Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus that causes coronavirus disease 2019 (COVID-19), was first reported in Wuhan, China, in December 2019 and has spread worldwide. As of 29 October 2020, 44,351,506 globally confirmed cases of COVID-19 have been reported on the World Health Organization COVID-19 dashboard, including 1,171,255 deaths. The fatality rate for COVID-19 has been estimated to be 0.5–1.0%1,2,3. From 1 March to 30 May 2020, 122,300 excess all-cause deaths occurred in the USA, of which 95,235 (79%) were officially attributed to COVID-19. Of note, mortality from COVID-19 and seasonal influenza are not equivalent, as deaths associated with these diseases do not reflect front-line clinical conditions in the same way. For example, COVID-19 pandemic-hit areas have been facing critical shortages in terms of access to supplies such as ventilators and intensive care unit (ICU) facilities.
The COVID-19 and diabetes infection is a double challenge. Diabetes has been reported to be a risk factor for the severity of the disease and at the same time, patients have to control glucose in a situation with a decreased and more variable food intake. In humans, the main route of SARS-CoV-2 transmission is through virus-bearing respiratory droplets9. Generally, patients with COVID-19 develop symptoms at 5–6 days after infection. Similar to SARS-CoV and the related Middle Eastern respiratory syndrome (MERS)-CoV, SARS-CoV-2 infection induces mild symptoms in the initial stage for 2 weeks on average but has the potential to develop into a severe illness, including a systemic inflammatory response syndrome, acute respiratory distress syndrome (ARDS), multi-organ involvement and shock10. Patients at high risk of severe COVID-19 or death have several characteristics, including advanced age and male sex, and have underlying health issues, such as cardiovascular disease (CVD), obesity, and/or type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM)11,12,13. A few early studies have shown that underlying CVD and diabetes mellitus are common among patients with COVID-19 admitted to ICUs14,15. T2DM is typically a disease of advanced age, and, therefore, whether diabetes mellitus is a COVID-19 risk factor over and above advanced age is currently unknown. Diabetes and coronavirus can be deadly.
How to Avoid Infection?
The novel coronavirus spreads through tiny droplets that spray into the air when a person with the infection sneezes or coughs. Anyone within 6 feet Trusted Source, or 2 meters, of the person, can inhale these droplets. There are ways to lower the risk for diabetes and coronavirus patients.The virus can also transmit via surfaces that a person with the infection has touched.
People with diabetes and coronavirus infection can protect themselves from contracting the virus in the same way as everyone else, by:
- Stock up on a few week’s worth of medical supplies and insulin those who have covid-19 and diabetes.
- Make a virtual medical plan in case you are quarantined covid 19 and diabetes patient.
- Have an emergency contact on speed dial who has diabetes and coronavirus.
- Maintaining an adequate intake of food and fluids trying to keep blood sugar levels in a healthy range for covid-19 and diabetes patient.
- Frequently washing the hands with soap and water for covid-19 and diabetes patient.
- Diabetes and coronavirus patient should use an alcohol-based hand sanitizer when soap and water are not available.
- Avoiding frequently touched surfaces when possible covid-19 and diabetes patient.
- Frequently disinfecting any potentially contaminated surfaces, such as counter tops, tabletops, and door handles.
- Not touching the eyes, nose, or mouth with unwashed hands by covid-19 and diabetes patient.
- Practicing physical distancing by staying 6 feet, or 2 meters, away from others in public.
- Covering coughs and sneezes with a tissue or inner elbow — not the hands by diabetes and coronavirus patient.
- Avoiding all contact with people who are sick, especially if they have a fever, a cough, or both for covid-19 and diabetes patient.
- Keeping the immune system strong by getting at least 7 hours of sleep a night and reducing stress levels as much as possible whether a person is covid-19 and diabetes patient or not .
Diet Plan For Covid-19 And Diabetes Patient
1. Eat At The Right Time
This time isn’t a weekend; you are at home to stay safe and it’s a long time. Eating at the right times means better regulation of blood sugars by preventing binge eating, supplying a steady and measured carbohydrate in the blood preventing spikes and troughs. Eat within 1 hour of waking up and eat every 3-4 hours. Three well-planned major meals, with two snacks in between, is a good strategy to follow. Close the kitchen by 9 pm, take a cup of milk at bedtime. These are rules to maintain discipline diabetes and coronavirus patient.
2. Add Whole Grains
Make sure you add whole grains in at least 3/4th of meals. They ensure a slow and steady supply of carbs, keeping up your energy levels. Whole-grain fiber slows down the release of glucose into the blood and at the same time provides many beneficial vitamins and minerals. Millets like Jau aka Barle, help control blood sugars. Try using them in one meal in two days at least who has diabetes and coronavirus.
3. Benefits of Eating Protein
Proteins don’t just build up a healthy body, they also add to the satiety value. Adequate protein intake for an adult is about 0.8g/kg body weight as per the recent guidelines of the National Institute of Nutrition. High protein diets with very low carbs may be followed, but only if your doctors decide as they need very close follow-ups and monitoring. They have been shown to control very high sugars but must not be tried without your doctor/dietician by your side. Plant proteins like legumes- Rajma, grams, lobia are excellent for sugar control. Low-saturated fat animal proteins from fish, chicken breast, eggs can also be included safely. Fat-free/low-fat milk and curd also add quality proteins. Curd or yogurt is a probiotic that enhances gut health which is directly related to better sugar controls for diabetes and coronavirus patient.
