong indicators of COVID-19. With any of these symptoms, she urged people with diabetes to seek care and stay home from work.

Do medications to treat COVID-19 put me at risk because I have diabetes?

The steroid dexamethasone, now a frequently used treatment for patients fighting COVID-19-related respiratory problems and requiring oxygen, drives up blood glucose levels.

“It’s becoming a common issue in the hospital,” she said, adding that UCHealth is working on incorporating care guidelines and treatment options to protect diabetes patients with COVID-19 infections who receive dexamethasone.

What else can I do to protect myself?

“I strongly recommend that people maintain healthy habits,” Low Wang said. These include eating a balanced diet, maintaining physical activity, reducing stress and getting enough sleep.

She also counseled finding equilibrium in this age of pandemic-driven extremes. That’s important for people with diabetes – and everyone else.

“I’ve seen a whole spectrum of reactions among patients: those who think [the virus] is a hoax; those who think returning to normal life is more important than being careful because there is nothing we can do to change the situation; and those who are afraid to go outside,” Low Wang said. “Most people that I see in the clinic have found a happy medium in between, with the realization that there is a lot that each of us can do to get through this safely, together.”

About the author

Tyler Smith has been a health care writer, with a focus on hospitals, since 1996. He served as a writer and editor for the Marketing and Communications team at University of Colorado Hospital and UCHealth from 2007 to 2017. More recently, he has reported for and contributed stories to the University of Colorado School of Medicine, the Colorado School of Public Health and the Colorado Bioscience Association.

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