Doctors have reported a definite increase in the number of diabetes cases during the pandemic; and they blame the viral infection itself, the use of steroids in the treatment, and the sedentary lifestyle during the pandemic. The doctors say that many patients with coronavirus disease (Covid-19) come to hospitals with severe diabetic crisis just like that of childhood or type 1 diabetes.
“Many Covid-19 patients initially show type 1 diabetes-like symptoms – extremely high sugar levels, ketoacidosis (a complication where blood turns acidic because of excess ketones produced), and need insulin injections. But, these are not true cases of type 1 diabetes as we have seen that they convert to normal type 2 diabetes, dependent on oral medicines three or four weeks after the infection,” said Dr Anoop Misra, chairman, Fortis-CDOC Centre for Diabetes, Metabolic Diseases and Endocrinology. He said seven of every 10 new diabetes patients who consulted him last month had been infected with Covid-19.
This happens in around 5% of the hospitalised Covid-19 patients, he said.
Type 1 diabetes, which is usually diagnosed in childhood (hence the name), happens because the body stops producing the glucose-digesting hormone insulin. Type 2 diabetes, on the other hand, happens because the body’s cells become resistant to the insulin produced.
Dr Misra added, “The diabetes could be triggered by the stress to the body during the Covid-19 infection. Now, there is also a discussion of Covid-19 directly affecting the beta cells in the pancreas as they have the ACE II receptors used by the Sars-CoV-2 virus.”
Dr M Ashraf Ganie, professor of endocrinology at Sher E Kashmir Institute of Medical Sciences, Srinagar, said, “The new onset of diabetes can be because of two reasons – stress due to the infection (cytokine storm is also known to make the body insulin-resistant), or the infection destroying the beta cells in the pancreas as shown by lab studies. It’s too premature to say what is happening.”
“We need to follow up with patients and administer a beta cell panel test to see what is happening. We might get results in couple of months.The sheer number of people who had Covid-19 since last year would speed up the diabetes epidemic,” said Dr Ganie.
Theoretically, those who are predisposed to diabetes, such as the obese and those with family history, might not return to their baseline blood sugar levels before Covid-19 , he said.
Just after the April-May deluge of Covid-19 cases in Delhi, 90% of the new diabetes patients coming to Dr Misra’s clinics were those who got it after being administered steroids for the treatment of moderate and severe Covid-19.
Last year, he had seen an increase in diabetes because of the sedentary lifestyle of the people due to the lockdown resulting in on average 2 to 4kg weight gain. This year, he said, people have adapted and have either been exercising at home or stepping out for walks.
“The high numbers are also because many people who were unaware of their diabetic status got diagnosed when they reached hospitals with Covid-19. Around 30% of the diabetics with Covid-19 were unaware that they had the condition,” said Dr Misra.
Will the people with new onset of diabetes after Covid-19 become lifelong diabetics? The doctors do not know for sure, yet.
“The use of corticosteroids leads to blood glucose levels to shoot up not only in diabetics but even those without history. But, we will need long-term follow-up data to see whether this is hyperglycaemia (high sugar levels) after the infection or whether it converts into diabetes. Various infections like mumps and measles are known to trigger diabetes due to the stress on the body. But now people are talking about Covid-19 directly impacting pancreas, leading to diabetes,” said Dr Ambrish Mithal, chairman, department of endocrinology and diabetes, Max Healthcare.
What is encouraging is that he has seen most of his patients return to their baseline blood sugar levels before Covid-19 within few weeks. “We are tracking some of the patients who haven’t. We have to see how much of this goes on to become permanent diabetes,” he said.