On December 31, 2019 China reported a cluster of cases of pneumonia in Wuhan and a novel coronavirus was identified as the cause and disease was called COVID-19 (coronavirus disease – 2019). Six months later the world has crossed 7 million cases and we are living in a pandemic trying to adapt, survive and live as normally as we can. During the early studies it was evident that although COVID-19 mostly causes mild to moderate symptoms it could potentially lead to serious complications in the elderly, immunocompromised, patients with heart disease, respiratory diseases, kidney diseases, diabetes and hypertension. This is especially important to us as 19% of the population in UAE suffers from diabetes.
The relationship between viral outbreaks and diabetes is not new, in 2003 diabetes was a risk factor amongst patients with SARS (severe acute respiratory distress syndrome). In 2009 during the Influenza (H1N1) outbreak it was noted that ICU rates were up to four times high in patients with diabetes and in 2012 MERS (middle eastern respiratory syndrome) outbreak mortality rates among diabetics were up to 35% higher. In studies up till now with COVID patients, it is seen that patients with diabetes are up to 32% more likely to have a serious COVID-19 infection. In one study it was noted that Hba1C of more than 9% was associated with 60% increase in hospitalization and severe infection. The reason to this is proposed as unregulated blood sugar level in diabetic patients and the reduced immunity due to which it becomes harder for the body to fight this virus.
Am I Doomed?
While the numbers may paint a grim picture, is it just a one-sided fight for diabetics? Certainly Not. Studies have shown that diabetics are not more likely to catch the COVID-19 virus, the risk is same as with anyone without any co-morbidities. What is important is to have proper education, prevention and management. Below are mentioned some of the precautions and specific advice to diabetic patients in terms of prevention and treatment.
General Precautions to take:
- Regular handwash for 20 seconds using soap and water, if not available a hand sanitizer can be used.
- Avoid touching face, nose, mouth and eyes
- Cleaning and disinfecting objects and surfaces that are touched frequently.
- Covering cough or sneeze using tissue and bin it immediately. Using of elbow bend in case tissue is not available.
- Avoid contact with anyone showing flu like symptoms or fever; and staying home if oneself has any symptoms.
- Avoiding unnecessary trips; be it business meetings, grocery shopping, going to mall or large family gatherings.
Advice specific to patients with Diabetes:
- Eat a healthy balanced diet with good amount of protein, fibre and limitation of saturated fats is important to maintain a good glycaemic control.
- Do exercise and especially in these times, home based exercise like cycling, stationary jogging and resistance exercise are helpful.
- Having a good control on blood sugar; at the same time avoid getting blood sugar too low.
- Having a good supply of medicine and associated items required such as glucose strips or lancets for at least a month, in case there is a need to be isolated
- If one is on insulin or medicine that cause low blood sugar (such as glim, diamicron) make sure there is a supply of fast acting sugar such as a small candy, juice or glucagon injection. If possible, have a family member trained to give injection.
- Take medications as prescribed and measure blood sugar frequently every 4-6 hours, if you are unwell or blood sugars are too high or low, contact your doctor or nurse.
- Be up to date with influenza (flu) and pneumococcal vaccines, while they do not prevent COVID-19, they can prevent a secondary infection.
What to do if you suspect COVID-19 or are sick:
- If you have symptoms of COVID-19 specifically fever, cough or breathlessness, please seek medical advice calling the government COVID-19 help line and call your treating doctor for specific advice.
- Drink plenty of water and have paracetamol every six hours as required. Avoid using NSAIDs such as ibuprofen especially if you have kidney disease associated with diabetes
- Know the emergency warning signs and know when to get attention immediately (shortness of breath, chest pain, confusion or half sided body weakness, bluish lips or face)
In conclusion, yes, it is scary to be living alongside a new virus that has consumed our lives but with proper education and prevention all of us together can make sure we keep ourselves, our friends and our families safe. We all are responsible for each other and it is together we can and we will eventually come out of this pandemic.
Author: Dr. Ali Khalid