There are not enough data to show that diabetics are more prone to catch Covid-19 infection than the general population. But increasing evidence suggests that the disease severity is worse in diabetics than in the general population. Diabetics with additional comorbidities like heart disease and chronic lung diseases are known to be prone to more severe complications. The coronavirus infection can put one at a greater risk of complications like Diabetic ketoacidosis, also known as DKA, and sepsis. Diabetic ketoacidosis is a life-threatening condition that occurs when acidic substances called ketones build up to dangerous levels in the body. This happens when your blood sugar is too high for too long. Sepsis is also a life-threatening medical emergency resulting from an extreme immune response to an infection. It can lead to tissue damage, organ failure, and death, if not treated on time. The risk of severe Covid-19 illness and related complications reduces if diabetes is well managed.

In this article, Dr. Sudarshan S. MBBS, DNB Family Medicine, Consultant Physician, Medall Healthcare Pvt. Ltd., talks about precautions to be taken by diabetic individuals to prevent Covid-19, what to do if someone taking insulin to control blood sugar catch the viral infection, diet people with diabetes should follow if they get Covid and more. Keep reading …

What to do next if you catch a Covid infection?

Consult a doctor immediately, preferably online. You will be assessed by your treating physician online. If needed, in-person visits may be recommended to assess you in detail by clinical examination.

Isolate yourself immediately to a single room, right from the onset of symptoms. Have this equipment handy:

  • Pulse oximeter
  • Thermometer
  • BP apparatus if you are hypertensive.
  • Glucometer if you are on multiple diabetic medicines &/or insulin.

The decision to continue treatment at home with isolation will depend on the severity of the illness. Mild symptomatic patients can be managed at home while those with moderate to severe infection need to be admitted.

Mild Covid-19 infection in diabetics

If you are eligible for home isolation, you need to follow certain instructions and precautions. There’s no FDA approved Oral Antiviral drug as of yet for treating

mild symptomatic Covid. The treatment focuses on symptomatic management that includes control of fever using paracetamol, cold symptoms using decongestants, usage of multivitamins. The other parameters that need to be taken care are – hydration, blood glucose levels and blood pressure (if you are hypertensive).

You may be asked to check your capillary glucose levels after finger pricking and using glucometer multiple times in a day, especially if you are on insulin. This is because infection can alter your blood glucose levels and your food intake might not be adequate. This is the reason why we need to target diabetic management individually.

The frequency of monitoring varies case to case basis. Some may need frequent monitoring. This includes fasting glucose, post prandial sugar. If you are on twice daily or more frequent insulin, you might in addition need to check sugar using glucometer before dinner and at bedtime till the values are in a stable range.

Usually, the regular medications for Diabetes and Hypertension are continued. The medications may be adjusted at times and it’s best that you seek advice from your treating doctor.

You may or may not need additional tests like blood tests or a CT scan. The treating doctor is the best judge who will assess you clinically and plan on management. So, do not do additional tests or scan on your own without consulting a doctor first.

Moderate to severe Covid-19 infection in diabetics

Sicker diabetic patients are managed in the hospital setting. You may be started on oral or IV steroids if your oxygen saturation is not in good range. Steroids can increase your blood glucose levels; hence your sugars will be monitored aggressively.

Many hospitals practice the Basal Bolus regimen of administering insulin in hospitalised diabetic patients, in replacement of or in addition to your usual oral diabetic medications. Basal bolus regimen consists of 1 long acting insulin that is administered once daily injection subcutaneously and 3 pre-meal short acting insulin injections that has to be taken before meals. Your capillary glucose levels will be monitored as long as you are on steroids and insulin as the dosage of insulin needs to be titrated accordingly.

Diabetes can lead to complications like DKA and sepsis. These are life threatening complications that need management in an intensive care setting. Covid infected diabetic patients are prone to these complications, hence the necessity of proper management of blood glucose levels. Even after discharge from the hospital, the blood glucose has to be maintained in the normal range.

There is a rare fungal infection called “Mucormycosis” that is on the rise. This is especially seen in diabetic individuals during covid or post covid infection. The main reasons behind these infections are poor diabetic control, immunosuppression due to usage of steroids, poor hygiene. Symptoms of Mucormycosis when nasal sinuses are involved include one sided facial swelling, nasal discharge, nose block, redness of eyes. This infection can get life threatening if not treated early. Hence make sure you follow up regularly with your physician post discharge.

What prior precautions to be taken by diabetic individuals during the pandemic?

 If there are no contraindications, please get vaccinated with Covid-19 vaccine as early as possible. This not only reduces the chance of getting an infection, but also reduces the severity of infection.

  • Have regular follow ups with your physician.
  • Keep your blood sugars in control.
  • Stay fit, eat healthy and be active by doing exercises regularly.
  • Reduce weight if your BMI is above the normal range.
  • Practice “Covid appropriate behaviour” at all times
  • There are also other adult immunizations recommended for diabetics such as annual flu shots, vaccination against pneumococcal infections. Make sure you are vaccinated against other potential infections.
  • Keep other comorbid conditions if you have any, like hypertension, heart disease and asthma under good control.

What diet should I follow if I get Covid?

Continue your usual diabetic diet without much changes. The diet should contain a balanced amount of proteins, fat and complex carbohydrates.

  • Take plenty of green leafy vegetables.
  • Stay well hydrated by drinking soups, rasam and other liquid items suitable for diabetics.
  • Avoid fruit juices as they can increase your blood glucose.


This post first appeared on The Health Site

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