Covid-19 and Diabetes : Effective ways to manage the condition



                          


Covid-19 has been proved the destructive and deadly virus impacting millions of people globally. Reports from major Covid-19 centres have revealed the morbidity and mortality is more among patients with history of diabetes, hypertension, obesity, kidney or heart disease. 

What is the relation between COVID-19 and Diabetes? 

Diabetic patients appear to be more vulnerable of becoming severely ill with Covid-19.When people with diabetes develop a viral infection, it can be harder to treat due to fluctuations in blood glucose levels and, possibly, the presence of diabetes complications.

There appear to be two reasons for this. Firstly, the immune system is compromised, making it harder to fight the virus and likely leading to a longer recovery period. Secondly, the virus may thrive in an environment of elevated blood glucose. 

According to a study published in lancet journal, 

Data from two hospitals in Wuhan including 1561 patients with COVID-19 showed that those with diabetes (9·8%) were more likely to require admission to an intensive care unit (ICU) or to die. Similarly, in a British cohort of 5693 patients with COVID-19 in hospital, the risk of death was more common in those with uncontrolled diabetes (hazard ratio [HR] 2·36, 95% CI 2·18–2·56).

What factors worsen the condition? 

Age is associated with worse outcomes in COVID-19, and it can be hypothesised that this relationship is stronger in people with diabetes for at least three reasons.
First, the prevalence of diabetes increases with age to reach a peak in people older than 65 years.
Second, people older than 65 years are more likely to have a longer duration of diabetes and a greater prevalence of diabetic complications. 
Third, diabetes and older age often correlate with comorbidities such as cardiovascular disease, hypertension, and obesity.


What is the treatment? 

Patients admitted to hospital for severe COVID-19 might need modifications to their diabetes therapy, including withdrawing ongoing treatments and initiating insulin therapy. 
Such a decision should be based on the severity of COVID-19, nutritional status, actual glycaemic control, risk of hypoglycaemia, renal function, and drug interactions.

 Treatment with chloroquine or hydroxychloroquine can cause hypoglycaemia, particularly in patients on insulin or sulfonylureas, because of their effects on insulin secretion, degradation, and action. 
Below are the medicines which can be brought from the best online pharmacy in India ,  where you can order medicines online:

           
1.Metformin
There is no risk of hypoglycemia

2.DPP-4 Inhibitors
No risk of hypoglycemia. Potential modification of SARS-CoV-2 binding to DPP-4 inhibitors  
Lopinavir/Ritonavir used against Covid-19

3.SGLT2-inhibitors
No risk of hypoglycemia
Rotinavir used against Covid-19

4.GLP-1 receptor agonists
Potential anti-inflammatory action.

5.Sulfonylureas
   Lopinavir/Hydroxychloroquine can be used 

6.Pioglitazone
Anti-inflammatory action

7.Insulin
Recommended in critical patients


  
                    
Usual at home antidiabetic therapy can be maintained in patients receiving treatment in hospital with regular caloric and fluid intake according to the clinical status, risk of drug-related adverse effects, and interactions between antidiabetic agents and drugs used for the treatment of COVID-19. However, insulin is the preferred agent for glycaemic control in patients with diabetes receiving treatment in hospital, and its use is mandatory in critically ill patients. 

In patients with type 1 diabetes treated with basal bolus or insulin pump therapy, the insulin doses should be titrated using frequent glucose and ketone monitoring to avoid hypoglycaemia in patients with reduced food intake, and adding correctional bolus of fast-acting insulin to avoid severe hyperglycaemia and ketoacidosis.

In many patients with type 2 diabetes, insulin treatment will be preferred and need to be initiated, which is complicated because of the limited time for instruction and titration of insulin. Patients already treated with basal insulin will need fast-acting bolus insulin to correct hyperglycaemia. Insulin can be brought from online pharmacy delivery or medlife online pharmacy. 

Patients with diabetes need intensive attention to reduce the risk of fatalities. Patients with diabetes should follow the general prevention advice given by the authorities thoroughly to avoid infection with COVID-19.


Conclusion
The inter-relationship between diabetes and COVID-19 should trigger more research to understand the extent to which specific mechanisms of the virus (eg, its tropism for the pancreatic β-cell) might contribute to worsening of glycaemic control  
Once again, diabetes management in patients with COVID-19 poses a great clinical challenge, one that requires a much-integrated team approach, as this is an indispensable strategy to reduce the risk of medical complications and death. 

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