Diabetes in the time of Coronavirus

Managing Diabetes Mellitus well will likely reduce the chances of developing serious complications once a diabetic patient catches the virus, writes Dr Noor Gill

Diabetes mellitus, just plain ‘diabetes’ or ‘sugar’ as we Indians like to call it, is a chronic illness associated with abnormally high levels of glucose in the blood. Now this rise in the blood glucose levels can be because of one of the two reasons below:

1. There is insufficient production of insulin. Insulin, as we know, is a hormone produced by the pancreas which promotes the absorption of glucose from the blood into the liver, fat and skeletal muscle cells for it to be converted and utilised for producing energy.
2. Or this can be because of inadequate sensitivity of cells to the action of insulin

Based of what is causing the problem and the mechanism of it, diabetes is broadly divided into two types.

Diabetes Mellitus Type 1 : This is when there is no, or not enough production of insulin.

Diabetes Mellitus Type 2 : This is the case when there is enough insulin, but the cells upon which it normally acts are not sensitive to its action.

With the Covid-19, a lot of questions regarding the effects that the virus can have on a diabetic patient have given rise to a lot of curiosity. Here are some of those questions answered.

Can the virus trigger the onset of diabetes?

Currently, no evidence of the coronavirus acting as a trigger for diabetes has been found. There is not enough data to show whether people with diabetes are more likely to get Covid-19, as compared to the general population. However, if you have diabetes, you are at a higher risk for serious complications, if contacted with the virus. Which means that being a patient of diabetes mellitus increases your risk for complications from the virus and not the risk of catching it.

A study published in The Lancet Diabetes and Endocrinology noted that the risk of COVID-19 was upto 50% higher in people with diabetes, particularly, elderly Type 2 diabetes mellitus.

It was also noted that the risk of COVID 19 in young people with Type 1 diabetes appears to be much less, provided they have access to satisfactory medical care and assistance and maintain a good control of their blood glucose levels.

However, some Italian colleagues and co-authors for the same study observed that the virus can cause potential pancreatic beta cell damage, leading to insulin deficiency- exacerbating the disease and causing severe complications.

“The problem people with diabetes face is primarily a problem of worse outcomes, not greater chance of contracting the virus,” says the American Diabetes Association.

What patients require specific attention?

Diabetic patients that require specific attention. But some need more careful monitoring than others. Some of them are:

• Patients with poor blood sugar control and pre-existing complications as a result of long standing and uncontrolled diabetes.
• Obese patients with diabetes
• Diabetic patients with other illnesses, such as hypertension and other cardiovascular complaints.
• Patients with a prior chronic illness or transplantation and patients on renal dialysis.
• Patients on immunosuppressive or corticosteroid therapy for some other disorder.
• Patients who have undergone a surgical procedure in the recent times.

What are the complications that we are talking about?

The complications that a patient of diabetes who has come in contact with the corona virus includes- severe pneumonia, Adult Respiratory Distress Syndrome (ARDS), multiple organ failure, including the lungs, heart and kidney.

When sick with a viral infection, people with DM do face an increased risk of Diabetic Ketoacidosis, also known as DKA.

DKA is a serious condition that can lead to diabetic coma or even death. When infected with a viral illness, your cells don’t get the glucose they need to convert it into energy for uptake. The body, to compensate for the loss, begins to burn fats for the same. Which in turn produces ketone bodies as a by product.

When the ketone bodies keep accumulating in the blood, they make it more acidic, hence the term “Keto-acidosis”.

DKA is a warning sign trying to inform you that your blood glucose levels are higher than they should be.

What can one do to reduce the chances of developing serious complications due to the corona virus?

Managing DM (Diabetes Mellitus) well will likely reduce the chances of developing serious complications once a diabetic patient catches the virus.

• Monitor your blood sugar levels regularly.
• Eat well and healthy.
• Make sure you have enough food, especially healthy carbohydrates- vegetables, whole fruits, whole grains, nuts like almonds, walnuts, peanuts. Chia and pumpkin seeds.
• Stock up on simple carbs like sugar and candies- in case your blood sugar falls.
• Refill your insulin and other medications. Avoid insulin rationing which is basically altering the dose or taking lower than the prescribed dose of insulin, due to a multitude of reasons- which might be due to the unavailability of the prescribed medication, inability to go outside to get a refill for the same or because of the budget cuts at home- for long duration can cause hyperglycemia which can lead to serious consequences and complications.
• Take your insulin or other oral hypoglycemic as ordered to reduce the risk of dealing with severe symptoms and life threatening complications.

Keep a list of emergency contact numbers in handy, which should include contact details for your general physician, nearest hospital, ambulance and your immediate family (in case they don’t stay with you).