Diabetes & Covid-19

COVID-19 is a virus that affects the respiratory system (the system that enables us to breathe). People with diabetes are not more likely than others to catch the COVID-19 virus, but if they do catch it, they are more likely to have a severe form of the infection and to suffer more complications. This makes it particularly important for people with diabetes to do everything they can to protect themselves from this virus. Here are some things you can do to help protect yourself.

• Wash your hands thoroughly and often with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer.
• Avoid touching your eyes, nose, and mouth.
• Regularly clean commonly used surfaces and devices you touch or handle.
• Don’t make unnecessary trips away from home.
• If you do have to leave your home, try to stay at least 2 metres away from anyone else.
• Avoid contact with people who appear to be sick with a respiratory illness.
• Watch carefully to see if you develop any symptoms.

Common symptoms of COVID-19 to watch for include fever, tiredness, dry cough, aches and pains, nasal congestion, runny nose, sore throat, and diarrhea. However, some people who become infected with the virus never develop symptoms. If you do develop any of the symptoms, continue following your diabetes management plan and call your doctor to see whether you should make an appointment to go in for a checkup and for advice on how to treat your symptoms. Research has shown that insulin and other treatments for blood sugar control do not increase the risk of severe COVID-19, and you should continue to take them. In fact, you should not make any changes to your diabetes management plan without checking first with your doctor. It is always better to be prepared than to be surprised by something unexpected. For people with diabetes, this includes having a sick day management plan in place before you get sick.

The article “Sick Day Management” below will help you prepare for COVID-19 or any other illness you may develop.

Sick Day Management

Even a minor illness can cause serious problems for people with diabetes. When we are sick, our body reacts by releasing hormones to fight infection, but this can raise blood glucose (blood sugar) levels and make it more difficult for insulin to lower blood glucose. A little planning can reduce the likelihood of developing dangerously high blood glucose levels if you get sick.

Plan ahead
While you are still healthy, you should talk to your doctor or diabetes care team to create a sick day management plan. Your plan should include your target blood glucose goal during an illness, how often to test your blood glucose and ketone levels, how your diabetes medication schedule or insulin might have to be adjusted, if you should stop taking any other medications, and what warning signs indicate it’s time to contact a doctor. Make sure you keep your sick day management plan where it will be handy when you need it. Prepare a sick day kit that includes:
• glucose tablets to treat hypoglycemia (low blood sugar)
• sugar-free beverages
• a thermometer
• enough blood glucose testing strips
• a ketone meter and strips

Managing your blood sugar
If you are on insulin, continue taking it even if you are vomiting or have trouble eating or drinking. If you are managing your diabetes with medications or if you are taking medicines for other conditions, you may need to stop taking them if you are at risk of becoming dehydrated as a result of vomiting or diarrhea.

Speak with your doctor if you take any of these types of medicines to make sure you know what to do if you get sick:
• blood pressure medications
• diuretics (“water pills”)
• nonsteroidal anti-inflammatory drugs (NSAIDs)
• pain medicines
• sulfonylureas

Be careful about taking over-the-counter medicines. For example, if you have a cough or cold and you are looking for relief from your symptoms, you should be aware that some products contain sugar. Ask your London Drugs pharmacist for assistance in choosing a product that will help you feel better without affecting your blood glucose control.

Stay hydrated

If you are vomiting, have diarrhea, have a fever, or are exposed to excessive heat, you are at risk of dehydration. Be sure to drink plenty of fluids that contain minimal or no sugar. Try to drink at least one cup (250 mL/8 oz.) of sugar-free fluids periodically for a total of at least nine cups (2.2L/72 oz.) daily to prevent dehydration. Good choices of fluids include water, clear soup or broth, herbal tea, and caffeine-free diet pop (such as diet ginger ale). Limit the amount of caffeine-containing beverages you drink (e.g., coffee, some teas, and some types of carbonated soft drinks), because caffeine makes dehydration worse. You may want to consider electrolyte replacement solutions.

