Diabetes treatment and associated complications in the Covid-19 era

A significant number of cases of diabetes in our country are poorly regulated and are thus at an elevated risk of complications such as ICU admission, contraction of other infections, and ventilator requirements. Covid-19 can exacerbate diabetes and can complicate the condition further.

More than a million people around the globe were killed by Covid-19. There are several risk factors – age, obesity, and other co-morbid diseases such as diabetes and cancer – that can result in unfavorable results for a Covid 19 patient.
In diabetic patients, the mortality or death rate is considerably higher. In China, compared to 2.3 percent for the general population, the mortality rate for diabetic patients was 7.3 percent. Similarly, the mortality rate for the general population in the USA was 6.2 percent, but it was 14.8 percent in diabetic patients. It was as high as 28.8 percent in uncontrolled diabetic patients.

A significant number of cases of diabetes in our country are poorly regulated and are thus at an elevated risk of complications such as ICU admission, contraction of other infections, and ventilator requirements. Covid-19 can exacerbate diabetes and can complicate the condition further.

Obesity significantly raises the risk of complications from Covid-19. There are a considerable number of overweight diabetics. The road to recovery is complicated by this dynamic relationship of diabetes, obesity, and Covid-19 in a patient.

How can diabetes and its complications be controlled during a pandemic?

Surveillance of blood glucose should be performed regularly. While blood sugar may be elevated by infection, poor food consumption makes the patient more vulnerable to low blood sugar. So if the patient is being treated at home, it is important to monitor blood sugar periodically.

If the patient is on sulfonylurea such as glimeperide, gliclazide or glipizide, regular monitoring may be needed, especially if they are unable to eat properly. Inadequate nutrition can cause serious hypoglycemia.
Most patients with diabetes are now on newer medicines such as Empagliflozin, Dapagliflozin or Canagliflozin, known as SGLT2 inhibitors. These are known to minimize weight, and if you are unable to eat enough food, they should be discontinued. In addition, they may cause severe complications such as diabetic ketoacidosis, i.e. the development in the bloodstream of toxic materials. Ask your doctor if SGLT 2 inhibitors such as Empagliflozin, Dapagliflozin or Canagliflozin are safe to use.

Many patients with diabetes often take a blood pressure drug called an ACE inhibitor or ARB. Do not discontinue them without the doctor being contacted. Diabetic patients should drink 250 ml of water every two hours (or more frequently) to make up for fluid loss due to fever and elevated blood sugar levels.
If your blood sugar levels are still elevated, your doctor can recommend that you start taking insulin. Do not delay as this will be temporary in most cases and will help in faster recovery. The total goal of glucose to be maintained is 140 to 180 mg, i.e. neither too low nor too high.

Therefore, if you have type 2 diabetes and are able to eat properly, proceed with your daily drug. You should discuss your recovery options with your doctor because your daily prescription will need to be changed temporarily.

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