Updated on August 11, 2022.
Early in the pandemic, it became clear that having diabetes increases the risk for severe COVID. But mounting research shows this relationship is a two-way street. Having COVID could not only make diabetes tougher to manage, but also increase the risk for diabetes in people who do not already have the condition—even kids.
One large March 2022 study published in The Lancet Diabetes & Endocrinology suggests the risk rises along with the severity of the infection, but even mild COVID cases may increase the likelihood of developing diabetes for up to a year.
For the study, researchers examined the medical records of more than 180,000 people who were diagnosed with COVID more than a month earlier. These records were compared to those of two similar groups: two million pre-pandemic patients and two million who did not have COVID. The researchers found that those infected with COVID were roughly 40 percent more likely to develop diabetes for up to a year than the non-COVID groups. Most of the cases involved type 2 diabetes, which occurs when the body either doesn’t produce enough insulin or becomes resistant to it.
But research shows COVID is also tied to a higher risk for type 1 diabetes, which occurs when the immune system damages the pancreas, making it unable to produce insulin.
An April 2022 study of more than 27 million people in the United States published in PLOS ONE found those who were diagnosed with COVID were 42 percent more likely to develop type 1 diabetes than those who were not infected.
Type 1 diabetes can affect anyone, but it typically develops in kids, teens, or young adults. The researchers pointed out the risk for the condition post-COVID was highest among very young children, but also higher among older adults. They also noted differences across race and ethnicity. American Indian/Alaskan Native, Asian/Pacific Islander and Black people were more likely to be diagnosed than other groups.
An earlier January 14 CDC report also revealed that people younger than 18-years old with COVID are more likely to be newly diagnosed with diabetes more than 30 days after their infection than those without COVID and those who had acute respiratory infections before the pandemic began.
This begs the question: Why?
There may be many factors involved. Some of these new diabetes cases may simply have occurred in people with prediabetes—a condition which already affects 96 million U.S. adults and one in five U.S. teens.
People with prediabetes have higher than normal blood sugar levels and they are already at increased risk for going on to develop type 2 diabetes.
Another possible explanation: COVID could have increased diabetes risk indirectly. Excess body weight is a risk factor for severe COVID infection as well as diabetes. And over the past few years, the healthy eating and exercising habits of many Americans suffered during the pandemic.
One October 2020 study published in Frontiers in Endocrinology estimated that pandemic isolation was linked to a 33 percent decline in physical activity and a nearly 29 percent jump in sedentary behavior.
In a separate September 2021 report, the CDC cautioned that school closures, disrupted routines, increased stress, and fewer opportunities for physical activity and healthy eating has resulted in weight gain, particularly among kids and teens. Younger children and those who were already overweight when the pandemic began were among those with the largest increase in body mass index (BMI), the agency revealed.
COVID harms insulin-producing cells
COVID could also increase diabetes risk directly by attacking cells in the pancreas. The virus invades human cells when its spike protein latches on to receptors called ACE2 (angiotensin converting enzyme 2).
ACE2 is present in many organs, including the lungs and heart, making them vulnerable to COVID infection. Insulin-producing cells in the pancreas also highly express ACE2. These cells can be directly attacked and damaged when the coronavirus invades. This can disrupt the production of insulin—a hormone that helps move sugar from the blood into cells where it can be used as energy.
How to protect yourself
Everyone should take precautions to prevent the spread of COVID. This includes being fully vaccinated and getting a booster as soon as you’re eligible.
Keep a mask on hand and wear it when you’re in crowded settings with poor ventilation, particularly indoors. Wash your hands well and often with soap and water and avoid touching your face with unclean hands.
It’s important to monitor yourself or your children in the weeks following COVID infection to ensure your symptoms are resolving. Be aware of these possible signs of new onset diabetes:
- Having to urinate more frequently
- Extreme thirst
- Fatigue
- Changes in your vision
- Cuts or bruises that take longer than usual to heal
- Extreme hunger—even if you are eating the same amount or more food
- Unexplained weight loss
- Pain, loss of feeling, or tingling in your hands or feet
Young children who have developed type 1 diabetes, for example, may suddenly become increasingly tired, drink excessively, need to urinate much more often, and lose weight. Unusual nighttime accidents or bed-wetting are also possible signs of diabetes. In some cases, children with type 1 diabetes are diagnosed once they reach diabetic ketoacidosis (DKA), or when their blood sugar becomes dangerously high since they have no insulin to transport it into cells. At this point, their body is breaking down muscle and fat for energy, which triggers the production of byproducts called ketones. When ketones build up in the blood, it can be deadly.
Symptoms of type 2 diabetes, on the other hand, may develop more gradually. In some cases, there are few or no warning signs.
People who have symptoms of diabetes should see their healthcare provider who can use a blood test to make an accurate diagnosis. Those with warning signs of DKA should seek immediate medical attention as this is a life-threatening health emergency.
