COVID-19 & Diabetes

Dr Mahesh D M, Consultant – Endocrinology, Aster CMI Hospital, Bengaluru, India

Patients with diabetes have been in the spotlight since the early stages of the pandemic, as growing epidemiological data have revealed they are at higher risk of severe clinical outcomes of COVID-19.  Hospitalization of patients with diabetes due to flu-like infections is up to six times more likely to occur compared to healthy individuals.

1. How high blood sugar specifically increases the risk of complications of COVID-19? 

People with diabetes have much higher rates of serious complications and death than people without diabetes.

2. Increased COVID-19 severity in individuals with diabetes.

SARS-CoV-2 infects the lung tissue via entry through ACE2 receptor and individuals with diabetes have increased ACE2 receptor expression. Medications taken by diabetic people and who do not have their diabetes managed properly are more susceptible to COVID – 19 infection.

3. Is there a different risk for Type 1 patients compared to Type 2 patients? If so, what are the differences? 

Diabetes is a family of diseases that can lead to increased sugar in the blood (this is referred to as high blood glucose).

In type 1 diabetes, the immune system attacks the pancreas’ insulin-producing cells, resulting in the body not having enough insulin. 

In type 2 diabetes, the most common form of diabetes, the body doesn’t know how to appropriately use or make enough insulin.

Data from the NHS, England showed that the risk of COVID-19 mortality in either T1 or T2 diabetes is independently associated with the level of hyperglycaemia. After adjusting for key confounders, such as age, sex, ethnicity, index of multiple deprivation, and geographical region, the odds for in-hospital deaths with COVID-19 were 3·51 (95% CI 3·16–3·90) for people with type 1 diabetes and 2·03 (1·97–2·09) for people with type 2 diabetes compared with people without diabetes

4. What are the specific risks for pregnant women with gestational diabetes, who were highlighted as a high-risk group for complications? 

According to the CDC, “Pregnant women experience immunologic and physiologic changes which might make them more susceptible to viral respiratory infections, including COVID-19.”

However, gestational diabetes may make symptoms more severe. First up, you’ll want to make sure you have access to insulin, along with any other medication. Beyond taking any medication get adequate sleep and exercise, both of which can help support healthy glucose levels.

Food is the key, a low-carbohydrate diet will help keep your glucose values in range and reduce risk of severe disease. Stress affects our blood pressure, pulse, hormones, and sugar levels. Women with gestational diabetes can turn to a yoga, mindfulness, or breathing regimen.

5. Is there a link between diabetes medication and COVID-19?      

There is no direct link between diabetes medication and COVID-19. Patients admitted to hospital for severe COVID-19 might need modifications to their diabetes therapy, including withdrawing ongoing treatments and initiating insulin therapy.

Such a decision should be based on the severity of COVID-19, nutritional status, actual glycaemic control, risk of hypoglycaemia, renal function, and drug interactions. Despite better outcomes reported in patients with COVID-19 with diabetes treated with metformin, the drug should be stopped in patients with respiratory distress, renal impairment, or heart failure due to risk of lactic acidosis.

6. If people stop taking their medication, what are the risks that they become prone to?

If people stop taking their medication they would be at higher risk of severe clinical outcomes of COVID-19, including hospitalization and death.

7. With wearing the mask and hand washing, what additional precautions would most benefit diabetics?

Diet, exercise, medicine and monitoring are four pillars for effective management of Diabetes.

The current COVID-19 pandemic calls for a strict adherence to ensure that each one of these parameters are looked after adequately. Medical teams should ensure adequate glycaemic control in patients with diabetes with COVID-19. Hence, patients should monitor blood glucose levels and take medicines regularly as advised by their physicians.

Tips on how diabetics can stay safe in Covid-19

For people living with diabetes it is important to take precautions to avoid the corona virus as much as possible. The recommendations that are being widely issued to the general public are doubly important for people living with diabetes and anyone in close contact with people living with diabetes.

• Wash hands thoroughly and regularly for more than 20 seconds
• Try to avoid touching your face before you have washed and dried your hands
• Clean and disinfect any objects and surfaces that are touched frequently
• Don’t share food, glasses, towels, tools etc
• When you cough or sneeze, cover your mouth and nose with a tissue or use the crook (elbow) of your arm if you don’t have a tissue at hand (dispose off the tissue appropriately after use)
• Avoid contact with anyone showing symptoms of flu like illness
• Regular monitoring can help avoid complications caused by high or low blood glucose
• If you do show flu-like symptoms (raised temperature, cough, difficulty breathing), it is important to consult a healthcare professional
• Any infection is going to raise your glucose levels and increase your need for fluids, so make sure you have access to a sufficient supply of water
• Make sure you have a good supply of the diabetes medications you need for a few weeks
• Make sure you have access to a healthy low carb diet to maintain glucose control and weight
• Make sure you will be able to correct the situation if your blood glucose drops suddenly
• Maintain a regular schedule, home exercises for half to one hour, avoiding over-work and getting a good night's sleep
• Monitor blood glucose and blood pressure, consistently
• If you live alone, make sure someone you can rely on knows you have diabetes as you may require assistance if you get ill.

Finally, get tested early and think whether you can make changes that will help protect yourself or loved ones.  For example, can you avoid unnecessary business travel? Can you avoid large gatherings? Can you avoid public transport?