Coronavirus Induces Diabetic Macrophage
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Edited by Steven Z. Josefowicz, Weill Cornell Medicine, New York, NY, and accepted by Editorial Board Member Carl F. Nathan July 29, 2021
What Should People With Diabetes Know And Do
For people living with diabetes it is important to take precautions to avoid the virus if possible. The recommendations that are being widely issued to the general public are doubly important for people living with diabetes and anyone in close contact with people living with diabetes.
If you have diabetes:
What Happens If I Have Already Got Diabetes
People with diabetes are at no more risk of catching the COVID than anyone else but if you do then you could become more ill this is why you are classed as high risk. This is the same for all types of diabetes . People with diabetes can be more vulnerable to becoming unwell. There is a new dedicated helpline for people with diabetes to access information by the health service in England.
If you do become ill, this may affect your blood sugars . This is due to the body trying to fight the virus. The body releases glucose to help give you energy but cannot produce enough insulin to cope with this, resulting in higher glucose levels.
In most cases, the main symptoms for COVID-19 are mild flu-like symptoms. These can include a high temperature, dry cough, shortness of breath , feeling tired, muscle aches, headaches and a loss of taste and smell. The way the virus affects people will vary from person to person.
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New Cases Of Diabetes
At the start of the coronavirus pandemic, doctors started to raise concerns around new cases of diabetes in people who had caught the virus.
Since early reports first came to light, we’ve seen results from larger studies looking at big groups of people whove recovered from coronavirus. One study tracked over 47,000 people in England who had been admitted to hospital because of coronavirus before August 2020. The researchers followed their health for up to seven months after they were discharged and found 5% of people went on to develop diabetes.
They also showed that people whod been in hospital with coronavirus were 1.5 times more likely to be diagnosed with diabetes after theyd been discharged than people of the same age and background who hadnt been in hospital with coronavirus.
The evidence to suggest a link between coronavirus and new cases of diabetes is growing but theres still a lot we dont know. We cant yet be sure if coronavirus is directly causing diabetes, or whether there are other factors that could explain the link.
What’s Going On Inside The Body
One theory is that inflammation inside the body caused by coronavirus brings about insulin resistance, a feature of type 2 diabetes, which means the body isnt able to make proper use of the insulin its producing.
We also know that coronavirus uses a protein found on the surface of some cells, called ACE-2, to enter and infect them. ACE-2 is found in the pancreas and theres some evidence that this makes it vulnerable to coronavirus infection.
Small studies looking at pancreas cells grown in the lab and pancreas samples taken from people who sadly died from coronavirus have suggested that the virus can enter and infect insulin-producing beta cells in the pancreas, causing them to die or change how they work. This means people cant produce enough insulin.
Another theory suggests that when coronavirus infects the pancreas it could trigger the immune system to attack and destroy beta cells, a key feature of type 1 diabetes.
Research into the biological processes that explain how and why coronavirus could cause diabetes is at an early stage and we need to be cautious about applying what scientists see in the lab and in donated pancreas samples to whats happening in people infected with the virus. And we need more research to look at the types of diabetes were seeing in people who have had coronavirus to understand whether these are cases of type 1 and type 2 diabetes or something new altogether.
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Blood Glucose Levels And Covid Vaccine
Lawrence D said:I have had both the first and second round of the Moderna vaccine. I did not notice a bg increase that I could attribute to the vaccine, or if there was one it was slight. The second shot did cause a more vigorous physical reaction, but no more than the feeling of being hit by a school bus. Only lasted a day or so.
Meryl A said:Everyone reacts differently. We had first Moderna vaccinations on Thursday afternoon . Both were fine afterwards. Took us about 45 minutes to drive home By the time we were home his shoulder was hurting. By the time we settled in and drank some water his shoulder was swollen and his back hurt. Saturday was the first day that his back did not hurt and his arm is less swollen. Personally I think in his case it may be psychosomatic. If he had been told that a side effect might be for his nose to turn blue – I am sure his would have. I had no side effects at all.
Meryl A said:I had my first shot of Moderna a week ago Thursday – no immediate any problems. The past 3 days my BG has been high for me – today fasting was 117, normally is in 80s or 90s . I had started a new bottle of strips earlier in the week and thought it might be related to same, so asked husband for one of his strips – same thing. He decided it must be due to the vaccination as some side effects can come later than immediate. I hope so, fasting over 100 annoys me.
Does High Blood Sugar Worsen Covid
Preliminary observations of COVID-19 patients with diabetes inspired an algorithm for glucose monitoring thats suspected to help combat the virus serious complications.
As COVID-19 continues to rage across the U.S., researchers are digging deeper into how the virus wreaks havoc on the body, especially for those with a pre-existing chronic illness.
