According to the International Diabetes Federation, India is home to 77 million diabetics, the second-highest in the world. Comorbidities such as hypertension, obesity, and abnormal cholesterol, and triglyceride levels can invite diabetes. Now, even coronavirus can raise blood sugar levels. The patients who don’t have a history of diabetes or are not detected to be diabetics present with high sugar. It will be worrisome for the doctors if they continue to see blood sugar spike in non-diabetic patients as it may present challenges for them.
Currently, it is also found that sugar levels are dangerously high in many non-diabetic patients suffering from coronavirus. “Patients come with high sugar levels and ketoacidosis and are detected to be COVID positive. The hospital has seen around 4-5 such cases of the patients. Also, diabetic patients are coming for ketoacidosis as a complication” said Dr. Kedar Toraskar, Chief of Critical Care, Wockhardt Hospitals, Mumbai Central.
A 41-year-old woman presented with fever, sore throat, and body ache, for 5 days, followed by breathlessness after 3 more days. No comorbidities history of increased thirst and frequency of urination, for the last 4 days. The patient was tested to be COVID-19 positive by RTPCR on an OPD basis. The patient presented to an emergency department for admission. Spo2 ((blood oxygen saturation levels) was 96 on room air with no drop of spo2 post-walk. The random blood sugar was 530 and the arterial blood gas was s/o severe metabolic acidosis. Her serum and urine ketones were positive. This was a presentation of diabetic ketoacidosis (DKA)in a proven COVID-19 patient with no past history of diabetes mellitus (DM).
Dr. Toraskar said, “The patient was treated for COVID and ketoacidosis, will be discharged in a couple of days. The line of the treatment for this patient was like any other diabetic ketoacidosis patient. We hydrate the patient, correct the sugar levels, control blood sugars with insulin, secondary infection, and electrolytes, and basic the basic standard of care for COVID-19 is given. So, in those patients we avoid steroids. This patient was shifted from the ICU to the general ward, and her sugar levels are under control.”
“This is a de novo presentation of ketoacidosis (one of the complications of diabetes). Either the patients come with high sugar or have diabetic ketoacidosis (DKA). The plausible reasons being that the SARS-CoV-2 causes injury of pancreatic beta cells and impaired insulin secretion, which may contribute to the development of DKA. Thus, this virus affects the pancreas. The interaction between the SARS-CoV-2 virus and the renin-angiotensin-aldosterone system might offer insight into the pathophysiology of DKA in these patients,” highlighted Dr. Toraskar.
The other cause of this COVID induced dysglycemia can be the use of steroids in COVID patients with respiratory failure. Further studies are necessary to understand the pathophysiology of DKA in this patient.
“Deaths have also been observed in the non-diabetic patients as well. One of the major risk factors is non-diabetics have hypertension. So, it is one of the common comorbidities. Those patients in which we see deaths belong to a higher age group. They are 60+ or 65+. 80% of the deaths are seen in those patients above the age of 60, not only in Mumbai but worldwide. And there are comorbidities such as hypertension, obesity, diabetes, kidney disease, immune-suppression, or any other cause. The chances of mortality are higher in the patients having these comorbidities. We have a scoring system and comorbidity classification. Depending on this, we calculate the risk score. The probability of death is higher with higher scores,” said Dr. Toraskar.
Currently, Mumbai is at its peak while talking about COVID-19. The ICU is always full and we are getting seriously ill patients. The numbers in the ward are slightly going down because a lot of mild asymptomatic patients are treated at-home quarantine. Those patients in the hospital who are mildly ill are less. That is a good thing as the hospital can take moderate and severely ill patients.