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Diabetes Patients Face Serious COVID-19 Complications

Doctors say it may be critically important to control blood sugar

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En español | People with diabetes have extra incentives right now to stay on top of their blood sugar levels. Doing so will not only help them live with the disease and avoid complications such as cardiovascular disease and kidney damage but also help them stay safe during the new coronavirus pandemic.

Although diabetics are no likelier to get COVID-19 than the general population, they are far more likely to experience severe complications, even death, if they contract it.


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According to a recent report in the Lancet, the risk of death from COVID-19 is up to 50 percent higher in people with diabetes than in those without it. To get a handle on why that is, researchers are looking at the role blood glucose may play.

"It's thought — and this is all very preliminary — that people with uncontrolled blood sugar might be more susceptible to the effects of COVID, partly because of the way the virus gets into our cells,” says Emily Nosova, M.D., a fellow in endocrinology at the Icahn School of Medicine at Mount Sinai in New York City. “Once someone with diabetes is diagnosed with COVID, even if they have mild symptoms and are recovering at home, what we've seen is erratic blood sugar patterns — either dramatic spikes or dramatic drops."

Low blood glucose raises the risk for a life-threatening condition known as diabetic ketoacidosis (DKA), which makes it challenging to manage your fluid intake and electrolyte levels — two things that are key to preventing sepsis, a potentially deadly COVID-19 complication. High blood glucose can also inhibit the release of infection-fighting white blood cells, further raising the risk for infection.

For diabetics who get the coronavirus, “blood glucose has to be managed along with everything else,” says Anne Peters, M.D., professor of clinical medicine at the University of Southern California (USC) Keck School of Medicine and director of the USC Clinical Diabetes Programs. “You have to make sure your blood glucose levels aren't too high or too low. If they're too low, you can lose consciousness; too high can make your body's infection-fighting cells not work well.”

Amplified effects of diabetes and COVID-19

And then there are the cascading effects of the coronavirus. Symptoms of COVID-19 — among them, profound fatigue and headaches, nausea and diarrhea, and a loss of your sense of taste and smell — interfere with one's ability to manage diabetes, too. “Sometimes all of these blood sugar fluctuations have to do with the fact that people simply aren't eating that much, compared to normal,” Nosova says. “Your appetite and whether you have gastrointestinal issues will affect the way you're metabolizing or digesting the diabetes meds. The treatments can also have dramatic effects on the blood sugar.”

Complicating matters even more is that people with type 2 diabetes are at high risk for cardiovascular disease and are often older and overweight — factors that can further raise the risk of severe cases of the disease caused by the new coronavirus. “The more chronic medical conditions you have, particularly those that aren't controlled well, that's what puts you at higher risk for developing complications from COVID,” Nosova explains.

In addition to social distancing, wearing a face mask and washing hands frequently — all recommendations from the Centers for Disease Control and Prevention (CDC) — experts recommend that diabetics consider these steps to stay safe.


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Look for opportunities

While stay-at-home orders can make activities like working out and grocery shopping more challenging, those with diabetes have to stay vigilant about managing their blood sugar. The key, says Peters, is to “create patterns that you stick to.” Set aside a time of day to exercise (whether it's using an exercise video, walking or lifting hand weights), and set alarms to remind you to get moving on a schedule. The good news? Peters says that many of her diabetic patients are showing improvements in their diabetes care right now, because they're eating home-cooked meals (which can be healthier than restaurant fare) and finding creative ways to stay active.

Monitor your blood glucose more frequently

Check your blood sugar when you wake up, before meals and before bedtime, Nosova suggests. Contact your doctor if it stays above 250 mg/dL for one hour, since you could be at risk for DKA, which occurs when the body burns fat for energy and creates high levels of blood acids, known as ketones. Eventually, these ketones can poison the body. If you use finger sticks to check your glucose, it's especially important to wash your hands thoroughly before doing so, Nosova says. “If anyone else is assisting with a finger prick, make sure they're practicing good hygiene, too."

Plan ahead

To make sure you're able to manage your diabetes if you contract COVID-19, create a hospital kit. Fill it with everything you need “to treat your diabetes so it doesn't interact with the COVID and get you into the hospital,” she says. Be sure to include Gatorade, juice and glucose tabs, as well as extra refills on prescriptions, enough insulin to last at least two weeks (if you take insulin), a spare glucose meter (with extra batteries and test strips) and ketone test strips to check for ketones.

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