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Why COVID-19 is Riskier for People With Diabetes

Why COVID-19 is Riskier for People With Diabetes

If you have diabetes, take these steps to help protect yourself from infection and serious complications.

Updated on May 6, 2020 @ 1:30pm EST.

Living with diabetes already requires a lot of mental energy, and the COVID-19 pandemic adds even more concern. The coronavirus that causes the disease, SARS-CoV-2, was identified back in January 2020. How this virus affects the body is still under investigation, but scientists have learned that people with chronic underlying health issues, including diabetes, are at greater risk for severe COVID-19 and related complications.  

Having diabetes doesn’t necessarily make you more likely to become infected. But it does increase your risk for a more serious infection that requires hospitalization if you do become sick.   

An April 2020 review of 30 existing studies found that diabetes is a risk factor for severe COVID-19 and death from the disease. The researchers found that the risk for acute respiratory distress syndrome (ARDS) was 4.6 times greater among those with diabetes, and their risk of death was 2.1 times higher.

Properly managing your condition, however, could not only help protect your long-term health but also help reduce your risk for COVID-19-related complications, according to a May 2020 study published in Cell Metabolism.

For this study, researchers in China identified 952 people with COVID-19 who also had type 2 diabetes. Overall, the patients with diabetes needed more medical treatment when hospitalized for COVID-19. But the study also showed that the COVID-19 patients whose diabetes was well-managed had fewer complications and better outcomes than those whose blood sugar levels were not under control.

Why blood sugar levels matter
Generally, viral infections can increase inflammation in people with diabetes and lead to blood sugar spikes that are more difficult to control.

"With any infection, diabetes control can suffer," says Robert Eckel, MD, president of medicine and science for the American Diabetes Association, and professor emeritus at the University of Colorado School of Medicine, Anschutz Medical Campus in Aurora, Colorado.

There are a few reasons why this is concerning. High blood sugars can interfere with the immune system’s ability to fight infection. It’s possible that they could even create an environment that would enable SARS-CoV-2 to thrive.  

“If people with diabetes have uncontrolled glucose, they are at higher risk for complications from a viral infection,” says Karl Nadolsky, DO, a spokesperson for the American Association of Clinical Endocrinologists and a clinical endocrinologist at Spectrum Health in Grand Rapids, Michigan.

Over time, consistently having higher than normal blood sugar levels can interfere with the response of your immune system—specifically white blood cells that help fight infections,” Dr. Nadolsky explains.

A 2018 paper published in the Journal of Diabetes Research suggested that diabetes or obesity were not only associated with the improper functioning of white blood cells, but also greater production of inflammatory molecules called cytokines.

Normally, cytokines help coordinate the body’s response to infection. But in some cases, this response can range out of control, doing more harm than good. This so-called cytokine storm can damage the blood vessels and organs and lead to blood clots, which may help explain why some people with COVID-19 develop more serious complications.

Managing diabetes-related complications
When people with diabetes get a viral infection, their risk for potentially deadly diabetes-related complications also increases.

One possible complication is diabetic hyperglycemic hyperosmolar syndrome, which occurs when the kidneys get rid of extra blood sugar through the urine, leading to dehydration. Once a patient becomes dehydrated, the kidneys are no longer able to get rid of the extra sugar, allowing it to accumulate to extremely high levels in the blood. The amount of salt, sugar and other substances in the blood also becomes more concentrated, which pulls water out of vital organs, including the brain.

The risk for DKA (diabetic ketoacidosis) also increases. DKA occurs when the body lacks enough insulin to usher sugar from the blood into cells where it can be used for energy. As a result, the body begins to burn fat for energy, which produces chemicals called ketones. As these ketones accumulate in the blood, it becomes more acidic.

DKA is dangerous on its own but if you have COVID-19, it can also make it more difficult to manage complications associated with the disease, including sepsis.

Diabetes also increases the risk for a slew of other serious health issues, including heart and kidney disease as well as stroke. It’s possible that these diabetes-related conditions may also play a role in worse outcomes among people with COVID-19.

“There are a lot of underlying risks that patients bring in addition to their diabetes,” Eckel says.

How to protect yourself
Everyone should take precautions to prevent the spread of COVID-19. This includes staying home and going out only when necessary. If you do venture into public, wear a facemask and practice social distancing, keeping at least six feet of distance between yourself and others. It’s also important to wash your hands well and often with soap and water and avoid touching your face with unclean hands.

