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December 22, 2020 Tuesday 10:54:37 AM IST

Living with Covid & Diabetes

Health Monitor

Diabetes is among the most prevalent non-communicable disease affecting the health of millions of people around the world. International Diabetic Federation (IDF) data showed that in 2019, 463 million adults (20-79 years age group) were living with diabetes across the world with 4.2 million deaths due to the disease. India is known as the ‘diabetic capital of the world’ with an estimated 77 million people having disease.

It is a major public health problem with majority of those affected by the disease (one out of two persons) not knowing that they are having it. Lack of awareness about the disease and poor glycemic control in those diagnosed with diabetes makes it a big challenge especially in the background of a pandemic like Covid -19.
Covid-19, a novel Corona Virus Disease caused by severe acute respiratory syndrome corona virus 2 (SARS-COV2) has recently emerged as a threat for human kind. It was first reported from Wuhan City of China and then spreadingacross countries affecting Europe, USA, Asia and most of the countries in the world.  In March 2020, World Health Organization (WHO) declared Covid as a global pandemic.

Flu or Covid

It can cause severe pneumonia (infection of lungs) with other associated complications like kidney and heart failure or even death. It differs from influenza (flu) as it spreads more easily, takes longer time before affected person shows symptoms, can be contagious for longer period and cause more serious illnesses in some people. Another important difference is that there is a vaccine to protect against flu; but Covid -19 vaccine is still in the pipeline. As flu and Covid-19 have similar symptoms, testing for the disease may be needed to confirm the diagnosis.  Older adults and people who have severe underlying medical conditions like diabetes, heart or lung disease seem to be at higher risk for developing more serious complications from Covid-19 disease.

Most people affected by Covid -19 will experience mild-to-moderate respiratory illness and recover without requiring any special treatment.

Diabetes Risk

Among those with severe Covid-19 and those who died there was a high prevalence of diabetes. Diabetes per se does not seem to increase the risk of getting Covid-19 infection when compared to general population. Problem is that those with uncontrolled diabetes especially elderly population are more likely to have severe disease, admission to an intensive care unit or death compared to those who had good glycaemic control. The risk of death is up to 50% higher in patient with uncontrolled diabetes than those who do not have diabetes.

1.    Being immune suppressed results in poor response to infection and delayed recovery from illness.
2.    More chance of getting infection as pathogen like virus thrive in an an environment of elevated blood glucose.
3.    Presence of other risk factors like high blood pressure, high cholesterol, obesity, fatty liver disease etc.
4.    Cardiovascular disease like coronary artery disease, stroke and diabetic complications like diabetic kidney disease are common in longstanding diabetes which increases the risk of Covid-19 becoming severe.

Diabetic patients when hospitalized for Covid-19 had very high requirement of insulin to control hyperglycemia. They also had a higher risk of complication like diabetic keto acidosis and hyperosmolar hyperglycemia.

New onset diabetes was seen in those without family history of diabetes and normo glycemia. This lead to a speculation that viruses probably has the potential to cause damage to insulin producing Islet cells of pancreas, although this has to be verified in future studies.

Obese diabetes have particularly increased risk. Body mass index (BMI) is an important determinant of lung volume, respiratory mechanics and oxygenation during mechanical ventilation. Hence overweight or obese diabetes could be at specific risk of ventilator failure and complications during mechanical ventilation.

Thus weight reduction, balanced diet, increased physical activity, good glycaemic control and maintaining social distancing and precaution to prevent respiratory droplet infection are the cornerstone in the prevention of Covid-19 in those with diabetes.

High Risk Category

Age people 65 years and older and all ages with underlying medical conditions, particularly if not well- controlled, including
•    Diabetes
•    Chronic lung disease or moderate to severe asthma
•    Serious heart conditions
•    Chronic kidney disease undergoing dialysis
•    Liver disease
•    Those who are immune compromised
•    Severe obesity (BMI of 40 or higher)
•    Living in a nursing home or long-term care facility

Many conditions can cause a person to be immune compromised, including cancer and its treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications

General precautions

•    Avoid being exposed to this virus, by maintaining physical distance fromother people (recommended distance is 6 feet or 2 arm length)
•    Wash your hands often with soap and water (for at least 20 s) If soap and water is not available, use a hand sanitizer with at least 60% alcohol
•    Avoid touching your eyes, nose, and mouth with unwashed hands Practice good hygienic practices (eg, coughing or sneezing into one's own flexed elbow)
•    Avoid close contact with people who are sick
•    Cover your mouth and nose with a cloth face cover or mask when around others.
•    Clean and disinfect any objects and surfaces that are touched frequently One should not share food, glasses, towels, tools, etc., with another person
•    Specific precautions and recommendations (for people with diabetes) Have all relevant contact details (Doctor, nurse, hospital, emergency/ ambulance) ready
•    Pay extra attention to one's glucose control; regular monitoring can help avoid complications due to high or low blood glucose
•    In case of any flu-like symptoms (raised temperature, cough, difficulty breathing), it is important to consult a doctor (telephone and if sick visit nearby hospital)
•    Ensure sufficient and regular intake of water to maintain hydration
•    Ensure adequatestock of diabetes medications you need, at least for a few weeks
•    Make sure to have access to enough food
•    Make sure you will be able to act if blood glucose drops suddenly
•    Keep a regular schedule, avoiding any undue exertion/overwork and having enough rest and sleep
•    Ensure good nutrition by eating a varied and balanced diet to keep blood glucose levels stable and enhance immunity
•    Recommended foods are those with a low glycaemic index (e.g., vegetables, pulses)
•    Avoid any excessive consumption of fried foods
•    Limit consumption of foods high in sugar, carbohydrates, and fat

Dr Zacharia PS

Consultant – Endocrinology, Rajagiri Hospital, Kochi Read more articles..