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Covid-19 and Diabetics by Shu Golda

Coronaviruses are widely distributed RNA viruses in humans and animals. Although most human coronavirus infections are mild, major outbreaks of two severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002-2003 and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, have caused deadly pneumonia (1). In December 2019, there was an outbreak in Wuhan China, most of the patients presented with flu-like symptoms and pneumonia. However, the disease mechanism was not clearly understood. Studies later showed that the causative agent was Coronavirus which was named Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), and the disease it causes is called COVID-19 (2). On 30 January 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a Public Health Emergency of International Concern, and on March 11, the epidemic was upgraded to pandemic (3). As of today (07.09.2020), 27 million confirmed cases are officially reported in more than 200 countries, with 893,000 deaths (4).

The United States CDC has estimated that symptoms of COVID-19 usually develop within 2-14 days after exposure. Therefore, fourteen days has been the time applied internationally for monitoring and restricting the movement of healthy individuals

The virus can be mainly transmitted through droplets, direct contact, and aerosols. Droplets transmission may occur when respiratory droplets, produced when an infected person coughs or sneezes, are ingested or inhaled by individuals nearby (within about 6 feet). A subject can also get infected by touching a surface or object contaminated with the virus and subsequently touching his/her mouth, nose, or eyes (2)

The length of time a COVID-19 patient can transmit the infection remains uncertain. Thus, the infectivity period is assessed by detecting the viral RNA from respiratory swabs.

All age groups can be affected by COVID-19, but the median age is between 47-59 years. This age range is usually higher among severe cases and subsequent death cases. Alternatively, fewer cases have been observed among infants.

Signs and symptoms include;

  • mild flu-like symptoms, which may sometimes develop to acute respiratory distress syndrome (ARDS), respiratory failure, arrhythmias, acute cardiac injury, shock, multiple organ failure and death.
  • fever
  • cough
  • fatigue
  • sputum production and shortness of breath.
  • Headache, upper respiratory symptoms (e.g., sore throat and rhinorrhea), and gastrointestinal symptoms (e.g., nausea and diarrhea) occur less often

Reverse Transcriptase Polymerase Chain Reaction is the standard method of diagnostic method for COVID-19. An individual is considered positive when nucleic acid of SARS-CoV-2 is found in sputum, throat swabs, and secretions of the lower respiratory tract samples.

Everyone needs to be careful about contracting the coronavirus. However, diabetes patients need to be more careful

Are people with diabetes more likely to get COVID-19?

There is not enough evidence to prove that people with diabetes are more likely to get COVID-19 than everyone else. Diabetics however portray worse outcomes. It has also not been proven that COVID-19 can cause diabetes. People with diabetes primarily face serious complications and death than people without diabetes. It is generally believed that the more health conditions someone has, the greater their chances of developing serious complications from COVID-19

Do people with diabetes have a higher chance of experiencing serious complications from COVID-19?

Diabetes mellitus has been associated with severity and death in patients with COVID-19. Initial reports were mainly on people with type 2 diabetes, although recent surveys have shown that individuals with type 1 diabetes are also at risk of severe COVID-19. Chronic inflammation, increased coagulation activity, immune response impairment, and potential direct pancreatic damage by SARS-CoV-2 might be among the underlying factors contributing to the increased severity and death of COVID-19 diabetics. During treatment, care should be taken to avoid potential hypoglycemia which can be caused by the use of chloroquine in people with diabetes and COVID-19. Glucose levels should be monitored rigorously, and dose adjustments of antidiabetic drugs may be necessary (5)

What are the symptoms and warning signs diabetes patients should watch out for?

Potential COVID-19 symptoms including fever, dry cough and shortness of breath. Call your doctor if you start developing any of these symptoms you feel like you are developing symptoms.

Emergency warning signs include:

  • Difficulty breathing or shortness of breath
  • Persistent pain or pressure in the chest
  • New confusion or inability to arouse

When you call your doctor:

  • Present your glucose reading
  • Present your ketone reading
  • Keep track of your fluid consumption and report
  • State your symptoms clearly
  • Ask any questions on how to manage your diabetes

What should people with diabetes know and do?

