COVID-19 & Its Impact upon Diabetic Patients

Diabetes is an appalling disease with an increased risk factor due to Covid-19. In such dynamic and distressful times, it becomes integral for us to be extra cautious and vigilante towards our loved ones suffering from diabetes.

It, therefore, becomes important for us to understand:

  • What diabetes is? 
  • The probable reasons it may occur. 
  • What are the different types of diabetes? 
  • The different lines of treatment required.
  • What precautions must be taken to safeguard diabetic patients, especially during this pandemic?

 

Our Medical Advisor Dr. Vivek Sharma is here to answer all these questions for you! And that’s not it, you can check out our detailed blog to understand the close proximity between COVID & Diabetes

Introduction:

The word “Diabetes” comes from ancient Greek and it means “excessive passing of urine”. The first known mention of Diabetes comes from an Egyptian physician named Hesy-Ra in 1552 BC. In ancient India, people used ants to detect whether a person was Diabetic or not. If ants came near the urine of a person, the person was considered diabetic. Hence came the term “Madhumeh” which means urine that is sweet as honey, this is because the urine passed by a Diabetic contains glucose (in common language we call it sugar instead of glucose).

In India, Diabetes has become a major health problem. According to “WHO Diabetes Countries Profiles 2016” India had less than 5% prevalence rate of Diabetes in 1980 that has increased to 7.8% in 2016. This means that 7.8% of the Indian Population was suffering from Diabetes in 2016. Another survey conducted by the Indian Government in 2019 mentioned that 11.8% of people aged 50 years and above in India were Diabetic.

These Diabetic patients are at increased risk of contracting infections as their immunity (the ability of the body to fight against microbes) is low and moreover it is difficult to control that infection in them because an excess of glucose (or sugar) in the blood acts a source of nutrition for the microbes. Diabetics are at higher risk of death if they contact COVID-19 versus healthy individuals. So what should be done?

About the disease:

Before reaching there let’s first try to understand the disease. All humans need some essential substances for growth, survival, and reproduction; we call them nutrients. Nutrients needed by humans include carbohydrates, proteins, fats, vitamins, minerals, fiber and not to forget water. Among them, carbohydrates are mainly used by the body to provide energy; although fats and proteins can also provide energy. The carbohydrates breakdown in our body and get converted to glucose. This glucose provides us with the energy needed to carry out our body functions. Our brain primarily uses glucose as a source of energy. However, this glucose must be taken up by our body cells from the blood in order to release energy from it.

Here comes the role of Insulin; a hormone (chemical messenger) released by an organ named Pancreas present in our body just below our ribs. Insulin enables the body cells to take up glucose and then use it for energy. First, the Insulin goes and binds to the body cells at a particular seat known as a receptor; this allows the opening of a gate, and glucose can move inside the cell. Some minimum level of Insulin is always present in our blood but the main release of Insulin happens when we eat; obviously to help us use the glucose present in the food.

Reference: Genetic Home Reference. Your guide to understanding genetic conditions. Available from: https://ghr.nlm.nih.gov/condition/type-2-diabetes#sourcesforpage Cited 28th May 2020

In some individuals the insulin is not produced or inadequately produced by the Pancreas; these people need Insulin from outside. This condition is known as Type 1 Diabetes. But this is very less common. The major health burden is due to Type 2 Diabetes. Type 2 Diabetes is not gifted by god to us but it is a self-created problem (although genetics also play some role in it). Sedentary lifestyle, eating junk food, lack of exercise, stress, smoking, lack of proper sleep, fat around the tummy all are responsible for this self-created problem. Earlier it used to develop in old aged people; now it is developing even in young adults. An early state of Diabetes known as Pre-Diabetes is found even in teenagers nowadays.

