Risk for Serious Complications
People with uncontrolled diabetes are more likely to be hospitalized and have serious complications from viral and bacterial infections. This is particularly true for respiratory viruses like the one that causes COVID-19.
Having uncontrolled diabetes means that your blood sugar level is consistently higher than your goal level for weeks or months. Uncontrolled diabetes can lead to many complications and can be attributed to many different factors.
“Although suboptimal diet and lack of exercise can contribute to high blood sugars, you may also need an adjustment in your medication regimen or insulin doses,” says Northwestern Medicine Endocrinologist Jyothi Gogineni, MD. “Blood sugar goals vary from person to person, and so do medication doses.”
Why the Risk Is Greater
There are a few reasons why someone with uncontrolled diabetes is more susceptible to worse outcomes from an infection.
- People with diabetes can have an altered immune response, which means their body is either slow to detect intruders like viruses and bacteria, or they don’t detect them at all. This can lead to a host of complications, including organ failure.
- People with Type 2 diabetes may have additional infection risk factors, such as obesity. Obesity may restrict lung function, making it harder to breathe, which is a concern for an infection like COVID-19 that commonly attacks the lungs. “Often a virus like COVID-19 will bring forward an underlying issue that someone with diabetes may have already had, but that wasn’t yet obvious, like lung dysfunction,” says Dr. Gogineni.
COVID-19 and Diabetes
There has been a higher incidence of new diabetes diagnoses during the pandemic worldwide. While we don’t know the reason for this, we have some understanding from studies of SARS-CoV-1 that the virus can damage the pancreatic cells that produce insulin.
COVID-19 infections can cause a “cytokine storm.” Your body releases proteins called cytokines when your immune response is triggered by an intruder like the virus that causes COVID-19. If your body releases too many cytokines, it can impair the function of insulin in your body, leading to a higher blood sugar level and can sometimes lead to serious complications, such as diabetic ketoacidosis.
Often patients with diabetes who contract COVID-19 will need much higher doses of insulin during treatment to combat these complications because their blood sugar will tend to be higher.
Other Impacts of COVID-19 on People With Diabetes
Other than the potential for severe infection, Dr. Gogineni notes the following indirect consequences that COVID-19 has had on people with diabetes.
Fear of healthcare facilities.
Because people with diabetes are at a higher risk of serious complications from COVID-19, Dr. Gogineni says many patients are likely putting off routine exams or bloodwork because they are uncomfortable or uncertain about going to a physician’s office or lab.
“I have seen some of the highest blood sugar levels in my career during the pandemic because people are afraid to come in to the hospital immediately when they notice something’s wrong,” she says. “Know that there are safety measures in place at the hospital and your physician’s office. Talk to your provider if you are afraid of an in-person visit. Telehealth visits are also available at Northwestern Medicine.”
Difficulty maintaining a healthy lifestyle.
With gyms closed and more time spent indoors, COVID-19 has led to poorer diet and weight gain for many people with Type 2 diabetes.
“Individuals who relied on going to a gym or fitness center to exercise are finding that they are less motivated to eat healthy and work out during the pandemic,” she says. “I encourage my patients going through this tough time to continue to walk regularly, as it’s a safer outdoor activity that you can do anywhere.”
Dr. Gogineni adds that many people are not getting healthy produce on a regular basis due to fear of grocery shopping or a desire to make fewer trips to the grocery store.
Higher levels of depression and stress.
Social isolation can lead to depression and stress, which can affect eating habits, resulting in poor blood sugar control and higher glucose levels. “If you feel isolated or find yourself stress eating, talk to your physician about mental health resources,” says Dr. Gogineni.
Impact of unemployment.
The pandemic has impacted employment for many people across the U.S., causing a loss of income and health insurance benefits to pay for medication. “If you have been laid off and are concerned about paying for your medication, talk to your physician because there are resources out there to help continue your care,” notes Dr. Gogineni.
Tips for Managing Diabetes During the Pandemic
- Get a flu vaccine. A flu vaccine will help prevent you from getting a severe form of influenza. It’s especially important during the COVID-19 pandemic to control what you can control regarding your health.
- Keep in touch with your healthcare provider. Don’t wait until your next appointment to raise a concern about your diabetes. Talk to your physician to create a pandemic plan. If you are facing financial and health insurance issues during the pandemic, less expensive insulin options are available. Your provider will be able to connect you with helpful resources.
- Stay on top of regular care. Continue to monitor your blood sugar and count your carbohydrates.
- Recommit to a diet and exercise plan.