Managing DIABETES in COVID-19 Pandemic

India is known as the Diabetes capital of the world, with over 60 million people affected by the condition. This number is expected to double by 2030, highlighting the importance of optimal diabetes care and management.

14th November is celebrated as the World Diabetes Day to mark the birth anniversary of Sir Frederick Banting, who discovered insulin along with Dr. Charles Best in 1922. The theme for this year is Nurse and Diabetes to acknowledge the efforts put in by the nurses in supporting those affected by the chronic condition.

This blog is aimed to help the general public understand the condition to enable its early diagnosis and management. It will also help those with the condition to understand the importance of optimal diabetes management particularly during the pandemic time. 

What is diabetes?

Diabetes is characterized by high blood glucose level over a long period of time due to reduced or no secretion of the hormone insulin in the body together with insulin resistance. Diabetes if left untreated can lead to several life-threatening complications including heart diseases, blindness, nerve damage, kidney failure, severe infections, limb amputations, etc. 

Diabetes can be broadly classified into 3 main types:

Type 1 diabetes: It generally develops in the early years of life and the patients stop producing insulin due to autoimmune conditions. 

Type 2 diabetes: This is usually seen in adults due to poor diet and lifestyle factors of physical inactivity and obesity. It is characterized by insulin resistance, a condition where the body fails to use the insulin ineffectively in regulating blood glucose levels. 

Gestational diabetes: This generally sets in during pregnancy and poses risk for both the mother and the unborn child. Patients with gestational diabetes are at higher risk of developing type 2 diabetes later in life. 

How to recognize symptoms?

Some of the most common symptoms of diabetes include:

  • Excessive thirst, urination, and hunger

  • Fatigue

  • Unexplained weight-loss

  • Blurred vision

  • Frequent infections

  • Swollen gums

  • Slow healing of wounds

  • Tingling sensation and numbness in hands or feet

  • In some patients, they may have no symptoms

What causes diabetes?

The exact cause of diabetes is not known. It is believed that in type 1 diabetes, the immune system of the body attacks and damages the insulin-secreting cells of the pancreas. This results in a low level or complete absence of insulin. Researchers believe that the complex interaction of genetic and environmental play a role in developing type 2 diabetes.

What are the risk factors for diabetes?

Some of the most prominent risk factors include:

  • Family history

  • Sedentary lifestyle

  • Sustained stress

  • History of gestational diabetes

  • Obesity

  • Increasing age

  • High blood pressure

  • Polycystic ovary syndrome

  • Abnormal triglyceride and cholesterol level

  • Tobacco use

How is the diagnosis established?

The following parameters are important markers of diabetes:

  • Random sugar level test: This test is done at any time regardless of the meal. A blood sugar level higher than 200 mg/dl suggests diabetes. 

  • Fasting sugar level test: This test is performed after an overnight fast. A level above 126 mg/dl indicates diabetes. 

  • Oral glucose tolerance test: In this test, the person requires to drink a glucose solution. The sugar level is measured after two hours. A reading of more than 200 mg/dl indicates diabetes. 

  • HbA1c test: This test provides the average sugar level for the last 2-3 months. A value of 6.5% or above suggests diabetes.

What is prediabetes?

When blood glucose levels are above the normal limit but below the level of diabetes then the condition is known as pre-diabetes, referred also to as “Borderline – High” levels. Patients with pre-diabetes are a high risk of developing diabetes in the future if not managed appropriately.

What are the treatment options for diabetes?

The management of diabetes includes:

Lifestyle modifications: Lifestyle modifications are one of the most key determining factors of optimal diabetes control, especially in pre-diabetes. A good lifestyle also cuts down one's need for high-dose medications and the number of medications.

  • Eat a healthy balanced diet low in carbohydrate, sugar and fat intake. 

  • Exercise regularly

  • Avoid stress 

  • Quit smoking 

  • Cut down on alcohol and junk food

Medications: Patients on type 1 diabetes and those on gestational diabetes are usually managed with insulin injection. Type 2 diabetes may require oral medications and injectable medications including insulin depending upon the patient's condition. 

Transplantation: In a small subset of patients, the doctor may recommend pancreas transplantation particularly in complicated type 1 diabetes. 

Impact of COVID 19 on diabetes

Diabetes itself is a serious condition and need lifelong care to avoid complications and death. Diabetes predisposes patients to a higher risk of infections. The ongoing pandemic has thus complicated the scenario as patients with diabetes are at increased risk of COVID 19 related complications. This may be attributed to the low immunity of patients suffering the chronic condition along with other co-existing medical problems. In light of the above information, many patients have kept away from a regular check-up with their health practitioners in fear of getting infected. This has led to a situation with a higher number of people with uncontrolled diabetes and related complications.

It has been established that the risk of COVID is low in patients if diabetes is well-managed. Thus, the need of the hour for all patients suffering from diabetes is to take extra care to keep their blood glucose levels in check.

  • Do not skip on regular doctor visit for follow-ups

  • Take all medications prescribed by the doctor

  • Get your blood tests done regularly as advised by the doctor

  • Avoid unnecessary travel and venturing outside home

  • Maintain social distancing and practice personal hygiene

  • Wear a mask while stepping out of home

  • Eat a healthy balanced diet, preferably cooked at home, exercise regularly and cut down on stress

  • Seek immediate medical help if you notice worsening symptoms 

 

Dr. Karthik Prabhakar

HOD & Consultant – Diabetes & Endocrinology

Manipal Hospitals Bangalore – Old Airport Road 

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