Although many Americans have now been vaccinated for the COVID 19 virus, scientists still know very little about the long-term health impact of the infection. In June 2020, the New England Journal of Medicine published a letter from 19 global diabetes organizations indicating that COVID 19 infection may cause the development of type 1 diabetes in certain patients, even those with the COVID vaccine. Ongoing research aims to illuminate the relationship between COVID 19 and diabetes.
How SARS COV 2 May Cause Diabetes (Type 1)
COVID-19 is just one of many different strains of coronavirus. About two decades ago, researchers studying a different type of the virus found that it entered the body through ACE-2 receptor cells. The virus cells bind to these receptors, which allows them to enter other cells, including those in the fat tissue, kidney, liver, small intestine, and pancreas. When this occurs, these organs cannot function as expected, which doctors think may explain why some people who get coronavirus subsequently develop diabetes.
Specifically, a team of German researchers has theorized that the virus damages beta cells in the pancreas, which produce insulin. The lack of insulin also causes the hallmark symptoms of diabetes, which occurs when the body cannot create or use this hormone properly. In fact, diabetes type 1 is an autoimmune disease that occurs when the body’s immune defenses mistakenly attack and destroy healthy beta cells.
Scientific American reports that some researchers think the virus indirectly attacks the body’s ability to produce insulin rather than directly attacking beta cells. For example, inflammation associated with the virus could interrupt the ability of the pancreas to release insulin or the ability of the liver, blood vessels, or intestines to metabolize blood glucose.
Some scientists suspect that the systemic inflammation caused by COVID 19 produces symptoms similar to diabetes but does not actually cause patients to develop the disease. They note that the increased blood glucose associated with COVID diabetes can also occur with other acute health crises, including stroke, heart attack, pneumonia, and trauma. Scientists believe this happens because of the release of the stress hormones cortisol and adrenaline.
Other doctors note that a steroid treatment used for COVID causes high blood glucose, which may also factor into these new-onset diabetes cases. Some scientists suspect that diabetes cases associated with COVID 19 occur in the estimated 34% of Americans who have elevated blood sugar categorized as prediabetes. This phenomenon may also reflect the approximately 20% of individuals in the U.S. who have diabetes but have not yet been diagnosed with the disease. As more doctors share research and case studies of people affected by the COVID 19 pandemic, we will begin to understand exactly how a coronavirus infection may trigger diabetes.
What To Expect After COVID-Associated Type 1 Diagnosis
Questions remain about whether diabetes cases that occur after coronavirus infection will eventually resolve or become permanent. The international diabetes organizations that contributed to the NEJM study have launched the CoviDiab Registry. With this global initiative, health care providers around the world can share notes about the progress and outcomes of type 1 diabetes patients who developed the disease after a SARS COV 2 infection.
Evidence indicates that the associated disease may represent a new type of diabetes. Some patients have displayed the symptoms of diabetes without the antibodies that usually occur with this condition. Often, these individuals do not have other risk factors associated with developing new-onset diabetes in adulthood, such as age or obesity.
Study authors recommend that health care practitioners be aware of symptoms of diabetes, even without antibodies, about one month after a patient’s COVID 19 infection resolves. Many cases involve a sudden need for high insulin dosages and dramatic insulin resistance. Talk to your doctor if you or your child has had coronavirus and experience unexplained weight loss, frequent urination, excessive thirst, dry mouth, and fatigue. Reuters reports that at the Children’s Hospital of Los Angeles, new diabetes cases doubled for the period from March to August 2020 compared to the average number of cases for the same six-month period in 2019 and 2018.
If you have concerns, Wexner Medical Center at Ohio State University recommends taking steps to prevent diabetes after a COVID infection. If you are overweight or obese, work on losing at least 15 pounds with a healthy diet and regular physical exercise. Make small changes in your nutrition plan such as cutting out sugary beverages or eating less meat. Ask your doctor to test you for diabetes at your first follow-up visit after recovery from the virus.
The Juvenile Diabetes Research Foundation is monitoring the progress of new type 1 cases associated with the COVID virus worldwide. However, JDRF notes that they do not currently have enough information to determine whether the virus has caused a statistically significant increase in new diabetes cases.
COVID-19 and Diabetes Complications
Researchers believe that in addition to triggering type 1 diabetes in some people, coronavirus disease can also increase the risk of complications in people with diabetes. The NEJM study reported that individuals with diabetes represent about 20 to 30 percent of deaths from COVID-19 infection. These patients also have a much higher risk of coronavirus-related complications, according to research published in The Lancet: Diabetes and Endocrinology. For example, people who have diabetes are more likely to experience high blood sugar and end up in intensive care based on their body’s response.
The American Diabetes Association notes that patients with multiple chronic conditions, such as diabetes and heart disease, have an increasingly higher rate of complications developing from the virus.
If you have diabetes, know the signs of coronavirus, including difficulty breathing, cough, fever, chills, headache, sore throat, muscle aches, body aches, new loss of smell or taste, diarrhea, and nausea, and vomiting. If you develop these symptoms, call your healthcare provider right away. He or she will need a full accounting of your symptoms as well as fluid consumption, ketone reading, and glucose reading.
Some signs of COVID 19 constitute a medical emergency. Call 911 or go to the nearest emergency department if you experience a blue-tinged face or lips, inability to be awakened or remain awake, confusion, pressure or pain in the chest, or difficulty breathing.
The Importance of Diabetes Management
According to the ADA, people with diabetes who successfully manage their blood glucose levels are less likely to develop serious illness from COVID-19 infection. However, all individuals who have coronavirus diabetes must be aware of the signs of diabetic ketoacidosis, which can occur with a viral infection. This complication results in confusion, shortness of breath, fatigue, weakness, vomiting, nausea, frequent urination, and excessive thirst. Left untreated, DKA can cause septic shock, coma, and even death.
Controlling blood glucose levels can decrease your risk of serious illness resulting from diabetes. If you do get sick, monitoring blood glucose closely ensures you get the medical care you need if complications arise. Rely on MedEnvios for convenient home delivery of continuous glucose monitoring supplies and other necessities to keep diabetes under control.
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