Coronavirus and DiabetesDo you wake up with an occasional sore throat, cough, or watery eyes and immediately think, “coronavirus”! You’re not alone. As the number of cases of COVID19 has surpassed one million in the US, we all await a vaccine in hopes of preventing the potentially deadly disease. To date, over 100,000 people have succumbed to the virus and the US will most certainly see even more deaths by summer^{. 1}While wearing a mask and social distancing may help to prevent the spread of coronavirus, the arrival of summer has made it more difficult for people to stay inside. Warm weather and relaxed rules, which vary from state to state are bringing people outdoors. And with the loss of jobs and plunge of the US economy, many people are eager to return to work, regardless of the risk.The good news is that most healthy people will recover from the virus, but certain populations tend to be more vulnerable. Studies show that adults with chronic health conditions such as diabetes, obesity, and heart disease are at higher risk of having more health complications than healthy adults. ¹Diabetes and coronavirus- risksAs mentioned above, one population that’s been found to be more vulnerable is those with diabetes. For starters, people with diabetes are at higher risk for any infection, including the flu and coronavirus. Patients with diabetes often have altered immune responses to infection including T-cell and macrophage activation. In addition, poor glucose control impacts many aspects of the immune response to viral infection including possible bacterial infection in the lungs. ²Individuals with diabetes are often obese, which also raises the risk of severe infection. Abdominal obesity specifically impacts immunity through secretion of adipokines and cytokines that may impair the immune response to infection.³According to the CDC, individuals with diabetes are not necessarily at higher risk for contracting the illness but do seem to have more dire consequences when they do. ¹ A recent study from Diabetes and Metabolism by Targher, et. al found a 4-fold risk of having severe COVID19 illness compared to a non-diabetic population. The researchers note this was independent of age, smoking, sex, hypertension, and obesity. The reasons behind the increased risk are not always clear, but scientists suggest it may be related to underlying, low-grade inflammation, impaired cell-mediated response, and underlying changes in metabolism. It’s also been noted that those with diabetes may have a higher angiotensin-converting enzyme-2, which increases viral uptake and may raise the risk for COVID19 severity. ⁴While good glycemic control helps to lower the chance of complications, being ill raises blood sugar and impacts morbidity and mortality. Blood sugar control is more difficult when medications, treatment, and altered appetite and intake are occurring at the same time. For example, medications such as steroids that are used to reduce inflammation during illness raise blood sugar. Poor intake or use of high-calorie supplements may cause blood sugar fluctuations. Decreased physical activity also impacts blood sugar. ⁵How to survive COVID19 with diabetesAs mentioned above, having well-controlled blood sugar may help reduce the chance of becoming severely ill with coronavirus (i.e. avoiding respiratory complications and ventilator dependence). Here are some ways to manage diabetes:

1. Seek advice. MyWay Digital Health, a company started by the University of Dundee, UK, ran a free online course called, “Understanding type 2 diabetes” on April 28 and 29 and attracted over 2000 participants. With less face to face interaction, there are more options and demand for telehealth services.  Check your online insurance portal or search webmd.com to see if you can find any telemedicine links or seek topics to help you improve your health or answer your questions. Certified Diabetes Educators (RNs and/or RDs) may be able to offer individual counseling. ⁶
2. Continue social distancing. Let other people go to the store for you or take advantage of grocery delivery if it’s available. Wear a mask when you are out and about and continue to wash your hands frequently.
3. Get moving. If there’s any silver lining to the virus, it’s that is happened in the spring. Go for a walk, take your bike for a spin, or do a video at home. Physical activity improves insulin sensitivity, reduces stress, aids in weight management, and improves sleep- all of which improve blood sugar.
4. Keep a regular meal schedule. It’s easy to slip into grazing all day when we’re working from home and don’t have the regularity of a normal office schedule. But planning and spacing out meals will help keep blood sugar and weight in check while you’re home.
5. Get enough sleep. Adequate sleep reduces cortisol levels and keeps cravings for sweets in check. Cortisol levels rise in response to stress and poor sleep and are linked with poor blood sugar control, hypertension, and heart disease.

References1. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

2. https://www.diabetes.org/coronavirus-covid-19/how-coronavirus-impacts-people-with-diabetes
3. https://www.touchendocrinology.com/insight/covid-19-infection-in-people-with-diabetes/
4. Targher G, Mantovani A, Wang XB, Yan HD, Sun QF, Pan KH, Byrne CD, Zheng KI, Chen YP, Eslam M, George J, Zheng MH Patients with diabetes are at higher risk for severe illness from COVID-19. Diabetes Metab. 2020 May 13. pii: S1262-3636(20)30075-6.
5. Pal R¹, Bhadada SK². COVID-19 and diabetes mellitus: An unholy interaction of two pandemics. Diabetes Metab Syndr.2020 May 6;14(4):513-517.
6. Ranscombe, P. How diabetic management is adapting amid the Covid19 pandemic. The Lancet, Diabetes and Endocrinology, published May 15, 2020

 Submitted by Lisa Andrews, MEd, RD, LD