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 while on the other, new-onset diabetes and severe metabolic complications of pre-existing diabetes have been observed in patients with COVID-19, says endocrinologist Sravani Tanna.
Many of those who develop diabetes during or after COVID-19 have risk factors like obesity, sedentary lifestyle and family history of diabetes. But diabetes was also seen in patients without the above risk factors and not treated with corticosteroids and had normal blood glucose levels prior to COVID-19 infection, says Dr. Sravani, a consultant at KIMS ICON Hospital.
This could be due to viral infection, or due to previously undiagnosed diabetes, discovered incidentally while investigating COVID-19 or the person could actually be in a pre-diabetic stage and acute inflammation and steroid treatment could have finally pushed him into diabetes, she said.
Dr. Sravani says that the association between viral infection and new-onset diabetes was seen in past outbreaks of other corona viral diseases such as SARS. SARS CoV2 that causes COVID-19 binds to ACE 2 receptors which are expressed in key metabolic organs, including pancreatic beta cells.
“The virus impairs insulin secretion from beta cells there by aggravating diabetes mellitus which was already present or triggering new-onset diabetes. Acute infection could also cause stress hyperglycemia which may resolve once the infection and coexistent inflammation subside. Further, COVID-19 patients are increasingly being treated with glucocorticoids which are known to induce hyperglycemia,” she says.
Awareness of symptoms
Auto antibodies against pancreatic beta cells triggered by viral infection may develop over months and causes Type 1 diabetes. Patients who recovered from COVID should be aware of the symptoms of diabetes like frequent urination, increased thirst, increased appetite, blurry vision, weight loss, slow wound healing, and fatigue. Fatigue could last in COVID-recovered patients for many months even without developing diabetes.
“Blood glucose levels should be checked immediately, if COVID-recovered patients develop the symptoms and provided treatment, if required. Undiagnosed and untreated diabetes may lead to increased morbidity. Whether these alterations in glucose metabolism persist or resolve is unclear at present,” Dr. Sravani added.
