Can COVID-19 trigger diabetes?
The coronavirus isn’t just deadlier for people with diabetes, it’s also triggering the metabolic disease in many who didn’t previously have it.
According to Dr. Eleonor Du, immediate past president of the Philippine Society of Pediatric Metabolism and Endocrinology, there have been reports of increased incidence of type 1 diabetes among patients with COVID-19.
“In fact, two studies done in Europe showed how often (type 1) diabetes appeared to strike COVID-19 survivors,” notes Dr. Du, during “The Choice to Live Free: Continuous Glucose Monitoring and Diabetes in the time of COVID-19,” a virtual roundtable discussion via Webex.
Although this is still not evidence-based, some doctors suspect the SARS-CoV-2 virus may damage the pancreas, the gland that makes insulin, which is needed to convert blood-sugar into energy.
“We know for a fact that type 1 diabetes could be triggered by viral infection,” Dr. Du says. “And a recent mouse study reveals how the enterovirus (coxsackievirus) could induce diabetes.” Enteroviruses are suspected to contribute to insulin-producing β cell loss and hyperglycemia-induced diabetes.
Sedentary lifestyle brought on by lockdowns could be another factor, as might late diagnoses as most patients refrain from going to their doctors’ clinics for fear of contracting the virus.
“Even some kids’ mild COVID-19 cases can be followed by the swift onset of diabetes,” Dr. Du adds. “And vice-versa. Kids with or without diabetes are not exempted from being infected with COVID-19. In our government hospitals, we already have more than 1,000 pediatric COVID cases since March 2020.”
Most of the children severely impacted by COVID-19 have other illnesses such as congenital heart disease, kidney problems, cancers, and viral infections like tuberculosis and bacterial pneumonia.
“The increase in their blood glucose levels increase the risk of severe infection,” explains Dr. Du. “When the blood sugar is uncontrolled, the body will be in a state of stress and imbalance. The immune system goes down, making it susceptible to infections. And since the body’s defense is interrupted, it cannot fight off infections.”
Diabetes care in the time of COVID
Over 400 million worldwide are diagnosed with diabetes. In the Philippines, eight percent of Filipinos are already pre-diabetic without them knowing it. Indeed, “mabuti pa ang langgam — alam.”
Early detection and treatment of diabetes — especially in the time of the pandemic — is, indeed, an important step towards keeping people with diabetes healthy.
I’m aware of all these because my dad and husband are diabetics, and I lost my dear sister to complications of this debilitating disease, which could have been prevented had she been aware of her risks and acted upon it.
“Pre-diabetic is one step below diabetes,” explains Dr. Jeremy Robles, immediate past president of the Philippine Society of Endocrinology, Diabetes and Metabolism. “If these patients don’t take care of themselves, they will eventually become diabetics as well.”
Some of the common risk factors for both type 1 and type 2 diabetes include family history, age and race. Knowing these risk factors is crucial to help identify which ones can be controlled and which ones are inevitable.
Knowing is not enough. Doing something about what you already know is very important. And so once you know that you’re at risk, consult your doctor right away.
“So we can assess your health status and conduct the necessary lab tests for better management of your condition,” notes Dr. Robles.
When you’re a diabetic, you’re not only dealing with hyperglycemia (high blood sugar). You also have to deal with episodes of hypoglycemia (low blood sugar).
“That’s why regular glucose monitoring is very important,” advises Dr. Robles.
In people with normal glucose tolerance, blood glucose levels are automatically monitored and controlled by the body. After eating, the body releases enough insulin to keep the plasma glucose within a normal range and usually returns to pre-meal levels within two to three hours. But that’s not the case with diabetic patients. Their body has little or no automatic control of blood glucose levels. And so after eating, they often experience extended periods of elevated blood glucose levels.
“Uncontrolled blood sugar levels could lead to long-term complications like heart and kidney diseases, nerve damage and vision problems, among others,” warns Dr. Robles. “Regular glucose monitoring is one way people with diabetes and their doctors can better manage their condition.”
The downside is, using an invasive glucometer (to check your blood glucose level) is painful. No matter how small and thin the needle is, pain is still there. While some people got used to it, it can be problematic for others, particularly children with diabetes.
Pediatric diabetes care
Around 1.1 million children and adolescents are living with type 1 diabetes around the world. In the Philippines, type 1 diabetes in children accounts for 8.5 percent.
Potential factors such as weight and inactivity impacted by the pandemic can possibly complicate diabetes management in children.
As recent COVID-19 cases mostly involve the youth, children living with diabetes need to be protected and ensure that their glucose levels are always in check.
“However, compliance to monitoring blood glucose remains difficult among children with diabetes,” says Dr. Eleanor Du, the pediatric diabetes expert. “The pain brought about by daily pricking lead to non-compliance among children.”
And this can affect their blood glucose control, which could result to episodes of hypoglycemia and hyperglycemia.
“Again, non-compliance can be dangerous because it can increase the chances of complications of diabetes,” the lady doctor warns. “I had a young patient who died recently because of poor diabetes management and the restrictions brought about by the pandemic.”
Pain-free glucose monitoring
To address this, Abbott introduces FreeStyle Libre, a revolutionary continuous glucose monitoring technology that monitors glucose levels every minute through a small coin-sized sensor worn on the back of the upper arm for up to 14 days. No daily pricking needed.
This easy-to-use gadget is a great alternative that parents and caregivers can use for their children. But before getting one, consult and get clearance from your kids’ doctors first.
“The Free Style Libre sensor measures glucose every minute in interstitial fluid through a small (5.5-mm. long) filament that is inserted just under the skin and held in place with a small adhesive pad,” explains Dr. Robles.
A quick scan of the sensor with a reader provides a real-time glucose reading and a detailed picture of a person’s glucose levels, without the need for painful, routine finger pricking or daily calibration.
The FreeStyle Libre Reader scans the sensor and displays the current glucose reading, the last seven hours of glucose data and a trend arrow to show where glucose levels are heading.
“The FreeStyle Libre System is easy to use and very convenient for a lot of our patients, especially those who are always on the go. They can check their blood sugar before or after meals, anytime, anywhere,” enthuses Dr. Robles.
What’s also nice about the system is that it comes with FreeStyle Libre View, a web-based software that will allow the patient to upload the data and send this to his/her doctor for monitoring (remotely).
“FreeStyle Libre is a game changer. It gives diabetic patients a better understanding of how much fluctuations in their glucose level could affect their overall health,” notes Dr. Robles.
Remember, proper management of the disease could mean fewer episodes of hyper and hypoglycemia, reduce hospital admissions, and prevent complications, which result in morbidity and mortality.
“Patient empowerment is key in managing diabetes in the time of COVID,” adds Dr. Robles.
