- 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.
- 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.