For COVID-19 and vaccination updates, view our information for the community. If you're experiencing symptoms, call your primary care provider.

COVID-19

COVID-Related Diabetes: Understanding, Treating and Preventing the Chronic Health Condition

Published: Dec. 1, 2021

COVID-19 infections have led to a number of new-onset diabetes cases. Although the reasoning behind the rise in COVID-related diabetes isn’t entirely clear, we’re beginning to learn more about the role the virus may play in the development of the chronic health condition.
 

Understanding Diabetes

Diabetes – a condition that affects how your body turns food into energy – can be diagnosed based on various criteria, including:

  • A fasting blood sugar level greater than 126
  • An A1C blood test – which measures your average blood sugar level over the past three months – that yields results of 6.5% or higher (An A1C of 6.5% is consistent with an average blood sugar level greater than 126.)
  • Symptoms of high blood sugar (increased thirst, appetite and/or urination, weight loss, and fatigue) and/or a random blood sugar level greater than 200

It’s important to know that most of the food we eat is broken down into sugars, which eventually make their way into the bloodstream. These sugars are also known as glucose or carbohydrates. High blood sugar levels trigger the release of insulin from the pancreas, which helps your body convert those sugars into energy by essentially unlocking “doors” – or receptors – that allow the sugars to go from the bloodstream and into the different organs in the body.

The two most common types of diabetes are:

  • Type 2: Your body can make insulin, but the insulin doesn’t do its job.

    Think of the pancreas as a machine that houses an insulin tank – kind of like the gas tank in your car. If your diet is higher in carbohydrates, your pancreas will constantly pump out insulin into the blood stream. Eventually, that insulin tank gets low. As a result, sugars will stay in the blood, as there isn’t enough insulin for your body to convert them into energy.

     
  • Type 1: Your body isn’t able to make enough insulin.

    In type 1 diabetes, the cells of the pancreas that make insulin – beta cells – are damaged. But with insulin therapy, sugar-energy conversion can still occur.
     

Theories Behind COVID-Related Diabetes

Much like your body uses pathways to move sugar from the bloodstream to different organs, COVID-19 also uses pathways to infiltrate other parts of your body and cause damage. Because COVID-19 triggers such a large immune response, significant damage to your body along the pathways can occur.

Most healthy patients are able to rebuild their bodies and pathways from the damage of the virus and the immune response it causes. These patients generally fare well and don’t develop long-term complications from COVID-19.

However, patients with underlying health conditions (whether they know about them or not) – such as pre-diabetes – are at much higher risk of developing diabetes or other complications following COVID-19 infection. But, of course, there are some cases of seemingly healthy individuals who have no risk factors for diabetes and still develop the condition.

While genetics certainly play a role in the development of diabetes, there are emerging theories on how exactly COVID-19 might also contribute to the condition. A couple of those theories include:

  • When the virus enters the pancreas, it damages beta cells. This could explain why patients with no history of diabetes suddenly develop the condition and require insulin after infection. Again, some people may sustain cell damage but then recover just fine. Others may have varying levels of cell damage and slightly higher sugars but won’t require insulin therapy.
  • Compared to other viruses that may trigger only parts of the immune system, COVID-19 seems to elicit an entire immune system response. The virus specifically triggers immune cells that can induce insulin resistance. In other words, they can damage and block critical pathways your body needs for sugar-energy conversion. As a result, the sugars get trapped in the bloodstream and start to rise.
  • COVID-19 can deplete the insulin tank in some people. But in others, it can cause damage to the receptors. Stress hormones and some of the immune cells released with the infection can also cause receptor damage


Treatment

If you’re one of the many individuals who’ve recently been diagnosed with diabetes following a COVID-19 infection, know that there’s already treatment options available, including insulin therapy and medications that help rid sugar from the bloodstream.

Some patients lack insulin and also have insulin resistance. Treatment options are still being studied for these patients but may include a combination of insulin and non-insulin therapies. 

Also being investigated is a medication designed to block the immune response in COVID-related diabetics and prevent further beta cell damage. Many patients who’ve already received this treatment have experienced better blood sugar control than those who haven’t been offered it.
 

Prevention

The best advice I can give to anyone right now is this: Do your best to eat healthy and stay active.

Even if you don’t contract COVID-19, we know that excessive amounts of unhealthy carbohydrates (sugary snacks, sodas, white bread, white rice, pastas, etc.) can overwhelm your body’s ability to handle any kind of sugar, resulting in diabetes. A diet higher in healthy carbohydrates, such as fresh fruit and vegetables, can help protect you from developing pre-diabetes or diabetes. 

High blood sugar levels can also trigger your body’s immune system. Combined with a viral infection, the response is even stronger and more damaging.

Avoid fast food, processed foods and high-fat foods. Aim for 150 minutes of light to moderate exercise each week. When your muscles are moving, they actually pull sugars out of your blood for you, leaving your body less reliant on insulin and those important pathways for sugar-energy conversion.

We have plenty of evidence that tells us this: Those who have normal blood sugar levels not only feel better but also are also less likely to develop diabetes – especially after a COVID-19 infection. So stay proactive in living a healthy lifestyle. And lean on your health care provider if you need additional support.

About the Author

Avin Pothuloori, MD, is committed to being a voice for diabetes and endocrinology patients. And as a diabetic himself, he can directly relate with many of them.

“It’s knowing what low sugar or high sugar feels like. Knowing what the patients are going through and being in their shoes,” said Dr. Pothuloori, who cares for patients at Methodist Physicians Clinic. “When I go through the disease process with them, it makes me want to advocate for them, and I truly understand a lot of the little things or nuances they deal with.”

Dr. Pothuloori has expertise relating to pituitary disorders, thyroid disease, endocrine cancer care, reproductive endocrinology and chromosomal disorders such as Klinefelter syndrome and Turner syndrome.

See more articles from Avin Pothuloori, MD
Avin Pothuloori, MD