4. Fats Oils and Nuts & Seeds
Healthy fats from plant sources like Olive oil, Peanut oil, Rice bran oil in combination with Mustard or sesame oil have a beneficial effect on our health. Recent research has highlighted that replacing excess carbohydrates and saturated fats with healthy fat choices improves both blood sugars and insulin control. Eating an ounce of nuts & seeds, at least thrice a week, has shown better sugar controls and heart health. They should be consumed by diabetes and coronavirus patient.
5. Fruits and Vegetables
Fill up half your plate with vegetables and salads. Choose seasonal and colorful. Add the whites, greens, reds, oranges and ensure that your body gets not just fiber but also lots of vitamins, minerals, antioxidants, and phytonutrients that protect against infections, oxidative stress and boost the immune system. Two fruits a day make a good snack providing little carbs, with fiber and electrolytes keeping you full and your sugars stable. They are good for diabetes and coronavirus patient.
Diabetes Full Meal Plan for Covid-19 and Diabetes Patient
BREAKFAST
2 Stuffed multigrain roti /bread+ big bowl of curd/1 egg+mint chutney/1 cup milk.
LUNCH/ DINNER
2 chappati/parboiled rice+1 big bowl rajma/thick sambar or chicken gravy+1 big bowl cauliflower/palak+1 bowl curd.
SNACK TIME
1. Roasted foxnuts or makhana+1 tablespoon roasted peanuts
2. Boiled corn with paneer cubes
3. 1 fistful of almonds+walnut+chia
What To Do If a Diabetes Person is Covid Infected?
Consult an online doctor. Isolate yourself immediately to a single room, right from the onset of symptoms of covid-19 and diabetes. Have the following equipment handy for a person who is diabetes and coronavirus patient:
- Pulse oximeter
- Thermometer
- BP apparatus if you are hypertensive.
- Glucometer if you are on multiple diabetic medicines and/or insulin.
Mild Infection in Covid-19 and Diabetes Patient
Diabetes and coronavirus patient if you are eligible for home isolation, you need to follow certain instructions and precautions. There’s no FDA-approved Oral Antiviral drug as of yet for treating mild symptomatic Covid-19 and diabetes patients. The treatment focuses on symptomatic management that includes control of fever using paracetamol, cold symptoms using decongestants, usage of multivitamins. The other parameters that need to be taken care of are – hydration, blood glucose levels, and blood pressure (if you are hypertensive).
You may be asked to check your capillary glucose levels after finger pricking and using a glucometer multiple times a day, especially if you are on insulin. This is because the infection can alter your blood glucose levels and your food intake might not be adequate. This is the reason why we need to target diabetic management individually. Specially, who has covid-19 and Diabetes.
The frequency of monitoring varies from case to case basis. Some may need frequent monitoring. This includes fasting glucose, postprandial sugar. If you are on twice daily or more frequent insulin, you might in addition need to check sugar using a glucometer before dinner and at bedtime till the values are in a stable range.
Usually, the regular medications for Diabetes and Hypertension are continued. The medications may be adjusted at times and you should seek advice from your treating doctor.
You may or may not need additional tests like blood tests or a CT scan. The treating doctor is the best judge who will assess you clinically and plan on management. So, do not do additional tests or scan on your own without consulting a doctor first.
Moderate to Severe Covid-19 and Diabetes Infection
Sicker diabetic patients are managed in the hospital setting. You may be started on oral or IV steroids if your oxygen saturation is not in the good range. Steroids can increase your blood glucose levels; hence your sugars will be monitored aggressively.
Many hospitals practice the Basal Bolus regimen of administering insulin in hospitalized diabetic patients, in replacement of or in addition to your usual oral diabetic medications. Basal bolus regimen consists of 1 long-acting insulin that is administered once daily injection subcutaneously and 3 pre-meal short-acting insulin injections that have to be taken before meals. Your capillary glucose levels will be monitored as long as you are on steroids and insulin as the dosage of insulin needs to be titrated accordingly to person who has covid-19 and diabetes.
Diabetes and coronavirus can lead to complications like DKA and sepsis. These are life-threatening complications that need management in an intensive care setting. Diabetes and coronavirus patients are prone to these complications, hence the necessity of proper management of blood glucose levels. Even after discharge from the hospital, the blood glucose has to be maintained in the normal range.
There is a rare fungal infection called “Mucormycosis” that is on the rise. This is especially seen in diabetic individuals during covid or post covid infection. The main reasons behind these infections are poor diabetic control, immunosuppression due to usage of steroids, poor hygiene. Symptoms of Mucormycosis when nasal sinuses are involved include one-sided facial swelling, nasal discharge, nose block, redness of eyes. This infection can get life-threatening if not treated early. Hence make sure you follow up regularly with your physician post-discharge.
Conclusion
Physicians need to be alert in diabetic admitted with diabetes and coronavirus, as they are at increased risk of developing complications. Diabetes and coronavirus patient have diabetic emergencies like DKA and HHS can be precipitated by COVID-19 infection, and if not recognized early and treated promptly, it may lead to catastrophic outcomes. Clinicians should focus on close monitoring of COVID-19 and diabetes, to prevent diabetic emergencies like diabetic ketoacidosis and hyperosmolar hyperglycemic state. As COVID-19 and diabetes are both highly prevalent in the Maldives, a high degree of suspicion is required to diagnose diabetic ketoacidosis and hyperosmolar hyperglycemic state timely for a better prognosis. In patients who develop diabetic emergencies, the intravenous fluid should be used judiciously with careful attention to markers of perfusion, to prevent volume overload and pulmonary hydropsy. Now you know in diabetes and coronavirus situation what to do what not to do.
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