As COVID-19 cases in the United States are in the millions and continue to rise, doctors are learning more about how to care for and advise patients with diabetes to prevent complications and death from the disease. On June 18, Jaime Davidson, MD, Professor of Medicine at the Diabetes Touchstone Center at University of Texas, led an online panel of four physicians who work with diabetic COVID patients to give the latest updates. Below are some of the key takeaways from the seminar.
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• Like any illness, COVID-19 can make diabetes worse by increasing inflammation and stress. But COVID can also directly damage the beta cells that produce insulin. Some patients have been diagnosed with type 1 after contracting COVID, even though they didn’t have the antibodies that usually attack beta cells. In other people who developed diabetes during or after COVID, the illness may have raised sugars, revealing a pre-existing case of type 2 diabetes.
• COVID can push a person with diabetes into diabetic ketoacidosis (DKA), a life-threatening complication. In a multi-center study published in Diabetes Care, almost half of all confirmed COVID-19 cases in people with diabetes also developed DKA. The panel said it was important to have a sick-day plan, which includes testing urine for ketones, to be warned of possible DKA. Keep in touch with your doctors frequently.
• Blood glucose is best kept below 150 mg/dl at all times, because higher levels help the virus to grow and increase risk of DKA. In the hospital, the panel recommended many patients receive continuous insulin. At home, your doctor might want you to increase your insulin dose.
• Keep your regular medications going for blood pressure and blood sugar. Antonio Anzueto, MD, a pulmonologist from San Antonio, said that no diabetes medicine has been shown to make COVID worse. However, a new study has found that the ACE inhibitor drug captopril (brand names Capoten and Captoril) is associated with a higher rate of severe lung disease in diabetes patients with COVID, and should perhaps not be used.
• George Bakris, MD, of the University of Chicago reported on Italian studies showing better outcomes for patients with higher vitamin D levels.
• Keep hydrated. Davidson said keeping fluid levels up is important to kidneys, which are often attacked by COVID.
• Some additional whole-body self-care measures are important. Anzueto said that sleep is crucial for fighting the virus. Infectious disease specialist Lilian Abbo, MD, said maintaining physical activity and reducing stress are important.
• Davidson said hospital treatment should be individualized, with emphasis on controlling blood glucose. Intubation (putting patients on ventilators) should be an absolute last resort. People with diabetes who are hospitalized for COVID should be sent to intensive care immediately.
• COVID-19 is an inflammatory disease, so anti-inflammatory drugs might help. However, steroid drugs, which have a strong anti-inflammatory effect, should only be used in the most severe cases, because they can affect glucose levels and be dangerous for people with diabetes.
• New treatments are coming, but they might take a long time. The plasma of recovered people may be able to help those who are currently fighting the disease (although some donors seem to have more disease-fighting antibodies than others). If you have recovered, you can learn about donating plasma here.
The measles, mumps and rubella vaccine (MMR) seems to help fight COVID-19, even in people who already have the disease. The rubella virus is similar to COVID in structure, according to an English research team. Researchers in Louisiana are recommending that all nursing home patients, healthcare workers, and others at high risk should get an MMR vaccine as a preventive measure.
• Diabetes UK petitioned their government to make work safer for people with diabetes, along with other vulnerable populations. Those with diabetes should be able to work from home or to stay off work if working from home is not possible, according to the petition. In addition, the organization said there must be “robust” guidance on employment protection, and workplaces should be assessed for COVID-19 risk.
• How to reopen safely? The panel seemed to feel some states had reopened too quickly without preparing people. They strongly believed that many places could open, but that social distancing, wearing of masks, and hand-washing needed to continue. They observed that many states seemed to have gone completely back to pre-COVID behavior, and that this would likely send case numbers and hospitalizations much higher.
Want to learn more about coronavirus and diabetes? Read “Coronavirus and Diabetes: What You Need to Know,” “Healthy Eating During Hard Times” and “Avoiding Coronavirus With Diabetes: Stock Up and Stay Home, CDC Says.”
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