The COVID-19 pandemic challenges the entire diabetes community, but the response has been encouraging. As the scale and severity of COVID-19 have become widely known, there has been an outpouring of support for those afflicted. Medical personnel and others on the front lines have shown courage and determination to chart out the tasks for Diabetic populations.
Some early studies have shown that about 25% of people who went to the hospital with severe COVID-19 infections had Diabetes.
1. BIDIRECTIONAL LINK
There is a bidirectional relationship between Covid-19 and diabetes. On the one hand, diabetes is associated with an increased risk of severe Covid-19. On the other hand, new-onset of diabetes has been observed in patients with Covid-19.
2. VIRUS AND PANCREAS
Viral infections are well known to be associated with the development of pancreatic autoantibodies leading to Type 1 Diabetes in genetically predisposed individuals and coronaviruses were identified as one of the incriminating pathogens in many studies. Viral infections have been seen to trigger autoimmune insulitis and pancreatic β-cell destruction through different mechanisms.
People with diabetes are more likely to have worse complications if they get it.
The more health conditions someone has diabetes plus heart disease, adds to their risk of getting complications from Covid. Older people are also at higher risk of complications if they get the virus.
5. GLUCOSE CONTROL
Risk of getting very sick from COVID-19 is likely to be lower if your diabetes is well-managed and HbA1c is under control.
6. TYPE OF DIABETES
Till date, the data available suggests that type 1 or gestational diabetes might be at an increased risk for severe illness from COVID-19.
7. DKA SCENARIO
DKA can make it challenging to manage your fluid intake and electrolyte levels—which is important in managing sepsis. Sepsis and septic shock are some of the more severe complications that some people with COVID-19 have experienced.
8. SELF MONITORING OF GLUCOSE
Self-management of diabetes by a patient using their own devices, even in a hospital setting, is the need of the hour for proper management of both diseases.
Virtual interactions, whether on an individual or group basis, are now routine. Health care providers can use this technology to guide the care of their patients, while clinical researchers continue ongoing studies and provide vital medications to study participants.
10. DIGITAL ACCESS
Digital technologies are providing remote access to educational and research meetings and, of course, to loved ones and friends who may be otherwise inaccessible.
11. TESTING TABOO
Until a proven vaccine and highly effective pharmacotherapy are developed, we need widespread testing of apparently well-informed individuals to determine who has immunity from prior infection, who is at risk, and who is unknowingly infected.
12. REGIONAL SCENARIO
Asians and especially Indians have a genetic predisposition that puts them at risk for diabetes. Inflammatory markers that increase during Covid expedite the process of virus directly attacking the pancreas and reducing insulin secretion.
13. COMMUNITY REDRESSAL
As the peak of COVID-19 begins to pass and we work to obtain better testing, therapy, and ultimately a vaccine, we will enter a longer interval in which we must continue to support the most vulnerable populations—especially older people, those with diabetes or obesity, and those who lack the resources to limit day-to-day exposure to infection. We hope a growing sense of community will help in this task.
14. DIET AND DRILL
One needs to establish a regular exercise program. This will help maintain insulin sensitivity and body weight and slow the progression to Type 2 diabetes. The exercise can be as simple as daily walking.
One needs to evaluate pre-COVID diet. Start by making some small changes to keep weight off or lose weight, such as switching sugared beverages to sugar-free beverages or water.
One needs to have your primary care physician formally test for diabetes at first post-discharge visit and tested again six months post-discharge and then annually.
15. QUARTER PLATE OF CARBS
A dietician can recommend specific diet and carbohydrate guidelines to best meet a person’s needs. However, as a general rule, people should try to include no more than a quarter plate of starchy carbs in one meal as a basic rule. Rest will follow.
16. AVOID RUMOURS ABOUT DRUGS
For Hypertension, if you take ACE inhibitors or ARBs for heart disease, or diabetes, keep taking them unless your physician recommends otherwise. They are safe and do not cause adverse outcomes in Covid 19 at all.
17. SPEEDY VACCINATION
Whichever type of vaccine, after clearance from the Doctor, the most important thing is that people with diabetes get vaccinated as soon as it becomes available to them.
18. EMOTIONS HOLD THE KEY
Mental health is a priority. It can have a big impact on diabetes and blood sugar levels. People with diabetes are also likely to have depression. So, one needs to take extra care to do things that keep happiness around. Simple relaxation techniques like, Breathe in deeply and slowly when you feel anxious. Talk to loved ones regularly. Using technology to stay connected to friends and family by online meeting or calling a friend is of great help in distress.
19. THIS TOO SHALL PASS
World is too impermanent. Above all, we need to remember that this is a unique season of life. It won’t always be this way. Tough times shall pass.
20. SHIFT TO NATURE
In pandemic people shifting to healthier outdoor activities is increasing each day. Watching wildlife, gardening, taking photos or doing other art in nature, relaxing alone outside and, yes, making their masked and distanced way on walks has been a way to live in pandemic times .
But, understanding further, detailed bidirectional interactions between diabetes and COVID-19 will be crucial to analyze this conspiracy and help to protect and manage people with diabetes or at high risk of metabolic dysfunction.
As rates of diabetes and non-communicable diseases continue to increase worldwide, now more than ever, Diabetes prevention and control has to be a priority.
So as it was rightly said in UNITED NATIONS
“We must come to the aid of the ultra-vulnerable millions upon millions of people who are least able to protect themselves. This is a matter of basic human solidarity. It is also crucial for combating the virus. This is the moment to step up for the vulnerable.”
Dr Nasir Shamas
JLNM Hospital Srinagar