18 May 2020 г.
Children with diabetes and COVID-19. What is important to know?
Just as with adults, children exposed to the coronavirus can be infected with it and display signs of COVID-19. However, the course of the disease in children has a number of features. Often children have mild symptoms without development of viral pneumonia. The incubation period ranges from 2 to 10 days (usually two days). Fever (temperature is often up to 38° C) and respiratory syndrome (dry cough, shortness of breath) prevail in the clinical picture, blood inflammatory markers and lymphopenia are less pronounced. In a group of children from zero to three years old the symptoms are likely to be more severe, including vomiting and diarrhea. Cases of disease are also registered among newborns. But intrauterine vertical transmission potential of COVID-19 infection is not proven.
Be aware that in case a child has signs and symptoms of viral infection, parents must immediately call the doctor.
Angelica Solntseva, doctor of medical sciences, professor of the 1st Department of Pediatric Diseases of the Belarusian State Medical University, сhief non-staff pediatric endocrinologist of the Ministry of Health of the Republic of Belarus.
The most common risk factors that contribute to severe manifestations of the disease include:
- unfavorable preclinical background (lung diseases, congenital heart defects, bronchopulmonary dysplasia, Kawasaki disease);
- immunodeficiency disorders;
- combination with respiratory syncytial virus.
Сhildren with type 1 diabetes can get infected with COVID-19 just like other children without diabetes. The main sources of infection are family and child care facilities.
How to prevent infection?
In order to decrease the risk of infecting the child should:
- wash hands frequently with soap and water for 20 seconds or clean hands with an alcohol-based hand wipe;
- maintain a safe distance (at least 1.5 metre) from others;
- cover mouth and nose with tissue when coughing or sneezing;
- avoid close contact with sick people and their stuff;
- avoid touching eyes, nose and mouth;
- disinfect surfaces frequently using alcohol-based sanitizers, disinfect means of self-control and insulin administration (glucometer, lancet, test strips, insulin syringes and pens).
Should a child with diabetes attend school?
The question is rather complicated and the decision should be made individually with respect to peculiarities of each patient. On the one hand, it is necessary to follow general recommendations for children. On the other hand, we need an individual approach, taking into account the level of diabetic compensation (if necessary, it is better to organize distance learning).
Currently, there is no ground research devoted to the effect of COVID-19 on children with diabetes. Given a number of asymptomatic or mild cases of disease, children are considered as possible sources of infection. However, type 1 diabetes has been identified as a risk factor that contributes to more severe course of the disease. It may be necessary to provide intensive care for these patients. Pancreatic tissue is a potential target for viral infection which can lead to glucose metabolism disorders. According to some experimental studies an increased level of blood glucose can enhance the replication of the virus in the body and can be a factor of suppressing the antiviral immune response. Prolonged hyperglycemia affects lungs which may result in development of respiratory dysfunction. Prolonged hyperglycemia may also cause acute complications of diabetes (diabetic ketoacidosis and hyperosmolar coma).
How to control your child’s diabetes if he/she has COVID-19?
- In case of having flu-like symptoms, stay at home and call the doctor.
- Remain at bed rest and take plenty of fluid.
- Use paracetamol (agent of choice) to reduce high temperature. The oral dose of paracetamol for children is 15 mg/kg per dose with a maximum of 60 mg/kg daily.
- While taking paracetamol use blood glucose meter to monitor blood glucose because paracetamol can affect the accuracy of continuous glucose monitors.
- Monitor blood glucose and ketone (blood or urine) levels more frequently. Blood glucose should be monitored every 3-4 hours, including night time, sometimes every 1-2 hours.
- Aim for a blood glucose level between 4-10 mmol/L, and ketone level under 0.6 mmol/L.
- Do not stop insulin! Regulation of the dose of insulin (additional doses during illness) and other changes in its intake should be carried out depending on the results of monitoring blood glucose levels.
- Often, for several days before the development of the disease (incubation period) and after recovery, you may need to increase the dose of insulin for your child due to insulin resistance (low insulin sensitivity).
- You need to contact your endocrinologist immediately if your child is experiencing any of the symptoms below: fever, vomiting and/or weight loss, which indicates dehydration; fruity breath odor with elevated blood or urine ketones despite extra insulin and hydration; impairment of consciousness; shortness of breath or breathing difficulties; severe abdominal pain.
- If you were recommended to self-isolate, you must stay at home with your child. Avoiding contact with others will help to prevent the spread of the virus.
- Pay extra attention to your child’s glucose control. Always try to keep your child’s target blood sugar levels.
- Make sure that your child has enough fast carbohydrates for hypoglycemia, good supply of the diabetes medications (insulin) and means of self-control and insulin administration (test strips, sensors, lancets, needles, insulin pump supplies, etc.) for at least a month.
- Ensure that your child eat healthy and keep regular meals.
- Provide your child with daily exercise at home.
- Keep track of the psychological state of your child and all family members. Try to think positively!
Angelica Solntseva, doctor of medical sciences, professor of the 1st Department of Pediatric Diseases of the Belarusian State Medical University, chief non-staff pediatric endocrinologist of the Ministry of Health of the Republic of Belarus.
Translation: Varvara Boika