Louisiana Patients Diagnosed With Diabetes After COVID: “We Should Be Worried” | Coronavirus

David Owens thought he could fall with COVID-19.

Although he had masked himself for work and his wife was a “disinfectant fanatic,” with two school-aged children, it was difficult to avoid exposure. In January, a test came back positive.

But the thing Owens, 53, didn’t expect to result from his battle with the coronavirus was a diagnosis of type 2 diabetes.

He learned the news when he went to the emergency room for what turned out to be a blood clot, another complication related to COVID. The nurses checked her blood sugar when she arrived and it was three times higher than normal.

“They were surprised that I was aware,” Owens said.

Over the past year, researchers have identified a cascade of problems that can result from COVID, including neurological issues, kidney and heart damage, and blood clots. More recently, signs have emerged in patients like Owens that diabetes may also be linked to coronavirus infections.

In Louisiana, where approximately 1.27 million people have prediabetes and a further 124,000 have undiagnosed diabetes, doctors see an increase.

“I have had more new diagnoses of new diabetes this year than I have probably ever had,” said Dr. Josh Denson, a New Orleans intensive care pulmonologist who felt he had diagnosed up to ten times more diabetic patients than usual, even specializes in lung care and not in metabolic disorders.

Denson began researching chronic disease in COVID patients after noticing a connection. But he says it’s a ‘chicken or egg’ situation – it’s unclear whether patients were already on the path to diabetes or whether the coronavirus exacerbated it.

“We had a healthy 32-year-old guy who recently contracted severe COVID and passed away,” Denson said. “He didn’t have any medical issues. However, if you start looking… he actually had very mild diabetes.”

Doctors knew that diabetic patients had a harder time with coronavirus infections. But it wasn’t clear until more recently that the connection could be a two-way street. In November, a study found that 14.4% of hospitalized COVID patients developed some type of diabetes, according to the Journal on Diabetes, Obesity and Metabolism. But experts cannot yet say whether COVID triggers the chronic disease, tips the scales toward it, or simply uncovers an unknown and already present affliction.

Diabetes refers to a range of metabolic disorders related to the way the body manages blood sugar. In patients with type 1 diabetes, the pancreas – an organ that helps digestion and balances blood sugar – loses the ability to make enough insulin to regulate blood sugar. Type 2 diabetes occurs when the body develops resistance to insulin and the pancreas cannot produce enough insulin to lower blood sugar levels.

Type 1 diabetes has long been linked to viruses and is thought to start when the immune system attacks the cells responsible for making insulin. The link between viruses and type 2 diabetes is not so clear, but there is some evidence that viruses can completely disrupt the body’s ability to regulate blood sugar.

During the 2003 SARS pandemic, 20 of 39 patients in a study developed diabetes within days of hospitalization, although only two of them still had diabetes three years later. In another study of the 2003 epidemic, out of 22 patients without previous diabetes, 7 developed high blood sugar in hospital, although researchers cannot say whether this was due to the treatments or the virus itself.

Owens had no history of diabetes, although his medical records showed slightly elevated fasting blood sugar compared to a few years earlier. Before COVID, he had never been hospitalized.

Whether COVID triggers diabetes and how new diabetes linked to COVID might play out differently is debated among endocrinologists. Some, like Dr. Franck Mauvais-Jarvis, endocrinologist and professor at Tulane Medical School, suspect that the way the virus infiltrates pancreatic cells is having a detrimental effect.

“It’s like the pancreas has had a heart attack,” said Mauvais-Jarvis, who found autopsied pancreas from COVID patients riddled with micro-clots and inflammation.

In a small sample of primates from the Tulane Primate Center, two of six monkeys who were not prediabetic also developed type 2 diabetes after COVID infection, Mauvais-Jarvis said.

A number of other factors could also explain a diagnosis after COVID. Serious illness of any type can turn a person who may have had prediabetes into full-blown type 2 diabetes. COVID patients may have had diabetes before, but it took a fight with COVID to find out. Dexamethasone, a steroid commonly used for the treatment of COVID, is like gasoline on a fire for blood sugar levels in diabetic patients, doctors said.

“It’s possible that all of these stories were just the effect of an infection plus some steroids,” Bad-Jarvis said. “But it’s also possible that the virus is having a toxic effect on the pancreas.”

The virus can interfere with insulin production by damaging cells that produce insulin, a hormone that controls blood sugar, said Taniya de Silva, section chief of endocrinology at LSU Health New Orleans School of Medicine.

The inflammation that COVID creates by stoking the immune system could damage these pancreatic cells or other systems or organs in the body, all of which affect the regulation of sugar in the body.

“With the data still available, we don’t know for sure, but there are mechanical possibilities for new diabetes,” said de Silva. “In our population, given that we are already at risk, this is something we should be concerned about. ”

Dareen Berniard was one of those at-risk patients. She has a family history of diabetes, but has been particularly careful with her diet and had her blood sugar checked regularly. When she contracted COVID in July 2020, she was thinking more about breathing problems and a blood clot than about diabetes. But a few months after COVID, she received a call from her doctor: her blood sugar had skyrocketed, taking her from mild prediabetic status to full type 2 status.

She redoubled her efforts to control her diet, in collaboration with a nutritionist. But another test a few weeks later showed that his blood sugar had risen again.

“It was a lot. It must have been stressful, ”said Berniard, a 48-year-old Medicare case manager. “It made me wonder: was I really eating as healthy as I thought? Am I doing enough?

His doctor saw the sharp rise in blood sugar in two patients who had previously had coronavirus infections.

“I really think it’s associated with COVID,” said Dr. Jason Halperin, Berniard’s doctor at CrescentCare in New Orleans. “The timing, the lack of a change in her lifestyle and having such a big change over a three month period is just very surprising.”

But until the data is collected and investigated, the connection remains a mystery. Mauvais-Jarvis begins a study at the Veterans Affairs Medical Center in New Orleans with approximately 1,500 patients. An international group of researchers has established a global registry to track new-onset diabetes and COVID.

In the meantime, patients can’t help but think that it has something to do with the onset of a life-changing disease.

“Maybe I went Type 2 down the line,” Owens said. “COVID crossed the finish line the rest of the way.”