corona) from its crown-like spike protein on its surface. But this protein does more than help to classify the virus. It is the protein that helps the virus invade and enter a living cell. The spike protein binds to another protein on the cell’s surface called ACE2R, which helps the virus gain entry into the cell. Many cells in the respiratory tract have the ACE2Rproteinand this enables the virus to enter the body and begin the process of multiplying. The body’s immune response tries to take quick action against the intruding virus, but often it does not have enough information to mount a surgical strike. Instead, it mounts a general attack known as a ‘cytokine response’, destroying everything in sight whether friend or foe. Unfortunately, this cytokine response can do more harm than good and if the response is excessive, it can result in what is termed a ‘cytokine storm’, which contributes to most deaths from Covid-19.
Diabetes and a higher risk of Covid-19 complications
Even in the early months of the pandemic, doctors noticed that those with type 2 diabetes were more likely to have severe Covid-19 illness, higher rates of hospitalization, and higher death rates. There are many reasons for this, including the fact that people with uncontrolled diabetes have a higher number of ACE2 receptors, which means that there are a higher number of potential points of virus entry. Patients with uncontrolled blood sugar have higher levels of inflammation, and lower oxygen saturation on being admitted to hospital for Covid-19. Some initial experiments also suggest that high blood sugar levels may speed up the virus’ ability to make copies of itself in some cells. Moreover, people with uncontrolled diabetes are more susceptible to several viral infections because of changes in their immune response and lower interferon response. It is possible that patients with uncontrolled diabetes have more ACE2R on their cell surfaces thus inviting greater viral entry.
Better diabetes control is needed during the Covid-19 pandemic
The evidence we have so far seems to suggest that if a patient has severe Covid-19 and high blood sugar levels, it worsens the outcome. In light of this, it is particularly important for those with diabetes to do their best to reduce their risk of infection, and also take special care to keep their sugar levels in check. The anxiety, social distancing and restrictions in movement over the last year have taken a physical and mental toll on most people and may make it even harder to focus on glycaemic control at this time. Nonetheless, it is a must.
For this reason, I encourage patients with diabetes to adhere to their prescribed course of treatment and monitor their blood sugar regularly. If they notice an unexplained sustained increase in blood sugar, they must report it to their diabetologist so that changes in dose or drug can be made, as required. Currently, most parks and gardens are open so I encourage patients to go out during non-peak hours and get some outdoor exercise, which has both physical and psychological benefits. And finally, every single person must take steps to reduce their stress levels, as difficult as that may seem in the current scenario. Infection risk reduction, proper sugar control and stress management are all vital for patients with diabetes to continue to live their best possible life, at such a time as this.
Dr. Sudip Chatterjee, Professor VIMS & Secretary Park Clinic, Kolkata