The COVID-19 pandemic has changed a lot about how doctor’s offices and hospitals across the country are operating. For many medical specialties, this often means using technology to have remote appointments whenever possible. But for hospitalized patients remote care isn’t an option, and hospitals have to rely on widespread use of personal protective equipment (PPE) to limit the spread of COVID-19 in the hospital setting.
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Of course, the greatest risk of spreading COVID-19 in the hospital comes with treating people hospitalized for the viral disease itself. And the unfortunate truth is that even with the best protective equipment, there is some risk of infection whenever hospital personnel interact with these patients. It’s essential to limit unnecessary contact between hospitalized COVID-19 patients and hospital staff as much as possible.
For people with diabetes who are hospitalized for COVID-19, managing their diabetes is a critical part of caregiving. But doctors also can’t check their blood glucose too often, as a new article on managing diabetes and COVID-19 in the hospital notes.
Why glucose management matters for COVID-19
The article, published in the journal Diabetes, shares insights gained from treating 200 hospitalized patients with COVID-19 and severe hyperglycemia (high blood glucose). The authors, doctors at the University of Michigan Medicine, note that diabetes management is especially important in the context of COVID-19 because of the worse outcomes associated with higher blood glucose levels.
The doctors write that elevated blood glucose in people with diabetes creates inflammation that “promotes fertile ground for the virus’ inflammatory surge, resulting in severe insulin resistance and severe hyperglycemia.” In other words, high blood glucose, inflammation, and COVID-19 are all part of a vicious cycle making each other worse.
But managing blood glucose in hospitalized people with COVID-19 is especially complicated, since the infection can lead to kidney failure, low blood pressure, and the use of many different drugs and intravenous (IV) nutrition. All of these factors mean that checking glucose levels won’t be the same as it is outside the hospital, and that continuous glucose monitoring (CGM) may not be as accurate or helpful.
Despite the challenges posed by blood glucose management, lead author Roma Gianchandani, MD, notes in a Michigan Medicine blog post that “our team is convinced this management is essential to prevent complications that lead to prolonged inpatient stays, or morbidity.” In fact, good blood glucose management can lower inflammatory markers and interrupt the cycle of inflammation that the virus causes.
Keeping both glucose and visits down
To help manage blood glucose in hospitalized patients with COVID-19, the doctors came up with an algorithm to identify different risk categories for different patients. This tool takes into account how high blood glucose is, whether a patients is obese, the level of insulin resistance, the presence and extent of kidney problems, and signs of rapidly changing inflammatory markers.
One main goal of this algorithm was to limit how often hospital staff had to visit patients with diabetes and COVID-19, since each visit to a hospital room requires new PPE and carries a risk of virus transmission.
The protocol that the doctors developed involved delivering insulin every 6 hours, at which time a nurse would check in on the patient. This could involve a routine blood glucose check with a glucometer, or using blood samples from veins or arteries in patients who already had this blood drawn for other reasons.
For patients with severe hyperglycemia, delivering insulin by IV was recommended as an option until levels fell closer to the normal blood glucose range.
The doctors noted that this protocol helped reduce blood glucose levels in hospitalized patients without increasing contact with nurses, adding to the burden of primary care teams, or increasing use of PPE.
“Improving blood sugar control was important in reducing the amount of secondary infections and kidney issues this cohort of patients are susceptible to,” says Gianchandani in the blog entry. “This might help shorten ICU stays and lessen the amount of patients that need a ventilator.”
A larger, randomized clinical trial is still needed to confirm that the algorithm developed by the Michigan Medicine doctors leads to improved outcomes in people with diabetes and COVID-19, which the team is pursuing as the next step in their research.
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.”