People with diabetes are among the groups most at risk for more severe complications to the novel coronavirus and its disease, COVID-19.

That’s around 1 in 10 Americans who should be thinking about how to manage diabetes while self-isolating and social distancing, as well as how to care for themselves should they feel themselves getting sick.

People over the age of 60 with diabetes and other health issues are especially at risk, according to a statement released by the American Association of Clinical Endocrinologists (AACE).

“Recent studies have shown that of those hospitalized for severe disease, 22.2% to 26.9% reported living with diabetes,” they wrote. “Diabetes and high glucose levels are associated with increased complications, respiratory failure and mortality in hospitalized patients with COVID-19.”

Diabetes and COVID-19 risk

Researchers aren’t sure why people with diabetes may have a higher risk for complications and death from COVID-19, or if there’s even a higher risk at all.

For instance, a studyTrusted Source of more than 72,000 cases of COVID-19 in mainland China published in the journal JAMA found that people with diabetes had more than triple the death rate of those without diabetes — about 7 percent compared with about 2 percent.

While other studies have corroborated this one, there are still other studies that have not confirmed these findings. The COVID-19 disease is still new, so the body of knowledge is limited and evolving.

Of special note, however, is the apparent risk to people with type 1 diabetes as well as those with type 2 diabetes who take ACE inhibitors as part of their doctor-prescribed disease management, according to Heather de Vries McClintock, PhD, an assistant professor of public health at Arcadia University in Pennsylvania.

“Persons with diabetes — particularly type 1 — who experience a viral infection have a greater likelihood of having diabetic ketoacidosis, which inhibits the body’s ability to mitigate sepsis, a major contributor to death among persons with COVID-19,” McClintock told Healthline.

In addition, she noted, “Pathogenic coronaviruses bind to their target cells through angiotensin converting enzyme II (ACE II). Persons with diabetes (both type 1 and 2) who are treated with ACE inhibitors and angiotensin II type I receptor blockers (ARBs) may have increased expression of ACE II.”

How to prepare for COVID-19

Knowing the risks, the question then is how best to prepare.

“The best option is to obtain a 90-day supply of insulin if possible. It is best to request refills as soon as possible and not wait until supplies are low,” said Ashlyn Smith, an NCCPA-certified physician assistant at Endocrinology Associates in Scottsdale, Arizona, and president of the American Society of Endocrine Physician Assistants.

“In locations that have declared a state of emergency, people with diabetes may be able to receive an additional 30-day supply of medications and supplies,” she said.

If you can’t get extra medications this way, try using mail-order medications, says Dr. Olufunmilayo Abidemi Onobrakpeya, medical director at the University of Maryland Center for Diabetes and Endocrinology at Upper Chesapeake Medical Center.

In addition, if you have checkups or doctors’ visits outside of the house, consider rescheduling or seeing whether there are telemedicine options available, Onobrakpeya told Healthline.

Beyond insulin, people with diabetes should prepare for COVID-19 the same way everyone else is: paying special attention to washing hands thoroughly, disinfecting surfaces, practicing social distancing, and self-isolating as much as possible.

In addition, doctors writing in the journal Diabetes & Metabolic Syndrome: Clinical Research & Reviews recommend these specific best practices for people with diabetes in preventing an infection:

• Maintain a good glycemic control. This could help in reducing the risk of infection and also the severity of disease. Frequently monitor blood glucose levels with use of self-monitoring blood glucose.
• Eat healthy. Paying attention to nutrition and adequate protein intake is important, as well as avoiding deficiencies of minerals and vitamins.
• Exercise. Exercise may improve immunity, although do it safely through activities such as running outside. Don’t go to the gym or attend other group activities.
• Get flu and pneumonia vaccinations. The latter especially may decrease the chances of secondary bacterial pneumonia after respiratory viral infection (though the researchers note that data in present viral epidemic is not available).

Finally, the AACE is offering a free Diabetes Emergency Plan that people can use as a checklist and resources hub for dealing with COVID-19.

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