Living with type 1 diabetes (T1D) can be challenging. Every day you must make choices that will affect your diabetes and your life. This is particularly true when you are sick. If not cared for properly, even a minor cold can make your diabetes harder to control and lead to severe complications like diabetic ketoacidosis (DKA).
Diabetic ketoacidosis is a condition that occurs when the body does not have enough insulin to use glucose for energy and starts burning fats. But fat isn’t clean fuel; it leaves an acidic waste in your bloodstream called ketones.
Your body can get rid of some, but not all, of the ketones by excreting them in the urine. Eventually, they’ll build up—an acidic poison in the bloodstream.
A recent study in the Journal of Clinical Endocrinology & Metabolism analyzed data from 180 people with T1D and COVID-19 from 52 clinical sites in the United States.
The study found Black patients were four times more likely than whites to be hospitalized for DKA. Black patients were also less likely to use diabetes technology like continuous glucose monitors (CGMs) and insulin pumps, and they had worse glucose control than white patients.
Black patients’ A1C was 11.7 percent compared with 8.3 percent in white patients. Target A1C for diabetes control is no more than 7.0 percent. These findings suggest Black patients with COVID-19 and T1D have an additional risk of DKA beyond the usual risk associated with TID.
Technology can make it easier to manage diabetes. When you get sick, it’s more important to keep your blood glucose in control—but it’s also harder to do. Continuous glucose monitoring automatically tracks glucose levels throughout the day and night. You can see your glucose level anytime at a glance. The ability to see your glucose levels in real-time is especially helpful in preventing DKA.
It’s also important to keep taking your insulin when sick. COVID-19 is stressful to the body, and the stress hormones that are released cause the liver to produce more glucose, resulting in high glucose levels. You might have to take more insulin than usual to bring your blood glucose levels down.
An insulin pump makes it easier to get the right amount of insulin and manage glucose. The device pumps insulin continuously day and night. It can also deliver insulin more rapidly (bolus) before meals.
Knowing the signs of DKA and making a sick day plan—before you get sick—can reduce your risk of this life-threatening condition. DKA usually develops slowly. You’ll notice you’ll feel thirsty and your mouth is dry, and you’re urinating more than usual. Your glucose levels and ketones in the urine will be high.
As the condition worsens, symptoms include: fatigue, dry and flushed skin, nausea, vomiting, abdominal pain, difficulty breathing, a fruity odor on the breath, and confusion. DKA can cause you to lose consciousness and lead to coma and even death, so it must be treated as a medical emergency.
COVID-19 and DKA have some of the same emergency warning signs such as difficulty breathing or shortness of breath, and confusion or inability to arouse. Other emergency COVID-19 symptoms include persistent pain or pressure in the chest and bluish lips or face.
Don’t hesitate to call your doctor when: you’ve been sick or had a fever for a couple of days without getting better, you’ve been vomiting or had diarrhea for longer than six hours, your urine contains high ketones, especially high ketones in combination with glucose higher than 240 mg/dl or vomiting and if you have any symptoms of DKA or COVID-19 outlined above.
Making a sick day plan involves figuring out how often and when you should check your blood glucose and urine ketones, when you should call your healthcare provider, foods to eat during this time, and how to take your insulin and other medicines. You will also include important phone numbers so you can reach your health care providers quickly if illness strikes.
The very nature of a plan is that you do it before you need it. So you want to work with your doctor and other members of your diabetes team ahead of time, so they can individualize a plan for you. Make an appointment to see your healthcare providers before you get sick.
By subscribing, you consent to receive emails from BlackDoctor.com. You may unsubscribe at any time. Privacy Policy & Terms of Service.
