Dr. Tiffany E. Groen likened learning about the coronavirus as “running across a bridge while trying to build it.”
The knowledge changes every day, Groen, a board-certified family and preventive medicine doctor with the Silver Cross Medical Group, said.
“It’s amazing how differently the virus affects people,” Groen said. “It might give one person respiratory issues. Another person might have no respiratory issues but have blood clots.”
But one thing appears clear. Having diabetes is a risk factor for severe COVID-19.
"There is not enough evidence that having diabetes will increase the risk of contracting the virus," Dr. Babak Pazooki, an endocrinologist with AMITA Health Saint Joseph Medical Center in Joliet, said. "But there is enough evidence to support the notion that if you have diabetes, your outcome may be worse."
In fact, diabetics are at risk of complications when they contract any virus, the ADA said.
Diabetics are also at greater risk of acquiring – and having worse outcomes – certain infections, such as urinary tract and respiratory infections,” Pazooki said
Groen said diabetes, especially diabetes that isn't well-controlled, can cause inflammation. This may lead to complications in times of illness.
“When a diabetic gets sick with any illness, the tendency is for the blood sugar to be elevated,” Groen said. “The immune system doesn’t work as well, and it can’t fight it [the illness] very well.
Jan Smith of Joliet saw that firsthand with her husband James V. Smith, who was diagnosed with type 2 diabetes about five years ago. He kept it under good control – until he caught the coronavirus, she said.
Jan feels her husband’s lack of appetite during his illness might have affected his blood sugar control. She said James was treated in an emergency department on Aug. 31, but his condition continued to worsen.
“He went into the hospital on Sept. 8,” Jan said. “and he died on Sept. 23.”
Pazooki said diabetes becomes difficult to manage once the patient becomes severely ill.
In July, the Centers for Disease Control and Prevention published a study of 10,000 people who died from the virus, which further showed the connection between diabetes and COVID-19.
The study found that 49.6% of those aged 65 and up had diabetes as did 35% of those younger than age 65. When compared to people who were white more Hispanic and non-white people were older than 65, the CDC study also said.
“But generally speaking, diabetes is more common in people of color and the complications and outcomes are worse, for whatever the reasons might be,” Pazooki said.
The CDC study also said more studies are needed to clarify some of the associations, such as those among age, race/ethnicity, SARS-CoV-2 infection, disease severity, underlying medical conditions (especially diabetes) poverty and access to health care and the ability to comply with mitigation recommendations while maintaining essential work responsibilities.
Groen said the longstanding health and social inequities in the U.S. increases the risk in some minority groups, who often have additional chronic conditions, too, such as obesity and high blood pressure.
On top of that, not all types of diabetes are the same and it’s unclear if the risks are the same.
Certainly high blood sugar plays a role in all forms of diabetes, she said.
A study published April 15 in the Journal of Medical Virology suggests that blood sugars that remain high over time might contribute to the severity of COVID-19 in some people with diabetes.
Pregnant women are also more prone to blood clots, Groen said. In some cases, the SARS-CoV-2 virus also causes blood clots, she added.
What might make Type 2 diabetes particularly troublesome in terms of covid is that it often involves multiple other factors: metabolic syndrome, obesity and even genetics, Pazooki said.
“So it is possible that those are other conditions that leads to the type 2 diabetes being more of a bigger risk factor for having adverse outcomes,” Pazooki said.
But even treating the coronavirus in a diabetic patient is tricky, Groen said.
“If they need steroids, that can elevate the blood sugar,” she said.
A study published July 17 in The Lancet said these blood sugar elevations can become quite high, along with an increase insulin resistance, when steroids are administered to a diabetic patient.
Pazooki said diabetics who don’t normally take insulin might have their oral diabetes medication temporarily stopped and then switched to insulin if they are being treated for COVID-19 in the hospital.
Oral medication might be harmful if the patient has abnormal kidney function, needs to fast for tests, or has an irregular meal schedule, Pazooki said.
But often this change in treating the diabetes is temporary.
“The majority of patients go back home on the medications they came to the hospital with,” Pazooki said.
So what’s a diabetic to do?
Pazooki suggests diabetics work with their health care providers to keep their condition controlled. Eat a healthy diet, get regular exercise, he said.
Then, hypothetically, outcomes from COVID-19 might be better, he said.
“We don’t have strong evidence in terms of COVID-19,” Pazooki said. “But we do have strong evidence in terms of all other types of infection…and COVID-19 is just another infection.”