A/Prof Spiros Fourlanos is a consultant endocrinologist, and Director of the Diabetes and Endocrinology Department at Royal Melbourne Hospital.
We talked to A/Prof Fourlanos and passed on your biggest questions about how COVID-19 affects adults and young adults with T1D. In this article, he talks about whether people with T1D are at higher risk of getting the virus, how to best manage T1D when you have a virus and what can be done to help lessen the symptoms.
1. Are people with T1D at higher risk of getting COVID-19?
Currently, there is not very much data on how COVID-19 affects people with T1D. However, there is also no evidence to date that people with T1D are at an increased risk of being infected with COVID-19. In theory, prolonged periods of high blood glucose can affect T-cell immunity – a key part of your immune system. Therefore, it’s possible that people with chronic elevated blood glucose levels may be at risk of more viral infections in general.
2. Are people with T1D at a higher risk of developing a severe response to COVID-19 / more likely to require hospitalisation?
It appears that people with diabetes, especially the elderly, can experience more severe disease with COVID-19 and have higher rates of hospitalisation. However, there is little data to date on type 1 diabetes specifically. In most cases, the severe response is likely to be due in part to other significant conditions people may have (like heart, respiratory or kidney disease).
3. What do other viruses, like the flu, tell us about what it might be like for a person with T1D to have COVID-19 – will it make diabetes management more difficult?
Any illness, including viral infections such as influenza or COVID-19, can affect blood glucose levels. When you get sick, this raises your levels of ‘stress hormones’ like adrenaline and cortisol. This can in turn increase blood glucose levels and may require increases to background insulin. A decreased carbohydrate intake when you’re sick could also mean that meal time insulin may need to be decreased. This means that it’s always important to monitor blood glucose levels closely when you are sick. In severe cases, diabetic ketoacidosis (DKA) is a possibility – so it’s also important to monitor ketones and keep taking basal insulin.
4. Should people with T1D be taking any special measures to avoid getting COVID-19, or should we follow the same guidelines as people in the general population?
It’s important for people with T1D to follow guidelines, same as the general population, around physical distancing and regular and thorough hand washing. People with T1D and additional risk factors should practice social distancing as much as possible, including working from home if you can.
5. What can a person with T1D do if they are diagnosed with COVID-19, to help lessen the symptoms?
It’s recommended that you drink plenty of fluids, take paracetamol for any fever, and get as much as rest as possible. Close monitoring of blood glucose and ketones is also important.
There is no specific treatment or vaccine available for COVID-19 at this stage.
6. How long does the COVID-19 infection last and is there a longer recovery period for someone with T1D?
Most cases (80%) are mild and last up to two weeks. Those with severe symptoms may take 3-6 weeks to recover. There is no evidence to date to suggest recovery takes longer in people with type 1 diabetes who have a mild case.
7. Some research has indicated that ibuprofen should not be used to treat symptoms of COVID-19. But paracetamol causes inaccurate BGL readings with some CGMs. What advice should we be following?
Paracetamol is recommended as the first line of treatment for symptoms including fever and muscle aches. However, paracetamol may interfere with the Dexcom G5 CGM by inaccurately raising blood glucose measures. The level of inaccuracy depends on the amount of paracetamol active in the body and is different for each person. In this scenario, it’s likely that ibuprofen can be safely used instead. There was some initial controversy around the use of anti-inflammatories like ibuprofen to treat COVID-19 symptoms, but the World Health Organisation (WHO) has recently released a statement saying it does not recommend against using ibuprofen.
Read part 1: COVID-19 and children with T1D here.
You can read more about T1D and the coronavirus here.
Please note that the above is meant to provide general guidelines and advice to families. For individual medical advice or health concerns, please speak to your healthcare professional.