How to help your patients with diabetes during Omicron BA.2 surge

Healthcare professionals should be making sure patients with diabetes have a plan for sick day management as more people contract COVID-19 during the rise of the Omicron BA.2 variant, experts say. The information needs to be tailored for each patient with diabetes, depending on their risk factors for complications or poor outcomes. To start, healthcare professionals can go over the basics of sick care management. "I would go over this with them in advance of coming down with COVID, in advance," said Susie Jin, a community pharmacist who sits on the dissemination and implementation committee of Diabetes Canada. "They do need to know how to care for themselves," "It could have a significant impact on a person's healthcare outcomes should they come down with COVID," she said. Pharmacists need to make sure patients know they should begin drinking fluids with minimal sugars to avoid the risk of dehydration when they begin to feel sick. "I actually do tell people they should have some consume soups in their cupboards," Jin said. "Then you're replenishing with not just water, but something with electrolytes, which is important for the kidney and the heart and can help prevent acute kidney injury and other acute complications that people with diabetes are at higher risk for." Patients also need to know which medications need to be put on hold when they become dehydrated or are eating less than normal, and when those medications should be re-started. A resource is available from Diabetes Canada that pharmacists can use to help inform patients about which medications they should pause. Read: QUIZ: Test your knowledge of diabetes and COVID-19 infection They also need to know how to adjust their insulin and how often they should check their blood glucose levels when feeling ill. The Juvenile Diabetes Research Foundation notes that many medicines used to treat symptoms of COVID-19 can also impact insulin management. "These are things that the pharmacist needs to go over with the person and make sure that they're at least aware of the checklist of what needs to happen," Jin said. Pharmacists should be aware of who may benefit from Paxlovid in their communities, and then let them know, Jin said. This ensures that if a patient gets a positive COVID-19 test, they know to get a prescription so they can start the medication within the first five days of infection. Paxlovid has many drug-drug interactions, Jin noted. Some are absolute contraindications while others can be managed by adjusting doses of other medications, or temporarily pausing certain medications, while on Paxlovid, and for two days following Paxlovid therapy, she said. The dose of Paxlovid also needs to be adjusted depending on the person’s kidney function. Patients also need to know when they should seek more urgent medical care. "That's also very individualized, because different people, depending on the type of diabetes, depending on the medications that they're on, and possibly depending on how long they've had diabetes, are at risk of different acute complications," Jin said. Read: Kids can cook: New program for children with Type 1 diabetes "So much of this self-management is so individualized. That's the beauty of having the healthcare team speak to that person on an individual basis to support them to the best of their ability to self-care," Jin said. In preparation for the potential of a positive COVID-19 test, pharmacists and patients should work on goals that will lower a patient's risk of a poor outcome. Good management of blood glucose, blood pressure, kidney function and other health factors will all contribute to a better outcome following COVID-19. The patient-centred resource for sick day management from Diabetes Canada is available on the Diabetes Canada website. There's also information for caring for patients at risk of hypoglycemia. Read: Good long-term glycemic control can keep diabetics with COVID out of the ICU

How to help your patients with diabetes during Omicron BA.2 surge

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