Don’t Be Scared but Be Smart

THE FIERCE coronavirus continues its Genghis Khan-like journey across the world, moving from East to West, trampling everything in its path and conquering new territories every day. India is no exception as it now braces itself for the worst phase of this onslaught. SARS-CoV-2 is highly contagious and primarily affects the lungs. Fortunately, it produces only mild disease in 85 per cent of those it infects. The remaining 15 per cent get seriously sick and may require hospitalisation; about 5 per cent require intensive care.

Among those who tend to get more seriously sick are diabetics older than 60 years, especially those also suffering from high blood pressure, heart disease or chronic lung conditions. India being the hub of diabetes, with almost 30-40 per cent prevalence at the age of 60 in the metros, we need to know how to live in the times of the coronavirus. But we first need to understand that all diabetics are not the same. A 35-year-old with recent onset of diabetes who keeps sugar level under control has a very different risk from a 75-year-old with long-standing diabetes, high blood pressure and heart disease.

Let’s look at the evidence so far. (It’s a fluid, dynamic situation, and we are learning everyday! I have used the most reliable sources like the American Diabetes Association.)

Are diabetics more prone to Covid-19?

In general, no. This, of course, includes all diabetics and the scenario might be different if we look separately at the high-risk group defined above. At the moment, though, there is little evidence that diabetics are more prone than the rest.

Once infected, do diabetics have worse outcomes?

In China, diabetics had threefold higher rates of complications and death. Presence of other disorders also made a big difference to the outcome. Presence of heart disease increased serious outcomes by four-five times. Hypertension and lung disease also contribute to greater risk of complications. Presence of cancer, kidney and liver disease is associated with poor outcomes. Older diabetics with uncontrolled sugar are at greater risk than the younger ones. In general, diabetics are more likely to experience severe symptoms and complications when infected with a virus. However, if diabetes is well-managed, the risk of getting severely sick from Covid-19 is probably about the same as the general population. In addition, when diabetics are down with any viral infection, there is an increased risk of diabetic ketoacidosis, particularly for Type 1 (those who are insulin-dependent or have had diabetes since childhood). Any signs of developing this condition (rocketing sugar with positive ketones in urine), abdominal pain, vomiting or laboured breathing is an indication for hospitalisation. Diabetics are more prone to septicaemia and shock if affected by Covid-19.

How should we protect the vulnerable group, namely, older diabetics with heart disease?

Every individual should protect themselves by following social distancing, hand hygiene and respiratory hygiene. For those above 65 with conditions listed above, these have to be followed even more strictly. All family members should consider themselves a risk to the older diabetic and even within the house some social distancing might help. The person who ventures out should be kept at a distance.

Should we be stocking supplies?

It’s good to ensure supplies for a month (not more, as you may be depriving others) in these uncertain times. This includes all your medicines, testing devices, glucose strips, etcetera. You should not run out of supplies. It is also very important to establish contact with your doctor or diabetes educator beforehand. This could be via email, WhatsApp, SMS and so on. Many doctors have started providing formal consultation online or using telemedicine. Please have all details noted down in advance so that you don’t have to scurry around in case there is a sudden need.

Should I be altering any medication?

A concern has been raised that some blood pressure medications (ACE inhibitors or ARBs, commonly with the suffix ‘pril’ or ‘sartan’) can increase the severity of the coronavirus impact in diabetics. However, this remains a conjecture at present. Don’t discontinue any medicines: ask your doctor if you have any doubt.

In general, remember to follow two sets of basic rules. First are the sick day rules for diabetics (eating the right kind of food on time, regular exercise, adequate sleep, hydration, checking sugar frequently and checking ketones if blood sugar is very high); second are all the measures outlined for preventing the spread of Covid-19. Meanwhile this may also be a good time to destress. You have unlimited ‘me time’: read, write, paint as you like. Be smart, don’t get scared of this tiny organism.

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About The Author

Dr Ambrish Mithal

Dr Ambrish Mithal is Chairman, Endocrinology and Diabetes, Max Healthcare

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