There’s never a better time to manage your blood sugar than the present. Especially in the midst of a coronavirus pandemic. 

If you’re one of the 29.1 million people with diabetes in the US, according to the American Diabetes Association, you are not at greater risk for contracting COVID-19—the infection caused by the novel coronavirus. That’s the good news. The bad news is that if you have diabetes and become infected, there’s a greater chance that you’ll have more serious complications. 

In general, says the Association’s website, people with diabetes are more likely to experience severe symptoms and complications when infected with a virus.

Reasons Why Diabetes Can Make COVID19 Infection Worse

In this podcast, Dr Dipesh Patel, a specialist in endocrinology and diabetes explains there is altered or reduced effectiveness of the immune system with people with diabetes mellitus. This is especially true of people who have higher blood glucose levels, or higher levels of diabetes. 

Patel says that when the immune system is compromised, it makes it harder to fight the virus, which will likely lead to a longer recovery period. 

Comorbidity Factors With Diabetes

Many people with type 2 diabetes have other chronic health concerns. A common underlier in patients with type 2 diabetes, says Patel, is excessive abdominal fat. This fat reserve is a sign of excess inflammation, which is commonly seen in people suffering from severe illnesses such as COVID-19. 

In the podcast, it was mentioned that in the UK, a higher proportion of COVID-19 patients in intensive care units had high body mass index (BMI) scores, indicating that being obese places you more at risk for developing severe complications from COVID-19 infection. 

According to Harvard University, 85% of people with type 2 diabetes—which accounts for roughly 90% of diabetes patients—are overweight. 

In addition to obesity, hypertension and heart disease are common co-factors. According to a study published in The Lancet, diabetes was the most distinctive comorbidity factor in a small group of patients in China who died from COVID-19 infection. 

The Lancet also references a larger study, which included 1099 patients with confirmed COVID-19. Of these patients, 173 had comorbidities of hypertension (23.7%), type 2 diabetes (16.2%), and coronary heart diseases (5.8%).

Can Diabetes Medication Cause COVID19 Complications?

With COVID-19, the virus enters the cells by attaching itself to an enzyme commonly known as ACE 2 receptors. 

The expression (activity) of ACE2 receptor levels may be increased in patients with type 2 diabetes. Theoretically, then, the more expressive your ACE2 receptors are, the more at risk for the virus replicating itself in your cells. 

Many people with type 2 diabetes, hypertension and cardiovascular disease take ACE-inhibitor drugs, which are designed to dilate the blood vessels. 

Could it be that taking an ACE-inhibitor (or an ARB drug) puts you at greater risk for COVID-19 infection? The theory that ACE-inhibitor medications increase the number and expression of ACE2 receptors emerged around February 2020. 

In fact, the co-authors of The Lancet study wrote, “ACE2 expression is increased in diabetes and treatment with ACE inhibitors increases ACE2 expression. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. We therefore hypothesise that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19.”

Should You Stop Taking Your Diabetes Medication?

Absolutely not. First of all, the evidence linking ACE-inhibitors with COVID-19 infection is “scant”, in the words of science writer Ashley Yeager, who reported on this dilemma in The Scientist. Furthermore, it would be potentially dangerous or even fatal to stop taking your medication—especially without your doctor’s consent. 

Yeager’s article mentions that since ARB (Angiotensin II Receptor Blockers) drugs boost ACE2 expression, they might counteract the effects of the viral infection. In this preliminary study of over 500 patients with COVID-19 in China, those over age 65 taking ARBs were at a lower risk of developing severe lung damage from the viral infection. However, more research is needed to confirm this initial data. 

Sugar and COVID19 

But let’s focus on the specific problem that causes type 2 diabetes in the first place: High blood sugar. 

With type 2 diabetes, insulin, the hormone that escorts excess blood sugar (glucose) into the cells for energy, becomes less effective. When glucose can’t enter the cells, more glucose circulates in the bloodstream. Having persistently high levels of sugar in the blood damages the vessels that carry oxygen-rich blood to your organs. 

So what does this have to do with coronaviruses such as SARS-CoV-2, aka the novel coronavirus? 

Coronaviruses seem to thrive in an environment of elevated blood glucose. Adam M. Brufsky, Professor of Medicine at the University of Pittsburgh, explains here that high blood sugar increases the number of sugar-coated ACE2 receptors.

So not only are the number of receptors greater, but also there are more sugars attached to them. This makes it easier for the virus to infect cells. 

That’s why it’s critical to manage your blood sugar levels and exercise. With more normalized blood sugar and exercise, there will be less chance for the novel coronavirus to enter the cells. This is because ACE2 receptors won’t be coated with nearly as much sugar. 

The degree and control of the lungs’ immune response, Brufsky writes, “May also depend on how much sugar is attached to the virus’s spike proteins approximately eight to 10 days after symptoms start.”

Can Coronavirus Cause Diabetes?

Temporarily, it may. 

Brufsky explains that there are a lot of ACE2 receptors on the islet cells of the pancreas. Islet cells produce insulin. If the virus infects these cells, your insulin-making ability can plummet, causing a temporary diabetes with COVID-19 infection.

Brufsky also suggests that people who contracted SARS, another type of coronavirus,  seem to get high blood sugar temporarily when they become infected. 

Conclusion

Research shows that people with diabetes are more vulnerable to COVID-19 complications.  

Controlling your blood glucose levels through proper diet and exercise may help reduce the severity of the disease should you become infected. 

When it comes to managing diabetes, the same evergreen wisdom applies even during a pandemic:

• Control your stress levels
• Don’t be fearful of becoming infected, or excessively worry (don’t be glued to the TV watching the news)
• Avoid foods that can make your glucose levels fluctuate (added sugars, juice, processed grains, alcohol)
• Check blood glucose levels regularly
• Get plenty of sleep
• Make sure to drink lots of water
• Exercise regularly: go for walks after meals, which is proven to help control blood sugar levels.