COVID – 19 and Diabetes – What You Need To Know

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Not everyone who contracts COVID-19 has a severe illness. Most patients end up with mild disease that is no worse than the simple flu.

However, a few people who have certain risk factors have worse disease than others. I have listed these risk factors in the table below –

Here, I will talk about diabetes and its relation to the severity of COVID. This will be a short article, unlike some of my long-winded ones.

Diabetes And COVID-19

Those who have diabetes or constantly high blood sugars have a 2 to 4-fold higher risk of complicated COVID compared to those without. This is mostly because people with diabetes have a low immunity, and their ability to fight the COVID virus is very poor.

Why Is COVID-19 More Serious In Diabetes?

I am going to get a little technical here, keeping it as simple as possible, so bear with me.

Within the cells of the lung tissue are receptors called Angiotensin Converting Enzyme-2 receptors, or ACE – 2 receptors. They are also present in the kidney and the pancreas.

Normally, ACE-2 is responsible for the conversion of angiotensin-2 to angiotensin 1-7 and 1-9. Angiotensin 2 by itself is harmful, and this conversion has a protective effect on the lung, preventing serious lung infections.

In those with diabetes, there exists an enzyme called Furase that circulates in higher levels in the blood. This is a ‘cleavage enzyme’, meaning it splits the ACE-2 receptors, allowing the COVID virus to enter it.

The COVID virus attaches to the ACE-2 receptors. 

This means angiotensin 2 is no longer converted to its protective form, leading to lung injury that is seen in COVID infection. 

But that’s not all.

Having diabetes means your immune system is not as strong as it is supposed to be. Instead of powering up cells that have anti-inflammatory effects, the weakened immune system is bombarded by compounds and cells that increase inflammation. 

The higher the blood sugars, the worse the inflammation. This can have a detrimental impact on all vital organs. 

Worse Markers In Test Results

Those with diabetes who get infected with COVID infection have very abnormal blood reports.

For example, markers such as CRP, D-dimer and IL-6 can be quite high, indicating severe infections.

Markers indicating damage to the heart muscle were more elevated, indicating cardiac involvement in diabetic patients with COVID.

Chest CT scans can also show worse lung involvement compared to those without diabetes. 

COVID Can Worsen Diabetes

I have just discussed how COVID-19 virus enters the ACE-2 receptors. The ACE-2 receptors have the capability of entering the cells of the pancreas, damaging them.

This can lead to an increase in blood sugar levels, sometimes to dangerously high levels requiring ICU care.

I have personally seen glucose levels exceed 600 mg/dL in some patients.

These patients end up needing insulin infusion into their body through a pump.

Can COVID-19 Cause Diabetes?

I have seen a few patients who have been treated for COVID-19 infection successfully develop diabetes soon after.

Does COVID-19 infection lead to diabetes?

It is not very clear.

Some data suggests that a COVID-19 infection can lead to type I diabetes, albeit temporarily. This means that your sugar levels will be high, and the only treatment that will work will be insulin.

It is believed to be due to the virus attacking the pancreas, as I have mentioned earlier.

In some patients, it is possible that they were developing diabetes and were unaware of it. They only found out when they were undergoing blood tests when being treated for COVID-19 infection.

Individuals who are obese are often predisposed to diabetes. By contracting COVID-19, along with steroid treatments that are sometimes given to treat the infection, it is possible that blood sugars start to go up.

Finally, some patients may have ‘prediabetes’ – a condition where the blood sugars are only slightly high, but not high enough to be classed as diabetes. When infected with the virus, prediabetes becomes diabetes due to the stress the infection creates within the body.

When the virus affects the lung, a complex series of events takes place in the body that makes it resistant to the effects of insulin. This is called insulin resistance, and it is a precursor to the development of diabetes.

The high blood sugars in COVID infection is usually short lived, and resolves once the infection has been completely treated. That being said though, the high blood sugars can also affect the cells within the pancreas responsible for insulin production, causing some degree of damage.

There are other immune mechanisms through which Sars CoV-2 virus can lead to diabetes. However, it is a little too complicated to discuss them here, and I will therefore refrain from doing so. 

Any Drugs To Avoid In Diabetes?

As such, most of the treatment we prescribe in diabetes management is safe and effective even in the presence of COVID.

In hospitalised patients or patients who are on steroids, blood sugar levels can shoot through the roof. Such patients may require insulin for a short duration.

One drug that is avoided (or stopped) if affected by COVID is SGLT-2 inhibitors. These include drugs such as Empagliflozin, Canagliflozin and Dapagliflozin. They can cause a small amount of damage to the kidney, and in the presence of infections can sometimes precipitate a condition called Diabetic Ketoacidosis (a serious condition).

Never stop medicines of your own accord. Always consult your doctor before doing so.

Managing Diabetes During COVID

The treatment of COVID infection is complicated, with only a few showing real benefit.

If you are affected by the virus, your diabetes management will not really change as much.

You should still follow the same dietary advice your doctor has given you. I understand that exercising might be harder, but walking briskly in your veranda or your house itself can be helpful in lowering your blood sugars.

Remember that patients who have controlled blood sugar values have better outcomes than those whose sugars have been poorly controlled. In other words, if your sugars are well controlled, chances are you will not have a serious COVID illness.

Watch what you eat. Stress eating is a problem when stuck at home, and can lead to unhealthy choices. 

Mental stress can worsen sugar levels, but taking the right precautions can still keep it under control.

If you are concerned about your sugars going out of control, contact your doctor. Telemedicine has picked up well over the last 6 months, and is likely to stay.

Vaccination

There is no question about it. Take the vaccine.

Closing Remarks

Diabetes is a risk factor in the development of severe COVID infection. Better blood sugars control is an essential step to take to reduce your risk of succumbing to the illness.

Dr Vivek Baliga B
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5 Comments

  1. Very informative article. Thank you Dr. Vivek. Kindly talk about the impact of substance use, especially tobacco & alcohol on COVID cases outcome. Have come across a meta analysis of 11,189 patients which indicates a 50% increase in mortality. am mailing it to you separately. Thanks once again

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