During the COVID-19 pandemic, numerous reports stated a rise in the number of type 1 diabetes cases in children. While they suggest a link between COVID-19 and type 1 diabetes, it’s still unclear if the COVID-19 virus (SARS-CoV-2) can cause diabetes. Happiest Health spoke to pediatric endocrinologists to find out the connection between the two.
Experts say type 1 diabetes is an autoimmune condition caused when one’s immune system damages the insulin-producing beta cells in the pancreas. Dr Namratha Upadhya, consultant pediatric endocrinologist, Aster RV Hospital, Bengaluru, says, “There are genetic and environmental risk factors that usually trigger autoimmunity, with viral infections being one of them. Several studies have reported a higher incidence of type 1 diabetes in those affected by COVID-19. This indicates that the viral infection could unmask type 1 diabetes in those who were already at risk for developing the condition,” she says.
Diabetes incidence during COVID-19
Dr Smita Ramachandran, consultant pediatric & adolescent endocrinologist, New Delhi, says when there is a viral infection, our body produces antibodies to act against the virus. “A certain subset of these antibodies are the autoimmune antibodies, which attack our own pancreas, hence the word autoimmunity,” she explains.
According to a recent study published in JAMA, SARS-CoV-2 infection contributed to the increased incidence of type 1 diabetes cases during the pandemic. The observed incidence rate of type 1 diabetes was 29.9 per cent per one lakh people between January 2020 and December 2021. Undiagnosed infections could also have contributed to this moderately increased incidence. It further states that possible mechanisms include initiation of autoimmunity or acceleration of disease progression.
Link between COVID-19 and type 1 diabetes
While experts agree that there has been a rise in type 1 diabetes cases during the pandemic, they say more research is required to suggest a causative link between the two.
Dr Ramachandran adds, as there was such an upsurge in the number of viral infections during the pandemic, there could have been an increase in the number of type 1 diabetes cases as well. “As the US reported more cases of infections, there were more reports on type 1 diabetes. In India, the rise in type 2 diabetes cases was higher compared to type 1,” she notes.
How COVID affects people with diabetes
Dr Upadhya says retrospective studies have shown that children affected by COVID-19 during the first wave had an increased risk of severe diabetic ketoacidosis (DKA), which was probably due to the lack of timely access to health care.
Based on her experience, Dr Vaishakhi Rustagi, consultant pediatric and adolescent endocrinologist, New Delhi, says she noticed that undiagnosed children (less than five years old) were hit the hardest by the pandemic. “I had received 10 cases of severe DKA after COVID-19, and eight of them had the anti-insulin antibodies. However, this does not confirm that COVID causes a rise in these antibodies,” she says.
Roughly 80 per cent of the pancreas is destroyed by the time a child presents with acute symptoms, says Dr Ramachandran. The child can present with DKA if he/she has severe COVID infection and his/her sugar levels are very high. However, she says that she hasn’t seen very severe cases of DKA.
Dr Rustagi says some children developed an increased respiratory rate and altered sensorium (inability of the brain to receive, process or interpret sensory information), and they had to be directly admitted into the pediatric ICU. “The acid levels in the body can go up in untreated diabetics due to insulin deficiency. It then causes metabolic acidosis, which in turn causes an increase in the respiratory rate. All the metabolic parameters (like BMI and glucose levels) and electrolytes get deranged. There is weight loss as well,” she says, adding that children also present with polyuria and polydipsia.
Can COVID increase blood sugar levels?
Diabetes can increase the risk or severity of any infection, especially in those with poor control. Dr Upadhya says, “Elevated blood sugar levels along with medications, such as steroids for managing COVID-19, could pose additional challenges for managing diabetes in these children.”
Any severe infection will lead to high blood sugar levels. Dr Ramachandra says blood sugar levels will also be higher if one has regular fever or common cold. Dr Upadhya adds, “Infections can elevate stress hormone levels in the body, which have the opposite effect of insulin. This can increase blood sugar levels.”
What precautions should diabetics take for COVID-19?
Dr Rustagi says that the precautions to avoid COVID infection can be similar to those for type 2 diabetes. Some of these measures include:
- Maintaining hygiene
- Wearing a mask
- Avoiding crowded places
- Getting vaccinated against COVID-19
- Getting annual flu shots after a doctor’s consultation
- Maintaining proper blood sugar levels
- Consulting an endocrinologist for managing insulin doses
- Having a healthy diet and exercising regularly
- Informing your doctors about your diabetes if you are on steroids
Takeaways
- Several reports have suggested a spike in type 1 diabetes cases during the pandemic.
- COVID-19, like other viral infections, can trigger autoimmunity in children with genetic predisposition, say experts. However, more research is required to confirm a causative link between the two.
- Experts recommend wearing masks, avoiding crowded places and maintaining hygiene to help prevent further health complications due to COVID-19 infection.
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