In our country, a large number of diabetes cases are poorly controlled and hence, are at an increased risk of complications like admission to ICCU, contraction of other infections and ventilator requirement. Covid-19 may worsen diabetes and can further complicate the situation. Covid-19 has killed more than a million people across the globe. There are many risk factors that can result in unfavorable outcomes for a Covid 19 patient - age, obesity, and other co-morbid illnesses like diabetes and cancer.
Mortality or death rate is significantly higher in diabetic patients. In China, the mortality rate for diabetic patients was 7.3% as compared to 2.3% for the general population. Similarly, in USA, the mortality rate for the general population was 6.2 %, but in diabetic patients, it was 14.8%.In uncontrolled diabetic patients, it was as high as 28.8%.
In our country, a large number of diabetes cases are poorly controlled and hence, are at an increased risk of complications like admission to ICCU, contraction of other infections and ventilator requirement. Covid-19 may worsen diabetes and can further complicate the situation.
Obesity greatly increases the risk of Covid-19 complications. A large number of diabetics are overweight. This complex association of diabetes, obesity and Covid-19 in a patient complicates the path to recovery.
How to manage diabetes and its complications during the pandemic?
Blood glucose monitoring should be done frequently. While infection may increase blood sugar, poor intake of food makes the patient more prone to low blood sugar. So it is imperative to check blood sugar regularly if the patient is being treated at home.
If the patient is on a Sulfonylurea like Glimeperide, Gliclazide or Glipizide, they will require frequent monitoring, especially if they are not able to eat properly. Inadequate diet may cause severe hypoglycemia.
Many diabetic patients are now on newer drugs known as SGLT2 inhibitors like Empagliflozin, Dapagliflozin or Canagliflozin. These are known to reduce weight and should be discontinued if you are not able consume sufficient food. Else, they may cause serious complications known as diabetic ketoacidosis i.e., the production of toxic materials in the bloodstream. Ask your doctor if it is safe to continue SGLT 2 inhibitor like Empagliflozin, Dapagliflozin or Canagliflozin.
Many diabetic patients are also receiving medicine for blood pressure called ACE inhibitor or ARB. Do not discontinue them without consulting your doctor. It is necessary for diabetic patients to drink 250 ml water every two hours (or more frequently) to match fluid loss due to fever and increased blood sugar.
If your blood sugar remains high, then your doctor may recommend starting Insulin. Do not hesitate as in most instances this will be temporary and will aid in quicker recovery. Overall glucose target to maintain will be 140 to 180 mg, i.e., neither too low nor too high.
Hence, if you are suffering from Type 2 diabetes and are able to eat regularly, continue your usual medicine. You should discuss your treatment plans with your doctor because he may need to adjust your regular medication temporarily.
Inputs from Dr. K. S. Chhajer.
(Dr. Chhajer specializes in Internal Medicine and Diabetes, and has over 25 years of experience in the field.)