Non-communicable Diseases

The unholy union between diabetes and COVID-19

Single and ambitious.

A 34-year-old banker in senior management

Loves her tipple.

Lives for road trips and exotic destinations.

Covid-19 positive.

Diagnosed with diabetes Type 2.

Nothing could have prepared Triza for the last two statements by the doctor. The medical pronouncement brought her to her knees, sending her into a world of confusion before she faced reality.

Being diagnosed with diabetes which is mostly associated with persons older than her by a decade or two, sent her into a phase of denial.  But she was determined to take up the dual diagnosis with a gallant heart, and pancreas too.

Admitted for three weeks in hospital to stabilise her blood sugars and monitor her lungs, Triza resolved that much of her recovery depended on her emotional connection and her will to live.

And following the doctor’s advice too.

She was lucky that she didn’t need to be on a ventilator.

During admission, she learnt more about self-administering the daily insulin shots, keeping her plate clean health wise, the importance of a stress-free life and regular physical activity.

A COVID-19 and diabetes diagnosis

But how can COVID 19 trigger a diabetes diagnosis?

Consultant physician at the Aga Khan University Hospital Dr Erick Njenga explains that the association between diabetes and COVID-19 has now being closely studied.

Some of the patients who are COVID-19 positive are likely to develop high blood sugar due to the direct distractive effects of the coronavirus on the pancreas, which is responsible for insulin production.

This therefore leads to elevated blood sugars and a diagnosis of new onset diabetes secondary to COVID-19 infection which may now be considered as a distinct sub-set of diabetes. Some individual who develop diabetes as a result of COVID-19 may be required to use insulin long-term and some may only use tablets.

“We will need long-term follow-up of these patients to establish whether this type of diabetes will disappear with time,’ said Dr Njenga.

Photo by Mykenzie Johnson on Unsplash

What is diabetes ?

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar.

The risk of severe illness and death from COVID-19 complications is higher in persons living with diabetes. There is a growing concern on the increased number of persons globally, and Kenya too, who are unaware they have diabetes.

“We have a large undiagnosed diabetes and pre-diabetes burden in Kenya which is as high as about 75 %  ,” said Dr Njenga. Pre-diabetes is defined as a condition when your blood sugar level is higher than it should be but not high enough for your doctor to diagnose diabetes.

Dr Erick Njenga Physician and Senior Instructor at Aga Khan University School of Medicine

Scientific studies have also shown that coronavirus infections have a huge effect on the management of diabetes mellitus because they aggravate inflammation and alter immune system responses, leading to difficulties in managing blood glucose to the recommended range.

The World Health Organisation advises that persons with diabetes should be creative while staying safe to adhere to the mainstay of diabetes management which is to ensure the recommended physical activity and observe a healthy diet. Vaccination is also encouraged for persons with diabetes who are a priority group in the COVID-19 vaccination programme.

“The health systems should also ensure that persons with diabetes have access to their medicines and other health services,” said Dr Gojka Roglic from the World Health Organisation. Dr Gojka  further notes that Type 1 diabetes has a higher risk than type 2 of severe COVID illness and death.

In a research paper published in November 2020 by Soo Lim from Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, and colleagues in Nature Journal found out that COVID-19 might also predispose infected individuals to high blood glucose, also known as hyperglycemia.

Titled, ‘COVID-19 and diabetes mellitus: from pathophysiology to clinical management,’ the researchers also found out that patients with diabetes were also twice likely to develop blood clots

“Patients with diabetes mellitus are already in a high-risk category for a thromboembolic event or stroke. To prevent such complications, patients with diabetes mellitus who are at risk of SARS-CoV-2 infection should try not to be sedentary for long periods, as regular physical activity is associated with decreased incidence of  formation of blood clots,”

“Instead, these individuals should try to engage in physical activity to improve blood circulation. Appropriate simple exercises for performance at home (ankle rotations and calf massage) are available and effective,” read excerpts of the study.

According to Dr Njenga who is also a senior instructor at the Aga Khan University Hospital School of medicine, the treatment of COVID-19 in diabetes has the primary aim of maintaining good blood sugars with the fasting sugars in the range of 5 -7 mmol-per litre and the two-hour after-meal sugars between 5 to 10 mmol-per litre.

Our major concern in the treatment of COVID-19 in persons with diabetes is ensuring good sugar control throughout the duration of treatment especially with the use of steroids in the setting of moderate to severe COVID-19,” said Dr Njenga.

The major complication that can occur in the setting of COVID-19 and diabetes is high sugars leading to acid build-up, also known as diabetes ketoacidosis. The treatment protocol for diabetes ketoacidosis differs from the non-diabetic patient where less aggressive fluid management is adopted. This is to prevent build-up in the lungs which could lead to breathing distress culminating in the person ending up on ventilatory support.

The basics of training of patients, their families and caregivers on how to manage diabetes has also been greatly impacted by the COVID-19 pandemic.

“We now heavily rely on the nurse in the ward to provide patient education during admission and on virtual meetings with the nutritionists and also adopted videos and tele-consults to provide the much-needed awareness,” Dr Njenga added.

Dr Njenga adds that insulin is still the backbone of treatment in the management of diabetes though there are other patients who will only use other medicines or adopt lifestyle changes. The duration of insulin use after a COVID-19 diagnosis is a case-by-case discussion with the diabetologist.

Diabetes can also have further complications on your sight. It can lead to vision loss due to the damage of the network of blood vessels supplying the retina, a  condition known as diabetic retinopathy. A longer-term effect of diabetes is that the lens of your eye can go cloudy, a condition known as a cataract.

From the sickness, came Triza’s chance to rise above both diabetes and COVID-19 to conquer it with wisdom, science and the determination to stay alive.

It came with a lifestyle change too but in all, she is glad to be alive.



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