Now, after preliminary observations of 200 COVID-19 patients with severe hyperglycemia, a Michigan Medicine team is shedding light in a new Diabetes paper about why high blood sugar may trigger worse outcomes in people infected with the virus. And researchers have developed a blood sugar management tool that may potentially reduce risk of secondary infections, kidney issues and intensive care stays in people with diabetes, prediabetes or obesity who get COVID-19.
Based on preliminary observations of our patients, those with one of these pre-existing conditions are at high risk for making the virus-induced respiratory dysfunction much worse, potentially resulting in death, says first author Roma Gianchandani, M.D., a professor of internal medicine in the Michigan Medicine division of metabolism, endocrinology and diabetes.
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Both High And Low Pre
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Contributed equally to this work with: Michal Shauly-Aharonov, Asher Shafrir
Roles Data curation, Formal analysis, Investigation, Methodology, Writing original draft, Writing review & editing
Affiliations Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, The Jerusalem College of Technology, Jerusalem, Israel
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Contributed equally to this work with: Michal Shauly-Aharonov, Asher Shafrir
Roles Conceptualization, Data curation, Formal analysis, Investigation, Writing original draft, Writing review & editing
Affiliations Division of Medicine, Meuhedet Health Services, Tel Aviv, Israel, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, Department of Gastroenterology, Hadassah Medical Center, Jerusalem, Israel
How Coronavirus Can Affect People From Black Asian And Minority Ethnic Groups
The risk of death from coronavirus for some ethnic groups is higher than for people of white ethnicity. But it is important to remember that there are lots of factors involved, like age, and overall risk of dying from coronavirus is very low.
In England and Wales, data from the Office of National Statistics shows how people from certain Black, Asian and minority ethnic groups are more at risk than people of white ethnicity. Research in Scotland hasnt shown this increased risk, but the BAME population there is very small. And we dont have data on this in Northern Ireland at the moment.
We dont know why this is happening. The data takes into account factors which we know can increase risk, such as age, socioeconomic status and health, including obesity. And we do know that some ethnic minority groups are more at risk of developing conditions like type 2 diabetes and heart problems, which are linked to increased risk of death from coronavirus.
Its clear that we need further research to understand whats causing this whether the causes are physical, cultural or social. We are pushing for clearer guidance from the government on risks to people from ethnic minority backgrounds.
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Going To Appointments Or Into Hospital
If you have coronavirus symptoms, do not go to a GP surgery, pharmacy or hospital even if you have an appointment.
If you’re already having treatment for something like a foot or eye problem, and you don’t have coronavirus symptoms, then your appointments should still carry on. If you’re worried about going to your clinic or hospital at this time or want to check whether your appointment is still going ahead, call the number on your appointment letter or speak to your GP.
Measures are in place to keep health and care settings safe. Patients, visitors and NHS staff are still required to continue to use face coverings and maintain social distancing in all healthcare settings.
It’s likely that most appointments with your diabetes healthcare team will be on the phone or online, using a video call. There are some groups of people who need to be seen face-to-face more than others at the moment. Your diabetes healthcare team will give you advice on the best type of appointment for you at this time. Having a phone or video appointment might feel strange if you’re not used to it but we’ve got advice on preparing for a remote appointments.
And remember to get your free flu jab as early as possible. Speak to your GP or go to your local pharmacy. Find out more about the flu jab.
Therapeutic Approaches And Research Strategies
The evidence that patients with elevated blood glucose or IGT are more prone to severe primary infection and COVID-19 complications and death in the literature is overwhelming. Elevated glucose can not only explain much of the variance in COVID-19 severity as a correlative biomarker, but because virtually every action of glucose in biochemical, metabolic and homeostatic pathways seems to serve only to facilitate the infection, it could also be a primary determining factor in the severity of the disease. Controlling glucose levels could therefore reduce the severity of the disease and consequently also the mortality rate.
Glucose Lowering Drugs
Lowering Carbohydrates in Diet
Guidance for COVID-19 Biomarkers at Admission
Importance of Systematic Glucose Metabolism Measurement
Alternative Biomarkers
Ang II plasma level. Ang II is strongly associated with dysglycemia, and patients who are at risk for severe COVID-19 disease present with an increased basal plasma level of Ang II, that is further amplified by SARS-CoV-2 infection. Ang II possesses inflammatory and vasoconstrictive effects that appear to play a critical role in the COVID-19 disease severity. Hence, measuring Ang II at admission or/and during the course of the disease, could be an additional biomarker for risk stratification or as a prognostic indicator.
