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Written By: Editorial Team | Updated : December 7, 2020 3:20 PM IST
Diabetes occurs when the pancreasdoes not produce enough insulin or the body can't use insulin properly.
In absence of a vaccine or established treatment for COVID-19, ongoing clinical trials evaluating potential treatments remain the mainstay. Most patients who experience mild to moderate disease recover with symptomatic treatment. Older persons, and especially those with co-morbid conditions like diabetes, cardiovascular disease (CVD), chronic respiratory disease, renal disease and cancer are more likely to develop serious illness. Diabetes remains in epidemic proportion in India (11.2% prevalence ICMR-INDIAB) and combination with the ongoing COVID pandemic is an ongoing threat to the human race. Data from across the world, including Max Healthcare, suggests higher incidences of deaths in the elderly and particularly in those with co-morbidities such as uncontrolled diabetes.
The situation in India is worse due to the poor level of awareness about these diseases and inadequate health care facilities. The response to the pandemic involved lockdowns, social distancing, home isolation with reduced physical activity and limited scope for sports and exercise. This has resulted in increased exposure to risk factors like tobacco and alcohol consumption, unhealthy diets and reduced access to health care experts. This has led to an increase in higher diabetes cases and CVD related deaths.
The New England Journal of Medicine (NEJM) also reported in August 2020 about the bi-directional relationship between Covid-19 and diabetes. It is not uncommon for physicians to uncover new-onset diabetes, including ketosis-prone diabetes (worse form), sometimes transient rise after any acute illness or any infections. The complex pathophysiology of Covid-19 in altering glucose metabolism is being seen and being studied for the potential direct and independent diabetogenic effects of this virus.
Moderate to severe forms of COVID causes profound inflammation and subsequent damage to body organs, especially the lungs and more heart attacks and stroke, particularly in patients with diabetes, hypertension and heart disease. Treatment of confirmed moderate to severe COVID patients includes the use of steroids as part of clinical protocols to prevent or minimise inflammatory damage from the virus, particularly on the lung at an early or even late phase.Steroids can spike sugars besides increase appetite, causing increased calorie intake. Risk benefits outweigh the use of steroids if indicated during COVID or post-COVID lung damaged reduce inflammation of the lung. The magnitude of the hyperglycemic response and the duration of the effect depends on the dose and type of steroid.
Insulin treatment is recommended as steroids push sugars up, peaking after 8 to 12 hrs and gradually settling down, which may need a different type of insulin to avoid both high and low sugars. Insulin works best in managing the glucose surges during treatment with steroids. Insulin dose should be reduced to match requirements and reduce the risk of hypoglycaemia post-recovery. Those patients who are on enteral nutrition (or tube feeding to the stomach) due to prolonged respiratory failure in COVID-19 can have different insulin requirements. Insulin requirement may change and drop post full recovery and may lead to hypoglycaemia. Thus, insulin management should be re-evaluated daily, taking into account the course of the underlying illness and the nutritional plan.
During illness and also post-recovery, good control of diabetes through timely review of progress and adjustments of medicines is the key to a good outcome for every patient.
Long-standing and poorly controlled diabetes has been associated withmuch higher rates of deaths in patients with COVID-19 due to higher rates of stroke and heart attack (cardiovascular diseases or CVD). Post-discharge, patients may require proper treatment of other risk factors like hypertension and cholesterol management like statins, and blood thinners like aspirin.
Most patients require a protein-rich diet to avoid weight loss or muscle wasting post-illness. Those who have fully recovered from lung effects of COVID or are maintaining oxygen saturation above 95% without the need of oxygen or steroid treatment can start walking with a proper mask (to avoid pollutants and other flu illness as well). They can start exercise gradually like short walks within the bedroom, first with monitoring of oxygen saturation. Post walk, if any drop of saturation is seen or breathlessness or weakness is felt, treating doctor should be consulted. Most patients go back to routine walk of 30 min a day (at least 5 days a week) post-discharge, once they are weaned off from steroids or don't require oxygen at home.
Diabetes has been of epidemic proportion in India for more than a decade, and unfortunately has been under-diagnosed, and the pandemic only makes us more conscious about the importance of keeping our general health and immunity in check at all times. Screening of diabetes status of self and family members through available simple laboratory tests becomes imperative.
We strongly recommend routinely screening for diabetes of individuals who are above 35 years of age, or even younger with excess body weight or other risk factors. Diabetes, pre-existing and unknown, existing and uncontrolled, or new-onset, all need to be, and definitely can be, addressed by consulting the doctor regularly. Where physical visits are not feasible, patients should take benefit of telemedicine consultation (as per approved guidelines of the government of India) in such scenarios. Optimum diabetes control is imperative, lowering risks of hospital admission ICU or deaths.
Post-Covid, diabetes control may worsen due to infection, steroid treatment, lack of physical activities and poor diet. Diet and walk remain an important part of the treatment, along with oral and insulin treatment. Most persons with high sugar may need Insulin which is safe as long as sugar is monitored carefully.
(Article by Dr Sujeet Jha, Principal Director Endocrinology Max Health Care)
