Diabetes and COVID-19: Are diabetics more susceptible?

Being Diabetic alone does not necessarily mean that one is more likely to get infected with COVID-19. Everyone is exposed to an equal risk of getting infected. However, the likelihood of adverse outcomes after being infected is increased in persons with Diabetes, compared to a healthy individual due to the immunocompromising nature of Diabetes Mellitus.

 

Our bodies have an internal security network called the Immune system. When a pathogen or an unidentified particle enters the body, it is perceived as a threat, and a triggered Immune system fights off the offending agent.

Patients with uncontrolled Diabetes are considered immunosuppressed due to the effects of elevated blood sugar on the immune system. If the pathogen can invade the host while the immune system is weak, there is an increased risk of severe disease. Poorly controlled diabetes also impairs the white cell action.

High blood sugar over a long period (chronic hyperglycemia) slows down the perfusion of oxygen and other nutrients through blood vessels, causing nerve damage and damage to other vital organs as time progresses. Skin, the first barrier itself is no longer competent due to poor perfusion and associated nerve damage. Due to the nerve damage, patients would not be able to identify sensations of pain and temperature, especially in the feet, and wounds go unnoticed, therefore, untreated, and becomes a breeding ground for infections. Soft-tissue infections are prominent in uncontrolled Diabetes, and may even lead to amputation of limbs. Prompt and general foot care is vital in Diabetic foot ulcers. Diabetics become prone to Urinary Tract Infections as well, due to glycosuria and decreased immunity.

 

According to the CDC (Center for Disease Control and Prevention), adults of any age with the following conditions are at increased risk of severe illness from the virus that causes COVID-19:

Dr. Manilka Sumanatilleke, Consultant Endocrinologist and the President of the Sri Lanka Diabetes Federation, shared some insight on preventive measures and lifestyle advice for individuals with Diabetes.

 

You have closely interacted with a person who is infected with 

COVID-19:

Depending on your symptoms, the doctors will diagnose accordingly and will decide if a PCR test is required.

You have been diagnosed with the Covid-19 virus,

Do not Panic; even amongst Diabetic patients, only a few get complications.

In Sri Lanka, all patients with complications will be hospitalized. Remember to take your test reports, prescriptions, blood glucose readings taken at home, etc.

 

Maintain the recommended glucose level. Insulin could be required.

General advice for Diabetes patients during a pandemic:

Continue taking your diabetes medication/Insulin as usual, as well as your blood pressure medicines including Enalapril,Peridopril, Losartan etc. Cholesterol medications also should be continued.

 

Preventing diabetic complications involves proper glycemic control. The Standard of care includes maintaining HbA1c < 7%, blood pressure <130/80 mmHg, and control of cholesterol levels. Patients with high risk feet( with neuropathy) should also inspect their feet daily. 

 

Adherence to the previously mentioned tips benefits both the patient and doctor, prevention is always 

the key.