A severe course of COVID-19 occurs more often in people with chronic diseases, among them diabetes mellitus. Why is this happening and how should patients behave?
Head of the Department of Endocrinology, Faculty of Physics, Russian National Research Medical University named after V.I. N.I. Pirogov
In patients with diabetes mellitus, the coronavirus is 2-4 times more severe than in other groups of patients. Risk factors include hyperglycemia, obesity, and impaired immunity. Poor blood glucose control interferes with the immune response to viral infection and to potential bacterial infection in the lungs. This increases the mortality rate, in patients with COVID and diabetes, it is 9,2%.
First of all, with the development of coronavirus, the risk of hypoxia, disorders of mineral and electrolyte metabolism, dehydration, a more severe inflammatory process of the respiratory tract, the development of a formidable complication – ketoacidosis (an emergency condition associated with an increase in the level of glucose and ketone bodies in the blood) increases. In patients with diabetes mellitus, especially type 1, ketoacidosis can develop rapidly and, if infected with COVID, have a severe course.
A characteristic manifestation of the coronavirus, especially in uncompensated diabetes mellitus and its concomitant diseases, is bilateral atypical pneumonia, anemia with destruction of erythrocytes, disseminated intravascular coagulation syndrome (a pathological process characterized by the formation of blood clots), myocardial damage.
When should I see a doctor?
No specific manifestations of COVID-19 have been described for patients with diabetes mellitus. They, of course, need to urgently see a doctor if such classic symptoms as fever, malaise, cough, shortness of breath appear. Even with a slight increase in temperature, an increase in the dose of insulin or tablets may be required. In the event of a persistent increase in glucose levels above the target values, it is necessary to contact the attending doctor for advice on adjusting therapy. Please note that the detection of ketones in urine using test strips requires immediate medical attention..
Collect a first aid kit
Patients should have a good supply of antidiabetic medications and self-management at home.
It is worth buying in advance an additional number of test strips for a glucometer or sensors for continuous monitoring of blood glucose, since in most cases self-monitoring of glucose levels is required quite often – at least 4 times a day.
Regardless of the type of diabetes in this situation, it is worth having test strips at home to determine ketones in urine. In the case of a persistent increase in glucose above 13-15 mmol / l, they should be used in order to detect ketoacidosis in time.
Drinking lots of unsweetened liquids is recommended to prevent dehydration.
Without self-medication
Some people with diabetes believe that medications used to treat the underlying condition increase their risk of contracting COVID. It’s a delusion. Patients diagnosed with diabetes need not only to correct glucose levels, but also to normalize blood pressure. For this purpose, they are almost always prescribed ACE inhibitors-antihypertensive drugs necessary for the treatment of hypertension, chronic heart failure, diabetic nephropathy. They have been proven to be effective and safe, as well as the ability to prolong the life of patients. Unreasonable cancellation of these drugs can lead to serious consequences.