Amity Island
Well-Known Member
- Relationship to Diabetes
- Type 1
Hi Everyone,
I thought this was worth sharing and an interesting perspective on treating diabetics with covid19 in hospital, gives some insight in how it is approached...see link at bottom of page.
Notes from from their summary below:
Persistently high glucose levels may need treatment with subcutaneous or intravenous insulin. If infusion pumps for intravenous insulin are not available to manage hyperglycaemia, use alternative s/c regimens to manage hyperglycaemia and mild DKA.
Stop SGLT-2 inhibitors (Cana-/Dapa-/Empa or Ertu-gliflozin)
Stop metformin in all people admitted to hospital but after satisfactory review of blood lactate, renal and hypoxic status, recommence treatment, as recent data suggests that metformin may reduce progress to severe COVID-19 disease.
ACE inhibitor and ARBs do not worsen COVID-19 disease but their use, and the use of NSAIDs, must be reviewed in the individual clinical context.
Never stop basal insulin in patients with known type 1 diabetes – DKA may result.
If ketosis persists despite treatment in line with usual protocols then consider using 10-20% glucose.
Managing blood ketone levels: if blood ketones are 1.5 – 2.9mmol/L – consider rapid-acting insulin if glucose above 16mmol/L. Note: glucose can be <11mmol/L if patients are on SGLT-2 inhibitor treatment, are pregnant and/or have severe COVID-19 infection.
If patients are unable to manage their personal insulin pump and no specialist advice is immediately available, start a VRIII or S/C basal-bolus insulin regimen then remove the pump and store it safely. If S/C regime required and not able to find out total daily insulin dose from pump then the following would be safe: calculate total daily insulin dose using 0.5 units/kg and give half the total dose as basal/background insulin and half as bolus/mealtime rapid acting insulin. Ensure that pump is disconnected after S/C basal insulin given.
I thought this was worth sharing and an interesting perspective on treating diabetics with covid19 in hospital, gives some insight in how it is approached...see link at bottom of page.
Notes from from their summary below:
Persistently high glucose levels may need treatment with subcutaneous or intravenous insulin. If infusion pumps for intravenous insulin are not available to manage hyperglycaemia, use alternative s/c regimens to manage hyperglycaemia and mild DKA.
Stop SGLT-2 inhibitors (Cana-/Dapa-/Empa or Ertu-gliflozin)
Stop metformin in all people admitted to hospital but after satisfactory review of blood lactate, renal and hypoxic status, recommence treatment, as recent data suggests that metformin may reduce progress to severe COVID-19 disease.
ACE inhibitor and ARBs do not worsen COVID-19 disease but their use, and the use of NSAIDs, must be reviewed in the individual clinical context.
Never stop basal insulin in patients with known type 1 diabetes – DKA may result.
If ketosis persists despite treatment in line with usual protocols then consider using 10-20% glucose.
Managing blood ketone levels: if blood ketones are 1.5 – 2.9mmol/L – consider rapid-acting insulin if glucose above 16mmol/L. Note: glucose can be <11mmol/L if patients are on SGLT-2 inhibitor treatment, are pregnant and/or have severe COVID-19 infection.
If patients are unable to manage their personal insulin pump and no specialist advice is immediately available, start a VRIII or S/C basal-bolus insulin regimen then remove the pump and store it safely. If S/C regime required and not able to find out total daily insulin dose from pump then the following would be safe: calculate total daily insulin dose using 0.5 units/kg and give half the total dose as basal/background insulin and half as bolus/mealtime rapid acting insulin. Ensure that pump is disconnected after S/C basal insulin given.