The COVID-19 pandemic is already one of the most devastating pandemics in recent memory. Everyone is at risk of contracting COVID-19.
In addition, if you are living with diabetes, you have a higher risk of developing serious complications with COVID-19. This is especially if your blood sugar levels are not well controlled.
Managing your diabetes well can help to protect you against the worst effects of COVID-19. Here are some tips to help you manage your diabetes and take preventive steps during the COVID-19 pandemic.
Firstly, take steps to protect yourself from becoming infected.
STAY INFORMED on the latest developments in the rapidly changing COVID-19 pandemic. Use official websites and beware of FAKE news.
FOLLOW recommendations: 1
Observe good hand hygiene
Minimise going out
If you do need to go out, wear a mask, avoid crowded places and practise safe physical distancing (at least 1 metre apart)
To minimise trips to the doctor or pharmacy, ensure that you have enough medications and supplies (including insulin needles, glucose test strips and lancets for blood sugar tests) to last until your next medical appointment, and one month longer.
Don't stockpile medications or supplies because they may expire. Adequate stocks will be available when you need them. If you are running out of medications and supplies, please contact the clinic to refill your medications at least two weeks before they run out so that there is sufficient time to process your prescription requests and for your medications/supplies to reach you.
Keeping your blood sugar levels within recommended levels (4-10 mmol/L)2 may help to reduce the severity of COVID-19 infection for people who get the disease.
Staying at home during the pandemic presents both advantages and challenges for maintaining good control of your blood sugar levels. While at home, continue to take your medications regularly and periodically monitor your blood sugar levels using a glucose meter.
Check your finger-prick blood sugar levels at least two days a week (before and/or 2 hours after meals and at bedtime). You may need more frequent monitoring if your blood sugar levels are unstable, or if you have been instructed by your healthcare team do so.
Take advantage of this time at home to gain better control of your diet, including making healthier food choices and eating more home-cooked meals that follow the healthy-plate principle.
On the other hand, you probably won't be able to go to the gym and may be walking less. Try to keep up your physical activity levels with indoor exercises. For an added motivational boost, invite a buddy to participate in an indoor steps or other exercise challenge with you, and update each other by instant messaging or video calls.
Discuss with your doctor whether your next doctor's appointment can be safely postponed, or whether your visit can be replaced with a tele-consult.
Monitoring your blood sugar at home can help your healthcare team to monitor your diabetes and adjust your treatment through tele-consult.
You can record your blood sugar readings using a log-sheet like this, or use an app (on your phone) which allows you to export your records as a report.
You may also use dedicated software programmes to download the readings from your device and export them as a report. You can use these reports during your discussion with your healthcare team. For example, if you use one of the following devices:
FreeStyle Optium Neo glucose meter
Download the FreeStyle Auto-Assist Neo software onto your desktop and connect your FreeStyle Optium Neo to your desktop
Or use a third party software such as Tidepool
Accu-Chek Guide glucose meter
Download the mySugr app on your phone and pair it with your Accuchek Guide meter. Transfer results from the meter to your phone via blue-tooth.
Style Libre flash glucose monitoring system
If you are using your phone as a reader, download the FreeStyle LibreView software onto your desktop. Log-in to view your results.
Or use a third party software such as Tidepool
Firstly, if you're feeling sick, you should see a doctor at a Public Health Preparedness Clinic (PHPC) or a polyclinic.
In addition, as someone living with diabetes, you may experience changes in your blood sugar levels if you get sick with COVID-19 or other illnesses. Your sick-day plan tells you how to detect and manage these blood sugar changes. For example, you may need to monitor your blood sugar more often and adjust some of your medications that could cause problems when you are sick.
If you're not sure what your sick-day plan is, you can refer to this plan.pdf , which is suitable for most people with diabetes.
If you have type 1 diabetes, speak to your diabetes doctor about developing an individualised sick-day plan for your specific needs.
So far, children (including those with diabetes) seem to be less likely than adults to get COVID-19 or, if they fall sick, often have a milder form of the disease. If your child has diabetes, you can take steps mentioned above to help manage your child's diabetes during the COVID-19 pandemic. Keeping good sugar control will help reduce the risk and severity of COVID-19.
You may be tempted to skip your child's regular doctor's visits during the pandemic. Before skipping appointments, talk to your child's doctor and ask whether you and your child can do tele-consult instead. Tele-consult could help your child's doctor to review your child's blood sugar control and insulin dose, and identify any issues. This is especially important for younger children.
If your child falls sick, they should follow their sick-day plan. This includes more frequent monitoring of blood sugar and ketone levels if they have type 1 diabetes. If you are a patient of NUH Paediatrics, please contact the Diabetes Nurse Educators if you need help when your child is sick.
1 These recommendations are current as of April 2020. Please check the MOH COVID-19 website for the latest recommendations.
2 Or follow the targets set by your doctor for you.
Diabetes mellitus is a condition associated with high blood sugar levels.
