COVID-19 & ADULT DIABETICS
COVID-19
& ADULT DIABETICS
Ptns with type 2 DM
are more vulnerable to develop serious
complications, more ICU
admission, longer hospital stay, and death from coronavirus infection
2019 (COVID-19).
Despite there’re sparse data, ptns with type 1 DM also may develop higher MR
from COVID-19 as compared to general
population. COVID-19 diease appears
to induce and unmask severe complications of DM e.g. diabetic ketoacidosis (DKA), hyperosmolar
hyperglycemic state (HHS), and intense insulin
resistance. Sick-day control may focus on prevention of hypoglycemia, severe
hyperglycemia, & DKA. For
ptns with a known PH of DM, or in ptns with metabolic
acidosis on initial admission lab-evaluation,
we should evaluate the serum ketones levels.
There’re no strict data
to provide the precise glycemic target for ptns with COVID-19.
Generally, the goal is usually the same as in other hospitalized ptns (e.g.,
avoid intense hyperglycemia, volume depletion, & electrolyte imbalance; avoid hypoglycemia; keep adequate
nutrition). The blood glucose target of 140-180 mg/dL (7.8-10 mmol/L) is accepted for most
hospitalized ptns. Many oral drugs hv special CI that may be observed in hospitalized ptns. So,
home DM medications are usually withdrawn.
Particularly, sodium-glucose
co-transporter 2 (SGLT2)
inhibitors must be stopped owing to the higher
risk of dehydration & volume depletion. Metformin
is C.I. in condition in which kidney function and/or hemodynamic states
is either compromised or threatened,
due to a higher risk of lactic acidosis,
so, they must be withdrawn at least temporarily until the clinical status is clearer. Other diabetic
medications may not be appropriate due to untoward
side-effects.
Insulin is the preferred therapy for hyperglycemia in ptns hospitalized with moderately severe COVID-19 disease.
For ptns with type 2 DM, the need for insulin
therapy may be transient. Ptns with
type 1 DM are in absolute need for insulin therapy at ALL the time, whether or not they’re eating, to abort ketosis development. SC insulin protocol
are usually applied with increasing
frequency to treat mild/moderate DKA during
the COVID-19 pandemic episodes if I.V.
insulin is not practical due to the need to limit frequencies of contact betwen staff and the ptns. In such case, dosage &
monitoring are being performed
every 2-4 hs. S.C.
insulin protocol is not used in ptns with the following conditions:
1)
Advanced DKA;
2)
Severe cardiac
disease,
3)
Renal, or hepatic co-morbidity;
or with
4)
Pregnant ladies.
Intense insulin resistance has been reported in critically ill ptns with COVID-19 disease. Severity of insulin
resistance, however, may be ameliorated rapidly with COVID-19 subsided disease, that may lead to a rapid decline in insulin
requirements.
REFERENCES
- Zhou F, Yu
T, Du R, et al. Clinical course and risk factors for mortality of adult
inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.
Lancet 2020; 395:1054.
- Guo W, Li
M, Dong Y, et al. Diabetes is a risk factor for the progression and
prognosis of COVID-19. Diabetes Metab Res Rev 2020; :e3319.
- Bode B,
Garrett V, Messler J, et al. Glycemic Characteristics and Clinical Outcomes
of COVID-19 Patients Hospitalized in the United States. J Diabetes Sci
Technol 2020; 14:813.
- Targher G,
Mantovani A, Wang XB, et al. Patients with diabetes are at higher risk for
severe illness from COVID-19. Diabetes Metab 2020; 46:335.
- https://www.england.nhs.uk/wp-content/uploads/2020/05/valabhji-COVID-19-and-Diabetes-Paper-1.pdf
(Accessed on July 02, 2020).
- https://www.england.nhs.uk/wp-content/uploads/2020/05/Valabhji-COVID-19-and-Diabetes-Paper-2-Full-Manuscript.pdf
(Accessed on July 02, 2020).
- Wu Z,
McGoogan JM. Characteristics of and Important Lessons From the Coronavirus
Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314
Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020; 323:1239.
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