COVID-19 and Diabetes Mellitus Management from an Endocrinologist View
The Covid-19 pandemic has destabilised everything and not only are people suffering directly due to the infection but it has also set off a series of reactions leading to various other health threatseven for healthy individuals. Specialist panels have been set-up at Metro Hospitals to observe and analyse the situation to devise a strategy to counter these effects at the best hospital in Delhi effectively.
It is not surprising to see a large number of diabetics, both type 1 and type 2, with increased morbidity and mortality. ICU admissions have doubled, mortality in diabetes patients has increasedalmost by 3 times, and severe disease rates twice of the normal population have been seen in the recent epidemic in China. Reports of ACE receptor up-gradation requiring anti-hypertensive medication modification are being published. Having been witnessed these cases first-hand, one finds certain factors aggravating this phenomenon.
- Lack of healthy lifestyle i.e., improper diet, lack of adequate exercise, improper sleep, increased stress due to financial deprivation, loss of jobs, lack of social communication.
- Failure to access healthcare due to presumed risk of infection, hospitals converted to COVID hospitals, lack of functioning diabetic, and endocrinology OPDs.
- Lack of information about diabetes monitoring treatment, check-up during this period.
- No information on medication changes, insulin sick day guidelines, changing schedules of treatment during this period.
The diabetes care panel at the best hospital in India hasobserved that patients are suffering from rising blood glucose levels due to isolation. Infection with COVID-19 significantly worsens the glycaemic status. Very few endocrinologists are available on the ground to care for diabetic patients and due to the lack of adequate specialists, the job is being left to inexperienced young residents, physicians, and nurses who find it increasingly difficult to control hyperglycemia, fluids, and electrolytes. The frequent use of steroids and the stress of infection also worsens the situation with an added rise in metabolic control due to concurrent comorbidities and the use of inotropes.
While treating patients suffering from COVID-19 and it was found that a large number are diabetics who suffer from poor immunity leading to an increased risk of moderate to severe COVID-19 infection. There is a need to step up glycaemicmonitoring with frequent blood glucose measurements and early appropriate use of insulin in the basal-bolus regimen to achieve glycaemic control. There have been cases of severe DKA that have been managed with IV fluids, electrolyte correction, insulin infusion, and bicarbonate depending on the severity of acidosis which is also further complicated by lactic acidosis and uremic acidosis. Factors like dehydration, fever, sepsis, use of multiple medications, inotropes, and frequent steroids make the situations truly challenging.
We have preferred to discontinue Metformin in these serious situations though DPP-inhibitors and insulin find a place in diabetic management.
Also very important is the role of regular monitoring of blood glucose levels at home and maintenance of normal blood glucose with regular use of prescribed medications which include oral hypoglycemic agents, GLP1 analogues, insulin subcutaneous, insulin pump therapy and treatment of concurrent illnesses. The role of exercise which includes atleast 150 minutes of aerobic exercise and 2 days of resistance training on a weekly basis cannot be overemphasized.
As a specialist at Metro Hospitals, the top diabetes hospital in Delhi I must point out the role of maintaining a regular balanced diabetic diet which is high in protein and unsaturated fats and avoidance of high carbohydrate load and saturated fats are emphasized to maintain appropriate body weight and muscle.
Furthermore, due to fear of infection patients should not compromise on their health, especially if they are diabetic. They should constantly stay in touch with their consultants and if required should visit COVID safe Hospitals such as Metro Group of Hospitals, which take extra care to ensure safety for all concerned.
Dr. Manoj Kumar Dutta
Consultant Internal Medicine (Endocrinologist)