COVID-19 Insights: Diabetes and COVID-19

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. Diabetes and COVID-19

Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China
https://jamanetwork.com/journals/jama/fullarticle/2762130

Chinese data till February 11th 2020
Case fatality rate (CFR)
Cardiovascular diseases: 10.5%
Diabetes: 7.3%
Chronic respiratory diseases: 6.3%
Hypertension: 6%
Cancer: 5.6%

Prevention steps to stay healthy
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprepare%2Fprevention.html

Diabetic patients are
More prone to dehydration due to elevated glucose. (As the kidneys throw the glucose out and in the process throw the water out as well.) So keep it controlled.
When A1C goes in 9-10 range then the risk of complications increases significantly.

What to do?
Wash hands
Wear mask
Get a flu shot
If you are insulin dependent then keep extra insulin at hand.
Keep your diabetes and hypertension well managed.

What happens to immune system in diabetes?
https://www.ncbi.nlm.nih.gov/pubmed/19069085

https://www.researchgate.net/post/What_is_cause_of_immunosupression_in_diabetes_melitus

Chronic hyperglycemia causes blood vessel narrowing and damage leading to slower perfusion and nerve damage. Nerve damage occurs both because of poor blood supply to the nerves and the accumulation of glucose in the myeline sheath and damaging it.

High glucose levels impair neutrophil activity (innate arm.)
Cytosolic calcium increases in PMN cells. This in turn reduces their ability to phagocytose. It happens because high levels of calcium reduce the synthesis of ATP that in turn is needed for the cellular function.
Study showing that the hyperglycemia increases intracellular calcium: https://www.ncbi.nlm.nih.gov/pubmed/9387128

PMN chemotaxis is also impaired.
Reduced complement response
Reduced leukocyte adherence to the blood vessels. Study mentioining endothelial dysfunction: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3348526/
Reduced response to pathogens
Chronic hyperglycemia leads to acidosis which further reduces the activity of the immune system. (Study mentioning immune dysregulation with various acids: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1065014/)
Skin cells become less efficient and skin and urinary infections become common.

Additionally, the reduced carbohydrate metabolism causes increased fatty acids mobilization. This results in the vascular endothelium to become atherosclerotic. Resulting also, in the narrowing of the blood vessels and reduced perfusion.
High free fatty acids also cause high levels of reactive oxygen species. This in turn makes our tissues prone to easy damage.
FFA cause disruption of insulin responding mechanisms.
Inflammation caused by ROS leading to adipocyte insulin resistance and inflammation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4995181/

Hyperglycemia causes an increase of dicarbonyl production. Dicarbonyl in turn reduces the function of beta-definsins. That are necessary to kill pathogens.

Endocrine and metabolic link to coronavirus infection
https://www.nature.com/articles/s41574-020-0353-9

MERS COV and diabetes
Comorbid diabetes results in immune dysregulation and enhanced disease severity following MERS-CoV infection
https://insight.jci.org/articles/view/131774

T Helper 17 cells that release IL-17alpha
https://en.wikipedia.org/wiki/T_helper_17_cell

Transforming growth factor beta (TGF-β), interleukin 6 (IL-6), interleukin 21 (IL-21) and interleukin 23 (IL-23) contribute to Th17 formation in mice and humans.

Vitamin D in turn severely impairs the production of the TH17 cells. Hence, reducing the proinflammatory behavior.

ACE2 activity is upgregulated in pancreas of the diabetic patients.
https://www.mdpi.com/1422-0067/18/3/563

Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes
https://link.springer.com/article/10.1007/s00592-009-0109-4

Why Is Coronavirus a Bigger Worry for People With Diabetes?
https://www.medicinenet.com/script/main/art.asp?articlekey=230197

Everything You Should Know About Coronavirus and Diabetes
https://www.healthline.com/diabetesmine/coronavirus-and-diabetes

https://www.diabetes.org/covid-19-faq
Are people with diabetes more likely to get COVID-19?

How about DKA and complication?

What are the concerning signs?
Shortness of breath
Persistent pressure/pain in the chest
New confusion or inability to arouse
Bluish lips/tongue or face

High blood sugar means that cells have less sugar to function. This includes the immune cells. Hence, all cells become an easy target.

Calcium depletion in the presence of hyperglycemia
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5639077/
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