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Managing Diabetes during COVID

Updated: Oct 16, 2020

STUDENT CONTRIBUTOR: Cristina Cirone | School of Nutrition, Ryerson University

October 13, 2020

On March 11th, 2020, COVID-19 was declared a pandemic. Amidst the start of a second wave and the absence of an effective vaccine, the end is nowhere in sight. Impacts of this virus can be seen in any community and all of our lives have been impacted drastically.

What does this mean for people with type 1 diabetes or T1D?

I’m sure you’ve heard many people say things such as “It’s really nothing! Way more people have died from the flu” or “I’ll be completely fine, only older people get it”.

Unfortunately, there are many factors that can affect the severity of the virus. Anyone can get COVID, This virus does not discriminate. The real question seems to be...

'Who is most at risk?'

T1D and T2D - What’s the difference when exposed to COVID-19?

When comparing Type 1 and Type 2 Diabetes with respect to the coronavirus, the following factors could affect the chances of hospitalization or mortality:

1. An individual's overall health.

If you have maintained a healthy weight, make food choices as recommended by Canada's Food Guide, exercise regularly and monitor your mental health, you are less at-risk than those who don’t. NOTE: this applies to everyone, not just people with diabetes!

2. The type and length of time an individual has been living with diabetes.

T1D is usually diagnosed at a younger age, thus people with T1D are more likely to have had diabetes longer than an older individual living with Type 2. The longer a person has had to manage diabetes, the higher their risk of developing more severe complications (e.g. kidney problems, nerve damage, heart disease, etc.).

A recent study performed in England collected and compared over 60 million health records between people with diabetes and people without. Results showed that people Type 1 diabetes have a 3.5 x greater risk of dying in hospital from covid-19, while thoes with Type 2 were only twice as likely to suffer grave consequences.

3. Diabetes management.

Monitoring your blood sugar and ketones more than usual (every 4 hours) is a great plan! Early evidence suggests that diabetics with consistently elevated blood sugar, high blood pressure, and obesity are the most at risk. Poorly managed T1D can interfere with the body’s ability to fight off infection. Follow the advice of your care team to protect yourself from exposure and prepare yourself to fight the virus if you get it.

COVID and T1D - What You Need to Know

First off, it’s very important to understand that having T1D does NOT make you more susceptible for catching COVID. People with T1D who maintain well-managed blood sugars with an A1c under ~8% are typically able to recover from COVID quickly and without much issue. However, if you or someone you know has this virus there are many precautions that must be taken to ensure good health outcomes.

While advanced age and poor cardiovascular health are the biggest factors affecting the severity of cases, it is important to note that people with T1D are experiencing prolonged complications as a result of COVID. Regardless, it is important to monitor your blood sugar levels, now more than ever, especially if you think you may have been exposed.

If you think you may have contracted the virus, you should be measuring your blood glucose and ketones approximately every 4 hours. Elevated ketone levels often indicate that blood sugar levels are higher than they should be. This may also be a sign that your body is using fat and muscle for energy, instead of sugar. If ketone levels are left unmonitored, this can lead to diabetic ketoacidosis (DKA), a very serious condition that can become fatal in the absence of immediate attention. Roughly one third of diabetics experience DKA if they have tested positive for COVID-19, or have a suspected case.

Signs of DKA include flu-like symptoms - feeling tired, weak, aches, nausea or vomiting, abdominal pain, dehydration and also a fruity smell to the breath with more rapid breathing, which happens when the body is trying to eliminate the ketones and acid.

Symptoms of COVID-19 to Watch Out For

Common symptoms may include:

  • Fever

  • Fatigue

  • Coughing

Less common symptoms:

  • Aches and pains

  • Nasal congestion

  • Runny nose

  • Sore throat

  • Diarrhea

Note: The less common symptoms are usually mild and begin gradually.

Recovery and Post-virus/Prolonged Health Consequences

Most people (80%) that contract COVID-19 are able to make a full recovery without any treatment; however, sometimes symptoms can be persistent, or cause permanent damage, even in mild cases. Symptoms that tend to linger include:

  • Fatigue

  • Cough

  • Shortness of breath

  • Headache

  • Joint pain

In some cases, this virus can do serious damage to vital organs:


Images taken after recovery have shown damage to the heart muscle. This could increase the risk of complications or heart failure in the future Cardiovascular disease is the leading cause for an increased fatality rate from COVID-19. The overall death rate from COVID-19 is 2.3%. In comparison, the overall death rate of a person with cardiovascular disease is almost 5 x that amount!


COVID can cause strokes, seizures, and temporary paralysis. It can also increase the chance of developing Alzheimer’s or Parkinson’s disease.


The type of pneumonia associated with COVID-19 can damage the tiny air sacs in the lungs, resulting in scar tissue which can lead to long-term breathing problems.


  • Blood clots and blood vessel problems

  • Problems with mood and fatigue

  • Many long-term effects that remain unknown

There also have been recent reports on the new onset of Type 1 Diabetes and DKA, though primarily in children - due to a protein on the Coronavirus is capable of attacking insulin-producing cells in the patient's pancreas. It is important to note that COVID-19 is still a new virus and more research is still underway to uncover the long-term effects.

Mortality Rate

As you already know, there are many factors that dictate the severity of a COVID-19 case.

A report summarizing recent evidence suggests that age seems to be the leading factor in determining the highest risk for hospitalization and death from COVID-19. A 45 year old has a 0.4% mortality risk and a 45 year old with Type 1 Diabetes has a mortality risk of 1.4%. This is still much lower than a person without diabetes who is 60 years old and has a 3.5% mortality risk.

Ways to Protect Yourself while Living with T1D

Prevention is key. Although some of these statistics are alarming, there are many things you can do to prepare yourself in the event of a potential exposure:

  1. Continue social distancing regardless of decreased restrictions

  2. Continue to wash your hands regularly and thoroughly

  3. Always use a face mask when you’re indoors and around people

  4. Avoid crowded places

  5. Ask your family to be extra cautious to avoid bringing germs into the house

  6. Know your rights to care for your own diabetes should you become hospitalized

  7. Create contingency plans in case you cannot care for your diabetes on your own

  8. Continue to manage your diabetes and keep your body strong and healthy

Remember, COVID doesn’t discriminate. We must all do our part to keep ourselves and those around us healthy and safe. Click HERE for a quick download with tips & tricks to stay safe and prevent the spread.

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