If you have diabetes, however, it’s also essential be vigilant about following your diabetes treatment plan and maintaining strict control of your blood sugar levels—checking it regularly or as often as your doctor recommends.   

Call your doctor if your blood sugar level stays above 250 mg/dL. If you have type 1 diabetes and your blood sugar rises above this level, you could be at risk for DKA.

It’s also important to keep your ketone levels down and avoid preventable trips to the emergency room during the COVID-19 pandemic.

Other precautions you should take:

Stock up on medical essentials. Make sure you have enough prescription medications to last for a prolonged period of time. Give yourself plenty of time to get refills. Ask your doctor about getting early refills or more than usual at one time, such as a 90-day supply.

It’s also important to have an adequate stock of essentials, such as glucose tablets and testing strips as well as syringes or insulin pen or pump supplies, including batteries and alcohol swabs, Nadolsky advises. Check with your pharmacy to find out if the items you need could be mailed to your home.

Adhere to your treatment plan. Do not stop taking any of your prescriptions unless your doctor instructs you to do so. This is true even if you’re taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). The American College of Cardiology, the American Heart Association, the Heart Failure Society of America and the European Society of Cardiology have all issued guidelines saying patients should not stop taking these drugs, pointing out that there is no evidence to suggest they could contribute to more severe cases of COVID-19.

Try to stick to your routine. Maintaining a healthy diet and keeping up with your exercise regimen can help keep your blood sugar levels in a normal range, Eckel advises. The immune system is better to able to fight infection when blood sugar levels are under control than when they are high, he adds.

Don’t skip your check-ups. As hospitals are working hard to meet the needs of COVID-19 patients, many people with other health concerns are avoiding emergency rooms for fear of exposure to the coronavirus. Meanwhile, routine check-ups have been cancelled or postponed. But if you have diabetes, it’s important to stay in touch with your doctor and keep all necessary follow up appointments.

Telemedicine has emerged as a valuable tool for doctors and patients during the pandemic. The ability to talk to your doctor and discuss your concerns virtually—or by video conference on your smartphone, tablet or computer—can help you manage your condition and avoid unnecessary exposure to SARS-CoV-2.

If you think you have COVID-19
Pay attention to your symptoms and don’t ignore or delay seeking help if you develop possible COVID-19 symptoms, such as fever, dry cough and shortness of breath.

If you suspect that you’re infected, call your healthcare provider right away. Your doctor will determine if you should be tested for COVID-19 and advise you on where that should be done.

Keep in mind, serious warning signs of COVID-19 warrant emergency medical attention. These reg flags include:

  • Difficulty breathing or shortness of breath
  • Persistent pain or pressure in the chest
  • Feeling confused
  • Bluish lips or face

If you develop these serious symptoms, call 911 and let the operator know. If you have a medical mask, put it on before help arrives.

Medically reviewed in May 2020.

Sources:
American Diabetes Association. “How COVID-19 Impacts People with Diabetes.”
Ian Huang, Michael Anthonius Lim, Raymond Pranata. “Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia – A systematic review, meta-analysis, and meta-regression.” Diabetes & Metabolic Syndrome: Clinical Research & Reviews. Volume 14, Issue 4, 2020.
Lihua Zhu, Zhi-Gang She, Xu Cheng, et al. “Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes.” Cell Metabolism. 2020.
Harvard Medical School. “What you need to know about COVID-19 if you have diabetes.”
International Diabetes Foundation. “COVID-19 and diabetes.”
T Zhou, Z Hu, S Yang, L Sun, et al. “Role of Adaptive and Innate Immunity in Type 2 Diabetes Mellitus.” Journal of Diabetes Research. Nov 8, 2018.
Qiming Wang, Peining Fang, Rui He, et al. “O-GlcNAc transferase promotes influenza A virus–induced cytokine storm by targeting interferon regulatory factor–5.” Science Advances. Apr 15, 2020.
U.S. National Library of Medicine. “Diabetic hyperglycemic hyperosmolar syndrome.”
American Diabetes Association. “DKA (Ketoacidosis) & Ketones.”
The National Institute of Diabetes and Digestive and Kidney Diseases. “Diabetes, Heart Disease, and Stroke.”
New England Journal of Medicine: Journal Watch. “ACE Inhibitors and ARBs During the COVID-19 Pandemic.”
American Heart Association. “Patients taking ACE-i and ARBs who contract COVID-19 should continue treatment, unless otherwise advised by their physician.”

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