Can COVID-19 cause diabetes?

Researchers suspect COVID-19 may trigger diabetes in otherwise healthy people.

A study published in The Lancet Diabetes and Endocrinology reported “damage to pancreatic beta cells (the cells that make insulin) may lead to direct damage to the function of the pancreas”.

“Although this has not been verified in humans, they suggest that diabetes might not only be a risk factor for a severe form of COVID-19 disease, but also that infection could induce new onset diabetes.”

Diabetes is a chronic condition that affects how the body metabolises sugar (glucose) – a major source of fuel for the body. Insulin is the hormone that regulates the movement of sugar into cells.

The Lancet study reported that Italian colleagues had observed “pancreas cell damage caused by the virus leading to insulin deficiency …” and “frequent cases of severe diabetic ketoacidosis (DKA) at the time of hospital admission.” DKA is a serious, often deadly complication of diabetes, when blood sugar is too high and there is a sharp rise in the level of acidic ketones in the blood.

The study recommends that COVID-19 patients without diabetes “be monitored for new onset diabetes that might be triggered by the virus”.

Co-author of the study, Monash University Professor Paul Zimmet, is co-chair of a group that has been advising the federal health minister on the government’s national diabetes strategy.

“We should consider everyone who gets sick with COVID-19 is also tested for diabetes,” Prof. Zimmet said. “They should be tested at the time they become ill as it clearly will influence their medical management and health outcome.”

According to the study, coronavirus patients already diagnosed with diabetes have a higher risk of “severe complications”, including organ failure, and the risk of death is “50 per cent higher in patients with diabetes than in those who do not have diabetes”.

The COVID-19 outbreak is a “double challenge” for people with diabetes, says Danish endocrinologist Sten Madsbad, from Hvidovre Hospital at the University of Copenhagen.

“It is a fact that people with diabetes are at increased risk of infections, including influenza and for related complications such as secondary bacterial pneumonia. Diabetes patients have impaired immune response to infection,” he wrote.

The International Diabetes Federation explains how diabetes complicates treatment: “When people with diabetes develop a viral infection, it can be harder to treat due to fluctuations in blood glucose levels and, possibly, the presence of diabetes complications. There appear to be two reasons for this. First, the immune system is compromised, making it harder to fight the virus and likely leading to a longer recovery period. Second, the virus may thrive in an environment of elevated blood glucose.”

Patients with diabetes often have other conditions, such as obesity and high blood pressure, increasing their risk from coronavirus. A report from the US Centers for Disease Control and Prevention found nearly half of hospitalised coronavirus patients had hypertension and/or obesity.

“People with diabetes are more prone to infections, and if they have infections, they’re more prone to poor outcomes,” Dr John Buse, the head of endocrinology at the UNC School of Medicine in Chapel Hill, North Carolina, told NBC news.

When blood glucose levels are too low or too high, it makes it more difficult for the body’s white blood cells to function effectively, said Dr Mary Vouyiouklis Kellis, an endocrinologist at the Cleveland Clinic.

“That’s when the immune system starts to go haywire,” Dr Kellis said. “The ability to fight infection is diminished.”

If you have diabetes:

  • People with diabetes are not more likely to get COVID-19 than anyone else. Diabetes patients face worse outcomes from the disease, not a greater chance of contracting the virus.
  • Go to the National Diabetes Services Scheme site, where there is information about temporary changes to the Continuous Glucose Monitoring initiative. You can get a starter kit sent to your house.
  • Keep an ample number of testing strips and other supplies on hand.
  • List all medications, including vitamins and supplements, and your dosage.
  • Have simple carbohydrates, such as honey and lollies, on hand to help keep blood sugar up.
  • Have all relevant contact details on hand.
  • Pay extra attention to your glucose control. Regular monitoring can help avoid complications caused by high or low blood glucose.
  • If you show flu-like symptoms (raised temperature, cough, difficulty breathing), consult a doctor. If you are coughing up phlegm, you might have an infection, so you should seek medical support immediately.
  • An infection will raise glucose levels and increase your need for fluids, so make sure you have enough water.
  • Be prepared in case your blood glucose drops suddenly.
  • If you live alone, make sure you have someone you can call on if you get ill.
  • Prioritise foods with a low glycaemic index (e.g. vegetables, whole wheat pasta/noodles)
  • Avoid eating too much fried food.

Are you following the research around COVID-19? Does it seem to you that there is so much more we need to know?

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Disclaimer: This article contains general information about health issues and is not advice. For health advice, consult your medical practitioner.

Written by Will Brodie

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