Doctors unsure why but say the COVID-19 virus appears to have links to diabetes – Foster’s Daily Democrat

Recent reports linking COVID-19 to new and existing diabetes cases seemvalid, but local doctors say much more information and research is needed before drawing any conclusions as to why.

Doctors are finding that COVID-19 is affecting diabetics differently and it is suspected the virus might be triggering new cases.

"There seems to be multiple levels of connection," said Dr. Michael Davidson, an endocrinologist at Wentworth-Douglass Hospital. "It is interesting, but so far it is a poorly understood relationship. Does it cause new cases? People are talking about this heavily at the Endocrinology Society. "

"There is some truth to this," said Dr. David Itkin, an infectious disease specialist at Portsmouth Regional Hospital. "There are two types of diabetes and there is less evidence to link COVID to one of those types."

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Type 1, commonly called juvenile onset diabetes because it tends to manifest at a young agebut can occur at any time, does not seem to have strong links to COVID-19 cases.

"Type 1 is when there is an inadequate or no production of insulin in the body," Itkin said. "Insulin must be provided to treat and control glucose levels. The COVID virus does not attack the pancreas, where insulin production takes place. Autoantibodies (against the self) might be produced."

Type 2 diabetes is an insulin resistant disease, where the body produces insulin, but it is not used well, also resulting in elevated glucose levels, said Itkin.

"The effects of type 2 diabetes from COVID is more apparent," said Itkin. "We should note, however, that this is not a phenomenon of just COVID. Other infectious and non-infectious conditions can impact a Type 2 diabetic. Even heart attacks or trauma can have an effect. It is uncommon, but it can happen."

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Davidson said it is recognized that people who have diabetes are at risk for more severe cases of COVID-19.

"The virus seems to induce metabolic complications in a diabetic patient," he said. "They are at risk for conditions like ketoacidosis,hyperglycemia and insulin resistance. They seem to require more critical care. But a lot of people presenting with acute COVID have high blood pressure."

Another theory is that the new cases might be temporary, similar to gestational diabetes some women experience in pregnancy.

"It's not the same exactly," said Davidson. "Pregnant women can show insulin resistance while the placenta is making hormones. After pregnancy, mostreturn to normal. Still they have a higher risk of developing diabetes in the future. Will the COVID cases have the same risk? We just don't know yet. We do not know the ramifications."

Dr. Gretchen Volpe, an infectious disease doctor at York Hospital, said concerns have been raised about people coming in with new diabetes cases when they come in with COVID-19.

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"Can it be caused by COVID?" she said. "We just do not know yet. We did create a registry to try and learn the answers. Could it be like gestational diabetes? We are trying to figure out if there is a real correlation."

One of the more common treatments forhospitalized COVID-19 patients, steroids, couldbe the cause of what seems to be happening, said Itkin.

"It is known that steroids can elevate glucose levels," he said. "So, that might be the tipping point."

Volpe agreed that steroids and some other treatments can cause high glucose levels, mimicking diabetes.

Davidson said there is a registry being formed in the UK on the diabetes cases.

"They are identifying nuances and reporting on them, looking for trends," hesaid. "They are looking at how frequently this happens, what are the features presented and whether the cases more closely resemble Type 1 or Type 2 disease."

For now, Davidson said this is something clinicians need to be aware of, so when a patient with diabetes comes in with COVID-19, they can know how to best manage diabetic patients'treatmentand look for new cases.

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Doctors unsure why but say the COVID-19 virus appears to have links to diabetes - Foster's Daily Democrat