INSULIN FOR COVID -19 PATIENTS WITH DIABETES
What is the risk for a patient with Diabetes when suffering from COVID-19?
Patients with diabetes are not at an increased risk of getting COVID-19 infection. However, if they get the infection, they can have a higher risk of getting complications and severe illness. Also, glucose levels are likely to get worse due to the virus infection.
What are the glucose levels that have to be maintained during COVID-19 infection?
- Patients with diabetes can have high glucose levels due to COVID-19 infection, so the aim is to achieve reasonable control as perfect control may be difficult during an illness.
- The fasting glucose can be maintained around 100mg/dl and post meal or random glucose can be kept below 180mg/dl.
- Always, avoid a hypoglycemia, i.e. a glucose level below 70mg/dl.
- Always keep a Glucometer if glucose levels are high and keep a sugary drink or Glucon D handy in the fridge just in case you get a hypoglycemic episode during the illness.
Why are my glucose levels raising during the COVID-19 illness?
- Glucose levels during COVID-19 illness are likely to go up due to various reasons. The illnesses due to the virus can cause stress hyperglycemia.
- Stress hyperglycemia (high glucose levels due to stress of infection) can lead to excess hormones like cortisol (steroids), glucagon, catecholamines and growth hormones, all of which can raise glucose levels.
- Also, sometimes when doctors give STEROIDS for severe covid illness, there can be a raise in glucose levels.
- Mental stress due to anxiety, fear and depression also can contribute to high glucose levels.
How can I manage my glucose levels during the COVID-19 illness?
- You need to monitor your glucose levels with a Glucometer and seek advice from your endocrinologist.
- You can take plenty of non sugary fluids unless advised otherwise by your doctor.
- Increase your diabetes medications as advised by your doctor.
- May have to start insulin for few days/weeks until glucose levels get under control. Follow your doctor advice.
What are the risks of having uncontrolled glucose levels during the COVID-19 illness?
- High glucose levels can prolong the illness and worsen the condition.
- Can lead to dehydration and drowsiness.
- Uncontrolled diabetes can lead to Diabetes Ketoacidosis (DKA).
- High glucose levels can lead to secondary bacterial and fungal infections.
- High glucose levels along with steroids when used for COVID-19 can cause fungal infections like Mucormycosis (Black Fungus).
How does steroids cause uncontrolled glucose levels during the COVID-19 illness?
- Sometimes high doses of steroids are given for severe COVID-19 infection.
- Steroids can raise glucose levels particularly after food.
- High glucose readings after steroids can be managed by increasing the diabetic medications.
- Sometimes we may need to start Insulins either once daily, twice daily or four times a day.
How do steroids and uncontrolled glucose levels lead to mucormycosis (Black Fungus) during or after the COVID-19 illness?
- People with uncontrolled diabetes mellitus with long-term corticosteroid during or after COVID-19 infection are at risk of mucormycosis.
- Mucormycosis affects the sinuses, the brain and the lungs and can be life-threatening in diabetics, particularly in those taking steroids for COVID-19.
- Symptoms of mucormycosis include headache, fever, pain under the eyes, nasal or sinus congestion and partial loss of vision.
- Patients suffering from the fungal infection typically have symptoms of stuffy and bleeding nose; swelling of and pain in the eye; drooping of eyelids; and blurred and finally, loss of vision. There could be black patches of skin around the nose.
- Most of the patients are middle-aged diabetics who were struck down by the fungus two weeks after recovering from Covid-19.
- The treatment involves Amphotericin injections for 21 days. The basic cost of the injections is around ₹9,000 per day. This anti-fungal intravenous injection which costs 3,500 rupees a dose and has to be administered every day for up to eight weeks is the only drug effective against the disease.
- Overall mortality rate of 50% is seen in these patients affected with the black fungus.
How can I manage my glucose levels after the COVID-19 illness?
- After recovering from the COVID-19 infection, the glucose readings may slowly get better, particularly after stopping the steroids.
- Diabetes medications may need to be cut down as per glucose readings; otherwise, there is a risk for hypoglycemia.
How to adjust insulin doses?
- If the insulin used is the once daily long acting lantus or Tresiba, the fasting glucose levels should be kept around 100mg/dl without subjecting the patient to hypoglycemic episodes.
- However, if patient is on premix insulins like Mixtard, then dose adjustments are based on pre meal values at the mornings and evenings.
- Sometimes, patients can be on basal bolus regime with four injections a day for better control.
- One may have to take the help of the doctor to adjust the doses.
How can I inject insulin?
- Pinch the skin and put the needle in at a 45º angle or even straight up at 90º angle in those patients with thick subcutaneous fat tissues.
- Leave the syringe in place for 5 to 10 seconds after injecting or till you count 10.
How to get help?
You can contact 8008166166 to speak to one of our endocrinologists or email firstname.lastname@example.org