IssueNov 21Opinion

COVID-19 and Diabetes: What is The Relationship?

With the increasing rise of incidence of diabetes, people must shed the ‘Oh nothing will happen’ attitude. An insight by Dr V Mohan, Chairman & Consultant Diabetologist, Dr Mohan’s Diabetes Specialities Centre

People with diabetes are generally prone to all infections. Some data suggests that people with diabetes are also more prone to COVID-19 but this is not certain. What is known is that uncontrolled diabetes can lead to a worse prognosis in those with COVID-19. In other words, the presence of diabetes can make COVID-19 worse. Hence, people with diabetes should take particular precautions concerning COVID-19, as they already have a slightly immuno- compromised state.

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COVID-19 and Diabetes Mellitus
The relationship between COVID-19 and diabetes mellitus is complex and bidirectional. On the one hand, diabetes mellitus is perceived to be one of the key risk factors for a severe attack of  COVID-19. This is because uncontrolled diabetes triggers a hyper-immune response called a ‘cytokine storm’ which can lead to severe damage of several organs in the body. Conversely, severe COVID-19 infection, especially if treated with steroids, can have a specific negative impact on diabetes itself, leading to worsening of hyperglycemia through increased insulin resistance and reduced B-cell secretory function. There is also a view that COVID-19 can damage the pancreatic beta cells and produce diabetes, but this still needs more evidence.

Several factors that are present in people with diabetes are likely to contribute to a worse prognosis of COVID-19. These include a proinflammatory and hypercoagulable state, hyperglycemia and underlying comorbidities (hypertension, cardiovascular disease, chronic kidney disease and obesity). However, it has been our own experience, that if their diabetes is well controlled, people with diabetes also do well. Indeed, hundreds of my patients with diabetes have had COVID-19 without any complications, whatsoever.

Special precautions for people with diabetes
It is most important to keep one’s blood sugar under good control. Any infection is likely to increase blood sugar levels and uncontrolled diabetes can further lead to worsening of the infection. Increased testing of the blood glucose levels with a glucometer or using continuous glucose monitoring (CGM) may be necessary. There are small sensors that can be placed on the arm which can monitor one’s sugar levels throughout the day and night. If the blood sugar levels are found to be very high, it’s imperative to consult your doctor and get your sugar levels
under good control as well as quickly as possible to reduce the risk of severe Covid related complications.

Unless one has the severe insulin requiring type of diabetes, wherein the sugar levels tend to go very high and signs of ketosis or diabetic ketoacidosis (DKA) develop, it is generally not necessary to get admitted to the hospital. One needs to follow all the usual precautions like washing your hands with soap and water regularly and maintaining ‘social distance’, i.e. keeping a distance from people who are likely to be infected. Although spreading the infection through a needle used for blood glucose testing or insulin injections is highly unlikely, it is better not to share one’s blood testing lancet or insulin needles with anybody else.

Can people with diabetes take covid vaccination?
People with diabetes can safely take the covid vaccination and indeed they should receive priority for the vaccination. Hundreds of my patients with diabetes have taken both doses of the vaccine and have had no side effects. Hence, if you have not yet had your Covid vaccine shots, please do it immediately.

The ‘Black Fungus’ menace

One of the terrible aftermaths of the second wave of Covid-19 in India was an unexpected increase in a severe fungal infection called mucormycosis or black fungus. This is a deadly fungus infection that can destroy the nose, eyes and can even be fatal. It was seen that almost 80 per cent of mucormycosis occurred in those with uncontrolled diabetes. This is another reason why diabetes has to be kept under good control.

Can usual medicines for diabetes be continued?
If the COVID-19 is mild and if you are confined to your home, please continue your antidiabetic medicines as usual. If the diabetes is severe and uncontrolled, or the Covid-19 is severe and you are hospitalised, you will most likely be started on insulin. This is because, for treatment of severe COVID-19, steroids are usually given which can profoundly increase your sugar levels. Usually, this can only be tackled by giving insulin, at least till the steroids are stopped.

India Perspective
India is often referred to as the ‘Diabetes Capital of the World’, as it accounts or 17 per cent of the total number of diabetes patients in the world. There are currently close to 80 million people with diabetes in India and this number is expected to increase to 135 million by 2045. While there are several health conditions that Indians are combating, diabetes is one of the most important. This was clearly shown by the COVID-19 pandemic where it was those with comorbidities like diabetes who had worse outcomes including the dreaded mucormycosis or the black fungus.

People need to realise that with the kind of fast and stressful life they lead today, there is a dire need to detect diabetes early and control it well. They should also remember that diabetes may not produce any symptoms at all. Hence an annual check-up to rule out diabetes is mandatory.

And it’s not just about diabetes. It’s the various complications that diabetes could lead to, that is more worrisome. Diabetes is one of the main causes of blindness, kidney failure, cardiovascular diseases and peripheral vascular diseases. Around 50 per cent of deaths due to cardiovascular disease, is due to diabetes.

With the increasing rise of incidence of diabetes, people must shed the ‘Oh nothing will happen’ attitude. Doctors and healthcare institutions should also increase awareness about the ‘silent killer disease. What needs to be communicated is that by good control of diabetes, people can have a long and healthy life even after having diabetes for 60 or 70 years.

Looking Ahead
Do not be afraid of COVID-19, even if you have diabetes. All you have to do is to take the usual precautions and keep your diabetes under control. The majority of my patients with diabetes have fully recovered after getting COVID-19. The treatment for COVID-19 as also dramatically improved in the last few months. Moreover, if you are vaccinated, COVID-19 can behave just like a common cold.

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