There are at least two pandemics raging through the world at this time. The first is obesity. The second is, of course, COVID-19. Diabetes sits uncomfortably at their intersection. In a vicious cycle, diabetes makes COVID-19 infections more likely and more dangerous. Meanwhile, COVID-19 can trigger diabetes or make it worse. A new study in Lancet Diabetes & Endocrinology, March 21, 2020 reinforces the connection between COVID and diabetes.

Type 1 and Type 2 Diabetes:

In the most common form of diabetes, type 2, body tissues develop resistance to insulin and end up having trouble utilizing glucose. In type 1 diabetes, the beta cells of the pancreas stop making insulin completely. As a consequence, none of the body’s cells can utilize glucose unless the person is able to inject the appropriate amount of insulin at the correct intervals.

We generally think of type 2 diabetes as sensitive to changes in the environment, since it is closely linked to obesity as a risk factor. However, viral infections can trigger type 1 diabetes. Consequently, the pandemic is also contributing to an increase in type 1 diabetes.

COVID Causing Diabetes:

There is now research suggesting that the virus that causes COVID-19 can also trigger type 2 diabetes. This COVID and diabetes connection will come as a shock to many health professionals.

A study utilizing data from the Department of Veterans Affairs analyzed records of 181,000 patients who were treated for COVID between March 2020 and September 2021. Those who had lingering symptoms a month after recovery were 46 percent more likely to get a diagnosis of type 2 diabetes later.

COVID and Diabetes: How Many Could Be Affected?

In this study, the absolute risk of developing type 2 diabetes after COVID was two more patients out of 100. That may not seem too scary, but when you calculate that 80 million Americans have caught SARS-CoV-2 and 477 million people in the world have contracted COVID-19, the numbers become daunting. In the US COVID could contribute to 1,600,000 new type 2 diabetes cases. Worldwide, we could see 9,540,000 new cases.

Even if these numbers are an overestimate, there could still be an epidemic of type 2 diabetes because of COVID infections. And these patients were not all hospitalized because of COVID, so even those with mild to moderate cases could be at increased risk. That means many people who got over the coronavirus may need regular testing and treatment because of COVID and diabetes.

The authors state:

“…diabetes should be considered as a component of the multifaceted long COVID. Post-acute care strategies of people with COVID-19 should also integrate screening and management of diabetes.

“The implications of our findings are clear. In the post-acute phase of the disease, COVID-19 was significantly associated with increased risk of incident diabetes. Although the risks and burdens increased according to the severity of the acute infection (as proxied by the care setting), they were evident and not trivial among people who were not hospitalised for COVID-19—this group represents most people with COVID-19.”

The Bottom Line on COVID and Diabetes:

People who have recovered from COVID-19 should be vigilant for signs of type 2 diabetes. What should you look out for?

       Symptoms of Type 2 Diabetes:

• Frequent trips to the bathroom to pee, especially at night
• Hard to quench thirst
• Weight loss that is unusual
• Frequent hunger pangs
• Visual changes, blurred vision
• Fatigue, lethargy, exhaustion
• Tingling or numbness in fingers, hands or feet
• More infections than normal; sores that don’t heal
• Dry skin and/or skin color changes

The Consequences of Diabetes:

If there is a connection between COVID and diabetes, the long-term implications are scary.

      The Consequences of Type 2 Diabetes:

• Increased risk of cardiovascular diseases (heart & brain)
• Nerve damage (neuropathy manifest as pain and/or tingling)
• Increased risk of kidney damage
• Visual changes, eye disease
• Foot problems
• Bladder problems
• Sexual dysfunction
• Skin infections
• Alzheimer’s disease, dementia

The Vicious Cycle of Diabetes and Inflammation:

People with diabetes start with higher levels of inflammation in their bodies. When the immune system fights infection, it produces inflammatory compounds called cytokines. That explains why individuals who already have high levels of these compounds might be more vulnerable to a cytokine storm as an expression of severe COVID-19. Unquestionably the best treatment for this complication is systemic steroid treatment. However, steroids, especially in high doses, raise blood sugar and make diabetes much harder to control.

Obesity and Metabolism and Another Vicious Cycle:

The usual explanation for obesity is that people consume more calories than they expend–they eat too much and move too little. However, this simple energy balance paradigm is now being questioned by some nutrition researchers. They suggest that food quality may be even more important than food quantity. In particular, when people eat highly-processed quickly digested foods high in sugar and refined grains, their bodies respond with insulin that quickly adds energy to the fat cells and may leave other body tissues wanting. As a consequence, people may feel hungry too soon after eating and consume more snack foods, keeping the vicious cycle rolling.

Our guest, Dr. Mitchell Lazar, describes how he counsels his patients with diabetes to eat. In addition, he extolls the benefits of continuous glucose monitoring to help people determine exactly how their food choices change their blood sugar.

How Does Circadian Rhythm Affect Blood Sugar?

When we think about risk factors for developing diabetes, we will certainly list metabolic syndrome and obesity. Moreover, many people recognize that genetics can play a role. But how often do we think of shift work or other changes to our daily schedule?

Circadian rhythm can have a powerful impact on metabolism, although it may be difficult for shift workers to address this problem. Getting the eating schedule as close to “normal daytime” as possible may help. Adopting a time-restricted eating plan or intermittent fasting could also be useful. However, people with diabetes need to work closely with their health care providers to make sure that intermittent fasting does not result in episodes of very low blood sugar.Finally, Dr. Lazar offers some advice we can all use to lower our risk of developing diabetes.

This Week’s Guest:

Mitchell Lazar, MD, PhD, is the Willard and Rhoda Ware Professor in Diabetes and Metabolic Diseases, and the Director of the Institute for Diabetes, Obesity, and Metabolism at the University of Pennsylvania. This is the link to his research laboratory: https://www.med.upenn.edu/lazarlab/

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Learn More About COVID and Diabetes:

To learn more about other complications of long COVID check out this link. If you know someone who has had COVID, please let them know to be alert for signs of type 2 diabetes. Because there is now a connection between COVID and diabetes, people who have recovered from the coronavirus should be alert for signs and symptoms of this metabolic disorder.

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