New Delhi: Ever since the novel coronavirus was identified in China, scientists and health researchers have been studying the virus relentlessly, including how the virus spreads, whether it poses an extra threat to certain groups of people, and how to treat it. With time, researchers are learning a lot about this virus, yet, there’s so much as the SARS-CoV-2 that causes COVID-19 is new to the world. People with diabetes are categorised in the ‘high-risk’ group.
In an Exclusive Interview with Times Now Digital, Dr RV Jayakumar, Senior Associate Consultant-Endocrinology, Aster Medcity, and Chairman of the Indian Thyroid Society, tells us how COVID-19 affects diabetes patients, and whether people with type 1 and type 2 diabetes are at similar risk for the deadly respiratory illness. Below are excerpts from the Interview.
How does COVID-19 affect people with diabetes?
Dr RV Jayakumar: COVID-19 is a new disease, hence, understanding of this illness is still evolving. Till date, there is no evidence of diabetics being at a higher risk of contracting coronavirus infection. Nonetheless, it’s natural that diabetes being a disease with elevated blood sugar which causes immune system malfunction, it increases the risk of infections. Considering that we can say they might be at a higher risk, but again, no study has proven this link.
The prevalence of diabetes in India is about 15 to 20 per cent, similarly, we can consider the same ratio of patients who might be diabetic amongst the total number of COVID-19 patients. While the risk of catching the virus isn’t higher in a diabetic patient than anyone else’s, they could develop severe complications if they do get sick.
Is the presentation of COVID-19 different in diabetics in comparison to those without diabetes?
Dr RV Jayakumar: The symptoms and effects of COVID-19 in diabetics are the same as in non-diabetic patients. But diabetes could worsen the chance of getting seriously ill from COVID-19 like other viral infections because the ability to fight off an infection is compromised in a diabetic person. The clinical manifestation is different for a diabetic patient as compared to a non-diabetic patient. Typically, symptoms are mild in the general population, though they vary from person to person. But a diabetes patient might get severe symptoms and the death rate amongst diabetics will be higher because of implications related to comorbid conditions like blood pressure, kidney damage, heart problems, etc.
Do people with type 1 and type 2 diabetes have a similar risk for COVID-19 considering the fact that multiple factors are at work in these conditions? Do they (both type 1 and type 2) show the same symptoms or react differently to an infection like COVID-19?
Dr RV Jayakumar: Type 1 and type 2 diabetes are two different entities. Type 1 is the absolute absence of insulin. Without insulin, the glucose level in your blood gets too high, hence, they require lifelong insulin treatment. Type 2 diabetes is insulin resistance, meaning the insulin that is available in the body is not working properly – deficiency of insulin may vary from mild deficiency to severe deficiency. So, even the treatment options vary, but when it comes to COVID-19, there isn’t any study yet in this regard.
But, type 1 diabetes, as we know, is more of an insulin deficiency, hence, there are higher chances of kidney damage and eye changes, which are the most common complications, whereas type 2 is often mild. So my clinical experience says that there may be more severe symptoms, complications, and mortality in type 1 diabetes.
I have also experienced 40 per cent of type1 diabetes patients suffer from kidney damage, compared to only 10-20 per cent of type 2 diabetes patients who develop kidney problems. More importantly, some factors play a role in outcomes irrespective of either type of diabetes – such as age, complications, and how well they manage their condition.
What should diabetics do if they have been infected with coronavirus?
Dr RV Jayakumar: As the severity in a diabetic patient will be more, they should be more cautious and consult a doctor even if they see any minor symptoms in them. They should get admitted to the COVID-19 isolation wards to get required care. They need to be placed under observation along with regular monitoring of blood sugar and blood pressure levels, kidney function and other organs as the chances of multi-organ failure are higher in a diabetic patient compared to a non-diabetic patient getting COVID-19.
Apart from that, during the treatment procedure, we also need to be careful when it comes to a diabetic patient. There are different kinds of medicines approved by ICMR for COVID-19 treatment. One of them is Hydroxychloroquine which is being used by a few. Doctors need to be cautious while prescribing this drug to a diabetic patient because it may increase insulin level by lowering glucose levels. They should also be cautious while prescribing drugs which induce hypoglycaemia (can reduce blood sugar level below 70 milligrams per decilitre).
Rather, other antiviral drugs like Ritonavir and Lopinavir can lead to diabetes in non-diabetic patients. At present there are so many confusions as per literature, hence, a diabetic patient should be under observations since the very first day of any kind of symptoms.
What are the precautions diabetics can take to stay healthy?
Dr RV Jayakumar: A diabetic patient must take ultracare and should make sure that they are not exposed to the virus.
- The guidelines of lockdown should be followed strictly and they shouldn’t come out of their houses to maintain social distancing.
- Frequently wash hands with soap and water or use an alcohol-based solution, especially before eating and after being in public along with wearing masks.
- As diabetic patients stay at home, there’s a high chance of eating more with less physical activity. They must follow a strict diet along with some exercise – such as going down and up through stairs at least once a day.
- They should stock up on medicines, ensuring that they don’t miss their doses.
- Diabetic patients should avoid prolonged sitting such as watching TV or working on a laptop.
- They must get adequate sleep at least for 7 to 8 hours and maintain a disciplined life.
- They should adopt a positive attitude and not get depressed due to Covid-19 situation, which may worsen their health condition.
What is diabetes remission? What are the guidelines for those who are in diabetes remission?
Dr RV Jayakumar: Diabetes remission means patients with diabetes (type 2) have a healthy blood pressure level and are no more under diabetes medication. But they may be still under some dietary restrictions and be doing some regular physical activities and exercise to maintain their weight. Considering all this, I feel there is nothing called ‘remission’ in diabetes because they might have controlled their diabetic level by following non-pharmacological methods of lifestyle changes, food habits and exercise. But if they fall ill with a condition like COVID-19 or any other severe infections, their diabetes level will come up. So, they should also be cautious and should take the same precautions that diabetic patients take.
The views expressed by the author are personal and do not in any way represent those of Times Network.