For diabetes patients, it is vital to take as many precautions as possible against the virus. The widely issued recommendations to the general public are doubly important for diabetes patients and anyone in close contact with them. These recommendations include:

    • Wash hands thoroughly and regularly.
    • Try to avoid touching your face before you have washed and dried your hands.
    • Clean and disinfect any objects and surfaces that are touched frequently.
    • Don’t share food, glasses, towels, tools, etc.
    • When you cough or sneeze, cover your mouth and nose with a tissue or use the crook of your arm if you don’t have a tissue to hand (dispose of the tissue appropriately after use).
    • Try to avoid contact with anyone showing symptoms of respiratory illness such as coughing.
    • Think of whether you can make changes that will help protect yourself or your loved ones. For example, can you avoid unnecessary business travel? Can you avoid large gatherings? Can you avoid public transport?
    • If you are ill with flu-like symptoms, stay at home.

If you have diabetes:

    • Prepare in case you get ill.
    • Make sure you have all relevant contact details to hand in case you need them.
    • Pay extra attention to your glucose control. Regular monitoring can help avoid complications caused by high or low blood glucose.
    • If you do show flu-like symptoms (raised temperature, cough, difficulty breathing), it is important to consult a healthcare professional
    • Any infection is going to raise your glucose levels and increase your need for fluids, so make sure you can access a sufficient supply of water.
    • Make sure you have a good supply of the diabetes medications you need. Think about what you would need if you had to quarantine yourself for a few weeks.
    • Make sure you have access to enough food.
    • Make sure you will be able to correct the situation if your blood glucose drops suddenly.
    • Keep a regular schedule, avoiding overwork, and having a good night’s sleep.

Healthy nutrition and home-based exercise

Healthy nutrition and physical activity are important factors in diabetes management. That will help keep blood glucose at target levels and enhance immunity. It is recommended to:

  • Eat foods with a low glycemic index (e.g. vegetables, whole grains, beans)
  • Avoid excessive consumption of fried foods to reduce unsaturated fats
  • Limit consumption of foods high in refined sugar, carbohydrates, and fat
  • Choose lean proteins (eg. fish, meat, eggs, milk, beans after fully cooked).
  • Eat fruits in two or three servings

Regular exercise is essential for diabetes patients; it should however be done within the confines of your home to decrease exposure to Corona Virus

Tips to Avoid Infection

· The primary way to avoid being infected is to stay at home as much as possible. Social distancing has proven to be the most convenient way to prevent the spread of the virus

· If you have to go out for any reason, keep at least 6 feet away from other people, and wear a face mask. Wash your hands or use hand sanitizer often while out and when you get home.

· Also wash your hands before you give yourself a finger stick or insulin shot. Clean each site first with soap and water or rubbing alcohol.

· To protect you, everyone in your house should wash their hands often, especially before they cook for the family. Don’t share any utensils or other personal items. And if anyone in your house is sick, they should stay in their room, as far as possible from you. They should wear a cloth face mask when you have to be in the same room.

Your COVID-19 Diabetes Plan

While practicing social distancing, make sure you have the following:

Enough food, especially healthy carbohydrates like whole-wheat grains, vegetable, and fruits

  • Simple carbohydrates like sugar-sweetened drinks or fruit juices, in case hypoglycemia sets in
  • The maximum number of refills you can get of your insulin and other medications
  • Extra glucose and ketone strips
  • Phone numbers for your doctors

To recap, diabetes and other comorbidities are significant predictors of morbidity and mortality in patients with COVID-19. Future research is urgently needed to provide a better understanding regarding potential differences in genetic predispositions across populations, underlying pathophysiological mechanisms of the association between COVID-19 and diabetes, and its clinical management.

References.

1. Song Z, Xu Y, Bao L, Zhang L, Yu P, Qu Y, et al. From SARS to MERS, Thrusting Coronaviruses into the Spotlight. Viruses. 2019;11(1). Epub 2019/01/17. doi: 10.3390/v11010059. PubMed PMID: 30646565; PubMed Central PMCID: PMCPMC6357155.

2. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. Epub 2020/01/28. doi: 10.1016/S0140-6736(20)30183-5. PubMed PMID: 31986264.

3. World Health Organization. Naming the coronavirus disease (COVID-19) and the virus that causes it 2020 [31/03/2020]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/namingthe-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it.

4.www.worldometers.info › coronavirus

5. A. Hussain, B. Bhowmik, N. Cristina do Vale Moreira, COVID-19 and Diabetes: Knowledge in Progress, Diabetes Research and Clinical Practice (2020), doi: https://doi.org/10.1016/j.diabres. 2020.108142 T