Uncontrolled diabetes makes the fight against COVID-19 harder
Since being declared a global pandemic by the World Health Organization (WHO) earlier this year, COVID-19 cases around the world have continued to increase at an alarming rate with over 11 million people reported to have contracted the virus to date. As of 15 July 2020 there were 311 049 confirmed COVID-19 cases in South Africa.
According to the International Diabetes Federation (IDF), COVID-19 is mild with minimal flu symptoms in more than 80% of those who contract the virus. However, in up to 15% of cases COVID-19 has been severe with about 5% of cases needing critical care. In as much as the number of people needing critical care is lower compared to the rest of the cases who get diagnosed with the virus, the IDF states that people with pre-existing medical conditions like diabetes appear to be more vulnerable to becoming severely ill with COVID-19 once they contract it.
In an article published by the World Diabetes Federation recently, it is reported that people with poorly controlled diabetes are relatively more vulnerable to infections and have worse outcomes once infected. The article further states that people with long-standing, poorly controlled diabetes, may have poor lung function and are more likely to have underlying kidney and heart disease.
“COVID-19 does affect many organ systems and any pre-existing disease places the individual with diabetes at risk. As the virus causes a microangiopathy initially from the lung and then with the release of cytokines, other organ systems are involved,” says Dr Adri Kok specialist physician.
Dr Kok further explains that the experience worldwide has been that high glucose levels definitely worsen the outcome as well as the immune response to the virus as corticosteroids will be used in treating the disease, this poses an additional risk factor. “It is also clear that in COVID -19 infection, insulin resistance necessitates the use of more intensive insulin therapy and tight glucose control does impact recovery from the viral infection,” she says.
In addition to the guidelines shared by the World Health Organization and the South African National Department of Health, which recommend washing hands with soap and water, sanitising with an alcohol-based sanitiser, avoiding to touch one’s face, maintaining social distance of at least 1-2 meters and wearing a mask to minimise the risk of infection; what are some of the things people living with diabetes can do to ensure that they try to minimise their risk of falling severely ill in the face of this pandemic since they cannot change their condition?
“Healthy nutrition and exercise are known to boost the immune system, even in people with underlying conditions such as diabetes. Exercise is also recommended to help patients lower their blood glucose levels and help them achieve better control. People living with diabetes should eat a varied and balanced diet to keep their blood glucose levels stable in addition to taking their diabetes medication as prescribed by their doctor.” says Dr Kok
Adding that “several vitamin supplements including vitamin C, D and zinc have shown benefit in reducing the replication of the virus as well as reducing binding of the virus to the lung ACE 2 receptors. Early management of symptoms include tight glucose control and careful attention to any elevated sugar levels which may indicate a stress response in the body.” Hospital admissions are not always possible due to extremely stressed resources. At the same time; if any symptoms suggesting worsening glucose control, fever and myalgia, breathing difficulty and ketone production must prompt urgent discussion with your doctor to mitigate against complications” concludes Dr Kok.
It is recommended that patients keep their doctor’s number close to be able to consult virtually to seek advice about their health and ensure that they have adequate supply of their essential chronic medicines.
 World Health Organization [Internet]. WHO Timeline – COVID-19; c2020 [cited 02 July 2020]. Available from: https://www.who.int/news-room/detail/27-04-2020-who-timeline—covid-19.
 COVID-19 pandemic data [Internet]; c2020 [cited 08 July 2020]. Available from: https://en.wikipedia.org/wiki/Template:COVID-19_pandemic_data.
 COVID-19 and diabetes [Internet]. International Diabetes Foundation; c2020 [cited 02 July 2020]. Available from: https://www.idf.org/aboutdiabetes/what-is-diabetes/covid-19-and-diabetes/1-covid-19-and-diabetes.html.
 COVID-19 and diabetes – what patients and health systems should know [Internet]. World Diabetes Foundation; c2020 [cited 02 July 2020]. Available from: https://www.worlddiabetesfoundation.org/news/covid-19-and-diabetes-%E2%80%93-what-patients-and-health-systems-should-know.