COVID-19 and diabetes: why it’s a deadly combination

If you have diabetes, COVID-19 attacks can have a serious impact on your health. It’s not new. Diabetes is a known co-morbidity, an underlying disorder that can compromise the human immune system’s ability to fight the new coronavirus.

What is new is an increase in blood sugar levels in COVID-19 patients without diabetes. Most of these cases have been reported from India. Mumbai public hospitals have reported cases of patients with hyperglycemia (high blood sugar levels) of approximately 400-500 mg/dL. (Blood glucose levels below 140 mg/dL are considered normal).

Some of these patients are very young, about 25 years old. Many of them have no history of diabetes: they have neither prediabetes nor undiagnosed diabetes.

Typically, illness, infection, injury, or stress can result in high levels of sugar in the blood. However, sugar spikes in COVID-19 patients who are not diabetic are unusual, Mumbai Mirror Dr. Genham Shah, a pulmonologist, said that.

COVID-19 is primarily a respiratory disease, with coronaviruses attacking the lungs. However, other complications include damage to the tissues of the liver, kidneys, intestines, and heart, leading to organ failure. Blood clots, additional viral and bacterial infections, and brain and central nervous system damage have also been reported.

More than 6 months have passed since the virus named SARS-CoV2 was discovered in Wuhan, China. It then spread to more than 216 countries and territories, affecting more than 12 million people. Even now, after more than 555,000 deaths, the full extent of the health problems caused by the virus is still unknown. More complications are reported daily.

Not everyone is at risk of developing complications from COVID-19. The underlying medical condition increases the risk of complications, including diabetes.

Diabetes is a condition in which the body cannot produce enough insulin to process the sugars in the bloodstream. Insulin, a hormone produced by the pancreas, helps transfer sugar or glucose from the blood to the cells of the body.

The body breaks down carbohydrates from food into sugar (glucose), which is absorbed in the bloodstream. Glucose is needed by cells in the body to produce energy. Transporting glucose into cells in the absence of insulin can lead to lethargy (energy deprivation) and other complications.

Insulin therapy and other treatments help diabetics manage their condition and lead a healthy life.

Type 1 diabetes: In this case, the body does not produce insulin, so it is called insulin-dependent diabetes. It was usually called juvenile diabetes because it usually appears in childhood diabetes and adolescence, but adults can also develop type 1 diabetes.

There is no cure for the condition that is believed to be caused, but there are genetic factors and some viruses. Treatment is usually through insulin control of blood sugar and diet and lifestyle.

Type 2 diabetes: This is the most common form of diabetes, where the body does not produce enough insulin or the insulin produced is not used properly. If you don’t have enough insulin to transfer your blood sugar from your blood to your body’s cells, your blood sugar levels will rise dramatically.

This condition can be very well managed primarily by lifestyle changes such as diet and exercise. Medication is required for acute cases.

Gestational diabetes: It occurs when blood sugar becomes high during pregnancy. Gestational diabetes tends to go away after childbirth, but the risk of type 2 diabetes increases later. Although Class A1 gestational diabetes can be managed with diet and exercise, women with Class A2 gestational diabetes require medication.

General symptoms described in WebMD Includes increased thirst; very often feels hungry; frequent urination; unexplained weight loss; malaise; blurred vision; headache; red and swollen gums; slow healing of infections; tingling sensation in limbs And loss of consciousness.

There are many complications that result from diabetes, including hypoglycemia (blood glucose below 70 mg/dL), hyperglycemia (blood glucose above 180-200 mg/dL), neuropathy, glaucoma, etc. ..

People with diabetes lack a strong immune system to fight the new coronavirus. Reduced insulin output affects immunity and makes the body more susceptible to infections and other chronic health problems.

People with diabetes tend to have less than average blood flow, making it difficult for the body to carry nutrients to protect itself from infection and to help the healing process. Diabetes also says that it keeps the body in a low level of inflammation, which slows the healing response to infections. Medicine today..

High blood sugar and persistent inflammation can make it difficult for people with diabetes to recover from conditions like COVID-19.

When a person inhales a droplet containing a virus, SARS-CoV-2 gets into the nose and throat. The nasal cavity is rich in angiotensin converting enzyme 2 (ACE2) and normally helps regulate blood pressure. ACE2 is the entrance of coronavirus to cells. The virus infects cells by attaching to the surface via the receptor ACE2. This is facilitated by the sugar coating of both ACE2 and the virus.

Once inside the cell, the virus takes over the cell’s function and uses it to replicate rapidly. The new copy will invade more cells. At this point, if the immune system is unable to suppress the virus, it will travel through the trachea to the lungs.

The lung tissue is flooded with ACE2, making the patient’s condition worse, which makes it a good place (sometimes called Ground Zero) for the coronavirus to launch an attack. At this point, the situation can be serious and the infection can cause a cytokine storm, a potentially deadly overreaction from the body’s immune system.

ACE2 is also found in the pancreas and other organs, but it is less dense than in the lungs.

Adam M. Bluffski, a professor of medicine at the University of Pittsburgh, Journal of Medical Virology The severity of COVID-19 infection is affected by viral glycocalyx and ACE2 receptor levels in lung tissue. Therefore, hyperglycemia not only increases the number of ACE2 receptors in the lung, but also increases the concentration of glycocalyx. COVID-19 Ideal condition for virus invasion.

People with diabetes can avoid serious complications from COVID-19 if their blood sugar levels are properly controlled. Fluctuations in blood glucose increase your risk because your body’s ability to fight infections is compromised.

Because COVID-19 is a viral infection, it can increase inflammation, or internal swelling, and cause more serious complications.

A sudden increase in sugar levels in the blood is the body’s response to inflammation, infection, or trauma. This is a stress reaction that results in higher than normal blood sugar levels. Medicine today..

Therefore, the human body needs to produce extra insulin during an illness. However, stress prevents the body from releasing insulin and allows glucose to make blood. Sustained stress leads to higher sugar levels.

Viral attacks are stressful enough for the body to respond with extra sugar output. But in many cases, especially in cases reported from Mumbai, India, the sugar spike in COVID-19 is temporary. And now doctors are studying these patients to see if they will develop type 2 diabetes later in life.

Brufsky writes that U.S. doctors report that many COVID-19 patients in their hospitals are not only diabetics and pre-diabetics but also go unnoticed to hyperglycemia. conversation..

This temporary spike in sugar was also seen in SARS (due to another coronavirus) patients, he said.

Doctors at the Mumbai Municipal Hospital argue that the sugar spike in patients is not an undiagnosed case of diabetes.

Perhaps the observations of Mumbai-based endocrinologist Shashank Joshi have some clues to this phenomenon. “Patients not only have high glucose levels, but elevated pancreatic enzymes,” Joshi said. Indian era..

This is thought to be due to the presence of many ACE2 receptors in the islet cells that make insulin in the pancreas. When coronavirus infects these cells, it stops producing insulin, causing temporary diabetes.

When there is more insulin, there is less sugar. This means that the ACE2 receptor is low and the ACE2 receptor is low in sugar, which reduces the chance of the virus entering the cell. This may be the reason why doctors tell patients with COVID-19 to avoid sweet foods.