COVID-19 double whammy for diabetics


By Henrylito D. Tacio


The coronavirus disease 2019 (COVID-19) infection is a double challenge for people with diabetes.  The pandemic was first reported in Wuhan, China late last year and it spread quickly to other parts of the world.

“In China, where most cases have occurred so far, people with diabetes had much higher rates of serious complications and death than people without diabetes,” the American Diabetes Association (ADA) reports.

“Generally, we believe that the more health conditions someone has (for example, diabetes and heart disease), the higher their chance of getting serious complications from COVID-19,” ADA contends.

In the Philippines, an estimated 7.3 million people have diabetes, with 3.5 million of them diagnosed and the remaining ones undiagnosed.  In fact, the country is touted to be a “diabetes hotspot.”

The prevalence of diabetes in adults is 6.2%.  Every 6 seconds, studies show, one person dies of diabetes complications.  “Diabetes is the sixth leading cause of death among Filipinos,” says the Department of Health (DOH), the country’s leading public health government agency.

With COVID-19, more Filipinos with diabetes are expected to die.  “People with diabetes are more susceptible to infections, even if we are not in the middle of a pandemic,” Dr. Hajira Dambha-Miller, a British specialist in diabetes, told The Daily Mail.  “Diabetes leads to greater susceptibility to infection because there is more sugar for bugs to grow on and chronic inflammation means the immune system is slower to clear it.”

In the Mail feature, Dr. Dambha-Miller said that it’s harder for the immune system physically to get to the virus.  “The virus bugs do a lot of damage before the immune system even realizes it’s there,” she said.  “When the body does kick in, it won’t work as it should do.  The immune cells are damaged because they’ve been saturated in sugar for years and don’t work the way they should.”

Doctors, however, said diabetics would have better COVID-19 outcomes if they managed their condition properly.

“Your risk of getting very sick from COVID-19 is likely to be lower if your diabetes is well-managed,” ADA states in its website, diabetes.org.  “When people with diabetes do not manage their diabetes well and experience fluctuating blood sugars, they are generally at risk for a number of diabetes-related complications.”

Unfortunately, people with type 1 diabetes are more likely to die of COVID-19 than those with type 2 diabetes, says a study released by the by National Health Service (NHS) England.

“People with type 1 diabetes are three-and-a-half times more likely to die if they catch COVID-19 than non-diabetics, while type 2 diabetics are twice as like to die as non-diabetics,” wrote Denis Campbell, health policy editor of The Guardian, of a feature based on the NHS study.

Campbell described type 1 diabetes as “the autoimmune form of the disease” while type 2 diabetes is a form “closely linked to being overweight.”  In England, almost one in three of all deaths from COVID-19 among people confined in hospital have been associated with diabetes, the study found out.

“This research shows the extent of the risk of coronavirus for people with diabetes and the different risks for those with type 1 and type 2 diabetes,” said Prof. Jonathan Valabhji, NHS England’s national clinical director for diabetes and obesity and the study’s lead author. “Importantly, it also shows that higher blood glucose levels and obesity further increase the risk in both types of diabetes.”

“Diabetes is a lifelong condition that occurs in individuals who may not have enough insulin produced in the body or who does not respond properly to insulin (a hormone released from the pancreas),” explains Dr. Maria Princess Landicho-Kanapi of the Philippine Center for Diabetes Education Foundation, Inc.

Actually, there are two forms of diabetes.  Type 1 diabetes (also known as insulin-dependent diabetes) is caused by a reduction in the level of insulin.  The body’s immune system destroys the insulin-producing cells in the pancreas, causing insulin deficiency.  As a result, individuals with this type of diabetes need regular insulin injections to maintain glucose control.

In contrast, type 2 diabetes (also called as non-insulin-dependent diabetes) arises in the first instance not because there is a lack of insulin, but because the body fails to respond to circulating insulin effectively.  This condition is known as insulin resistance.  For this reason, newly diagnosed individuals do not require insulin injections.

“If you look at the spread of the scourge around the world, Type 2 diabetes occurs as a country advances technologically, when people come out of the fields to sit behind desks,” notes Dr. Irwin Brodsky, director of the Diabetes Treatment Program at the University of Illinois in Chicago.

The International Diabetes Federation (IDF), an umbrella organization of over 230 national diabetes associations in 170 countries and territories, urges people with diabetes to take necessary precautions to avoid being infected with SARS-CoV-2, the coronavirus that causes COVID-19.

All the standard precautions to avoid infection that have been widely issued to the general public – like frequent hand washing, wearing face mask, physical distancing, and covering coughs and sneezes with a tissue or elbow – must be strictly followed and observed.

ADA also urges to pay attention to potential COVID-19 symptoms.  The most common symptoms are fever, dry cough, and tiredness.  Less common symptoms include aches and pains, sore throat, diarrhea, conjunctivitis, headache, loss of taste or smell, and a rash on skin, or discoloration of fingers or toes.

The serious symptoms are difficulty breathing or shortness of breath, chest pain or pressure, and loss of speech or movement.  On average, it takes 5-6 days from when someone is infected with the virus for symptoms to show, however, it can take up to 14 days.

“Older people and people with pre-existing medical conditions (such as diabetes, heart disease and asthma) appear to be more vulnerable to becoming severely ill with the COVID-19 virus,” IDF states.  “When people with diabetes develop a viral infection, it can be harder to treat due to fluctuations in blood glucose levels and, possibly, the presence of diabetes complications.”

When sick with a viral infection, ADA says people with diabetes face an increased risk of diabetic ketoacidosis (DKA).  “DKA can make it challenging to manage your fluid intake and electrolyte levels – which is important in managing sepsis,” ADA explains.  “Sepsis and septic shock are some of the more serious complications that some people with COVID-19 have experienced.”

People with diabetes who feel like they are developing some of the symptoms mentioned earlier, they need to call their doctor.  When they call, ADA suggests that they have their glucose and ketone reading available, keep track of their fluid consumption and report, cleared on the symptoms (like nauseated or just a stuff nose?), and inquire on how to manage the diabetes.

However, if the person with diabetes has develop the serious symptoms, he or she needs to get medical attention immediately.

With COVID-19 still far from being beaten, doctors are urging people with diabetes to manage their condition well.  “People who are already have diabetes-related health problems are likely to have worse outcomes if they contract COVID-19 than people with diabetes who are otherwise healthy, whichever type of diabetes they have,” ADA stresses. – ###

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