Glucose Management in ICU
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Who Can Get The Coronavirus Vaccine
Anyone aged 18 or over can get the coronavirus vaccine. Nine priority groups were identified to begin with. Group one got the vaccine first, group two followed and so on. The UK Government have invited people in group six to come forward for their vaccine. This includes people with diabetes, and we strongly advise you to go and get your first dose.
If you are in group six and live in England, you can book an appointment online to receive your vaccine or call 119 free of charge, anytime between 7am and 11pm seven days a week.
There are differences in how England, Wales, Scotland and Northern Ireland are rolling out the vaccine. If you feel that you should be invited to get your vaccine but havent yet, speak to your GP and talk it through with them.
The Murine Coronavirus Mhv
The murine coronavirus MHV-A59 induces M-mediated inflammation. Il1b, Tnf, and Il6 expression measured in BMDMs from C57BL/6 mice 24 h following in vitro infection with MHV-A59 and compared to uninfected BMDMs . Supernatant protein levels of IL-1, TNF, and IL-6 from BMDMs from C57BL/6 mice 24 h following in vitro infection with MHV-A59 and compared to uninfected BMDMs . Il1b, Tnf, and Il6 expression measured in splenic Ms from C57BL/6 mice 24 h following ex vivo infection with MHV-A59 and compared to uninfected Ms . Il1b, Tnf, and Il6 expression measured in splenic Ms isolated from C57BL/6 mice 3 d after intranasal infection with MHV-A59 compared to uninfected Ms . *P< 0.05, ***P< 0.001, ****P< 0.0001. Data are presented as the mean ± SEM. All data are representative of two to four independent experiments. Data were first analyzed for normal distribution, and, if data passed the normality test, two-tailed Students t test was used.
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Behind The Headlines: Coronavirus And Blood Sugar Levels
You may have seen headlines today linking diabetes and high blood sugar levels to a higher risk of death from Covid-19. We know news like this can be scary and that youll have questions about what this might mean for the self-isolation guidance given to people with diabetes.
Here we take a closer look at the research behind these headlines so you can get a clearer picture of what it all means for you or your loved ones.
Managing Your Blood Glucose Levels
Research has shown that having a high HbA1c can increase your risk of becoming seriously ill from coronavirus. So its important to work with your diabetes team to try to bring your blood sugar levels to a healthy range.
We’ve explored some of the research behind reducing your risk, including vitamin D supplements.
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Remove Triggers From Your Food Environment
Molly Carmel, eating disorders therapist and author of Breaking Up with Sugar, suggests closing your kitchen after you make dinner.
Along with that is committing to alternate skills that you will do before you go back into the kitchen, whether thats a bubble bath, watching a movie, or calling a friend, Carmel told Healthline.
When you do all of those before walking back into the kitchen, she said often times you realize you werent hungry in the first place.
What The Vaccines Are Made Of
The coronavirus vaccines do not contain meat, egg or any animal products. The vaccines are halal and kosher.
Theres a very small amount of alcohol in some of the vaccines, around the same as there is in bread. We call this negligible, because it wont have any effect on your body. The vaccines are still halal because the alcohol in them is at a concentration of much less than 1%. The alcohol is there to preserve the vaccine ingredients, to make sure it works.
The vaccines contain the blueprints for making tiny fragments of coronavirus. This triggers the immune system to react and start making antibodies that are ready to protect you if you later catch coronavirus.
Vaccines also contain other ingredients which are added to keep them stable and help them work better. Common ingredients in the coronavirus vaccines include sucrose and salt. These are added in extremely small quantities and wont have any effect on the body.
You can find out full information on vaccine ingredients in the patient information leaflet for the vaccine when you are offered one.
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Algorithm For Blood Sugar Monitoring
The newly created hyperglycemia management teams set out to find a way to monitor patients diabetes without having to use more personal protective equipment to visit the rooms all the time. It was also important to reduce the health care providers exposure to the virus as much as possible.
Although typically accurate, a continuous glucose monitor wouldnt be as helpful because a patients low blood pressure and the use of blood pressure medications could falsely elevate blood sugar levels.
The new protocol called for insulin delivery every six hours, and at the same time a nurse would check in on the patient. Some patients who were on ventilators or receiving high doses of vitamin C would get their arterial or venous blood sugar levels checked, replacing the need for the teams blood sugar check.
For those with the highest blood sugar levels and severe hyperglycemia, insulin infusions were an option for patients until their levels fell between a normal range.
The result of these efforts helped successfully lower blood sugar levels without increasing nurse contact or the overall burden on primary care teams and PPE usage.
Improving blood sugar control was important in reducing the amount of secondary infections and kidney issues this cohort of patients are susceptible to, Gianchandani says. This might help shorten ICU stays and lessen the amount of patients that need a ventilator.