Diabetes and COVID-19
As time goes on, we have learned more about who is more likely to experience severe COVID disease. Many studies now indicate that risk for severe disease is highest in individuals with:
- male sex
- older age
- diabetes, especially if glucose is high or diabetes complications are present
- overweight or obese
- hypertension
- cardiovascular disease (heart disease, heart attack, heart failure, stroke, clogged arteries)
- kidney disease associated with diabetes
- other chronic medical conditions
All of the above conditions appear to cause an over stimulation of the immune system after COVID infection, resulting in more injury to the lungs, blood vessels, and other organs.
People with diabetes whose blood glucose levels are often higher than their target are more likely to have diabetes-related health problems. Those health problems can make it harder to overcome COVID-19 if they become infected.
Most of the available information is related to patients with type 2 diabetes. We do not yet have adequate information about risk in individuals with type 1 diabetes, but studies are in progress.
Complications linked to both type 1 and type 2 diabetes – such as coronary heart disease, heart failure, or kidney disease – are also associated with more severe COVID disease.
Evidence indicates that people with high glucose levels have more severe disease if infection occurs. This may be related to the fact that glucose often rises with infection, sometimes to very high levels. Moreover, high glucose levels before and after infection may also affect blood vessels, the immune system, and the body’s metabolism – increasing the risk of severe disease.
We are encouraging people to follow the CDC guidelines on how to stay healthy and lower your risk of contracting a virus.
Some helpful tips include:
- Check with your insurer on early refill and 3-month supply options, and delivery options
- Keeping all medication prescriptions up to date and filled
- Taking everyday precautions to keep space between yourself and others
- When you go out in public, keep away from others who are sick, limit close contact and wash your hands often.
- Avoid crowds as much as possible
- Stay home as much as possible.
We remind all patients, families, staff, and visitors to please follow basic precautions to prevent illness:
- Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer.
- Cover your nose and mouth with a tissue or your arm when you cough or sneeze. Throw the tissue in the trash after you use it.
- Do not touch your eyes, nose or mouth because germs spread this way.
- If you are sick with flu-like symptoms (fever, cough, body ache, etc.), please call your health care provider.
- Be extremely careful and minimize your exposure to the coronavirus.
- Carefully follow the CDC and state guidelines.
- Wear a mask or face covering.
- Avoid touching surfaces touched by many – door handles, elevator buttons, etc.
- Avoid touching your face.
- Wash your hands frequently with soap and water, or use hand sanitizer.
- Maintain social distancing.
- Avoid crowds, especially where ventilation is poor, as this may increase the risk of infection if someone in the crowd is infected (even if they don’t know it).
- Avoid individuals who are infected. Avoid all non-essential travel including plane trips and cruise ships.
- When possible, avoid individuals who are at high risk based on their job.
- Take Care of Yourself-Maintain Your Health:
Now maybe a good time to work on improving metabolism – blood pressure, lipids, weight.
- Take your medications for diabetes, hypertension, cholesterol/lipids, and other conditions as directed. Contact your physician if you have any questions about the dose or side effects. Please do not stop them on your own. Information you get from news media or friends may not be appropriate to your specific health conditions.
- Infection can increase the risk for severe hyperglycemia or ketoacidosis. Be sure to seek care if you are feeling poorly, including lightheadedness, nausea, vomiting, shortness of breath – as these can be symptoms of ketoacidosis. Be sure to keep ketone strips at home
- Be sure to maintain activity to help maintain a healthy metabolism. If you are unable to get outside safely, consider doing home exercises. There are many options for exercise which you can do safely at home, including online exercise classes, weights, and resistance training (e.g. resistance bands. Below
- Healthy eating is important. Avoid overly processed foods. Be sure to avoid sugar-containing liquids such as juices or sodas, as these can rapidly elevate your glucose and provide only empty calories. Try to eat more vegetables!
- Monitor your glucose levels regularly. Contact your Diabetes Health Care Team if you notice your glucose levels are higher – or lower than the goals you set for glucose management.
