Evidence suggests coronavirus may trigger diabetes in non-diabetic patients; healthy diet, exercise advised to thwart threat to life
There is increasing evidence that otherwise healthy people are at risk of developing diabetes after they contract the novel coronavirus
Diabetes is a known risk factor for severe COVID-19 . This does not mean that diabetic people are more likely to get COVID-19 if they come in contact with an infected person, rather what it does mean is that these people are at risk of developing severe illness if they contract the virus and maybe even dying of it as a result.
Earlier, experts assumed the connection to diabetes ended there. But now there is increasing evidence that healthy people too are at risk of developing diabetes after contracting the COVID-19 disease.
Though more studies are needed to understand why is it happening, or, if and how, the novel coronavirus is doing it.
Diabetes and COVID-19
According to the British Diabetic Association, when you are sick, you need more energy, which your body prepares to get by releasing stored sugar in the blood. Normally, an enzyme called insulin will make sure that your body cells pick up all the extra sugar from your blood, so it can be converted into energy.
However, since a diabetic person cannot make insulin (or enough insulin), their body is unable to provide this extra sugar to cells. So, they neither get the energy to fight the infection nor are they able to keep their blood sugar levels low.
When there is a severe insulin deficiency, the body starts to use stored fat as energy. This leads to the production of ketones and when ketones collect in the body, it leads to a condition called diabetic ketoacidosis. A person with diabetic ketoacidosis feels more thirsty and tired than usual. He/she may also have confusion and blurred vision and may faint, all within 24 hours.
Reportedly, there have been a few instances where people (both diabetic and healthy) have showed ketosis, ketoacidosis or diabetic ketoacidosis after getting COVID-19 . In a study done on more than 650 COVID-19 patients, about 42 people developed ketosis without showing fever or diarrhoea. Out of these, 27 did not have diabetes. Five patients (three diabetic and two healthy) showed ketoacidosis. Interestingly, it was also found that ketosis increased the time a patient needs hospital care for and also increases their risk of death. Though diabetic people with ketosis also had to stay in the hospital for long, it did not increase their risk of mortality.
The study also suggested that healthy people with ketosis should consume a healthy diet and keep exercising to stave off diabetes.
In a case study, a 37-year-old man developed signs of diabetic ketoacidosis and type 1 diabetes soon after he got COVID-19 . The man did not show any signs of insulin resistance at the time of admission and was not obese or overweight.
This is not a first though: various other viruses have been associated with type 1 diabetes-like mumps virus and rotavirus. Type 1 diabetes is an autoimmune condition in which the immune system destroys the insulin-producing cells.
A recent study published in the peer-reviewed journal Cell Stem Cell suggested that SARS-CoV-2, the causative agent of COVID-19 , may damage the pancreatic cells in our body that are responsible for controlling blood sugar. The pancreas is a leaf-shaped organ located in the abdomen. The beta-cells in the pancreas produce insulin and the alpha cells produce glucagon. Glucagon increases blood sugar levels.
This is because, pancreatic cells express ACE-2 receptors, the cell surface receptors that the COVID-19 causing virus uses to enter healthy cells. When the virus enters a cell, it damages those cells either directly or by triggering inflammation that then kills or damages the pancreatic cells.
Another possible suggested mechanism is that the expression of ACE-2 receptors are downregulated once the virus enters healthy cells.
ACE-2 or angiotensin-converting enzyme -2 is normally a part of the renin-angiotensin-aldosterone-system (RAAS). RAAS is responsible for maintaining blood pressure and electrolyte balance in the body. ACE-2 converts a protein angiotensin 2 into angiotensin (1-7). Angiotensin 2 has been shown to reduce insulin secretion and cause insulin resistance in the body. Insulin resistance is when the body cells do not respond well to insulin and don’t take up sugar from the blood.
SARS-CoV-2 and RAAS interaction may also make it difficult to deal with diabetic ketoacidosis since angiotensin 2 increases vascular permeability (the ability of blood vessels to allow water, nutrients and white blood cells) in lungs and hence the damage to the lungs occurs. It may also lead to a condition called hypokalemia (deficiency of potassium).
Experts are now trying to understand the link between COVID-19 and type 1 diabetes and if the disease can push prediabetic people to develop type 2 diabetes. Type 2 diabetes is associated with insulin resistance and not damage to insulin-producing cells.
For more information, read our article on Why COVID-19 is more dangerous for diabetes patients
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