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Diabetes in Post-Covid Patients

COVID

Diabetes in Post-Covid Patients

Whilst the world recuperates from the second wave of the pandemic, post-Covid symptoms in recovered patients are causing concern. One crore people who survived the virus globally and now have diabetes, even though their blood sugar levels had previously been perfectly normal, has turned into a significant health concern among Covid-recovered patient populations. This increase in new-onset hyperglycemia, a symptom that characterizes diabetes, occurs months after the patient has been hospitalized for COVID-19; the problem has been identified by researchers in COVID-19 patients who have been hospitalized.  The majority of patients admitted to the hospital with COVID-19 had newly diagnosed diabetes or hyperglycemia, as indicated by an Italian study.

According to the attending doctors, these patients were not diabetic before admission but became so during their stay. Although the majority of cases of hyperglycemia were resolved, a portion of this population remained hyperglycemic six months after infection. In addition, when compared to patients with no signs of glucose abnormalities, hyperglycemic patients had more clinical concerns such as:

  • Longer hospital stays
  • Worsened clinical signs
  • A greater requirement for oxygen
  • A greater requirement for ventilation
  • A greater need for intensive care treatment.

Corona virus

This prompted pandemic virus researchers to wonder if COVID-19 can directly cause diabetes, or if something else could account for these COVID-related cases. This is the subject of heated scientific debate and investigations, which may eventually lead to a better understanding of both diseases. There are several confounding factors that muddy the waters such as:

  • Any acute illness can disrupt glucose metabolism
  • COVID treatment can also affect blood sugar
  • Conflicting data on whether COVID-19 can invade insulin-producing cells in the pancreas, etc.

The researchers used several methods to learn more, including establishing an international registry to compile extremely detailed case histories of new-onset diabetes in COVID 19 patients, fitting glucose sensors on patients and recording abnormalities in glucose metabolic control over time, observing the effects of COVID-19 on the pancreas for a longer duration even after the patient was deemed cured, and so on.

As the study progressed, experts proposed five hypotheses to explain the sudden onset of diabetic symptoms in COVID patients. These are as follows:

     I.The Virus May Directly Target Pancreatic Insulin-Producing Beta Cells

Diabetes is fundamentally a disease caused by insufficient insulin production or response, the hormone that allows cells to use glucose as a fuel. People with type 1 diabetes, which usually manifests itself in childhood or adolescence, are unable to produce enough insulin because the beta cells in the pancreas have already been completely obliterated by antibodies that attack the body’s proteins. When it comes to type 2 diabetes, which is the most prevalent type, the beta cells become depleted or dysfunctional, as well as body cells become resistant to insulin.

The most contentious issue surrounding diabetes and COVID is whether COVID-19 directly attacks and destroys the specialized beta cells in the pancreas that produce insulin. This hypothesis is supported by both positive and negative evidence. Research conducted last year at Cornell University, for instance, discovered that insulin-producing cells cultivated in a lab evoke ACE2 receptors—the crucial gateway thru which COVID-19 enters human cells—and that virus can infiltrate these cells. Researchers found the ACE2 receptor on beta cells and speculated that the SARS-Corona virus could use it to enter and destroy those cells in a 2010 study. There is also evidence from postmortem studies of COVID patients whose pancreatic beta cells have been destroyed.

In contrast, a study led by Vanderbilt University researchers and published in Cell Metabolism in December looked for ACE2 protein expression in beta cells and found only trace amounts. It was also found that TMPRSS2, a second protein important for coronavirus entry, was generally absent. According to the director of the Vanderbilt Diabetes Center, negative findings are less interesting but extremely important.

   II.The Virus Could Inadvertently Affect Insulin Production

Even as researchers disagree on whether COVID-19 can enter beta cells directly, there is evidence that it can attack other parts of the pancreas. Studies on Cell Metabolism examined the pancreas and small blood vessels that nourish beta cells and found that viral entry proteins were expressed in both areas. They envisioned a scenario in which the virus infects other areas of the pancreas, causing inflammation that disrupts insulin production, or infects these micro blood vessels and kills beta cells.

There is also a possibility that the virus will cause diabetes by attacking or inflaming other tissues and organs involved in glucose metabolism. As ACE-2 receptors are abundant in the intestines, blood vessels, and liver, a viral infection there can cause them to become dysfunctional, preventing them from performing their normal function of regulating blood sugar levels. Even more concerning is a scenario in which the virus enters multiple organs at once, causing multiple disruptions that result in the emergence of previously unseen forms of diabetes. It would not be the typical type 1 or type 2 diabetes, but rather a completely different type of diabetes.

 III.Diabetes Symptoms Are Caused by a Combination of Acute Illness and Inflammation.

It is well-known that either a severe illness, such as pneumonia, a heart attack, or a stroke, can cause a spike in blood glucose levels, known as hyperglycemia, a symptom of diabetes. This elevation is thought to be caused by stress-related hormones like cortisol and adrenaline, which may go away once the patient recovers or may make the patient diabetic for life.

Severe COVID can also cause a similar type of stress, raising blood glucose levels in patients with no history of diabetes and sending them sky high in those who do. Doctors claim that admitted COVID-19 patients rarely have blood sugar levels in the normal range, which is less than 140 mg of glucose per deciliter of blood, regardless of whether they have a history of diabetes or not, and that a few arrive in an especially dangerous hyperglycemic state known as diabetic ketoacidosis, which is more commonly seen in type 1 diabetes. As a result, it is not a new onset of diabetes, but rather a new onset of the disease in a severe form.

Since hyperglycemia on admission is a predictor of mortality, COVID 19 patients should have their glucose count brought down immediately after admission, and it is not uncommon for these hospitalized patients to be injected with very large doses of insulin, even if they have never needed it before.

 IV.The Use of Steroids in COVID 19 Patients Causes a Rise In Blood Sugar.

A combination of the anti-viral drug and high doses of a steroid drug that reduces inflammation is a standard treatment procedure for severe COVID-19 patients in hospitals. However, the steroid increases insulin resistance, potentially exacerbating hyperglycemia. This treatment could be one of the reasons why COVID patients develop severe diabetes symptoms all of a sudden. Because both the COVID and the steroids cause blood sugar levels to skyrocket, patients are also given high doses of insulin to restore normal glucose levels.

Diabetes in post covid

   V.Diabetes That Is Newly Onset Might Not Be All That New

The absence of a documented history of diabetes does not rule out the possibility that the patient was already diabetic, pre-diabetic, or predisposed to the disease due to genetics, obesity, or some other factor. Diabetes is a disease that can go unnoticed for a long time, so it may take five or more years for a person to realize they have it.

One method for determining whether COVID patients have silent diabetes is to perform a blood test called A1C, which measures average blood sugar levels over the previous three months. A normal A1C indicates that the person did not have diabetes two or three months ago, whereas an abnormal A1C indicates that the person was predisposed to the disease or was already diabetic prior to COVID infection.

Conclusion

Understanding how the coronavirus disrupts glucose metabolism could help answer long-standing questions about the role of other infections in diabetes. The pandemic has increased the number of COVID patients who can provide more data to accurately deduce this mechanism. In any case, give us a call. If you have coronavirus-like symptoms such as a chronic cough, fever, or breathlessness, or if you have had covid in the past and have symptoms of hyperglycemia such as frequent urge to urinate, increased thirst, blurred vision, fatigue, and headache, come to Dr. Mehta’s hospitals.

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