- Medications may need to be adjusted when you are staying at home more, eating differently, and perhaps less active.
- Your Joslin team can help you with adjusting your meal plan and medication to help with this.
- Work-related concerns:
- As you consider a return to work, please discuss your risk with your doctor. Consider discussion with your supervisor and/or human resources department about options to work from home, stop working, or to reduce your risk of exposure while you are at work.
For more information please visit the Mass Department of Public Health or the Centers for Disease Control websites.
Joslin also recommends putting together a diabetes emergency preparedness kit.
The Diabetes Disaster Response Coalition provides a comprehensive list of recommendations for what should be contained in the kit. Download the checklist here. (Espanol)
People with diabetes have been identified as one group that may face a higher risk of complications when dealing with COVID-19. With that in mind, our clinicians have put together a list of guidelines for people with diabetes who may find themselves dealing with any kind of viral symptoms.
You can view steps to take when you are feeling sick in our Education Library.
Sick day guidelines can also be accessed here to download and print for reference.
If someone in your household has been quarantined at home, all close contacts - including household members, intimate partners, and caregivers - should monitor their own health and call their primary healthcare provider if they develop symptoms suggestive of COVID-19 (e.g., fever, cough, shortness of breath).
If your household member has been quarantined, and you have an upcoming appointment at Joslin, please call us at 617-309-2440 to reschedule your appointment
Pregnant women should engage in usual preventive actions to avoid infection like washing hands often and avoiding people who are sick.
Medicare has temporarily expanded its coverage for telehealth services. Joslin is currently moving its non-urgent patients to a remote care model. If you have a scheduled upcoming visit, it will be changed from a face-to-face visit to a remote visit. Joslin staff will call you prior to your scheduled appointment to confirm that the visit will occur over the phone with your regular provider.
Your Joslin provider will be able to document this as a visit and process the necessary paperwork for Medicare as usual.
If you are on an Omnipod® Insulin Management System, your pods are covered under Medicare Part D, and you are not required to be seen every three months by your diabetes healthcare provider at the Joslin Clinic.
You may call Omnipod Customer Care (24/7): (800) 591-3455. Or visit the Omnipod website.
Currently, Medicare has waived the six-month office visit requirement for Medicare patients on CGM. In addition, Medicare has temporarily expanded its coverage to telehealth services. Joslin is moving its non-urgent patients to a remote care model. If you have a scheduled upcoming visit, it will change from face-to-face to a remote visit. Joslin staff will call you prior to your scheduled appointment to confirm that the visit will occur over the phone with your regular provider.
Your Joslin provider will be able to document this as a visit and process the necessary paperwork for Medicare as usual.
You may call Dexcom Customer Service: (888) 738-3646 for any assistance.
Or visit the Dexcom website.
Please use the reference information below for links and directions on how to download and connect to the Joslin Diabetes Center clinic sites when applicable.
Glooko - most meters and Omnipod Insulin Pumps
Customer assistance: 800-591-3455
Proconnect to Joslin Diabetes Center: (Reconnect code: joslin1)
Text support 650-720-5310 or email support@glooko.com
You likely already have a Glooko account set up by Joslin from previous clinic visits. Check your email for an activation request which you would have received when Joslin created an account for you.
- Click the Activate Account button within the email and follow the onscreen prompts to activate the account. If you were given an activation code by Joslin, go to join.glooko.com/activate and follow the on-screen prompts to activate your account. join.glooko.com
- If you cannot find your activation request email try logging in with the email Joslin has on file and click forgot password.
- If all else fails create a new Glooko account and you can connect to Joslin Diabetes Centers account by entering proconnect code “joslin1”.
Customer assistance: 800-591-3455
Customer assistance: 877-801-6901
How do I set up data sharing with Joslin Diabetes Center?
You will need to provide us with your Tandem Username and Password for the initial linking of accounts.
Customer assistance: 1-800-646-4633
Medtronic CareLink: https://carelink.minimed.com
How do I set up data sharing with Joslin Diabetes Center?
You will need to provide us with your CareLink Username and Password for initial linking of accounts.
