It’s enough that SARS-CoV-2, the virus that causes Covid-19, can cause pneumonia, kidney failure, blood clots, arrhythmias and even heart attacks, but the potential that the virus may also lead to onset of diabetes provides a new set of implications and potential complications for survivors.
A recent report in Nature details the rationale and proposed mechanisms behind the ability of the virus to damage specialized cells in the pancreas that make insulin, otherwise known as beta cells, contained in surrounding specialized cells (islets).
When beta cells are destroyed, and the body is unable to manufacture insulin, a person develops elevated blood sugar, known as hyperglycemia, which effectively switches the body to an alternate pathway for energy using ketones and ketone bodies as a primary source. Using ketones bodies for energy will trigger a dangerous state where the body produces harmful acids, leading to diabetic ketoacidosis (DKA), which can be fatal if left untreated.
What’s clear is that diabetes is already recognized as a key risk factor for developing severe Covid-19, and persons with this condition have a higher risk of death.
But new research is emerging that the virus not only causes a more severe course in diabetics, but may also trigger onset of the condition in a subset of patients. The potential for a crush of patients with new onset diabetes (Type 1) may be a new reality that the medical community is yet to face.
“It’s important to note that not only are new diabetes cases possible but the more common scenario would be the development of diabetes complications in patients who already have diabetes such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemia syndrome (HHS), said Dr. Minisha Sood, an endocrinologist at Lenox Hill Hospital in New York City. “These conditions are characterized by very high blood glucose and dehydration, among other symptoms.”
Clinicians are now seeing previously well people with no history of diabetes who have suddenly developed new onset diabetes after being infected with SARS-CoV-2, along with the dangerous complication, DKA, in which people develop acid in their blood stream, accompanied by rapid breathing, which can lead to shock and death.
“Knowing the symptoms of DKA and HHS is important so one may seek medical care in a timely manner. It’s critical for patients with diabetes to have a plan in place should they contract Covid-19 in terms of having enough medication, glucose testing supplies and access to their doctors and healthcare providers should they develop complications,” added Sood.
If we look back at patients who developed SARS back in 2002-2003, there is a linkage with development of autoimmune conditions such as type 1 diabetes. We also know that many organs which play a role in regulation of blood sugar—the liver, pancreas, kidneys, small intestine and adipose tissue (fat)— have a large number of ACE-2 receptors, the receptor on the surface of cells that the virus attaches to using its “spike protein”. Thats said, the basis for onset of ketosis-prone diabetes following infection with influenza or herpes has been previously reported in the medical literature.
Additional research recently published using miniature lab grown pancreases also suggests that the virus may cause diabetes by injuring the specialized cells, beta cells, that regulate blood sugar.
That said, other researchers have been less convinced about the strength of the connection between Covid-19 and new onset or worsening of diabetes.