Eating while you are sick

If you can, try to stick with your meal plan. If you can’t eat the foods you usually eat, try to consume light foods or fluids that contain 15 grams of carbohydrates every hour. Options include:
• 1 slice of bread
• 7 soda crackers
• 1 medium-size piece of fruit
• 1 twin popsicle
• ¹/2 cup (125 mL) of unsweetened applesauce
• ¹/2 cup (125 mL) of 100% fruit juice
• 2/3 cup (165 mL) juice
• ¹/2 cup (125 mL) regular Jell-O®
• 2/3 cup (165 mL) regular soft drink that does not contain caffeine
• ¼ cup (60 mL) regular pudding or ½ cup (125 mL) sugar-free pudding

If you are not vomiting and don’t have diarrhea, you may also want to try:
• 1 cup (250 mL) of milk
• ¹/2 cup (125 mL) of flavoured yogurt
• ¹/2 cup (125 mL) of ice cream

If you are eating less than normal and the symptoms last for more than 24 hours, you may need to temporarily stop taking some medications, including certain diabetes pills, blood pressure and heart medications, and anti-inflammatory pain medicines, and you may need to stop taking all diuretics (water pills). Check with your healthcare professional before you get sick to find out if any of your medications should be stopped, and incorporate this into your sick day management plan.

Test, test, test
Your sick day management plan should include instructions for what tests you should perform and how often to do them, but the following are some general guidelines to consider:
• Check your blood glucose at least every two to four hours. If it is rising quickly, check it more often, even throughout the night.
• If you take insulin, test your blood or urine for ketones.
• If your blood glucose tests above 16 mmol/L twice in a row, test your blood or urine for ketones every four hours.
• Weigh yourself and check your temperature, breathing rate, and pulse frequently.

When to seek help
There are some warning signs that point to a more serious problem. You should contact your healthcare provider if:
• You are sick for more than 24 hours and aren’t getting better or if you start to feel worse
• You can’t drink enough liquids
• You take any medicines and aren’t sure if you should change your dosage or stop taking them when you are sick
• You take insulin and aren’t sure if or how you should change your dosage
• You have been told to check your ketones and they are moderate to high
• You are unable to keep your blood glucose level above 4 mmol/L

If you can’t reach your healthcare provider and are not getting better, consider going to the emergency
department of your local hospital.

Read all other articles in our Living with Diabetes Magazine here.

7 Services You Might Not Know Your Pharmacist Offers

You might be used to visiting your local pharmacist to pick up prescriptions, but did you know there are many other ways your pharmacist can help maintain and improve your health? For many years, pharmacists have been taking on expanded roles in our health care system, working closely with patients, their families and collaborating with other frontline health care providers to deliver personalized, team-based patient care.

In celebration of World Pharmacist Day on September 25th, we’ve rounded up a list of 7 services you might not know your pharmacist offers, from travel vaccinations to smoking cessation consultations. As the most accessible health care providers, it’s easy to take advantage of these services conveniently at your local London Drugs pharmacy!

1. Medication Reviews

The theme of this year’s World Pharmacist Day is “safe and effective medicines for all”. Pharmacists play a crucial role in maintaining patient safety, improving medication adherence and reducing medication errors. One of the many ways they do this is by providing medication reviews. Through medication reviews, pharmacists provide personalized consultations to patients to examine and discuss issues around medication use, side effects, interactions, and anything else related to medication therapy, with the goal of ensuring safe and effective treatments.

2. Vaccinations and Immunizations

Certified Injection Pharmacists are able to administer vaccinations right at the pharmacy. If you haven’t taken advantage of this convenient way of getting vaccinated yet, you aren’t alone. According to a recent survey conducted by Insights West on behalf of London Drugs, only four in ten say they have used this service before.

London Drugs’ Certified Injection Pharmacists can ensure you’re up-to-date with many vaccinations you require, and can administer vaccinations for pneumonia, tetanus, pertussis, shingles, and influenza.