In Type 2 Diabetes, our Insulin production is normal, sometimes even more than normal but our body cells fail to respond to Insulin and the gates for glucose don’t open (this is known as Insulin Resistance). To compensate for it, the pancreas produces more Insulin; but as the disease progresses even the pancreas is not able to produce enough insulin to match the resistance of the cells.  Now, when the glucose is not taken up by the cells, it remains in the blood; eventually, the unused glucose has to be excreted out through the urine. This causes the problem of excessive urination, which eventually results in increased thirst. Also since the cells can’t utilize the glucose, the body feels tired and we feel more hungry, we tend to eat more and the vicious cycle continues.

There are some long term complications of Diabetes as well. The excess glucose in our blood gets converted to a molecule called Sorbitol that deposits in our eyes, nerves, and kidneys and decreases their functioning over a period of time. Tingling and numbness in nerves, cataracts of eyes, and kidney failure can result.

Reference: Very Well Health. Available from: https://www.verywellhealth.com/how-do-i-know-if-i-have-insulin-resistance-2616646 Cited 28th May 2020.

Increased risk to Diabetic Patients

Diabetics are at high risk of developing serious illness including the need of an ICU if infected by SARS-CoV 2 (Name given to Corona Virus, while the disease is called COVID-19). Among the various reasons for this phenomenon are

  • Reduced immunity of Diabetic Patients
    • High blood glucose provides a favorable environment for the microbes to grow including Corona Virus
    • Also, high blood glucose prevents the action of the body’s immune cells against the microbes
    • Diabetics suffering from COVID-19 may suffer from other bacterial infections simultaneously, thus increasing the risk of death
  • Direct damage to Pancreas by the Corona Virus, hence less Insulin production and more blood glucose (vicious cycle continues)
  • Diabetes causes increased clotting (thickening) of the blood. Thickened blood can interrupt the blood supply to the Heart and can cause Heart Attack.
  • Inflammation caused by high blood glucose (sugar). It is just like the body is burning from inside.

Quick Tips to Take Care of a Diabetic Patient during COVID-19

  • Use all precautionary measures to prevent exposure to Corona Virus ( we all know about them)
  • Keep an adequate supply of all Diabetes medicines that you may need, including Insulin, at home.
  • Keep a Glucometer at home with all its accessories (strips, needle, swab, etc)
  • Regularly check blood glucose levels and maintain a diary of it. {It should fall between a below-mentioned range
    • Fasting- 80 mg/dl to 130 mg/dl
    • Postprandial (2 hours after meals)-Less than 180 mg/dl (American Diabetes Association)
  • Always lookout for symptoms of low blood glucose – restlessness, fatigue, sweating, increased heartbeat, giddiness. Whenever this happens, immediately take some toffee/chocolate/sugar/sweets, etc to bring it back to normal. Low blood glucose is more dangerous as the brain will not get glucose and the patient may go in coma.
  • Maintain adequate hydration. This is very important because if you are dehydrated then your respiratory secretions become thick and it becomes difficult to clear the lungs; the risk of pneumonia increases.
  • Take diet rich in protein and low in simple carbs (avoid bread, juices, cold drinks, biscuits, etc). Also, avoid oily food. A high protein diet will help in reducing weight and improving lipid metabolism; the risk of heart attack reduces. Bitter Guard, Mulberry, Garlic, Jamun Seeds (Java Plum), Fenugreek, and Giloy (Tinospora) are considered good in Diabetics.
  • Don’t overwork, avoid stress, and sleep well. Stress acts on body hormones and increases blood glucose levels; stress reduces immunity as well.
  • Exercise daily for about 90 minutes (at least walk). Moderate exercise helps in reducing Insulin Resistance.
  • Manage your blood pressure and cholesterol levels. Taking Garlic and Cinnamon helps in controlling blood cholesterol levels.
  • Quit smoking. Nicotine in cigarettes has an adverse effect on Insulin production and action. Also, smoking will reduce lung function. Corona Virus also adversely affects lung function. Ultimately the chances of respiratory failure increase.
  • Keep emergency numbers handy and don’t hesitate or delay in contacting your doctor in case you face any problems

By taking proper care and staying alert we can reduce the deaths due to COVID-19. This too shall pass!!!

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