Care of Diabetic people during Covid-19 pandemic

 What is the need?

Diabetes mellitus is a chronic metabolic disease which can lead to acute or chronic complications, if left untreated. The morbidity & mortality due to COVID-19 infection is significantly more among people who are immunocompromised, elderly, hypertensive, diabetic, with CAD & respiratory illness. Hence, people with diabetes needs to be taken care to prevent infection & complications due to COVID-19.

Guidelines for management of Type 2 Diabetes mellitus:

• All patients with diabetes should ensure to achieve & maintain a good glycemic control.
• Target fasting blood sugar (FBS) should be <120 mg % & postprandial blood sugar (PPBS) should be <180 mg %
• They should continue medications (OHAs/Insulin) in same dosage if blood sugar levels are under control.
• If blood sugar levels are uncontrolled their medications have to be increased or should be switched over to insulin as per protocol.
• They should take balanced & nutritious diet as it helps to boost immunity.
• Take adequate water to avoid dehydration especially in hot weather.
• They should do moderate physical exercises as well as yoga & meditation for relaxation.
• They should avoid alcohol & smoking.
• They should take care of co-morbidities like hypertension, hyperlipidemia, CAD etc. & should continue medications without fail.
• They should call to their physician if co-morbidities are not under control or need consultation for any new symptoms.
• Elderly diabetics (particularly >65 years) should take extra care to avoid outside movement.
• If they develop any symptoms like cough, fever, running nose, throat pain, vomiting, abdominal pain, chest pain, breathlessness, diarrhoea etc. (COVID-19 symptoms), they should immediately report to nearest health center.
• They should have adequate stock of medications like insulin, oral antidiabetic drugs, drugs for co-morbidities, blood glucose monitoring strips, glucose power for use in case of unexpected hypoglycemia.
• They should look after their feet daily for any injury or decrease in sensation & use soft footwear especially made for diabetics.
• They should follow all precautions to prevent COVID-19 infection like staying at home, wearing mask, maintaining social distancing & washing hands frequently with soap & water.
• Keep number of people you can take help if needed if you are staying alone.
• Keep a regular schedule, avoiding overwork and have a good night's sleep.

Guidelines for management of Type 1 Diabetes mellitus:

• People with type 1 diabetes should continue insulin without fail & increase the dose if diabetes is uncontrolled by taking consultation of the physician. 
• They should take plenty of fluids to avoid dehydration & take nutritious diet.
• They should check for ketone bodies if they develop symptoms like vomiting, abdominal pain or fever & report to the nearest health center.

Guidelines for management of Gestational Diabetes mellitus:

• Pregnant ladies with diabetes should check their blood sugars routinely & follow the proper diet plan.
• They should report to the physician if blood sugar is uncontrolled & should be shifted on insulin as per standard guideline.
• Report to the doctor for any unusual symptom & follow the instructions given.

References:

1. Guidelines for management of diabetes mellitus during covid-19 pandemic, National health mission, Tamilnadu.
2. https://www.idf.org/aboutdiabetes/what-is-diabetes/covid-19-and-diabetes/1-covid-19-and-diabetes.html
3. https://www.diabetes.ca/resources/tools---resources/faq-about-covid-19-and-diabetes
4. https://www.diabetes.org/coronavirus-covid-19
5. https://www.diabetes.org.uk/about_us/news/coronavirus
6. https://www.novonordisk.co.in/patients/diabetes-care/Diabetes-care-in-special-situations/Diabetes-and-COVID-19.html photo credit
7. https://www.medicalnewstoday.com/articles/317466 photo credit
8. https://in.pinterest.com/pin/515521488567629350/ photo credit