Diabetes and the Coronavirus
29 Apr 2020 • 1 comment
According to Diabetes UK, 3.9 million people are currently living with a diabetes diagnosis in the UK, with almost a million more people who don't know they have it, bring the total up to more than 4.8 million. Type 2 diabetes accounts for more than 90% of cases. The NHS has stated that insulin-dependent diabetic patients (who no longer secrete insulin) as well as those with complications of diabetes (neuropathy, nephropathy, cardiovascular disease, etc.) are at high risk of developing a serious form of the COVID-19 infection.
What explains this risk? How can we protect ourselves? Should we fear a shortage of anti-diabetic medications? Let us answer all your questions!
Why does my diabetes put me at greater risk of complications?
According to Professor Lyse Bordier, Head of the Diabetes Department at Begin Military Hospital in Paris, diabetic patients have weaker immune system defences than healthy patients. Their bodies therefore defend themselves less well in the event of contamination by SARS-CoV-2 (coronavirus) and they can develop a serious form of the infection.
Poorly controlled diabetes leads to more frequent hyperglycaemia, which also affects the organs and immune defences, leading to possible complications in the event of infection.
This risk is even greater if you have comorbidities, i.e. other conditions associated with your diabetes, such as high blood pressure and other cardiovascular problems, being overweight or obese.
A study published in the American Journal of Respiratory and Critical Care Medicine on patients treated in hospital in China between January 9 and February 15, 2020, showed that the majority of patients who died from complications of the infection were men around 50 years of age who had high blood pressure or diabetes (without specifying which type of diabetes).
Can COVID-19 worsen my diabetes?
Professor Bordier points out that the coronavirus infection can also worsen diabetes in a stable patient. Indeed, hospitalised diabetic patients may have an increased insulin requirement for insulin-dependent patients, or may require a switch to insulin therapy for patients treated with oral antidiabetic drugs such as METFORMIN, GLUCOPHAGE, AMARYL or DIAMICRON.
There are several hypotheses, according to Professor Bordier, regarding this destabilization of diabetes caused by the virus. However, due to the lack of hindsight on the pandemic, none of them has been scientifically proven for the time being.
The hypotheses are as follows:
- Blood sugar levels can be destabilised by the mechanisms of the infection.
- SARS-CoV-2 could have a direct impact on organs such as the pancreas and liver, resulting in impaired insulin secretion.
Is there a different risk depending on the age of diabetes patients?
Regardless of the chronic condition, and whether or not the patient has a chronic condition, the risk of developing complications with COVID-19 increases with age. The older you are, the less effective your immune system is in protecting you against infection.
Therefore, older diabetic patients are more exposed to this risk.
Is prediabetes a risk factor for complications?
As a reminder, prediabetes is defined as fasting blood sugar level from 100 to 125 mg/dL (5.6 to 7.0 mmol/L). Pre-diabetes can be observed before the transition to type 2 diabetes (fasting blood sugar level > 126 mg/dL (7.0 mmol/L)), and can also be reversed by diet and lifestyle adjustments.
Although you do not have hyperglycaemia in the prediabetes stage, this state of higher-than-normal blood sugar levels may put you at risk of destabilising your blood sugar concentration in the event of coronavirus infection. This may result in temporary insulin-dependent type 2 diabetes during the period of infection.
Due to lack of data, it is unclear whether the infection can also lead to a transition from prediabetes to long-term diabetes after recovery.
How can I keep my diabetes stabilised in spite of the lifestyle changes that the lockdown entails?
Professor Bordier, as well as Diabetes UK offer some helpful advice, such as:
- Reinforce your self-monitoring of your blood sugar levels to make sure your diabetes is stable.
- Have enough insulin, medication and diabetes to "last" two weeks - keeping a sufficient supply of insulin is clearly important, but you should also make sure to have enough equipment and monitoring supplies (test strips, lancets, infusion sets, syringes, catheters, reservoirs or pods, extra batteries, Glucagon, etc.)
- Keep up a daily form of physical activity, even if it is moderate. Diabetes UK has a few recommendations here.
The NHS fitness studio offers a wide variety of fitness guides and videos of all types (from yoga and Pilates to aerobics and weight training) for beginners to experts, it is a great place to start. The NHS also recommends the free fitness app iPrescribe Exercise, which creates a 12-week personalised exercise plan based on health information entered by the user.
- Know what to do in case of an imbalance in your blood sugars (hypoglycaemia in particular): make sure to brush up on ketones (and diabetic ketoacidosis (DKA)), correction bolus, etc.
- Have the emergency numbers available: 111, 999, the number for your diabetes clinic, the medical and technical on-call numbers if you use an insulin pump, etc.
- Maintain a therapeutic relationship with your GP or diabetes specialist, if possible through teleconsultation, to avoid serious complications specific to diabetes. It is also essential to continue necessary cardiovascular treatment and follow-up as well as follow-up for your diabetes, podiatry, ophthalmology or nephrology.
- Avoid going to hospital or the clinic for testing (where there is a potential risk of contamination) unless your doctor tells you that the test is urgent and obviously necessary. If you have any questions about your examinations and tests, do not hesitate to ask your doctor. In any and all cases, respect the isolation measures and barrier gestures.
I have a wound on my foot: can I defer my care?
Expert clinicians from Foot in Diabetes UK has developed pathway guidance to enable patients with diabetes to be taken care of quickly and to limit the risks of complications due to a delay in care, which can lead to serious hospitalisation.
If you think you need emergency podiatric care (wound, abnormal lesion, etc.), contact your usual podiatrist or your GP who will assess the urgency of your situation and refer you, if necessary to the emergency unit in your area.
Are there concerns about a shortage of diabetes medications?
There is no evidence that diabetes medications (insulin and others) may be in short supply. Similarly, there are currently no shortages of supplies for medical devices.
The Government has been working with industry and partners to monitor the impact of coronavirus on the UK supply chain of medicines and technology and put in place measures to protect UK patients. These efforts will help to ensure an uninterrupted supply of crucial medicines like insulin for NHS hospitals treating coronavirus patients.
How do I find support on Carenity?
Carenity currently has thousands of patients and relatives of patients affected by type 1 and type 2 diabetes. On the platform, you can find support from other members of the community. It is important to help each other, especially in this difficult time of COVID-19 pandemic. Join our current discussions below!
- Type 2 Diabetes and the Coronavirus - questions, concerns, precautions?
- Type 2 Diabetes and the coronavirus - should I stop working?
- Type 1 Diabetes and the Coronavirus - questions, concerns, precautions?
- Diabetes and the coronavirus - what is the risk?
Contacts and useful sites
- Diabetes UK is the leading charity for people living with diabetes in the UK, tackling the diabetes crisis through prevention, campaigning for and supporting those affected by diabetes, and funding research for a cure.
- The Juvenile Diabetes Foundation (UK) (JDRF) is the world's leading charitable funder of type 1 diabetes research; funding research to cure, treat and prevent type 1 diabetes. They provide information and give a voice to children, adults and parents living with the condition, at all stages from diagnosis and beyond.
- NHS Eatwell Guide - The Eatwell Guide
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Take care and stay safe!