Customer assistance: 1-877-339-2664
How do I set up data sharing with Joslin Diabetes Center?
If you aren’t already connected, ask your clinician for a sharing invitation. The invitation includes a sharing code that you enter in Settings of your Dexcom CLARITY account.
After you enter the share code, your personal Dexcom CLARITY account will share with Joslin’s Dexcom CLARITY account. This will happen automatically and continuously if you use the Dexcom CGM app as your receiver. If you use a Dexcom receiver, you will need to upload it to Dexcom CLARITY regularly (recommended every 30 days) for the data to be up-to-date.
Customer assistance: 1-855-632-8658
How do I set up data sharing with Joslin Diabetes Center?
Log into your account at the LibreView website. In settings enter practice ID Joslin617 to connect to Joslin Diabetes Center.
In an effort to support our patients as best as possible, we have compiled the following list of online video resources. Please review the links provided in advance of your appointment, or in addition to your appointment as extra visual support.
Glucometer teaching:
One Touch Delica Plus Lancing Device
Continuous Glucose Monitoring (CGM):
Freestyle Libre – All Support Videos
Freestyle Libre - Apply Sensor
Getting Started and Setting up Receiver
Getting Started and Setting up the App
Inserting Sensor and Attaching Transmitter
Removing Your Sensor and Transmitter
How to Replace Your Transmitter
Dexcom -Clarity in the Computer
Setting up Dexcom Share and Follow
Insulin Injection:
How to inject insulin with pen needle
How to inject insulin with a syringe
** most of the insulin company websites also have videos specific to the product you may use, visit their websites for more support if needed.
Finding low-cost options for your insulin can be overwhelming. Talking with your diabetes healthcare team about insulin costs will help your diabetes management and your budget. Please do not be afraid to talk to your providers about the cost of insulin.
To start, make sure you do the following:
- Check your health insurance formulary: every plan has a list of medications covered by the plan, called a formulary. Find the insulins covered by your plan.
- Know your copay options: most insurance plans divide their formulary by tiers to decide the copay. Insulin in a lower tier will cost less than insulin in a higher tier.
- Have a conversation with your provider about lowering your insulin cost: bring the list of insulin(s) covered by your plan to your medical visit. This information will help your provider choose the right insulin for you with the lowest copay or cost.
- If you are employed, ask if your employer offers a flexible savings account (FSA) or health savings account (HSA) which may help cover the out-of-pocket cost for insulin.
Programs available to help lower your out-of-pocket cost:
Patient Assistance Programs (PAPs):
Insulin manufacturers provide free or low-cost insulin to people that meet certain eligibility requirements, for one year for their products. You need to apply to each company and wait for the response.
Most PAPs are for people with no or very little insurance coverage. If you have private insurance or full Medicare, you may not qualify.
All PAP applications are free and most require:
- proof of income
- insulin prescription
- citizen of the U.S. or legal resident
Your provider will need to complete a portion of your application, so make sure you complete your part and bring it with you to the medical visit.
Three options for insulin manufacturers:
- Lilly pharmaceuticals: call the Lilly Diabetes Solution Center at 1-833-808-1234 or visit the Lilly Cares Foundation
- Sanofi Cares North America: call 1-888-847-4877 or visit their website
- Novo Nordisk: call 1-866-310-7549 or visit their website
Copay Saving Cards and Saving Programs from insulin manufacturers:
These programs only work if you have commercial insurance. If you have Medicare, Medicaid or other government insurance you do not qualify.
Novo Nordisk
- Savings Card program: offer discounts depending on the amounts of your copay and days supply of your prescription. You can access details and enroll on their website.
- Up-coming program (January 2020): Cash Card Program will allow people with diabetes to buy up to three vials or two packs of FlexPen/FlexTouch pens of any combination of analog insulins for a flat price of $99.00/month.
Lilly USA
- Savings Card program: it is available for Basaglar, Humalog U-200 and Humulin R U-500. You can access information and enroll on their website.
