It will increase the possibility if blood sugar stays high for weeks after recovery, he says, hey
Dr. Nikhil Tandon, Professor and Head of the Department of Endocrinology and Metabolism, AIIMS Delhi, speaks exclusively to The Hindu and explains the link between COVID-19 and the rise in blood sugar levels and its effects on patients.
Why do viral infections lead to increased blood sugar levels?
Any infection or febrile illness can raise blood sugar levels. It is essentially a result of the mechanism the body uses to fight the infection. In some cases, the drugs used to treat this infection can cause these increases in blood sugar levels.
If there is an increase in inflammation markers, an extreme example of this is the “cytokine storm” in COVID-19, this affects both the insulin release by the pancreas and the sensitivity of the tissue to insulin. Insulin facilitates the transport of glucose into the tissues and any malfunction (either in production or in tissue sensitivity) leads to an increase in the level of glucose in the blood.
In the case of COVID-19, a patient with moderate to severe illness may need to be given steroids, which can also cause the patient’s blood sugar levels to rise.
Is It Difficult to Treat COVID-19 Diabetic Patients?
In most cases, a person with well-controlled diabetes will respond to COVID-19 treatment in the same way as a non-diabetic. However, for people with long-standing and poorly controlled diabetes, or those with diabetic complications such as kidney or heart disease, treatment for COVID-19 can become more complex and disease progression can be more severe, requiring aggressive treatment, including the need for oxygen, ventilation, and intensive care .
Conversely, managing COVID-19 in such patients can make it more difficult to manage diabetes. For example, steroids, which are an important part of COVID-19 treatment, can make blood sugar control significantly worse. Therefore, patients with diabetes invariably require treatment with intensive insulin regimens.
In addition to steroid therapy, there are many other factors during the illness that contribute to this spike in blood sugar, such as changes in a patient’s diet. Then the stress of the illness and a patient’s inability to adhere to the normal diet and exercise regimen can also lead to high blood sugar levels.
Can COVID-19 cause diabetes?
Diabetes is an asymptomatic disease in most people, so there could be a large number of people who may not be aware of their diabetes before they contract COVID-19. There are studies that suggest that in countries with limited resources, up to 50% of people with chronic diseases like diabetes go undiagnosed. Some patients, even if they know they have diabetes, either cannot afford medical care or are not coping well with the disease, resulting in only about 1 in 8 people with diabetes having optimal blood sugar levels.
Then there are people who may have had a tendency to develop diabetes, and COVID-19 has caused what is known as stress hyperglycemia. In some patients, it may be a combination of stress hyperglycemia and drugs, such as steroids, that can cause blood sugar levels to rise. Finally, there is an ongoing discussion about the possibility that COVID-19 disease itself could cause emerging diabetes in a patient.
In theory, COVID-19 can also cause diabetes because the pancreas has ACE2 receptors that can allow SARS CoV2 to enter the beta cells of the pancreas, causing structural and functional damage. However, we need more data to support this.
So when can we say that COVID-19 caused diabetes?
At the time of COVID-19, if we do a test called HbA1c, which shows us the average glucose for the last three months, and if those levels are elevated, it means the person had diabetes before they became infected with COVID-19 . If the HbA1c level was normal, we should re-measure blood sugar levels after the COVID disease subsides and stopping steroid therapy (if used) – blood sugar levels return to normal if either the disease itself or steroid therapy has contributed to the increase in blood sugar.
If blood sugar remains high for weeks after recovering from the acute illness or stopping the steroids, or both, the chances are that COVID caused the diabetes.
And how does this knowledge help doctors treat their patients?
This test helps doctors know if the elevated blood sugar levels in a COVID-19 patient are temporary, caused by the reasons we discussed, or require long-term treatment for the disease. In the first case, once the person recovers from COVID or the steroids are stopped, blood sugar levels return to normal. These patients do not need medication to control their blood sugar levels after their recovery.
What precautions should a diabetic take when contracting COVID-19 to protect themselves?
Diabetes can cause complications in the kidney, heart, and eye. Such patients need to be much more careful and make every effort to keep their blood sugar levels under control. You need to be very careful about your diet, exercise, and medication.
Since such patients are at a higher risk of developing severe COVID-19 illness, the most important thing they should do is get a vaccine. Vaccination greatly reduces the likelihood of serious illness and mortality.
If a diabetic becomes infected with COVID-19, the person should immediately notify a doctor who can decide on the line of treatment.
