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Managing Diabetes during Covid

Why blood sugars spike during lock down and in COVID-19 infection and what are the consequences?

Covid 19 and Diabetes are synonyms with respect to disturbance in our glucose metabolism and worsening blood sugars. Covid 19, with its own virtue is capable of increasing the blood sugars to very high levels, by attacking the pancreatic insulin producing cells, also called Beta cells, thereby reducing insulin levels and causing high blood sugars.Also, steroids used during the treatment of Covid 19, also are known to increase blood sugars to extreme levels.

Sub-optimally managed blood sugars, during Covid 19 infection or per se in lock down phases (because of sedentary life style, and unhealthy choices of food) can cause worsening of Covid 19, related complications like acute lung injury, ARDS (Acute Respiratory Distress Syndrome), heart attacks, strokes and secondary infections, and subsequent to it mortality by 2-4 folds. The research from Wuhan (China), US and Italy, has shown that diabetes is associated with more chances of patient requiring oxygen& ventilator support and dying from covid 19.

The deadly Mucormycosis (black fungus) is the result of poorly managed blood sugars in covid 19 because of diabetes itself or because they are on high dose of steroids for pretty long time and are unaware about the fact the steroids can blood sugar spike in previously non diabetic individuals.

How are blood sugars optimised during covid 19.

Insulin is the main stay of therapy during the course of acute management of Covid 19. Oral medications most will be discontinued. Oral insulin therapy – short acting plus long acting insulin are deployed for treatment of Blood sugars.Insulin reduces the cytokines which is responsible for cytokinestorm.

The Blood glucose is managed in the hospital by protocols which have scientific basis and everyday insulin dosage should be adjusted as per the blood sugars and type of steroid used. Sometime continuous intravenous insulin is used to manage blood sugars, in a situation if the sugars remain more than 400 mg/dl and also if patients are admitted with Diabetic Ketoacidosis or in hyperosmolar coma due to extreme levels of blood sugars (≥600mg ldl), which are emergency situations.

The insulin dosage should be adjusted by an expert (Endocrinologist or Diabetes Specialist) to avoid hypoglycaemia (low sugar episodes). Sugars are monitored 3 to 4 times daily. Multiple times monitoring of sugars can now be replaced by continuous glucose monitoring systems.

AT HOME: Patient who are diabetic and at home seeking cure for Covid 19 should monitor the blood sugars at home and connect with the expert to manage blood sugars. In situations , where the patients have been unable to see their physician during lock down should resort to corrective measures by controlling diet, doing home exercises and optimising medication by virtual consultations with their physicians along with self monitoring of blood sugars. All should be aware about sick day rules, management of hypoglycaemia (low blood sugars) and the targets to achieve should be discussed with family physician, diabetologist or endocrinologist.