A new research paper published in the International Journal of Endocrinology and Metabolism has now warned of the onset of diabetes post-Covid-19 in some people without any blood sugar issues, or family history irrespective of Body Mass Index (BMI) and age. The research paper’s author, Dr Rujuta Katkar, mentioned a series of observations among eight patients aged between 36 and 74 years, reported MidDay. These patients, according to Dr Katkar, had no medical history or even family history of diabetes but developed it after Covid-19. Indianexpress.com reached out to experts to understand how common is diabetes in Covid-19 patients, which is being termed as Covid diabetes.
“Yes, we have been seeing increased incidences of diabetes and worsening of existing diabetes post-covid infection also. There is evidence that the covid virus per se can cause some damage to the beta cells,” said Dr Jugal Gada, endocrinologist, Bhatia Hospital, Mumbai.
Why is it a worry?
Since nearly one in six people with diabetes in the world are from India, also known as the world’s diabetes capital.
According to Dr Saket Kant, senior consultant, diabetes and endocrinology, Sri Balaji Action Medical Institute, Delhi, Covid selectively binds to and destroys beta cells in the pancreas which are responsible for insulin secretion.
“During Covid treatment, patient’s physical activities are restricted. As a result, bed rest covid patients tend to eat more than the physical activities they indulge in,” said Dr Kant.
This raises the risk of high blood sugar. As per World Health Organization (WHO), hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels.
According to a paper published in NEJM.org, there is a bidirectional relationship between Covid-19 and diabetes. “On the one hand, diabetes is associated with an increased risk of severe Covid-19. On the other hand, new-onset diabetes and severe metabolic complications of preexisting diabetes, including diabetic ketoacidosis and hyperosmolarity for which exceptionally high doses of insulin are warranted, have been observed in patients with Covid-19,” the 2020 paper noted.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes Covid-19, binds to angiotensin-converting enzyme 2 (ACE2) receptors, which are expressed in key metabolic organs and tissues, including pancreatic beta cells, adipose tissue, the small intestine, and the kidneys, states the paper.
‘Thus, it is plausible that SARS-CoV-2 may cause pleiotropic alterations of glucose metabolism that could complicate the pathophysiology of preexisting diabetes or lead to new mechanisms of disease,’ it reads.
How is steroids administration related to Covid diabetes?
Many patients are given steroids as part of their Covid treatment, which affects their glucose level, mentioned Dr Kant. According to Dr Gada, steroids for covid can worsen blood glucose levels even more. Insulin becomes necessary if you are on steroids or even without steroids, if sugars are very high for optimal management of covid and to prevent secondary infections, there are chances of diabetes onset,” said Dr Gada.
What can be done?
A high index of suspicion for new-onset diabetes should be kept due to the worsening of glycemic control during and post-Covid. For this, regular consultations and investigation as advised by the treating physician is paramount, said Dr Kant.
“Early diagnosis/intensification of treatment, graded physical activity, and diet control are the keys to good results,” said Dr Kant.
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