Updated on 24th April 2020

More than 2 million people have been affected by COVID-19 globally and more than 1.9 lakh have lost their lives, as of 24th April 2020. Most of those who have died had some underlying medical condition: doctors have stated that people with diabetesasthmaheart diseasekidney disease with a raised serum creatinine, high blood pressure, smokers and people above the age of 65 are at a higher risk of getting severe symptoms if they contract this new coronavirus infection.

Here in this article, we will tell you how a person with diabetes is more prone to get severe symptoms of COVID-19 and also the things that can be done to keep a person with diabetes safe and healthy during this pandemic. 

  1. Diabetes and COVID-19
  2. Things to keep in mind if you have diabetes
  3. What changes in medication are done for a diabetic patient with a suspected or confirmed COVID-19 infection?
  4. Doctors for Why coronavirus is more dangerous for diabetes patients
  5. COVID-19 fatality rate in patients with diabetes

Our body's renin-angiotensin system manages our blood pressure and fluid-and-electrolyte balance. Anytime we have low blood pressure, renin (present in the kidneys) breaks down a protein called angiotensinogen to form angiotensin 1. 

Angiotensin 1 is then converted into angiotensin 2 with the help of the angiotensin-converting enzyme (ACE). ACE binds to the ACE receptors - which are present on the blood vessels of the lungs, kidney and heart - and constricts the blood vessels, thus increasing the blood pressure of the body. 

SARS-CoV-2, the virus that causes COVID-19, attaches itself to the ACE2 receptors and attacks the lungs, kidney and heart.

Scientists have found that the levels of ACE2 increase in a diabetic person. This allows the virus to attack the organs of the body more efficiently.

This means that people with diabetes are more likely to get severe symptoms like pneumonia and respiratory failure if they get COVID-19.

Read more: What are ACE2 receptors and what do they have to do with COVID-19

There are certain things you need to keep in mind to keep your sugar levels in control during the COVID-19 pandemic especially:

  • Make sure you have all necessary medication: While the entire nation is on lockdown right now, chemist shops are open. Still, it is a good idea to make sure that you have all the necessary medications like your oral antidiabetic medications, injectable insulin, blood glucose strips, tablets to treat a sudden drop in blood sugar levels and other emergency medications. If you have high blood pressure, a heart condition or kidney disease along with diabetes, make sure you have the medicines for those too.
  • Monitor your blood sugar levels: Check your blood sugar levels twice daily (once before taking any meal and once after). You can check your blood sugar levels at home with the help of blood sugar monitors and blood glucose strips.
  • Exercise daily: Though you do have to stay home, do not miss out on your exercise. Make time to do basic exercises like joint mobility, stretching, walking from one corner of the house to another, climbing stairs if you have some in your home and or some yoga for at least 30 minutes a day. Exercising would help you to maintain your ideal blood sugar levels. You can use your diabetic footwear for walking as they are more comfortable and help in improving blood circulation.
  • Eat healthy food: Do not consume packaged snacks as they have more calories and salt. Eat fibre-rich food which helps in improving the digestive tract.
  • Do not panic: Most of the people with diabetes have been panicking that they are more prone to this virus. This stress can increase the levels of blood sugar in the body. So, all you need to do is to calm yourself and take good care of your health.

There are certain medications that are given to a diabetic to maintain the blood glucose levels but they can create problems if the person is suffering from COVID-19 infection. Some of those drugs are:

1. Metformin

Metformin is a commonly used oral anti-diabetes drug. However, if the diabetic is infected with COVID-19 infection it is possible that metformin can lead to dehydration and lactic acidosis in them. Metformin can also develop the risk of chronic kidney disease or acute kidney injury if the person is infected. So, it is necessary to stop the drug until the infection clears off.  

2. Sodium-glucose-co-transporter 2 inhibitors (SGLT2 inhibitors)

SGLT2 inhibitors are the class of drugs which help in lowering the blood sugar levels in adults with hyperglycemia (diabetes). Some of the commonly used SGLT2 inhibitors are canagliflozin, dapagliflozin, and empagliflozin. However, the patient may need to stop this medication if they contract COVID-19 infection as SGLT2 inhibitors can develop a risk of dehydration, diabetic ketoacidosis and acute kidney injury. So, it is advised that if the patient is already taking this medication they should stop the due course until the viral infection clears. Also, patients who would have developed respiratory symptoms of COVID-19 are advised to avoid initiating the SGLT2 inhibitor therapy until their symptoms resolve.

3. Glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists)

GLP-1 receptor agonists mimic the functions of the natural incretin hormones which are naturally present in the body that helps in lowering post-meal blood sugar levels. Some of the commonly used GLP-1 receptor agonists are albiglutide, dulaglutide, exenatide-extended release, liraglutide, lixisenatide, and semaglutide. However, if a person has been confirmed with COVID-19 infection, GLP-1 receptor agonists can lead to dehydration. Patients can continue the medication but are advised to take adequate fluid and regular meals to avoid any complication. 

4. Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors)

DPP-4 inhibitors are the class of drugs that help in lowering the blood glucose by blocking DPP-4, an enzyme which destroys the hormone incretin. Hormone incretin helps in lowering the post-meal blood glucose levels. Some of the most commonly used DPP-4 inhibitors are alogliptin, linagliptin, saxagliptin, and sitagliptin. These drugs can be work normally even during the viral infection period, so can be continued if the person gets COVID-19 infection. 

5. Insulin

Insulin is one of the most common injectables that is given subcutaneously to lower the high blood glucose levels in diabetics. Insulin therapy should not be stopped even if the person gets infected with COVID-19 infection. However, the person should self-monitor their blood glucose in every 2 to 4 hours with the help of a portable glucose testing machine at home.

Dr. Tanmay Bharani

Dr. Tanmay Bharani

Endocrinology
15 Years of Experience

Dr. Sunil Kumar Mishra

Dr. Sunil Kumar Mishra

Endocrinology
23 Years of Experience

Dr. Parjeet Kaur

Dr. Parjeet Kaur

Endocrinology
19 Years of Experience

Dr. M Shafi Kuchay

Dr. M Shafi Kuchay

Endocrinology
13 Years of Experience


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References

  1. Louisiana State University Health Sciences Center. ACE inhibitors and angiotensin receptor blockers may increase the risk of severe COVID-19, paper suggests. ScienceDaily. ScienceDaily, 23 March 2020.
  2. Zheng, Y., Ma, Y., Zhang, J. et al. COVID-19 and the cardiovascular system. Nat Rev Cardiol (2020). https://doi.org/10.1038/s41569-020-0360-5
  3. Science Direct (Elsevier) [Internet]; Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?
  4. Science Direct (Elsevier) [Internet]; Practical recommendations for the management of diabetes in patients with COVID-19
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