Dear Doctor/ Dr Dheeraj Kapoor, head, endocrinology, Kokilaben Ambani hospital, Mumbai
In the initial phase of the lockdown, the sugars of my patients actually improved. That was probably related to the non-availability of takeaway or dine-out options and the compulsion of having homemade food and on time. But subsequently, we noticed sugar levels going up and the reasons for that were multifactorial.
Mental health had a lot to do with it as well—the stress of being at home without work or working from home for long hours, and the worries associated with Covid-19 and the future. This was further compounded by a lack of exercise.
After people started visiting doctors, we found they were hiding certain things. I had a patient with diabetes-induced infections and heart-related complications but was afraid to visit a doctor for fear of catching Covid-19.
Diabetes and Covid-19
There is not enough data to show whether people with diabetes are more likely to get Covid-19 but the problem associated with diabetics is primarily related to worse outcomes. Diabetics tend to have more serious symptoms of a viral infection. It can be harder to treat because of fluctuations in blood glucose levels and, possibly, the presence of diabetes-related complications. Also, the immune system is compromised and the virus may thrive in an environment of elevated blood glucose levels. We have seen diabetics coming to us not with the regular symptoms of Covid-19 but with something as unrelated as seizures, and we found out only later that it was the viral infection along with extremely high sugar levels.
Diabetic ketoacidosis
People with diabetes, especially type-1 diabetes, face an increased risk of DKA (diabetic ketoacidosis) when hit by a viral infection. DKA can make it challenging to manage one’s fluid intake and electrolyte levels, which are important in managing sepsis. If one’s blood sugar has registered an abnormal high, one must check for ketones to avoid DKA.
Type-1 and type-2 diabetes
A 16-year-old girl has so far been my youngest type-1 diabetic patient to have contracted the Covid-19 infection. However, she recovered soon. Covid-19 is more serious among type-2 diabetics, who are much older and are more prone to complications.
Prevention
Basic precautions such as washing hands thoroughly, wearing a mask and maintaining social distancing are important. Besides, a regular check of one’s blood sugar levels is highly advised and controlling blood sugar through diet, exercise, monitoring and medication can keep oneself from catching the Covid-19 infection, at least until a vaccine proven to work in people with diabetes, too, reaches us. Regular exercise is one sure way of keeping one’s health in balance, more than anything else.
—As told to Pooja Biraia Jaiswal