Managing Diabetes & Covid-19

For this month’s topic, I thought it would be a good idea to focus on sick day management given the approaching cold & flu season as well some information regarding the management of diabetes & COVID-19. There is a lot of information out there, so I have complied a list of websites & handouts for you to refer to that focuses on the most up-to-date evidence based information. Please let me know if you have any questions or concerns about any of the material I present today. As always, I will provide a brief summary of all the information below.


Helpful Websites:

FAQ About Covid-19 and Diabetes

How Coronavirus Impacts People With Diabetes

Covid-19 (coronavirus) and Diabetes

Diabetes and the Flu Not A Good Combination

Novel Coronavirus 2019

Coronavirus Disease Covid-19


As per the 2018 Diabetes Canada Clinical Practice Guidelines, people with diabetes are recommended to get their annual influenza vaccine. This year, getting the flu shot is even more important as COVID-19 & the flu will circulate around our communities at the same time.
Reasons to get the flu shot include:

  • It will help prevent overwhelming our healthcare system. Both COVID-19 & the flu can take an enormous toll on healthcare resources including personal protective equipment, hospital beds available, ventilators available, etc.
  • Getting the flu shot will help to protect other people. Often, the flu is contagious in the 48 hours BEFORE people who are infected begin to have symptoms, so you can spread it to others without knowing you have it. The same is true for COVID-19.
  • Getting the flu shot may help cut down on symptom confusion. The flu & COVID-19 share many of the same symptoms including cough & fever, but it could be easier to figure out which condition you have if you’ve had the flu vaccine.
  • You may have more protection from worst-case scenarios. At this time, we don’t know whether people can become co-infected with both the flu & COVID-19 at the same time or what those consequences would look like.
  • Getting the flu vaccine can help even if it’s not 100% effective.

Experts have noted that people living with diabetes, especially those with poor blood sugar control & who get COVID-19 can have more severe symptoms & complications. At this time, there is not enough data to show whether people who have diabetes are more likely to get COVID-19 compared to the general population. At this time, there is also not enough data to determine whether COVID-19 contributes to the onset of diabetes.

  • Your risk of getting very sick from COVID-19 is likely to be lower if your diabetes is well managed.
  • People who are over the age of 70 years, have an underlying heart condition & who have diabetes are at higher risk for more serious complications & symptoms if diagnosed with COVID-19.
  • If you develop COVID-19 or the flu, blood sugars can become erratic & typically become higher than normal (hyperglycemia).

If you have diabetes & have symptoms such as cough, fever, shortness of breath, etc. you need to continue to take you medications & contact your family physician. If you test your blood sugars, you may want to consider testing your blood sugars more frequently. If you become unwell for any reason, it is important that you follow sick day management guidelines. These guidelines may be different depending on what diabetes medications you take (see attached).

  • As mentioned, when you are sick, blood sugars may be harder to control. Your blood sugars may become too high or too low.
  • Test your blood sugars more frequently when you are sick (at least every 4 hours)
  • Take your usual diabetes medications UNLESS you are unable to drink enough fluids to keep hydrated (e.g. vomiting, diarrhea). In this instance you should temporarily STOP the following medications: Metformin, Gliclazide (Diamicron), Glyburide, Invokana, Jardiance, Forxiga. Once you are eating & drinking normally, you can resume the above medications.
  • Drink plenty of sugar-free fluids to keep hydrated (e.g. water, weak or caffeine-free tea or coffee, diet pop, broth, etc. Try to drink 9-10 cups per day.
  • Continue to eat your usual foods as able. If you are not able to eat your usual foods, have one of the following every 1-2 hours even if your blood glucose levels are high. Each of the following contains 15g of carbohydrate.

Each of the following contains 15g of carbohydrate.

1 cup Gatorade

1 twin popsicle

½ cup regular Jello

1 slice of toast

6-7 soda crackers

½ cup liquid meal replacement (such as Ensure or Boost)

½ cup applesauce

  • Be aware of the signs & symptoms of a low or high blood sugar

Be prepared & have a plan should you become ill for any reason!

  • Gather contact information for doctors, clinic, pharmacy, insurance, dietitians, nurses, etc.
  • Write down the name & doses of medications
  • Have enough medication for 1-2 weeks in case you cannot get to the pharmacy
    Ensure you have enough supplies (e.g. blood sugar test strips, needle tips, insulin pens, etc.)
  • Know how to properly treat a low blood sugar event & keep fast-acting carbohydrate (E.g. juice, regular pop, Rockets candy) on hand. The ONLY medications known to cause a low blood sugar are: Diamicron (Gliclazide), Glyburide & Insulin. All other medications are not known to cause a low if used on there own but can cause a low if combined with either of the above medications.


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