Diabetes and COVID-19 | The NY Journal
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As we learn more about COVID-19, we know that the virus affects people differently.
I agree with you Centers for Disease Control and Prevention (CDC), although anyone can contract the virus, the people who are most vulnerable to contracting it are those over 65 or those who have an underlying disease (such as heart disease, asthma, high blood pressure, obesity or diabetes, among others) .
In the United States, 34.2 million people have diabetes, of which more than 21.4% have not been diagnosed, according to data from the CDC. Also an alarming number of more than 88 million Americans have prediabetes, and 84% of them do not know it.
The connection between diabetes and COVID-19
The SARS-CoV-2 virus, which is the one that causes COVID-19, binds to a specific receptor on the cell known as angiotensin converting enzyme or ACE2, for its acronym in English. This receptor is found not only in the lungs but also in the beta cells of the pancreas (which are those that produce insulin), as well as in the cells of the kidneys, the small intestine and in the fat cells. Because of this, it is being investigated whether COVID-19 could cause glucose (sugar) metabolism disturbances that complicate pre-existing diabetes or may even cause diabetes, according to a report in the New England Journal of Medicine.
Based on what we have learned, diabetic patients who contract other viral diseases tend to have more severe reactions. This is because diabetes causes a depressed immune system, and if diabetes is out of control (especially for a long time), it can cause inflammation. If the inflammation is chronic, as in poorly controlled diabetes, the inside of the blood vessels is damaged and that inflammation is harmful. There are markers in the blood that allow us to measure this inflammation.
Patients who, in addition to diabetes, have other risk factors such as high blood pressure, high cholesterol, are over 65 years of age, are men, are Hispanic and / or black, have an even higher risk of having more complications. The fact of being Hispanic or black is included as a risk factor because certain socioeconomic factors, such as their type of work, their family structure (where there are three generations living in a single household) or their dependence on public transportation, which makes it difficult physical distancing makes them more vulnerable to COVID-19.
When they studied people with type 1 diabetes and type 2 diabetes in the UK who died of COVID-19, they found that the risk was higher the higher the A1C (that is, the more out of control the diabetes was) and in a “U” -shaped relationship with the body mass index (which is related to weight and obesity). What’s interesting is that the risk of death was low for people with diabetes under 40 years of age.
Finally, uncontrolled diabetes is a risk factor for developing serious infections with adverse outcomes (hence the importance of trying to keep diabetes under control). And for people with late complications from diabetes like diabetic kidney disease (where the kidney has been affected) and ischemic heart disease, these can complicate their situation, making them more fragile. On the one hand, it can increase the severity of COVID-19 and, on the other, it can cause them to require care such as dialysis in acute form. In fact, in patients without diabetes it has been found that this virus can cause acute cardiac injuries with heart failure (failure), leading to impaired circulation.
What should you do if you have diabetes and COVID-19?
If you have diabetes and develop symptoms that suggest COVID-19, you should call your doctor as soon as possible. Even if you have diabetes, if you have a mild case of COVID-19 or are relatively asymptomatic, you may be able to stay home, especially if you can physically stay away from other people. What is very important is that you monitor your sugar levels frequently and call your doctor immediately if your diabetes gets out of control or if your symptoms get worse or if you develop nausea, vomiting or difficulty breathing.
If you are sick, you should monitor your ketone levels as well, especially if you take insulin injections or use drugs from the group of SLGT-2 inhibitors (for its acronym in English). These include medications such as: Invokana (canagliflozin), Farxiga (dapaglifloxin), and Jardiance (empaglifloxin). They work by helping to eliminate sugar in the urine. Your doctor may recommend a change in dosage or may change your medicine. But, never stop any medicine without consulting with your doctor.
As long as we do not have a vaccine and effective treatments against COVID-19, the only way to prevent contagion is to avoid being exposed to the virus. It is important to follow the recommendations of the World Health Organization and the CDC such as: wear a mask, maintain social distancing, wash your hands frequently, etc. Protect yourself and others!
-Aliza A. Lifshitz, known for her extensive career in the Hispanic media as Dra. Aliza, is the health expert for the educational television network for the Hispanic community HITN. At HITN, she is the host of the daily programming block Life and health, a space in which he shares information and tools to Hispanics to lead healthier lives and communicate better with their doctors.
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