After COVID, some patients in Louisiana will be diagnosed with diabetes.Coronavirus

David Owens thought he could be infected with COVID-19.

He wore a mask for work and his wife was a “disinfectant fanatic”, but it was difficult to prevent all exposures with two school-aged children. In January, the test returned positive.

But what he didn’t expect 53-year-old Owens to result from a match against the coronavirus was the diagnosis of type 2 diabetes.

He received the news when he visited the emergency room because he was found to have another COVID complication, a blood clot. When he arrived, the nurse checked his blood sugar level, which was three times the normal level.

“They were surprised at what I was aware of,” Owens said.

Over the past year, researchers have identified a range of problems that can be caused by COVID, including neurological problems, kidney and heart damage, and blood clots. Recently, patients like Owens have shown signs that diabetes may also be associated with coronavirus infection.

In Louisiana 1.27 million have pre-diabetes and an additional 124,000 have undiagnosed diabetes, Doctors are aware of the rise.

“We’ve probably made more new diagnoses of diabetes this year than ever before,” said Dr. Josh Denson, a New Orleans critical care pulmonary doctor, who has up to 10 times more people with diabetes than usual. I presumed that. We specialize in lung care, not metabolic disorders.

After noticing the connection, Denson began looking for chronic illnesses in COVID patients. But he says it’s a “chicken or the egg” situation. It is unclear if the patient already has diabetes or if the coronavirus exacerbates diabetes.

“Recently, there was a 32-year-old healthy man who died of a severe COVID infection,” said Denson. “He had no medical problems at all, but when you started to see … he actually had very mild diabetes.”

Doctors knew that diabetics suffered from a coronavirus infection. However, until recently, it was not clear that the connection could be bidirectional. A November survey found that 14.4% of hospitalized COVID patients had some form of diabetes. Journal of Diabetes, Obesity and Metabolism. However, experts cannot yet say whether COVID causes a chronic illness, tilts the scale towards it, or simply reveals an unknown, pre-existing distress.

Diabetes refers to a series of metabolic disorders related to how the body handles blood sugar levels. In patients with type 1 diabetes, the pancreas, an organ that aids digestion and balances blood sugar levels, loses the ability to produce enough insulin to regulate blood sugar levels. Type 2 diabetes occurs when the body increases insulin resistance and the pancreas cannot produce enough to lower blood sugar levels.

Type 1 diabetes has long been associated with the virus and is thought to be caused when the immune system attacks cells involved in insulin production. The relationship between the virus and type 2 diabetes is less clear, but there is evidence that the virus can completely disrupt the body’s ability to regulate blood sugar levels.

During the 2003 SARS pandemic 20 out of 39 patients in one study Although he developed diabetes within a few days of admission, only two had diabetes three years later. In another study of outbreaks in 2003, Of 22 patients who have not previously had diabetes, 7 developed hyperglycemia in the hospital, but researchers did not know whether it was due to treatment or the virus itself.

Owens had no history of diabetes, but his medical records showed a slightly elevated fasting blood glucose level from a few years ago. Prior to COVID, he had never been hospitalized.

The question of whether COVID causes diabetes and how new COVID-related diabetes develops differently is being debated among endocrinologists. Some, like Dr. Frank Moves Jarvis, an endocrinologist and professor at Tulane Medical College, suspect that the way the virus invades pancreatic cells may have a detrimental effect.

“The pancreas seems to have had a heart attack,” said Mauvais-Jarvis, who discovered an autopsy pancreas in a microclot and inflamed COVID patient.

In a small sample of primates from the Tulane Primate Center, two of the six non-prediabetic monkeys also developed type 2 diabetes after COVID infection, Mauvais-Jarvis said.

Many other factors may also explain the diagnosis after COVID. All types of serious illness can turn someone who may have had prediabetes into full-blown type 2 diabetes. The COVID patient may have already had diabetes, but a match with COVID was needed to reveal it. According to doctors, dexamethasone, a commonly used steroid for the treatment of COVID, is like gasoline to raise blood sugar levels in diabetics.

“All these stories could be just the infection and the effects of some steroids,” said Mauvais-Jarvis. “But the virus can also have toxic effects on the pancreas.”

Tanya de Silva, head of the endocrinology section of LSU Health New Orleans School of Medicine, said the virus may be blocking insulin production by damaging cells that produce insulin, the hormone that suppresses blood sugar levels. Said there is.

Inflammation caused by COVID stimulating the immune system can damage these pancreatic cells and other systems and organs of the body, all of which affect the regulation of sugars in the body.

“We don’t know for sure because we don’t have the data yet, but there are several possible mechanisms for new diabetes,” de Silva said. “This is something we should worry about, given that we are already at risk in our population.”

Dareen Bernard was one of those endangered patients. Although she has a family history of diabetes, she paid special attention to her diet and checked her blood sugar levels on a regular basis. When infected with COVID in July 2020, she was thinking more about breathing problems and blood clots than diabetes. But a few months after COVID, she got a call from her doctor. The blood sugar level rose sharply, and I changed from mild prediabetes to full-scale type 2 diabetes.

She worked with a nutritionist to double her efforts to manage her diet. However, another test a few weeks later showed that her blood sugar level had risen again.

“There was a lot, and I’m getting stressed,” said Berniard, 48-year-old health insurance case manager. “It questioned me myself — did I eat as healthy as I thought? Am I doing enough?”

Her doctor has seen the blood sugar levels of two patients previously infected with the coronavirus rise sharply.

“I really think this is related to COVID,” said Dr. Jason Halperin, Ph.D., Berniard, Crescent Care, New Orleans. “It’s very surprising to have timing, a lack of change in her lifestyle, and that significant change over a three-month period.”

But until the data is collected and investigated, the connection is still a mystery. Mauvais-Jarvis has begun a study at the Veterans Medical Center in New Orleans with approximately 1,500 patients.Established by an international group of researchers Global Registry for Tracking New Diabetes and COVID..

In the meantime, patients cannot help thinking that it has something to do with the development of life-changing illnesses.

“I may have been Type 2 in the future,” Owens said. “COVID has passed the rest of the finish line.”