Diabetic ketoacidosis and COVID-19: Doctors say coronavirus raises blood sugar levels in non-diabetic patients
India is currently reeling under the novel coronavirus crisis. It has also been observed that blood sugar levels are dangerously high in many non-diabetic patients suffering from coronavirus. Patients who don’t have a history of diabetes or are not diagnosed with the condition are now presenting with high blood sugar. Experts said 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.
Earlier, a study from China has linked abnormally high blood sugar with a higher risk of death in COVID-19 patients without a previous diagnosis of diabetes. 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. Experts said the novel coronavirus can raise blood sugar levels.
“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.
Dr Toraskar cited a case of diabetic ketoacidosis (DKA) in a proven COVID-19 patient with no past history of diabetes mellitus (DM). Diabetic ketoacidosis occurs when blood sugar level is very high and ketones build up to dangerous levels in the body. The patient was treated for COVID and diabetic ketoacidosis (DKA), 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,” added 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 per cent 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,” the doctor added.