Emphasis on Treatment of Diabetes in the impending corona pandemic. Lessons Learnt from the past.
This coronavirus consists of a single-strand RNA enclosed inside a lipid ball consisting of spikes on its surface resembling a crown, which is believed to have originated in bats and later transferred to human beings.
Covid-19 caused by the Novel Corona Virus is medically known as SARS-CoV-2,(Severe acute respiratory syndrome coronavirus) that causes upper respiratory disease and is a part of the coronavirus group, and is today responsible for millions of deaths causing an epidemic globally.
Covid-19 carries a risk to all ages but it poses a serious threat to older people accounting for the physiological changes occurring due to the ageing process and their associated comorbidities like diabetes, cardiovascular problems, etc.
When a covid-19 infected person coughs, sneezes or even talks he or she disperses fine air droplets which carry the deadly virus to the neighbouring individual or settle down on various things in the surrounding area. This virus has the capability to survive for a couple of hours or a few days depending on the favourable environmental conditions.
Pathophysiology of COVID-19
The ACE2 (angiotensin-converting enzyme2) is present in the lungs, the heart, the upper respiratory system, and the pancreas etc. The coronavirus enters the body and multiplies by making copies of itself leading to apoptosis of infected cells which further activate proinflammatory cytokines. Coronavirus invades the immune system by causing death to the infected lymphocytes thus reducing the potency of the fighting mechanism in our body.
A sudden release of inflammatory cytokines in covid-19 patients, stimulates the cytokine storm placing the body in a hyper inflammation state that finally leads to multiorgan failure.
Covid-19 and Diabetes:
According to the International Diabetes Federation ( IDA), prolonged elevated blood glucose in the bloodstream offers more susceptibility to infections and hence a more favourable platform for the coronavirus to thrive.
Diabetes is associated with an inflammation state of the body making the healing process slow to any infection including covid-19.
It has been studied that a diabetic individual is associated with inflammation which may activate the cytokine storm or the immune cells to fight against itself to weaken the entire immune system thus welcoming the coronavirus to invade the body.
As diabetes is associated with an imbalance of clotting factors and fibrinolysis, the body may be shifted to a prothrombotic state.
The risk of blood coagulation in a diabetic individual is further increased by the coronavirus.
Endothelial dysfunction caused by hypoxia or lack of oxygen to the tissues in a covid-19 patient can trigger intravascular coagulation up to tenfold. Anticoagulation therapies are the mainstay in the treatment of Covid-19 patients to address this problem.
A diabetes person contracting COVID-19 should seek medical treatment preferably hospital admission on a priority basis.
An individual exposed to the virus may exhibit typical flu-like symptoms that include cough, fever, body fatigue, headache, breathing difficulty, loss of smell and taste congestion, running nose, nausea or vomiting, and diarrhoea after 2 to 14 days.
Severely affected COVID-19 patients may develop blood clots in their arteries, lungs and legs, covid pneumonia, myocarditis, pericarditis, respiratory failure, septic shock, and liver impairment.
Diagnostic test: A swab test RT PCR from the nasal cavity and the throat is the test to confirm the diagnosis.
Emphasis on Treatment of Diabetes in the impending corona pandemic:
Keeping Diabetes under strict control is the mainstay treatment to keep the coronavirus at bay in Diabetic patients.
In those who have already contracted the virus, strict control is mandatory to halt the progression of the Covid 19, stabilization and faster recovery.
Preventive measures in those who are not yet diabetics, but who have a strong family history of diabetes and those who are prediabetic, plays a vital role in evading diabetes onset.
Lifestyle changes that include regular exercise, adopting a healthy diet plan, discontinuation of smoking and alcohol intake, are effective preventive measures that may keep this chronic condition of diabetes at bay.
For those who are known diabetics, strict diabetes control with medical management,
OHA (oral hypoglycemic drugs) and insulin is a priority. Negligence may lead to uncontrolled diabetes, a condition that could make a person more susceptible to contract Covid 19 if they are exposed to that environment when compared to a non-diabetic patient.
With the advancement in medical science, we now have Metabolic Surgery that can cause remission of type 2 diabetes in type 2 diabetics who satisfy the eligibility criteria for metabolic surgery. This novel surgery does not cause control of type 2 diabetes but causes remission. This means that without OHA and insulin, the person can maintain euglycemia.
Advancement in technology has made it possible to perform this super metabolic surgery with tiny keyholes i.e Laparoscopic surgery wherein the hospital stay is between 2 to 3 days. The person can get back to work within a week of the surgery. Types of Metabolic surgery include the Ileal Interposition and Roux-en-Y Gastric Bypass.
What is astonishing is that the effects of the metabolic surgery are evident as early as the next day of surgery up to a month after the surgery. This solely depends on the extent to which the pancreas has been assaulted due to IR ( insulin resistance ) caused by Type 2 diabetes, remembering the fact that the person has to fulfil the eligibility criteria to qualify for metabolic surgery.
Evidence-based data suggest that metabolic surgery has a success rate of up to 80% to 90% in the improvements and remission of diabetes in those eligible type 2 diabetics who undergo the procedure.
It is well known that many of those having Type 2 diabetes are a part of the metabolic syndrome which includes associated hypertension and dyslipidemia. This surgery is also associated with improvements in dyslipidemia, hypertension, reduced incidences of strokes, myocardial infarction, and overall morbidity and mortality.
Preventive measures for Covid-19, (SARS-CoV-2.) Virus infection.
Wearing a proper mask and maintaining a distance of six feet between yourself and others, washing hands with soap, clean water or alcohol-based sanitizer that destroys the virus, avoid touching your face with your hands which may be contaminated.
Diabetic reversal is always better than control of diabetes.
Kindly go through our website for more details.
LINK: 1) www.todsindia.com
Dr. Tulip Chamany (MS, FMIS, FIAGES, FALS, FMIBS (USA)
Surgeon of Excellence ( SOE) by Surgical Review Corporation ( SRC) USA.
Dr. Tulip’s Obesity and Diabetes Surgery Centre, Koramangala Bangalore 560034.
Centre of Excellence (COE) by Obesity and Metabolic Surgery Society of India (OSSI ).
Contact nos: 8880537537, 08046463333, 9886139999.
NOTE: The images have been taken from PIXABAY FREE IMAGES.
- Coronavirus- g3feb22cdc-1920
- Diabetes insulin syringe- g04314bcf5-1920
- Ileal Interposition and Roux-en-Y Gastric Bypass are TOD’s own creations and not taken from the internet.