Here’s why people with diabetes are considered an “at-risk” group for COVID-19.
At this point, you have probably heard that people with diabetes are an “at-risk group” during the COVID-19 pandemic. However, there are some misunderstandings about what exactly that means.
People with diabetes do not have a higher risk of getting infected with COVID-19. The risk is what happens if they do get infected. “People with diabetes should be particularly cautious about contracting COVID-19 because they can experience more severe complications if they do, in fact, get infected,” says Minisha Sood, MD, endocrinologist.
COVID-19 and Blood Sugar Levels
Normally, the hormone insulin helps to control blood sugar levels. For people with diabetes, the pancreas either isn’t producing insulin (type 1 diabetes) or the body isn’t responding to insulin like it’s supposed to (type 2 diabetes). As a result, some people with diabetes may have high blood sugar levels.
High blood sugar levels can have many effects on the body, including compromising the immune system. “First of all, it suppresses the immune system and the body's ability to fight off viral infections, including COVID-19,” says Dr. Sood.
“It also creates an environment in the blood vessels that is unhealthy and can actually promote blood clotting, which we know is an emerging issue in COVID-19 infections,” says Dr. Sood.
Got good control of your blood sugar levels? Your diabetes may be less of a risk factor for COVID-19 complications if your blood sugar levels are stable.
COVID-19 and Ketoacidosis
A viral infection, such as COVID-19, can increase the risk of diabetic ketoacidosis. “Ketoacidosis is a condition in the body where blood glucose levels are elevated, and insulin production is decreased. And in that environment the body produces an excess of acids called ketones,” says Dr. Sood.
Ketones are an acid that the body uses as an alternative fuel. Normally, your body uses glucose for energy, but without insulin, the body doesn’t know how to use the glucose. As a result, the liver produces ketones.
The problem is that excess ketones can lead to dehydration and a loss of electrolytes. This can be an emergency in itself, and it can also increase the risk of septic shock.
Advice for Safety During the Pandemic
“For patients who have diabetes and are concerned about their risk for severe complications from COVID-19, I would advise them to take this opportunity to talk to their physicians,” says Dr. Sood.
“Outline a plan to improve and optimize their blood sugar levels,” she suggests. “Take this opportunity to also address some other comorbidities that patients with diabetes often have such as obesity, high blood pressure, high cholesterol. Optimizing all of these areas would likely diminish the risk for severe complications.”
Additionally, you may need to show extra caution to avoid contracting the virus. Check out these COVID-19 prevention tips for at-risk groups.
Dr. Sood is a board-certified endocrinologist in private practice in New York City and an assistant professor at Hofstra School of Medicine.
00:00:01.500 --> 00:00:03.999
People with diabetes should be particularly cautious
00:00:04.000 --> 00:00:06.132
about contracting COVID-19
00:00:06.133 --> 00:00:08.999
because they can experience more severe complications
00:00:09.000 --> 00:00:11.466
if they do in fact get infected.
00:00:11.467 --> 00:00:17.499
00:00:17.500 --> 00:00:20.799
People with diabetes are more likely
to have serious complications
00:00:20.800 --> 00:00:24.566
from COVID-19 because of high blood glucose levels,
00:00:24.567 --> 00:00:26.199
or high blood sugar levels.
00:00:26.200 --> 00:00:29.266
What happens in the body when the blood glucose is elevated
00:00:29.267 --> 00:00:32.699
is that there's a chronic level of inflammation
00:00:32.700 --> 00:00:35.166
and this creates a few problems.
00:00:35.167 --> 00:00:37.366
First of all, it suppresses the immune system
00:00:37.367 --> 00:00:40.132
and the body's ability to fight off viral infections,
00:00:40.133 --> 00:00:41.666
00:00:41.667 --> 00:00:45.566
High blood sugar levels can predispose to cytokine storm.
00:00:45.567 --> 00:00:49.232
So cytokines are chemicals made by immune cells,
00:00:49.233 --> 00:00:52.166
and this is a part of natural immunity,
00:00:52.167 --> 00:00:54.299
but in patients with high blood sugar,
00:00:54.300 --> 00:00:56.699
there can be an overreaction of the immune system,
00:00:56.700 --> 00:00:57.899
and that cytokine storm
00:00:57.900 --> 00:01:00.699
can lead to more severe complications from COVID-19.
00:01:00.700 --> 00:01:03.732
And it also creates an environment in the blood vessels
00:01:03.733 --> 00:01:07.466
that is unhealthy and can actually promote blood clotting
00:01:07.467 --> 00:01:10.166
which we know is an emerging issue
00:01:10.167 --> 00:01:12.566
in COVID-19 infections.
00:01:12.567 --> 00:01:17.099
COVID-19 infection increases the risk of diabetic ketoacidosis.
00:01:17.100 --> 00:01:19.632
Ketoacidosis is a condition in the body
00:01:19.633 --> 00:01:22.032
where insulin production is decreased,
00:01:22.033 --> 00:01:23.999
relative to what it usually is,
00:01:24.000 --> 00:01:25.866
and blood sugar levels are high.
00:01:25.867 --> 00:01:28.666
The symptoms of diabetic ketoacidosis are dangerous
00:01:28.667 --> 00:01:31.566
because they can quickly lead to profound dehydration
00:01:31.567 --> 00:01:33.366
and electrolyte problems,
00:01:33.367 --> 00:01:36.032
which require immediate medical attention.
00:01:36.033 --> 00:01:37.832
For patients who have diabetes
00:01:37.833 --> 00:01:40.932
and are concerned about their risk for severe complications
00:01:40.933 --> 00:01:42.432
00:01:42.433 --> 00:01:45.732
I would advise them to take this opportunity to talk
00:01:45.733 --> 00:01:48.966
to their physicians,
to talk to their healthcare providers,
00:01:48.967 --> 00:01:53.499
outline a plan to improve and optimize
their blood sugar levels,
00:01:53.500 --> 00:01:55.799
and to take this opportunity to also address
00:01:55.800 --> 00:01:58.399
some other comorbidities that patients with diabetes
00:01:58.400 --> 00:02:01.632
often have, such as obesity, high blood pressure,
00:02:01.633 --> 00:02:04.932
Optimizing all of these areas
00:02:04.933 --> 00:02:09.733
would likely diminish the risk for severe complications.