COVID-19 and diabetes: UK guidance addresses management of hospitalized patients

  • Association of British Clinical Diabetologists

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • COVID-19 disease in hospitalized patients with diagnosed or previously unrecognized diabetes increases risks for emergency states of hyperglycemia with ketones, diabetic ketoacidosis (DKA), and hyperosmolar hyperglycemic state.

Why this matters

  • Adjustments to standard diabetes management protocols may be required.
  • Clinicians should contact a diabetes specialist team if available.
  • Guidance based on UK center experience will be updated.

Key guidance

  • Blood glucose should be measured in all newly admitted patients with COVID-19 and ketones in all with known diabetes or admission glucose >12 mmol/L.
  • Note: shortness of breath can also result from metabolic acidosis.
  • Stop sodium glucose co-transporter 2 inhibitors (SGLT2is) in all admitted patients.
  • Note: glucose can be
  • After restoring circulating fluid volume, fluid replacement rate may need adjustment if there is evidence of “lung leak” or myocarditis.
  • If infusion pumps are unavailable for insulin drip, use alternative subcutaneous regimens to manage hyperglycemia, DKA.
  • Some patients may require extremely high insulin doses, with paradoxical hypoglycemia risk.
  • Never stop basal insulin in individuals with type 1 diabetes.
  • Patients already using continuous glucose monitors and/or insulin pumps should continue to self-manage if able, but the devices must be removed for magnetic scans.
  • Always exclude acute foot infection/critical limb ischemia.