Yesterday, I discussed how persons living with diabetes and their families can reduce their chance of becoming infected with the novel coronavirus. Here I will share a few tips on how to manage if you do happen to become infected.These are your sick-day rules, and apply to any infection. But first, let’s discuss what we know about Covid-19 at present.As of yesterday at 3pm, 2,435,876 cases had been recorded worldwide, 639,239 had recovered and 167,369 people had died. Most people — more than 80 per cent — have a mild illness of Covid-19. This is great news. However, about 14 per cent are severe and one in 20 people will develop critical illness such as pneumonia. This is more common in people who have other health problems, but not always. We know that many people around the world who probably had the virus have not been tested, so the true number of cases is probably higher, which means that the death rate is probably not as high as these statistics make it appear. The incubation period for the Covid-19 virus is between two and 14 days, but many people may have only very mild symptoms or none at all and never realise they had it. These people may transmit the virus to others and never even know it. This is why social-distancing is so important. The first symptoms of Covid-19 virus may include cough, nasal congestion, fever, body aches and sore throat, just like any respiratory virus such as the common cold or flu. Indigestion and diarrhoea are also possible. These symptoms are your body’s response to the virus, not actually the virus itself. When a virus invades your body, the immune system acts to kill it. White blood cells are recruited to destroy the virus and hormones, enzymes and other chemicals are released. These chemicals are what cause the fever and runny nose, aches and pains. In later stages of the illness a person may develop shortness of breath, pneumonia and respiratory distress. If you think you may have Covid-19, call your doctor, stay home, limit contact with other people and wash your hands well and often. When we recommend that people just stay home and ride it out, that can be really scary for a person with diabetes, who may need more support. Be in close contact with your doctor if you don’t feel well.• Don’t panic — contact your diabetes team if you need help to manage your sugars • Do not go to a GP surgery, pharmacy or hospital unless you have severe illness• If you or someone you live with has symptoms of coronavirus, then all household members must stay at home and not leave the house for 14 days or until three days after the last symptoms have resolvedSick-day rulesAny stress can make diabetes more unpredictable and difficult to manage. This is true for illness, including the Covid-19 virus. If you’re not monitoring your blood sugars, you will not know if they are high.So to the rules: 1, If you’re unwell, you need to be testing more often. 2, If you take medications for your diabetes, you may need higher doses when you’re unwell. Some medicines, such as insulin, cause low blood sugars if you’re not eating properly or if you’re vomiting. Close monitoring of your glucose levels allows you to make adjustments to your medications. Call for help if you don’t know how to do this. 3, Keep eating and drinking — if you can’t keep food down, try snacks or drinks with carbohydrates to give you energy. Try to sip sugary drinks, such as fruit juice or non-diet cola or lemonade, or suck on glucose tablets or sweets like jelly beans. Letting fizzy drinks go flat may help keep them down. If you’re vomiting, or not able to keep fluids down, get medical help as soon as possible.4, If you routinely check your blood sugar at home, you will probably need to do it more often.5, If you don’t test your blood sugar levels at home, be aware of the signs of high blood sugar levels, which include passing more urine than normal — especially at night — being very thirsty, headaches, blurred vision, tiredness and lethargy. Call your diabetes team if you’re experiencing this. 6, If you have type 1 diabetes, check your blood sugar at least every four hours, including during the night, and check your ketones if your blood sugar level is high (>250mg/dL). If ketones are present, contact your diabetes team. 7, If your sugars are high, avoid carbohydrates and sugars. 8, Make sure you stay well hydrated. Drink plenty of water or sugar-free drinks. 9, Get plenty of rest.10, Remember that some glucose sensors — not regular meters — can be less accurate if you take Tylenol. 11, If measures you’re taking to keep your sugars under control aren’t working, call your diabetes team. When you call them be prepared:• Have your glucose readings available and, if you check ketones, have that ready, too• Keep track of your fluid consumption — you can use a one-liter water bottle — and report• Be clear on your symptoms — for example: are you nauseated? Just a stuffy nose?• Ask your questions on how to manage your diabetesWhen to seek medical attention?If you develop warning signs for Covid-19, get medical attention immediately. In adults, emergency warning signs include:• Difficulty breathing or shortness of breath• Persistent pain or pressure in the chest• New confusion or inability to arouse• Bluish lips or faceIf you’re having trouble breathing; if you’re not able to keep fluids down or you’re becoming dehydrated — dizzy, light-headed, faint, very dark urine.If you feel you cannot cope with your symptoms at home, your condition gets worse, or your symptoms do not get better after seven days, then call your GP or the Bermuda Hospitals Board support line. 444-2498, available 9am to 9pm daily. If you are encountering a medical emergency, call 911. • Additional reference: https://www.statista.com/topics/5994/the-coronavirus-disease-Covid-19-outbreak/• Annabel Fountain, MD, is a Bermudian physician who is board-certified in endocrinology, diabetes and internal medicine. She is the owner and medical director of Fountain Medical Group. Dr Fountain is available for telemedicine appointments during the Covid-19 isolation recommendations. Please call your primary-care physician for a referral or 232-2027 to make an appointment