Coronavirus: Should diabetics be worried?

Updated: Mar 29

Am I worried? No, but I am aware.


The UK Chief Medical Officers have raised the risk to the public from low to moderate. But the risk to individuals remains low.

My education: BSc Microbiology, MBiol Biology (with Virology), University of Leeds

What is Coronavirus?

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from common cold to more severe diseases such as Severe Acute Respiratory Syndrome (SARS-CoV) (WHO).


The majority of people will get infected with a common human coronavirus at some point in their lives, with the illness only lasting for a short period of time. Human coronaviruses can cause lower-respiratory tract illnesses, such as pneumonia or bronchitis. This is more common in those with weakened immune systems, infants and the elderly. (CDC)


Coronaviruses are zoonotic, meaning they are transmitted between animals and humans.


Why has this coronavirus made headlines?

The newly emerged coronavirus, 2019-nCoV is a novel coronavirus, meaning it’s a new strain that has not been previously identified in humans. As with any new strain of virus, our understanding changes rapidly as assessments are made from current and new cases.

Everyday protection

Keeping clean and sanitised has always been important to me. I will always have a pack of these antibacterial wipes in my bag or in a coat pocket. They're small, convenient and effective at making my hands clean. With the increasing spread of the 2019-nCoV, I think it's a good idea to invest. I've put a link below.



How does 2019-nCoV compare with the flu?

So far, the 2019-nCoV has led to over 20,000 illnesses and over 600 deaths. Whilst this may be a scary figure to see, especially since this virus is relatively new, these figures don’t compare with the flu (influenza).


In the U.S, the flu has already caused an estimated 19 million illnesses, 180,000 hospitalisations and 10,000 deaths this season alone (CDC).


The difference between the flu and the newly identified coronavirus is that seasonal flu has been studied for many decades. Despite the danger posed by the virus, we do know a lot about flu viruses and what to expect each season.


In comparison, little is known about the 2019-nCoV due to its very recent emergence. As a result, more time is needed to see how far it will spread and how many deaths it will cause.


Can 2019-nCoV be transmitted from person to person?

Yes, 2019-nCoV can be transmitted from person to person, usually after close contact with someone who’s infected.


What are the symptoms?

For confirmed cases of 2019-nCoV, reported illnesses have ranged from people with little to no symptoms, to people being severely ill and dying. The identified symptoms appear within 2-14 days after exposure.


Symptoms can include:

  • Fever

  • Cough

  • Shortness of breath

  • runny nose

  • sore throat


Who should be worried?

CDC - older people, and people with pre-existing medical conditions (such as diabetes and heart disease) appear to be more vulnerable to becoming severely ill with the virus.


Why are diabetics more vulnerable?

Being unwell, particularly from an infection, can raise your blood glucose levels significantly. As part of your body’s defence mechanism for fighting illness, your liver will dump more glucose into the bloodstream, regardless of whether you’re eating less than usual. The body’s natural solution to this is to produce more insulin to counteract this rise in blood glucose. But for us diabetics, our body is unable to do this.


Having diabetes makes us all more vulnerable to infection, both bacterial and viral. This is because an elevated blood glucose provides an environment for these types of microorganisms to thrive and multiply. Not only that, but elevated blood glucose interrupts the ability of our white blood cells to fight infection, making it harder for us to overcome an illness and thus increasing the likelihood for complications to occur. This is why it’s so important to keep a close eye on your blood glucose when you’re unwell.


A study from the University of Maryland School of Medicine (UMSOM) and the Johns Hopkins University School of Medicine investigated how diabetes contributes to mortality from MERS-CoV infections (a coronavirus). In a mouse model, they discovered that diabetic mice infected with MERS-CoV exhibited a delayed and pro-longed inflammatory response in the lung compared to non-diabetic mice. Diabetic mice had low levels of inflammatory cytokines and fewer inflammatory macrophages and T-cells. These findings indicate that the increased severity of MERS-CoV infection in patients with diabetes is likely due to a malfunction in the body’s response to infection. This study was carried out in relation to the emergence of MERS-CoV in Saudi Arabia in 2012, which led to more than 800 deaths. Clinical evidence has pointed at diabetes as a major risk factor in patient mortality.


Cytokines, macrophages and T-cells are all involved in the body’s response to infection.


Symptoms of Diabetic ketoacidosis (DKA)


Respiratory infections accompanied by a fever, such as those caused by coronaviruses, can cause your insulin requirements to rise and lead to an increase in insulin resistance. As a result, basal insulin requirements may rise. A severe infection accompanied by a high fever can also lead to you becoming dehydrated with incredibly high blood glucose levels. It is in these situations that the risk of ketones appearing becomes more likely. The presence of ketones in the blood is an indicator that you’re not receiving enough insulin.


When insulin (the key) is not available, glucose is unable to enter the cells of the body to be used for energy. Instead it remains in the blood, where it continues to increase in concentration. As the body is unable to use glucose as an energy source, it looks to the fat reserves. When fat is used as the energy source, chemicals known as ketones are released into the blood. Diets such as the Ketogenic diet work by placing the body in a mild state of ketosis.


In the case of diabetics, an overall lack of insulin (both basal and bolus) will lead to dangerously high levels of ketones in the blood, which causes blood to become acidic. I’m sure several gruesome images pop to your mind when you imagine your blood as acid. Rather than digesting your body from the inside out, it throws off the ‘biochemical environment’ in your body required for optimum function. The end result of being in this state is ketoacidosis - a serious condition that leads to coma and death.


Summary

As a Type 1 Diabetic, I am not worried about the emerging 2019-nCoV and my diabetes. The UK has robust infection control measures in place to minimise the spread of such infections and to respond immediately to new cases. Infection is something that all diabetics should be aware of.


References:

https://www.nature.com/articles/d41586-020-00236-9

https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/illness

https://www.myomnipod.com/poddertalk/patient/2018-12-20/managing-diabetes-when-youre-sick

https://www.sciencedaily.com/releases/2019/10/191018181045.htm

https://www.sciencemediacentre.org/expert-reaction-to-new-estimates-of-infection-rate-of-novel-coronavirus/

https://www.nhs.uk/conditions/diabetic-ketoacidosis/

https://www.cdc.gov/coronavirus/about/symptoms.html

https://www.wired.co.uk/article/china-coronavirus

https://www.livescience.com/new-coronavirus-compare-with-flu.html


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