What changes in diabetes medicine might be required during the COVID-19 crisis?

Hello, I’m Dr. Ralph Abraham consultant in diabetes and endocrinology at the London Diabetes Centre.

Today’s webinar is all about what changes in diabetes medication might be required as a result of this COVID-19 pandemic. We’re learning all the time. And as COVID-19 pandemic unfolds, there are some important drug effects, but it is important that I share with you.

Not all our knowledge is based on sound science, and much of the information comes from other parts of the world and may not apply to our populations. Diabetes patients take a large number of drugs. We divide them into groups, and then given technical names like ACE inhibitors or attributes in some respects blockers for blood pressure, status for cholesterol and for the diabetes, Metformin, Gliclazide, Glibenclamide, Gliptin, SGLT inhibitors, GLP-1 agonists, and of course insulin.

Now I’m going to deal with blood pressure medication changes in a separate webinar. So now I’m just going to discuss the diabetes medications here. There’s only really one group of drugs that needs attention and possible change. And if you do, consider change, you must always agree this for the doctor who’s in charge of your diabetes. This group of drugs are called the SGLT two inhibitors. That’s a bit of a mouthful for most of us. But the most commonly prescribed have the following names. Forxiga – which is otherwise known as Dapagliflozin, Jardiance which is also called Empagliflozin, and Invokana – which is also called Canagliflozin.

If one of these drugs is on your list of medications, then you need to listen carefully. One of the known side effects of these drugs is that they can cause ketosis, which in itself makes you feel unwell, which can lead to more serious diabetic ketoacidosis coma, and that’s serious. So if you have type two diabetes, although this is a rare and unusual, serious illness. The trouble is that COVID type of infection can be just that and could provoke ketosis. It’s, of course very unusual and rare if you have a type two diabetes and you’re not taking insulin. So current advice at the moment is that you should continue with these drugs. But I want to use this talk to draw attention to the fact that you have to be much more vigilant if you take these drugs. This means increased tension to your well being, to any symptoms you have, to glucose levels, and of course, if you have access to blood ketone testing, this is recommended.

Now the situation is much more serious and if you have type one diabetes, or for that matter if you have type two diabetes, and you are insulin dependent and take insulin. So the advice here is that you should stop your SGLT inhibitor, there are quite a few patients who use insulin who are also taking either Forxiga, Invokana or Jardiance. If you do all of these, you’re going to need to make a substitution or increase your dose of insulin and you’re going to need help from your diabetes team. If you’re going to keep your glucose levels well controlled. All patients who use insulin should have been instructed on blood ketone testing, as this is such a good alarm system for a deteriorating situation requiring more incidents. Now, it’s very straightforward for all our diabetes medication, COVID disaffected, there’s no change. Don’t change your medication, or the dose and carry on as before.

Remember that any medication change requires more testing of your glucose because if you make a change, it might lead to over or under treatment, and you need to reassess your diabetes after making any change. Never ignore high glucose levels, they are a wonderful way of telling you that something is not right, and it’s time to consult your doctor.

The doctors and nurses at the London Diabetes Centre are available for film and video consultations and advice whenever you need it. You can contact us during working hours on 08000483330 for an appointment on medication. Our website is www.Londonmedical.co.uk. Thank you for listening to this feature.