COVID-19 can cause diabetes, so more data is needed: Professor Nikhil Tandon of AIIMS Delhi

Dr. Nikil Tandon, Professor and Director of the Department of Endocrinology and Metabolism in AIIMS Delhi Hinduism Learn about the relationship between COVID-19 and elevated blood glucose levels and their effects on patients.

Why does a virus infection raise my blood sugar?

Infectious diseases and febrile illnesses can raise blood sugar levels. This is basically the result of the mechanisms that the body employs to combat infection. In some cases, medications given to treat the infection may increase blood sugar levels.

An extreme example of increased inflammatory markers is the “cytokine storm” in the case of COVID-19, which affects both pancreatic insulin release and tissue susceptibility to insulin. Insulin promotes the transfer of glucose to tissues, and dysfunction (either production or tissue susceptibility) leads to elevated glucose levels in the blood.

For COVID-19, moderate to severe patients need to be given steroids, which can increase their blood glucose levels.

Is it difficult to treat COVID-19 patients with diabetes?

In most cases, people with well-controlled diabetes respond to COVID-19 treatment in the same way as non-diabetic patients. However, in people with long-standing diabetes and poor control, or with diabetic complications such as kidney and heart disease, the management of COVID-19 becomes more complex and the course of the disease becomes more serious. It may require active management, such as: The need for oxygen, ventilation and ICU care.

Conversely, managing COVID-19 in such patients can make the treatment of diabetes more difficult. For example, steroids, an important part of COVID-19 treatment, can significantly worsen glycemic control. Therefore, diabetics always need treatment with intensive insulin therapy.

In addition to steroid therapy, there are many other factors that contribute to this elevated blood sugar level during illness, such as changes in the patient’s dietary patterns. And the stress of illness and the inability of patients to follow normal diet and exercise prescriptions can also lead to elevated blood sugar levels.

Can COVID-19 cause diabetes?

Diabetes is an asymptomatic disease for most people, so it is possible that quite a few people are unaware of diabetes before they become infected with COVID-19. Studies show that in resource-poor countries, 50% of people with chronic illnesses such as diabetes are undiagnosed. Approximately eight diabetics have optimally controlled blood sugar levels because some patients are known to have diabetes but cannot afford medical care or manage their illness well. Only one person.

Also, some people are prone to diabetes, and COVID-19 causes so-called stress hyperglycemia. For some patients, it may be a combination of stress-induced hyperglycemia and medications such as steroids that can lead to elevated blood sugar levels. And finally, there is ongoing debate about the potential of the COVID-19 disease itself to cause new diabetes in patients.

Theoretically, because the pancreas has ACE2 receptors, COVID-19 can also cause diabetes and SARS CoV2 can invade pancreatic beta cells, causing structural and functional damage. .. However, more data is needed to support this.

So when can we say that COVID-19 caused diabetes?

At the time of COVID-19, a test called HbA1c, which shows the average blood glucose level for the past 3 months, was performed, and if these levels were elevated, the person had diabetes before being infected with COVID-19. It means that. If HbA1c is normal, blood glucose should be reassessed after COVID disease has subsided and steroid therapy (if used) has been discontinued. If the disease itself or steroid therapy contributes to the rise in blood, blood sugar levels will normalize. sugar.

COVID is more likely to have caused diabetes if blood sugar levels remain high after recovery from an acute illness, or after discontinuing steroids, or both.

And how can this knowledge help doctors treat patients?

This test helps doctors determine if the increase in blood sugar levels in COVID-19 patients is temporary. In the first case, blood sugar levels normal as soon as a person recovers from COVID or when steroids are discontinued. These patients do not need medication to control their blood glucose levels after recovery.

What precautions should I take to protect myself if a diabetic is infected with COVID-19?

Diabetes can cause complications in the kidneys, heart and eyes. Such patients need to be more careful and make every effort to control their blood sugar levels. They need to pay close attention to diet, exercise and dosing.

Most importantly, such patients are at increased risk of developing severe COVID-19 disease and should be vaccinated. Vaccination greatly reduces the chances of serious illness or death.

If a diabetic becomes infected with COVID-19, he or she should immediately report it to a doctor so that he or she can decide on a course of treatment.