Flu Shots

To make getting your annual flu shot as quick and easy as possible during flu season, you can see one of our London Drugs Certified Injection Pharmacists, who are able to administer flu shots to patients. Patients are encouraged to call the pharmacy to confirm availability of the flu vaccine and that an injection pharmacist is on staff. This is a convenient alternative to public flu clinics, where you may have experienced long lines and wait times in the past.

Travel and Vaccination Clinics

When you’re planning a trip abroad, ensuring you are up-to-date on the appropriate travel vaccines is important. Do you know where to get your travel vaccinations? Only one in three (35%) Canadians are aware that travel vaccinations can be administered by a pharmacist.

Travel and Immunization Clinics are hosted at many of our pharmacies to help prepare you for international travel. Pharmacists will review your immunization history and make sure vaccinations are up-to-date according to provincial, national and even international immunization programs. They can also suggest and administer additional vaccines depending on your planned travel activities, previous immunization history and the local conditions at many common destinations.

3. Emergency Prescription Refills, Prescription Renewals & Drug Modifications

Pharmacists make significant contributions to the quality of drug therapy and patient outcomes by initiating, monitoring and adjusting drug therapy. Traditionally in Canada, the authority to prescribe medications has rested with doctors but as part of Pharmacists’ expanded scope of practice in Canada, pharmacists in many provinces now have the ability to provide emergency prescription refills, renew or extend prescriptions, modify or adapt drug therapy, change drug dosage and even have independent prescriptive authority (in Alberta).

4. Diabetes Management Consults

The most important thing you can do to manage your diabetes is to form a partnership with your healthcare professionals. Our London Drugs Certified Diabetes Educators can assist patients through individualized Diabetes Management Consults. These customized one-on-one consultations focus on blood sugar testing, medication management, preventing low blood sugar, foot care, eating well and getting enough physical activity.

5. Healthy Heart Clinics

Pharmacists are playing a key role in the prevention of heart attacks and other cardiovascular problems, by helping patients understand their risk factors, emphasizing the importance of medication adherence and offering counselling to make important lifestyle changes.

During our one-on-one 45-minute Healthy Heart Clinics, patients have the opportunity to sit down with a London Drugs Patient Care Pharmacist for a customized screening and evaluation. The pharmacist screens for total cholesterol, HDL cholesterol, random glucose and blood pressure, and can determine a 10-year cardiovascular risk factor based on those measurements. They also discuss with the patient how to lower their risk and improve heart health, which include recommendations for changes to their diet, fitness routines or lifestyle. As a collaborative health care provider, the pharmacist may also contact a physician, in order to recommend changes to the patient’s medications, or further medical intervention.

6. Smoking Cessation Consultations

Trying to quit smoking? Your local pharmacist can be a convenient support resource. During a one-on-one smoking cessation consultation, a London Drugs Certified Tobacco Educator will:

  • Discuss practical tips and advice to help you reduce/quit tobacco
  • Develop a personalized quit plan to help you stop smoking

In BC, pharmacists can also offer the BC smoking cessation program for nicotine replacement.

7. Hepatitis C Screening Clinics

Hepatitis C Screening is just one example in which our pharmacists provide Point of Care Testing to patients. Point of care testing refers to any medical test or screening that is performed outside of a lab or clinic. The testing happens at a place where the patient is receiving care (such as a pharmacy), making it a convenient option for the patient.

This innovative and potentially life-saving hepatitis C screening is available at select London Drugs locations. Patients can undertake a simple finger prick test at the pharmacy to check if they have been exposed to hepatitis C virus (HCV) at some point in the past. The test, called the OraQuick HCV rapid antibody test, is more than 99% accurate at detecting HCV antibodies and provides results in 20 minutes.

In cases of a positive result, pharmacists refer patients to their family doctor for a diagnostic lab test. Pharmacists provide initial counselling regarding the potential diagnosis and education about the ability to cure HCV.

You can find out which locations offer hepatitis C screening here.

 

There are even more ways that your pharmacist can help you maintain and improve your health! Just visit them at your local London Drugs pharmacy to learn how.