Sanofi USA
- Insulins Valyou Savings program: allows you to buy a month's supply of any of their insulins for $99 if you have no prescription insurance. There are eligibility requirements and restrictions apply. In order to pay $99 per month, all prescriptions for Sanofi insulin need to be filled together.
- Sanofi Patient Connection: is a program designed to assist patients in need of support. Access information at on their website.
Mankind:
- Savings Card program: it is available for Afrezza, access information or request a card on their website.
Novo Nordisk Human Insulin Program
If you don’t have prescription coverage and none of the programs above apply to you, talk to your diabetes healthcare team about using other insulin that have been around for a long time and are less expensive. For example, the following are available at Wal-Mart.
- Novolin ReliOn Insulin N 100units/mL vial à $24.88
- Novolin ReliOn Insulin N 70/30 flex pen à $42.88/box (contains 5 pens)
Coupons for insulin, other medications, syringes, and glucose monitoring supplies
Available sources for coupons or other available discounts on your diabetes supplies can be found at the following online sites.
- Blink Health: is a company that works with 35.000 pharmacies in the U.S. and negotiates better prices. You can make purchases using the website or smartphone app and pick-up at a store or ask for delivery. You can call 1-855-979-8150 to connect with their insulin patient support team. Visit their website for more information.
- GoodRX: this search engine collects prices and discounts from over 70.000 pharmacies to help you find better prices. Visit their website for more information.
- InsideRX: this search engine helps you find savings. The InsideRx card cannot be used with Medicare, Medicaid or other federally funded programs. Visit their website for more information.
Glucose monitoring supplies:
Review the formulary for monitoring supplies. Glucose meters, strips, and lancets can be expensive. You could consider a subscription service for your supplies. There are a few companies offering supplies for a fixed monthly rate. Here are some:
- Dario Health: visit their website
- One Drop: visit their website
Other resources where you can find information that may help you find ways to better afford your diabetes treatment:
Joslin providers use a secure system for emailing non-urgent confidential information. The first time you receive a secure email, you will need to create an account to read the email from your provider. The steps for creating this account are detailed below. If you save your username and password (if your smartphone or computer allows this) then you will only need to do this one time.
If you need assistance with sending secure emails or reading secure emails, please email the IT Service Desk at ITServiceDesk@joslin.harvard.edu or call 617-309-4488. You can also call your provider at 617-732-2603 instead of emailing your provider.
Create Your Account to Read Secure Email (For recipients)
Receive Email Notification
- Click on "Click here" in the envelope letter, you'll be taken to the create account
- Create Login and Password
Read Secure Email and Reply
- Recipients should be able to read the messages, download attachments, reply and forward
- Click on the "Reply" Button
- Click on the “Send” when you are ready;
- Select “Return to message” or “Logout”
High blood pressure, kidney disease, and heart disease are more common in patients with diabetes. Patients with diabetes are very often treated with a class of drugs, called ACE inhibitors or ARB to help control blood pressure and to prevent heart and kidney complications. Common examples of such drugs include lisinopril, losartan, valsartan, etc.
Recently, a few unconfirmed reports have raised the question of whether these drugs could increase the risk of COVID-19 infection in people with diabetes. These reports were based on very limited evidence and did not account for other risk factors for the severity of disease. Based on all the scientific and medical information we have reviewed, we recommend that people using these drugs CONTINUE to use them unless directly advised by their physician to stop for other medical reasons.
Similar recommendations were recently issued by many national and international organizations, including the American Heart Association (AHA), the American College of Physicians (ACP), International Society of Hypertension (ISH), and the European College of Cardiology (ESC).
About Joslin Diabetes Center
Joslin Diabetes Center is world-renowned for its deep expertise in diabetes treatment and research. Part of Beth Israel Lahey Health, Joslin is dedicated to finding a cure for diabetes and ensuring that people with diabetes live long, healthy lives. We develop and disseminate innovative patient therapies and scientific discoveries throughout the world. Joslin is affiliated with Harvard Medical School and one of only 18 NIH-designated Diabetes Research Centers in the United States.
