What is Diabetes?
Diabetes
mellitus (DM), commonly known as diabetes, is a group of metabolic disorders characterized
by a high blood sugar level over a
prolonged period of time. Symptoms often include frequent urination, increased thirst, and increased appetite. If left untreated, diabetes can
cause many complications. Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic
state, or death. Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, damage to the nerves, damage to the eyes and cognitive impairment.
· Type 1 diabetes results from the pancreas's failure to produce enough insulin due to loss of beta cells. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes".The loss of beta cells is caused by an autoimmune response. The cause of this autoimmune response is unknown· Type 2 diabetes begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses, a lack of insulin may also develop. This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". The most common cause is a combination of excessive body weight and insufficient exercise.· Gestational diabetes is the third main form, and occurs when pregnant women without a previous history of diabetes develop high blood sugar levels.
Type 1 diabetes must be
managed with insulin injections. Prevention
and treatment of type 2 diabetes involves maintaining a healthy diet, regular physical exercise, a normal body weight, and avoiding use of tobacco. Type 2 diabetes may be treated with medications such as insulin sensitizers with
or without insulin. Control of blood pressure and maintaining proper foot and eye care are important for people with the disease. Insulin
and some oral medications can cause low blood sugar. Weight loss surgery in those with obesity is sometimes an effective measure in those with
type 2 diabetes. Gestational diabetes usually resolves after the birth of
the baby.
What is Corona virus?
COVID-19 (Coronavirus Disease-2019) is caused by the
coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2), which
has spread quickly to more than 160 countries across the world.
The spreading mechanism of the virus is primarily by
transmission of respiratory droplets between people. The incubation time is on average 6–8 days, followed
by 1–2 weeks of symptomatic disease. It is characterized by a wide spectrum of
symptoms including coughing, fever, myalgia and respiratory problems such as
viral pneumonia, and respiratory failure. In worst cases, these can lead to
death. Time from first onset to hospital admission has been on the
average 6–7 days. A proportion of
the infected are without symptoms (yet remain infectious) or have only mild
symptoms.
Relation between Diabetes and corona virus?
Early studies have shown that
about 25% of people who went to the hospital with severe COVID-19 infections
had diabetes. Those with diabetes were more likely to have serious
complications and to die from the virus. One reason is that high blood sugar
weakens the immune system and makes it less able to fight off infections.
Your risk of severe coronavirus infection is even higher if you also
have another condition, like heart or lung disease.
If you do get COVID-19, the infection could
put you at greater risk for diabetes complications like diabetic
ketoacidosis (DKA). DKA happens when high levels of acids called ketones
build up in your blood. It can be very serious.
Some people who catch the new coronavirus have a dangerous body-wide
response to it, called sepsis.
To treat sepsis, doctors need to manage your body's fluid and electrolyte
levels. DKA causes you to lose electrolytes, which can make sepsis harder to
control.
It is a fact that people with diabetes are at increased
risk of infections including influenza and for related complications such as
secondary bacterial pneumonia. Diabetes patients have impaired immune-response
to infection both in relation to cytokine profile and to changes in
immune-responses including T-cell and macrophage activation. Poor glycaemia control impairs several aspects of the
immune response to viral infection and also to the potential bacterial
secondary infection in the lungs. It is likely that many of the patients with
diabetes in China have been in poor metabolic control when infected by COVID-19.
Many patients with type 2 diabetes are obese and
obesity is also a risk factor for severe infection.
It was
illustrated during the influenza A H1N1 epidemic in 2009 that the disease was
more severe and had a longer duration in about twofold more patients with
obesity who were then treated in intensive care units compared with background
population. Specically, metabolic active abdominal obesity is
associated with higher risk. The abnormal secretion of adipokines
and cytokines like TNF-alfa and interferon characterise a chronic low-grade in
abdominal obesity and may induce an impaired immune-response. People with
severe abdominal obesity also have mechanical respiratory problems, with
reduced ventilation of the basal lung sections increasing the risk of pneumonia
as well as reduced oxygen saturation of blood. Obese subjects also have an increased asthma risk, and
those patients with obesity and asthma have more symptoms, more frequent and
severe exacerbations and reduced response to several asthma medications.
