In a Washington Post article on Feb 1, 2021, it was revealed that 14% of patients with severe Covid-19 developed diabetes. Researchers did not understand if it is type 1 or type 2 diabetes or whether it would be short-term or long-term in these patients. What might be causing this?
First, let’s clarify the terms. Diabetes is diagnosed when a blood test shows elevation of glucose level, meaning blood sugar. Diabetes is classified into 2 groups: type-1 and type-2.
Type 1 diabetes usually appears in childhood and is caused by the severe deficiency of insulin in the body, usually due to a dysfunctional pancreas in the child. Children with Type 1 diabetes require insulin injections for the rest of their lives. Type 1 can also occur in adults, though this is rare and indicates a delayed insulin production problem in the pancreas. In contrast, Type 2 diabetes is usually diagnosed by finding high blood sugar level in an older person. They need to be treated with oral medications at first, but they may get insulin treatment later. Type 2 is known to be potentially reversible, however, with a change in diet and exercise habits.
What might cause Type 1 diabetes in an adult with Covid-19?
There are two possible mechanisms that might be at work. First, the coronavirus might activate an autoimmune disease already existing in the person which is attacking the body and creating a dysfunction in insulin production. In this case, a test to detect antibodies in the patient could confirm that the immune system has been triggered, and is affecting the body’s production of insulin, leading to high blood sugar.
A second cause might be that the coronavirus itself is interfering with or destroying the beta cells in the pancreas that produce the insulin. The virus enters a cell by first attaching itself to the cell’s wall receptor called ACE2. Researchers at Vanderbilt University found the presence of ACE2 receptors in the pancreas and an Italian study also identified such receptors in pancreatic beta cells. This suggests that the covid-19 virus can enter beta cells and damage the insulin production capability, leading to Type 1 diabetes, i.e., the person will probably have to take insulin injections for the rest of his or her life.
As for the diagnosis of Type 2 diabetes, there are three possibilities that might explain the appearance of high blood sugar leading to diabetes. First, it could be that the person actually already had high blood sugar that went undetected until they developed Covid-19 infection. Second, the administration of steroid drugs as the treatment for the Covid-19 or the person’s own stress response that release corticosteroids in the body— either one can cause an elevation of blood sugar. In either of these cases, there is the possibility that the condition could clear up once the steroid effect or stress effect is gone. The third possible cause could be that, similar to the second cause of Type 1 above, the virus is entering the beta cells in the pancreas and taking over the insulin production facility to make copies of the virus rather than insulin.
One way to determine if a Covid-19 patient with high blood sugar is experiencing Type 1 or Type 2 diabetes is the use a C-peptide blood test. This test can verify the production or non-production of insulin by the pancreas. C-peptide is a protein that keeps insulin from becoming active by keeping the two strands of the hormone separate. This protein is removed when insulin is released from the pancreas into the blood. However, the C-peptide is also released into the blood. Therefore, by measuring how much C-peptide is in the blood, it not only gives an idea of the amount of insulin has been released but also the fact that the insulin was made inside the body and not administered. In other words, detecting C-peptide means the person is still producing insulin and if blood sugar is high, the person has Type 2 diabetes.
The C-peptide test could be very useful in clarifying when someone has a worsening of high blood sugar levels due to Covid-19 and is already taking diabetes medications. A low measure of C-peptide on the test would indicate that virus may have caused damage to the beta cells, and no amount of oral medication or medications that are designed to release insulin from the patient’s pancreas will help. Rather, the person may need to switch to insulin injections immediately to ensure the body has enough insulin to control blood sugar. Otherwise he/she may suffer severe complications including ketoacidosis, as seen in Type 1 diabetes.
What can you do to prevent diabetes and Covid-19?
The first answer, of course, is to take all precautions to minimize your risk of catching Covid-19 — wearing a mask, social distancing, washing hands, and getting vaccinated as soon as you can.
But if you do develop Covid-19, there may be little you can do. However, be aware that the chances of developing diabetes are still not very high, although it is possible. As stated, it only occurs to 14% of covid-19 patients who are severely infected. This was detected as early as January 2020 by doctors in Wuhan China. It was also known to occur with other corona viruses such as SARS back in 2003, when some of those patients developed diabetes. At that time, studies in China showed the presence of ACE2 receptors on pancreatic islet cells, meaning that those corona viruses did damage beta cells in the pancreas. In addition, other viruses such as those associated with rubella, mumps, chicken pox and intestinal infections have also been associated with the development of Type 1 diabetes in humans. However, many of these patients recovered from their condition later on, meaning that the damaged pancreatic beta cells healed somehow.
If you already have diabetes…
For those who already have Type 1 or Type 2 diabetes, there is no evidence that you have a higher susceptibility of getting Covid-19. However, you are at a higher risk of severe complications if you do get Covid-19 that may require you to get ICU admission. So people with diabetes need to protect themselves from getting the infection by being vigilant, wearing masks in the public, avoiding groups, especially indoors, and keeping social distancing as much as possible.
In addition, if you are already taking diabetic medications, I highly recommend that you reduce your intake of grains by half of what you currently eat. This could help you reduce the dosage of your medications and lower your blood sugar to reduce your risk of getting a severe case of Covid-19 if you got infected. I suggest that the modern day diet is the most critical factor associated with the increasing incidence of Type 2 diabetes worldwide.
Unfortunately, we don’t yet know how to prevent Type 1 diabetes caused by autoimmune disease or viral infection. However, people with Type 1 diabetes can reduce their insulin dose and save money by consuming only minimal amounts of carbohydrates such as grain-based foods.
You can also watch this short video:
These are my suggestions if you have diabetes during a pandemic:
- You have to practice social isolation.
- Every type 2 diabetic person, when going outside, should wear a pair of thin cotton gloves and when you come back home wash the gloves and hands thoroughly.
- In order to reduce your blood glucose and insulin level in the body:
- reduce the intake of all grains and grain flour products to less than a third of your total daily energy intake
- drink something hot every few hours so that the normal temperature in your mouth will be increased
- slow down the viral multiplication so your immune system can take care of it boost your immune system
- eat a variety of foods such as fruits vegetables nuts seeds seafood and meat if you like eggs spices and herbs.
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