Well with more than one and half years of Covid 19, our understanding of the effects and complications it can cause on the human body is evolving.
Covid19 and Diabetes are Bidirectional:
The relationship between Covid-19 and diabetes is bidirectional. We know as diabetes is a risk factor for poor outcomes in Covid-19, severity (ICU) as well as mortality (Death). Form the yesteryears of diabetes being a risk factor for Covid-19 clinical course and outcome, now we are seeing a new set of metabolic issues, new Diabetes!
There are various studies that point to the same from the USA, CHINA, and the UK.
Directly or indirectly by reduced exercise, food issues, isolation stress, etc., it may cause new-onset diabetes. Let's look at few mechanisms.
Diabetes because of Covid-19: New onset/post-Covid / Covid triggered diabetes.
There may be various reasons for it. One there is a good possibility that a person who gets Covid-19, may have it attacking directly on the beta cells of the pancreas (The organ on the left side of the abdomen, its work is to produce insulin). This can cause an increase in glucose (sugar) and thus Diabetes. Other mechanisms are indirect, like an increase in cytokine and the enormous inflammatory response Covid-19 virus elicits the one it infects. Problems of the intestinal luminal lining may be a factor in diabetes causation. Also, as we all know steroids, oxygen and anticoagulation form the mainstay of treatment in moderate to severe Covid-19, in some patients with an already existing (pre-existing) diabetes may just be unmasked after the use of steroids. (Commonly steroids used for Covid-19 are: dexamethasone, methylprednisolone).
To add, Asian Indians have a genetic predisposition towards diabetes, and a person with Covid-19 may already have diabetes prior to infection. This can be easily checked by doing a test called an HbA1c or the glycated hemoglobin test. When the value of HbA1c is > 6.5 at or before having Covid-19, these are not corona triggered. These are considered diabetes diagnosed incidentally at the time of infection.
Just a note, while maximum cases are seen post covid are of type 2 diabetes although there are minute chances of type1 diabetes case, these are extremely rare.
How to Manage Covid triggered Diabetes:
The good part is whether it's a mild, moderate, or severe infection with Covid-19, it’s treatable and controllable. Just as we would treat any other type, 2 diabetes patients. When to check? It's important to note that all patients of Covid-19, may be tested for diabetes on admission or at diagnosis if in isolation or quarantine, during hospitalization, increase testing if steroids are started, and on the follow-up to check for new-onset diabetes. May be checked monthly post-recovery, to uncover this as a post-Covid complication. Look for new-onset weight loss, thirst, hunger, frequent urination, tiredness as these may be symptoms of new or sudden onset diabetes post-Covid. What to do? Have meals on time, at regular exercise only as tolerated, avoid heavy meals, avoid weight gain, sleep a minimum of 7-9 hours, meditate, and take medicines on time if at all you need them as advised by your endocrinologist. In most cases, post-Covid diabetes gets controlled and settles with lifestyle management, some may need treatment in the form of tablets, while a few may need term insulin to control and get over acute and emergencies.
To summarize, Covid-19 triggered diabetes is a rapidly evolving science, apart from its other complications, diabetes stands one of the most vital, and is salvageable! Do talk to your endocrinologist about diabetes reversal. Prevention or reduction in severity and mortality of Covid-19, by way of immunization, is also a crucial step in preventing Covid-19 triggered diabetes. Thus, even though it’s treatable, it's best to prevent Covid-19, by mask, distance, hygiene, and vaccine to prevent Covid-19 triggered diabetes.
(Dr. Altamash Shaikh, Consultant Endocrinologist, Diabetologist and Metabolic Super specialist, Masina Hospital)
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