Lastly, late diabetic complications such as diabetic kidney disease and ischemic
heart disease may complicate the situation for people with diabetes, making
them frailer and further increasing the severity of COVID-19 disease and the
need for care such as acute dialysis. Some findings indicate that COVID-19
could cause acute cardiac injury with heart failure, leading to deterioration
of circulation.
The most
frequent comorbidities to COVID 19 are hypertension and diabetes. Both diseases
are often treated with angiotensin-converting enzymes (ACE) inhibitors.
Coronavirus binds to target cells through angiotensin-converting enzyme 2
(ACE2), which expressed in the epithelial cells in the lungs, blood vessels and
in the intestine. In
patients treated with ACE and angiotensin II receptor blockers, expression of
ACE2 is increased. Therefore,
it has been suggested that ACE2 expression may be increased in these two groups
of patients with hypertension and diabetes, which could facilitate infection
with COVID-19 and increase the risk of sever disease
and fatality.
How to avoid?
The best way to avoid getting sick
is to stay home as much as you can. Under the Americans With
Disabilities Act, people with diabetes have the right to "reasonable
accommodations at work." That includes the right to work from home or take
sick leave when you need it.
If you have to go out, keep at least 6 feet away from other people, and
wear a cloth face mask. Wash your hands or use hand sanitizer often while
you’re out and when you get home.
Also wash your hands before you give
yourself a finger stick or insulin shot. Clean each site first with
soap and water or rubbing alcohol.
To protect you, everyone in your house should wash their hands often,
especially before they cook for the family. Don't share any utensils or other
personal items. And if anyone in your house is sick, they should stay in their
own room, as far as possible from you. They should wear a cloth face mask
when you have to be in the same room.
How to treat diabetes if suffering from covid?
Poor glycaemic control is a risk factor for serious infections and
adverse outcomes. However, the reverse is also true and the risk of infection,
including bacterial pneumonia, can be reduced through good glycaemic control.16 The problem is that infections cause loss of
glycaemic control, and treatment of hyperglycaemia is difficult during
intercurrent disease with fever, unstable food intake and use of drugs like
glucocorticoids in patients with respiratory problems. To maintain optimal
glycaemic control requires more frequent blood glucose monitoring and
continuous change in antidiabetic treatment after the measured glucose levels.
In patients with type 2 diabetes, metformin and SGLT-2 inhibitors with
moderate to severe illness should be stopped. Dipeptidyl peptidase 4 (DPP-4)
inhibitors and also linagliptin can be used in patients with impaired kidney
function without risk of hypoglycaemia. Sulphonylureas may induce hypoglycaemia
in patients with low calorie intake. The long-acting GLP-1 receptor agonist
which reduces appetite in sparse-eating patients and with a half-life of 1 week
cannot be stopped from day to day. In many patients with type 2 diabetes,
insulin treatment will be preferred and need to be initiated, which is
complicated because of the limited time for instruction and titration of
insulin. Patients already treated with basal insulin will need fast-acting
bolus insulin to correct hyperglycaemia. Hospitals have experience and
algorithms for the treatment of patients during intercurrent disease, but the
time involved for treating labile glycaemic control is a major problem in
situations where time is short.
In patients with type 1 diabetes treated with basal bolus or insulin
pump therapy, the insulin doses should be titrated using frequent glucose and
ketone monitoring to avoid hypoglycaemia in patients with reduced food intake,
and adding correctional bolus of fast-acting insulin to avoid severe
hyperglycaemia and ketoacidosis.
Taken all together, patients with diabetes are a high-risk and
complicated group of patients to treat for COVID19, with an increased
requirement of hospitalisation. Patients with diabetes need intensive attention
to reduce the risk of fatalities. Patients with diabetes should follow the
general prevention advice given by the authorities thoroughly to avoid
infection with COVID-19.
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