Diabetes is already a risk factor for greater severity of COVID-19, but evidence is now surfacing that some patients have received new diabetes diagnoses upon coronavirus hospitalization.
According to new data on COVID-19 patients, the virus may damage insulin-producing cells, resulting in higher levels of blood sugar and ketones, and in some cases a spontaneous diagnosis of diabetes.
[Monash University researcher Paul Zimmet] is among a growing number of researchers who think that diabetes doesn’t just make people more vulnerable to the coronavirus, but that the virus might also trigger diabetes in some.
Their hunch is based on a handful of [patients] who have spontaneously developed diabetes after being infected with SARS-CoV-2, and on evidence from dozens more people with COVID-19 who have arrived in hospital with extremely high levels of blood sugar and ketones, which are produced from fatty deposits in the liver. When the body doesn’t make enough insulin to break down sugar, it uses ketones as an alternative source of fuel.
A letter published in the New England Journal of Medicine written by Zimmet and other physicians says COVID-19 and diabetes have a “bidirectional relationship.”
On the one hand, diabetes is associated with an increased risk of severe COVID-19. On the other hand, new-onset diabetes and severe metabolic complications of preexisting diabetes, including diabetic ketoacidosis and hyperosmolarity for which exceptionally high doses of insulin are warranted, have been observed in patients with COVID-19.
In the aggregate, these observations provide support for the hypothesis of a potential diabetogenic effect of Covid-19, beyond the well-recognized stress response associated with severe illness.