Diabetes and COVID-19 Staying Healthy During the Pandemic.

Living with diabetes can bring daily challenges, and the COVID-19 pandemic has intensified concerns in the diabetic community. Although diabetes doesn’t necessarily make someone more susceptible to catching the coronavirus, it can significantly increase the risk of severe illness if one does catch it, say the Centers for Disease Control and Prevention.

Diabetics who contract COVID-19 are more likely to be placed in the Intensive Care Unit (ICU) and intubated. And their risk of death from the coronavirus is 50 percent higher than it is for most other patients.

Understanding the Risk

For diabetics, moderating blood sugar is of course always essential. But it becomes even more critical during a pandemic.

Individuals with Type 2 diabetes often have several markers of metabolic syndrome (a combination of high blood sugar, high triglycerides, high blood pressure, and obesity), making the patient more likely in general to experience inflammation, blood clotting issues, cytokine dysregulation, and immune dysfunction. Add to that a coronavirus infection that causes many of the same issues and patients with both diabetes and COVID-19 become doubly vulnerable to ill effects, both short- and long-term.

Generally, patients with Type 1 and gestational diabetes don’t share the same level of complicating factors and risk as Type 2 diabetics and are less likely to experience issues with inflammation and clotting.

Studies have found that people of color have suffered disproportionately throughout the coronavirus pandemic. A study in The Journal of Clinical Endocrinology and Metabolism found that Black and Hispanic patients with diabetes were three times as likely to be infected with COVID-19, and twice as likely to die.

Research does not suggest that this is due to biological or genetic factors, but rather to dense living conditions, limited access to healthcare, and working in essential occupations, where risk of exposure is higher. If you are in one of these demographic groups, monitoring of your condition becomes even more critical.

Medications

Certain medications may also leave Type 2 diabetics more vulnerable to a severe case of COVID-19.

The cells of the heart, lungs, gut, and nasal passages are lined with a protein called angiotensin-converting enzyme 2, or ACE2. The coronavirus can potentially use this protein to gain access to our cells and reproduce. Drugs that help regulate ACE2 levels are commonly prescribed for blood pressure and to protect the kidneys of Type 2 patients—for example, ACE2 inhibitors such as enalapril, lisinopril, and ramipril, or angiotensin receptor blockers (ARBs) such as losartan, olmesartan, and valsartan.

Although these drugs are known to affect COVID-19 response, the connection is still being studied. However, until we have more data, it is not recommended that a patient discontinue any medications as prescribed by their physician.

Managing Glucose

If you are Type 2, any infection can make it more difficult to keep blood sugar in the desired range. COVID-19—no matter how mild the case—is no exception. For a patient feeling ill from the coronavirus, the ability and desire to eat and drink may be affected, impacting their blood sugar levels. Hormones released by the body to fight the coronavirus could raise their blood sugar as well.

If you are a Type 2 patient sick with COVID-19, your doctor may ask you to check and record your blood sugar more frequently. Drink plenty of fluids, eat as regularly as possible, and stay with your medication regimen.

Fortunately for the diabetic community, the current pandemic has not affected the availability of insulin, oral diabetes medications, or blood glucose testing equipment.

Ketoacidosis and COVID-19

Diabetic ketoacidosis (DKA) is a life-threatening complication that can occur when illness accompanies diabetes. When the body doesn’t have enough insulin, it breaks down fat for fuel. That process generates chemicals in the blood, known as ketones.

Ketone production is normal and rarely a significant concern for non-diabetics. But when ketones are generated too quickly, they make the blood acidic, which can cause loss of consciousness or even death.

If you are a Type 2 diabetic, your doctor may ask you to check your urine when you are sick, using test strips available at most pharmacies. Contact your healthcare provider immediately if the test is positive.

Diabetics with COVID-19

Many cases of COVID-19 go undetected because infection does not always cause symptoms. This is one reason the virus spreads so quickly. Testing positive for the coronavirus does not necessarily mean you will become sick, even if you have diabetes and metabolic syndrome. Of those who do test positive, about 80 percent experience mild to moderate disease.

But for a Type 2 diabetic who tests positive for COVID-19, it is vital to keep blood sugar levels within the desired range, monitor for symptoms of respiratory illness or low or high blood sugar, and keep in touch with a health care provider. It’s also important to isolate, so as not to spread the virus to others.

Blood sugar may need to be monitored more frequently than usual, and oral medications or insulin may require adjustment. The prescribing physician might temporarily discontinue SGLT2 inhibitor drugs, like canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin. These diuretic drugs increase urine output, which may contribute to dehydration and lactic acidosis (when lactic acid accumulates in the blood, causing weakness, nausea, vomiting, and even coma).

If you are diabetic, notify your care provider or come to the Emergency Department if you experience:

• Uncontrolled blood sugar
• Urine positive for ketones
• Nausea, abdominal pain, or vomiting
• Dehydration
• Shortness of breath
• Rapid breathing
• Fever greater than 100.4° F

Telehealth options are widely available to keep in touch with your provider if you contract a mild case of COVID-19 and your doctor recommends managing it at home.

At MedStar Washington Hospital Center

Some cases of COVID-19 may, of course, require hospitalization. If you are diabetic and are hospitalized to treat the virus at MedStar Washington Hospital Center, we advise that you bring your personal blood glucose monitor and a list of all your medications and dosages when you check in.

Upon your arrival, our team will assess the severity of your illness. Some patients are managed in the COVID-19 unit; more severe cases are assigned to the ICU.

Within a patient room, the diabetic patient will most likely be able to test blood sugar using their own meter. This reduces repeated exposure between patient and staff and helps to conserve personal protective equipment.

On the other hand, in the ICU, where insulin is delivered to the patient via IV, a nurse will check blood sugar levels every hour. Certain medications used to treat COVID-19 can cause blood sugar levels to go high or low and can slow wound healing, among other complications, so our team maintains a watchful eye on these conditions.

For patients who take metformin to treat their diabetes, use of the medication may be halted temporarily to avoid lactic acidosis. Its use may be continued when the patient is discharged.

Stay Safe and Healthy

Patients with well-controlled diabetes who are hospitalized for COVID-19 recover better, with a higher survival rate. So, it’s important for diabetics to stay disciplined about their blood glucose control and reduce the risk of COVID-19 complications. Regular monitoring of blood glucose levels, adherence to all medications, maintaining a healthy weight, and following up with a healthcare provider are key to staying as healthy as possible.

Over the past year of the pandemic, the team at MedStar Washington Hospital Center has gained considerable experience and knowledge in treating COVID-19—and that has saved lives.

If you are visiting us on-site during the pandemic, you have our assurance that the Hospital Center is a very safe place to be. And telehealth has provided a useful tool for our diabetic patients to have timely follow-up visits with us after we’ve seen you in person.

Our most important message to you? If you are diabetic and feeling symptoms of COVID-19, don’t delay care! We’re here to keep you healthy and safe.