TORONTO – Among all the manifestations and complications of COVID-19, another puzzling question arises: does the virus trigger cases of diabetes?
Like many doctors around the world, Dr. Mihail Zilbermint in the middle of the pandemic something strange.
More and more people suddenly seemed to get diabetes.
“My team usually manages 16 to 17 or 18 patients with diabetes a day,” Zilbermint told CTV News. “And our number rose to 30 a day.”
Zilbermint is an Endocrinologist and Associate Professor at the John Hopkins School of Medicine in Maryland. The sudden change is surprising and worrying.
The diagnosis of diabetes also came as a shock to John Kunkel, who lives in Arkansas and had just recovered from a severe case of COVID-19 when he discovered that his pancreas was no longer producing enough insulin, which prompted him to take daily blood sugar tests and metformin forced to manage his diabetes.
Kunkel tested positive for COVID-19 in late June 2020.
He texted his doctor immediately after discovering that he had lost his sense of taste. When he got to the doctor’s office, he already had a fever of 101 degrees.
“At 7:30 am that night I was in the emergency room with a 103.5 fever,” he said. “So at 11 am I really lost my taste and was in the hospital at night with a very high fever.”
His fever was worryingly high for almost two weeks. He’s been to the emergency room five times.
In July, the situation worsened while he was recovering.
“I will never forget the day,” he said. “It was July 30th when I had blood tests.”
When his results came back it was clear that there was a problem with his blood sugar.
“So it’s like,” hey, you have diabetes, we need to start treating it right away, “because it was so high,” said Kunkel.
“A lot of it was, you know – why? I didn’t have it before. And it was the big question the doctors would just ask: They really don’t know. “
Doctors around the world are now sharing similar case reports of sudden onset diabetes following COVID-19 infection and finding that the link is strongest in patients hospitalized with the virus.
“We can clearly see that people without a history of diabetes get diabetes,” said Dr. Remi Rabasa-Lhoret of the Montreal Clinical Research Institute told CTV News. “It is very likely that COVID-19 will cause the disease.”
Studies suggest that up to 14 percent of COVID-19 patients can suddenly develop diabetes.
“We have seen this with influenza and other infections […] But the extent of what we see with COVID-19 is beyond what we are used to, ”said Rabasa-Lhoret.
People with diabetes are already at higher risk of serious consequences if they contract COVID-19, and now the virus may put people at higher risk of developing diabetes – a link made in an article in New England Journal of Medicine as “a two-way relationship. “
Why is this happening? Doctors and researchers are investigating, but a specific reason has not yet been pinpointed.
Among the theories is that this could be a side effect of a steroid used to treat COVID-19.
Zilbermint said that patients who develop complications from COVID-19 are often given a steroid drug called dexamethasone.
“[It’s] Our standard therapy for people with low oxygen levels and the side effect of this drug is high sugar or diabetes, ”he said. “So it’s possible that the drugs they’re using to treat COVID also add to an increased risk of developing diabetes.”
Kunkel said he had been on steroids for a full month and now he’s not sure if this contributed to his diagnosis.
“I had three rounds so that could have increased and caused,” he said. So there are all of these really unknowns. “
There is also evidence that the novel coronavirus itself could affect the body in ways that would cause them to develop diabetes.
“There are some suggestions that COVID-19 could get directly into the cells that make insulin in the pancreas and damage them,” Rabasa-Lhoret said.
Zilbermint added that the virus could potentially change the way cells metabolize glucose themselves.
The acute onset of diabetes was also reported more frequently in patients with SARS a decade ago, he said: “Compared to patients without SARS pneumonia, […] which I think is important to mention. “
Another thought is that maybe the infection makes people who are at risk of developing diabetes diagnosed earlier.
“It is possible that [a] The patient has lived with pre-diabetes for many years and didn’t know that, ”said Zilbermint. “Now they have COVID-19 infection and the infection is driving them to develop diabetes.”
Kunkel has thought of that.
“It could be that I was on the verge of developing diabetes and COVID-19 actually pushed it over the edge,” he said.
Some doctors wonder if this is even a new form of diabetes.
In type 1 diabetes, the patient’s immune system destroys beta cells that produce insulin.
However, COVID-19 patients who develop diabetes may also have the insulin resistance that occurs with type 2 diabetes. (Insulin resistance is when cells are “resistant” to the hormone insulin and therefore cannot use glucose. The pancreas produces more insulin and blood sugar spikes.)
Some doctors believe that the sudden onset of diabetes after COVID-19 infection may be a novel condition that includes both type 1 and type 2 diabetes.
“The main question is, will this be temporary or will it be permanent?” Rabasa-Lhoret said. “And in the short term we don’t know.”
It’s the questions that haunt patients like Kunkel and the doctors who treat those patients.
However, work is being done to figure out what is going on and how best to treat patients.
“A number of endocrinologists and diabetes experts around the world are researching this,” said Zilbermint.
“For example, my colleagues at King’s College in London and the UK have already set up a robust database where all researchers, clinicians and doctors can submit information about their patients to a global registry.
This new global database will try to collect all cases to understand if the coronavirus infection really has another bad side effect.
“I am sure that more research studies will emerge from this register in the coming months,” said Zilbermint.