Diabetes and COVID

zand

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I have tried to read it but my brain won't understand it. I don't think my understanding will ever recover to pre covid levels. Even the conclusion was too difficult. If anyone could pick out the salient points I would be pleased to read them.
 
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NicoleC1971

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Thanks. Seems to confirm that insulin resistance is very involved with impaired immune systems . Any type 1 who has been ill knows how huge this is (double or triple doses of insulin needed even when no food is eaten!) so I think the high sugar levels are artefacts of infection.
Have also heard the current viral issue described as a syndemic - a clash of chronic metabolic ill health rendering certain groups even more vulnerable to the virus of the day.
We can't reduce anyone's age but its frustrating that no mention is made in the mainstream about improving their susceptibility to this. Just lots of futile attempts to prevent infections!
 

NicoleC1971

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I have tried to read it but my brain won't understand it. I don't think my understanding will ever recover to pre covid levels. Even the conclusion was too difficult. If anyone could pick out the salient points I would be pleased to read them.
Re the meds it says that Dp4 inhibitors are okay but sglt2 inhibitors carry a theoretical risk (I assume because they involve kidney function) and insulin is the best way to reduce high blood sugars. I didn't get much beyond the abstract.
 
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zand

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Re the meds it says that Dp4 inhibitors are okay but sglt2 inhibitors carry a theoretical risk (I assume because they involve kidney function) and insulin is the best way to reduce high blood sugars. I didn't get much beyond the abstract.
Thank you.
 

DCB 2

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Interesting paper, importantly it confirms what was already said in the the following papers.

https://www.cell.com/cell-metabolism/fulltext/S1550-4131(20)30238-2#.XqxOw3EasVI.twitter

https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(20)30416-2/fulltext

From a type 2 perspective it is important to check your numbers when you are infected on regular basis some say every two hours. Once it gets to 13.34 mmol/L or 240 mg/dL and you try 30 minutes later and has not gown down you should call your doctor., your blood sugar is dangerously high. The value was chosen because it is used to indicate ketoacidosis and someone needs medical attention. The paper you mention also the need for regular testing as well. I am not trying to be negative or scare anyone, but waiting too long to take action may not be good thing. I reviewed this with my doctor and he agreed with me and have a plan in place. If my numbers get to 240 mg/dL and will not go down I am to call him immediately. I just like to have a plan in place, these thing almost happen late at night and having a plan would make things easier, just in case.

I know this sounds crazy, but every time make such a plan I never need it. However when I do not plan for things I wished I did.

The paper did give a good description of using insulin as a treatment option
 

Goonergal

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Once it gets to 13.34 mmol/L or 240 mg/dL and you try 30 minutes later and has not gown down you should call your doctor., your blood sugar is dangerously high. The value was chosen because it is used to indicate ketoacidosi

Can you provide the link for the this, please? I didn’t see it in either of the papers you link, although I did rather skim the second one.
 

zand

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Checking BGs more often is a great plan. However I was exhausted with simply trying to breathe and when I did check my BGs it was difficult as my blood just wouldn't flow as it was 'sticky'.
 

DCB 2

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Can you provide the link for the this, please? I didn’t see it in either of the papers you link, although I did rather skim the second one.

Sure
Some say 300 is limit and others say 240 is the limit. I used the more conservative number. Here is the link:
https://www.cdc.gov/diabetes/managing/manage-blood-sugar.html. The paper
"Diabetic ketoacidosis precipitated by Covid-19 in a patient with newly diagnosed diabetes mellitus" stated that one of the side effects of Covid infection is that the virus will cause enzymes which will inhibit the secretion of insulin which could could cause ketoacidosis. This was also touched in natrure atricle.

Since the virus can create enzymes that inhibits the secretion of insulin and could cause ketoacidosis. I applied what the warning values for ketoacidosis. Secondly I learned from several postings of people on the forum who had extremely high blood sugar and waited too long to take action.

Please I do NOT mean to point fingers at them, this was early in the pandemic and we had a massive learning curve. Hind sight is always 20/20. If it was me at the time with the same knowledge I would have probably have done the same. I am trying learn from other peoples experiences. The light came on after reading the paper "Diabetic ketoacidosis precipitated by Covid-19 in a patient with newly diagnosed diabetes mellitus" I am truly thankful that the posted their experiences, if they did bother to post them I would have never made the connection.
 
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Oldvatr

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I am not a medical man, but I think there is a relatively simple explanation which I will use reductio ad absurdum to describe. I start by assuming that Covid is a respiratory disease similar to influenza types, in that it causes the lungs to fill with fluid thus giving breathing difficulties. It also at the same time raises inflammation markers and triggers fevers. It is a virus after all.

It is quite severe for a fever, and the struggle to overcome the fever and the breathing difficulties will lead to a steep rise in adrenaline. One thing that adrenaline does is to cut off the supply of insulin and shut the doors on insulin entering the mitochondria, so our bodies come out of glucose storage mode and into use-it mode. For T2D type diabetics, this is massive insulin resistance. Not sure what it does for insulin users ( not normally noted for IR issues, but we all require some insulin to open up the pathways for glucose to be used and stored) So if left unchecked DKA will follow, and the blood will thicken with the excess glucose. This clogs up the kidneys and leads to blood clots, both are reported as being involved in the more serious stages of Covid progression.

I think this is basically what the OP is describing but they do it in a formal medical way. The main takeaway I get is that Covid is a 2 pass disease. Most people get over the fever and pneumonia stage but then a second wave strikes which is the one that has such devastating results. I think IR locking out the normal pathway for glucose is a viable explanation, and why inducing coma and using steroids is are successful treatments. Also explains why normal oral meds for diabetes are ineffective thus leading to insulin treatment at quite high levels. I suppose diabetics are more prone to having a severe reaction since our compromised metabolism is already on that pathway, Obesity is another associated factor I believe, and that may also predispose the possibility for IR to be present
 
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Goonergal

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Some say 300 is limit and others say 240 is the limit. I used the more conservative number. Here is the link:
https://www.cdc.gov/diabetes/managing/manage-blood-sugar.html.

Thanks for providing the link. I don’t want to derail the thread, but thought it worth pointing out as I probably didn’t make it clear in my first reply, the aspect of your earlier post that I was enquiring about was this:
The value was chosen because it is used to indicate ketoacidosis

A reading of 13-14 mmols is not by itself an indicator of DKA. It’s a combination of high blood sugars and elevated ketones - from the CDC article you linked:

‘If you’re ill and your blood sugar is 240 mg/dL or above, use an over-the-counter ketone test kit to check your urine for ketones and call your doctor if your ketones are high. High ketones can be an early sign of diabetic ketoacidosis, which is a medical emergency and needs to be treated immediately.’


I also think it’s important to distinguish between diabetes types and insulin and non-insulin users as the likelihood of DKA and the time taken for blood sugars to drop/change will vary enormously. Again, from the CDC article you linked:

‘If you think you may have DKA, test your urine for ketones. Follow the test kit directions, checking the color of the test strip against the color chart in the kit to see your ketone level. If your ketones are high, call your health care provider right away. DKA requires treatment in a hospital.

DKA happens most in people with type 1 diabetes and is sometimes the first sign of type 1 in people who haven’t yet been diagnosed. People with type 2 diabetes can also develop DKA, but it’s less common.’


I say all this not to dispute that there are links between Covid and diabetes or even DKA, but to clarify when action should be taken.