AACE Gulf Chapter Position Statement:
Coronavirus (COVID-19) and People with Diabetes.

As the coronavirus (COVID-19) continues to spread and is declared by WHO as a pandemic, it is important for everyone to take the necessary precautions to help prevent infection and spread of the virus. While it is difficult to assess the unique implications of COVID-19 in people with diabetes (type 1, type 2, or gestational) at this time, diabetes and other chronic medical conditions can make patients more vulnerable to infections, leading to serious consequences. In addition, uncontrolled diabetes with hyperglycemia is known to impair immune system. Many people with diabetes may have other comorbidities such as hypertension and cardiovascular disease, it is imperative to follow specific COVID-19 precautions and prevention guidance from the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) and your endocrinologist or health care providers in the Gulf region.

Actions that help prevent the spread of COVID-19:

  • Social distancing to all people with a minimum of 1 meter, preferably 2 meters
  • Avoid close contact with people who are sick
  • Continue to take your prescribed medications
  • Refill prescriptions and have enough medications and testing supplies to last 30 days.
  • Prepare a list of all your medication’s names and dosages.
  • Take preventive actions:
    • Clean your hands often
    • Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing, or having been in a public place.
    • If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol.
    • To the extent possible, avoid touching high-touch surfaces in public places–elevator buttons, door handles, handrails, handshaking with people, etc. Use a tissue and dispose immediately or your sleeve to cover your hand or finger if you must touch something.
    • Wash your hands after touching any surfaces in public places.
    • Avoid touching your face, nose, eyes, etc.
    • Clean and disinfect your home to remove germs: practice routine cleaning of frequently touched surfaces (for example: tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks & cell phones)
    • Wash your hands and clean your injection/infusion and finger-stick sites with soap and water or rubbing alcohol if soap and water not available.
    • Avoid crowds, especially in poorly ventilated spaces. Your risk of exposure to respiratory viruses like COVID-19 may increase in crowded, closed-in settings with little air circulation if there are people in the crowd who are sick.
    • Avoid all non-essential travel including plane trips, and especially avoid embarking on cruise ships.
    • Check with your country’s labor and health regulation rules about the right to reasonable accommodations at work, which could include medical leave or alternate work arrangements.

Emergency warning signs:

If you develop emergency warning signs for COVID-19 get medical attention immediately. In adults, emergency warning signs include:

  • Difficulty breathing or shortness of breath
  • Persistent pain or pressure in the chest or throat
  • New confusion or inability to arouse
  • Bluish lips or face
  • High grade fever

How to deal with COVID-19 sickness:

  • Call your local country COVID-19 hotline immediately.
  • Drink lots of fluids. If you are having trouble keeping water down, have small sips to avoid dehydration.
  • If you are experiencing a low (blood sugar below 3.8 mmol/l or 70 mg/dl), eat 15 grams of simple carbs that are easy to digest like honey, juice or regular soda, and re-check your blood sugar in 15 minutes to make sure your levels are rising. Repeat blood sugar checks extra times throughout the day and night (every 2-3 hours).
  • If your blood sugar has registered high (BG greater than 13 mmol/l or 240mg/dl) more than 2 times in a row, check for ketones for people with type 1 diabetes and follow sick day rules. For all people with diabetes increase fluid intake and contact your health care provider to see if you will need extra insulin (correction doses) or further adjustment to your diabetes medications.
  • Wash your hands and clean your injection/infusion and finger-stick sites with soap and water or rubbing alcohol.

For Health Care Providers:

  • Efforts should be made to offer consultation to patients with diabetes over phone or via telemedicine and minimize outpatient visits as much as possible except for emergency cases.
  • Securing medication refill for patients for at least 3 months.
  • Establishing hotlines for emergency inquiries
  • There is no clinical or scientific evidence to suggest that treatment with ACEi or ARBs should be discontinued because of the Covid-19 infection. Patients on these agents should continue to take them to assure target blood pressure control.
  • FDA is aware of news reports stating the use of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, could worsen coronavirus disease (COVID-19). At this time, FDA is not aware of scientific evidence connecting the use of NSAIDs, like ibuprofen, with worsening COVID-19 symptoms. The agency is investigating this issue further and will communicate publicly when more information is available. However, all prescription NSAID labels warn that “the pharmacological activity of NSAIDs in reducing inflammation, and possibly fever, may diminish the utility of diagnostic signs in detecting infections.”