When you consume carbohydrates, the body breaks it down into sugar. The pancreas then releases a hormone called insulin. The cells of the body use insulin to take in sugar and use it for energy. In diabetes mellitus, the pancreas is unable to make this insulin. The body may also be unable to use it effectively. This increases blood sugar levels.
Over time, high blood sugar harms the eyes, kidneys and nerves. People living with diabetes are also at higher risk of heart attacks and strokes.
However, diabetes-related complications can be prevented with the right care.
You can manage diabetes by making changes to your lifestyle. This includes:
Eating a healthy diet
Staying active and maintaining a healthy body weight
Taking your medications regularly to help keep blood sugar levels normal
Maintaining your blood pressure and blood cholesterol levels in the healthy range
Your doctor will also arrange for you to under go regular screening of your eyes, feet and kidneys. This will pick up early complications.
With proper care, many people with diabetes live long and well.
Diabetic retinopathy is a complication of diabetes mellitus. It is the most common reason for vision loss among people with diabetes.
When blood sugar levels are persistently high, it injures small blood vessels in the retina of the eye. This will eventually lead to vision problems and even blindness in some.
The good news is that it is preventable.
blood sugar levels and
blood pressure normal can prevent serious eye problems. Your doctor will also arrange for you to undergo regular eye tests.
In the early stages of diabetic retinopathy, your sight may be normal. It is only in the later stages when one will notice vision problems. Eye tests allow diabetic retinopathy to be detected in the early stages. If treatment is given early, blindness can be prevented. Therefore, it is important for people with diabetes to undergo regular eye checks
before vision problems surface.
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One of the complications of diabetes is kidney disease. Our kidneys carry out important functions. They contain millions of tiny filters to remove small waste products from our blood into our urine.
In diabetic kidney disease, high sugar levels damage the filters, causing them to leak and lose their function. Over time, when diabetic kidney disease worsens, the kidneys may fail completely.
However, kidney failure in diabetes is preventable.
blood sugar levels and
blood pressure normal can prevent kidney problems.
Your doctor will also arrange for you to undergo regular blood and urine tests to monitor your condition.
if you have diabetic kidney disease, your doctor will prescribe medications to lower your blood pressure and prevent the kidney disease from getting worse.
In early stages, diabetic kidney disease begins with leakage of small proteins into the urine. You will feel well and have no symptoms. However, this can be picked up early with a simple urine test, so that steps can be taken to prevent diabetic kidney disease from getting worse.
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People with diabetes are at increased risk of serious diseases of the heart and blood vessels (cardiovascular diseases).
Diabetes causes damage to blood vessels in your body and cause them to become blocked. This can lead to serious complications such as
heart attacks and strokes.
However, the good news is that you can do something to reduce your risk of heart attacks and strokes.
Heart attacks and strokes can be prevented by making a few changes to your life:
Plan your meals.
Reduce your weight if you are overweight
In addition to the above, work with your healthcare team to lower the following into your target range:
With all these steps, you can prevent complications of diabetes, stay healthy and live well!
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What to do when you are ill
During an illness such as flu or gastroenteritis, blood glucose levels can rise due to the stress of the illness. At the same time, poor appetite can also cause your blood glucose levels to drop and result in hypoglycemia.
It is important for you to know what to do when you are sick, to avoid high and low blood glucose levels.
If you have Type 1 Diabetes, please discuss with your healthcare team on an individualised sick day plan. The information here may not apply to you.
· Check your blood glucose level every 4 hours.
· Set a timer for to remind yourself.
· Drink plenty of water (if you are not on fluid restriction)
· Sip at least half a cup of water or sugar-free fluid every hour
· Take your meals as per usual as much as possible. Here are suggestions of easy-to-digest meals to help maintain your blood glucose levels:
· If you are unable to eat,
and your blood glucose is between 4 and 10 mmol/L, take any of the following every 1 to 2 hours to maintain your blood glucose levels:
· If your blood glucose drops to below 4mmol/L, treat hypoglycaemia according to the 15/15 rule. Refer to the patient information leaflet on Hypoglycemia.pdf
· Continue to take your insulin injections
· Continue to take your diabetes tablets (with some exceptions below)
· If you are vomiting, having diarrhoea, and/or eating or drinking very poorly,
STOP SGLT 2 inhibitors (dapagliflozin, empagliflozin)
· If your appetite is very poor, do speak to your healthcare provider regarding adjustments to your diabetes medication.
· Fever of more than 37.5⁰C for 2days
· Recurrent low blood low blood glucose (lessthan4mmol/L)
· Recurrent high blood glucose (morethan20mmol/L)
· Severe or persistent vomiting and inability to take in food
· Severe or persistent abdominal pain
· Feeling of breathlessness
· Persistent diarrhoea
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New Initiatives for NUHS Clinics and Community Partners to Improve Diabetes Care.pdf
The "Year of Care" Programme - transforming routine clinic visits into care and support planning for people living with diabetes mellitus