World Diabetes Day: Why diabetic patients with Covid-19 need more attention

Every year, World Diabetes Day is observed on November 14 to raise awareness about the chronic disease. According to the World Health Organization, India has an estimated 8.7 per cent diabetic population between the age group of 20-70.

Even as we are surrounded by diabetics every day, there is a lot of research being done on a daily basis by scientists to understand the disease better to aid treatment.

Mid-day Online spoke to Dr Abhishek Subhash, consultant, internal medicine, Bhatia Hospital Mumbai and Dr Harsh Parekh, consultant endocrinologist and diabetologist, Wockhardt Hospitals in Mira Road to explain it simply. Subhash delves into why people need to be very careful if they have diabetes in a post-Covid world. He also busts myths, stresses on eating properly, and last but not the least not restricting oneself due to worry of wounds.

What is diabetes and what are its causes?
Subhash: Type 2 diabetes is what is common in adults. Type 1 diabetes is essentially seen in children. Diabetes is a disease wherein there is hyperglycemia (increased blood sugar levels also known as blood glucose levels). The primary cause of type 2 diabetes is insulin resistance along with inadequate insulin secretion by the pancreatic beta cells. Both these phenomena are responsible for type 2 diabetes. Insulin resistance essentially occurs because of environmental factors - obesity being one of the primary reasons; other factors like stress may also be there. Type 1 diabetes in children is an autoimmune disorder.

Parekh: Diabetes develops when blood sugar levels rise. This occurs as a result of inadequate insulin production by the pancreas. Most kinds of diabetes lack a recognised precise aetiology. Diabetes of either type 1 or type 2 may result from a mix of hereditary and environmental causes.

How does one know if they have diabetes or not?
Subhash: Generally, many patients, especially those who are overweight, may not really see any symptoms. It can be seen when they go for a health checkup or for some other ailment or there may be some other signs like increased urination, increased thirst, longer time for infections to heal, and repeated vaginal infections in women, balanoposthitis in men can also be a precursor to an impending diabetic situation.

Parekh: A blood test is the most reliable approach to find out if you have type 1 diabetes. Extreme hunger, unintentional weight loss, weakness and weariness, impaired eyesight, agitation, and other mood swings. You should consult your doctor if any of these symptoms apply to you or your child.

Which age group is more prone to diabetes?
Subhash: Type 2 diabetes is essentially seen in adults. The age group of 40 years and above is what we would generally consider to be the presenting age group. But these days, things are changing. Adolescents and young adults are also presenting with diabetes. So the age group is becoming lower. Once upon a time it was above 50 or 60 years. But nowadays even people in their late 20s or early 30s are being diagnosed with diabetes.

Parekh: As people age, their chance of having diabetes rises. According to the CDC, 4 per cent of adults between the ages of 18 and 44, 17 per cent of people between the ages of 45 and 64, and 25.2% of those over the age of 65 have diabetes.

Do the reasons for this differ from age to age?
Subhash: I think the shifting of the age group is possibly because of our lifestyle - the adoption of a more Westernised lifestyle that includes junk food, not enough adherence to physical activity and mobility, obesity, and increased smoking and alcohol that can also be risk factors. I think a very important factor is inadequate stress management by individuals. These are the reasons why we are seeing a shift towards the lower age bracket.

Is diabetes seen more in any particular gender?
Subhash: I don't think so. I don't see any gender disparity.

Parekh: Diabetes, particularly type 2, affects men more frequently than women. However, females frequently experience more severe complications and a higher risk of passing away. The prevalence of diabetes and impaired glucose tolerance has been estimated to be 9.3 per cent and 24.5 per cent, respectively based on the nationally representative sample of adults aged 18-69-years in the National NCD Monitoring Survey.

Has Covid-19 changed diabetes care? Do diabetics who have Covid need to be concerned?
Subhash: First of all, Covid itself affected the pancreas and lots of people got diagnosed with diabetes after Covid. But I think because so many people had Covid and there were a lot of blood tests being done, people just became more aware of their health. People who were not diabetic earlier and got detected as diabetic during Covid just became more particular about taking care of their health. Covid made those who were already diabetic more particular about their health.

Those who have had Covid and who are diabetic need to be concerned because Covid itself has got a tendency to cause blood clots in the body. We see people coming in with blood clots in their heart causing heart attacks, in their brain causing a stroke, or anywhere else. Now diabetes itself can cause this kind of macro vascular complication that is a heart attack, stroke or a peripheral artery disease, vascular disease. So the combination of diabetes and Covid just increases the risk by a factor of two. People with diabetes who have got Covid need to be very careful about this. It means they need to go for routine checks of their heart, and especially keep their cholesterol, blood pressure and of course their sugar in control.

Parekh: The inflammation-stimulating cytokines appear to be dramatically affected by Covid. This worsens insulin resistance and can cause blood sugar levels to rise. When infected by a coronavirus, diabetes patients are more prone to experience severe symptoms and high blood sugar levels following Covid-19.

What are the easy ways for diabetics to take care of themselves while carrying out their day-to-day activities?
Subhash: First of all, it is important to take care of your diet, mobility and exercise (if you have been advised to exercise by their physician), getting adequate sleep and stress management. These are the cornerstones of diabetic treatment. Having said that, if they have been prescribed medication, one easy thing is to stick to the schedule of their medication and getting periodic checks of their sugar. They should take care of their feet because a lot of diabetic patients get foot infections. So, wearing closed footwear and socks is important. Trying to prevent dry skin, because sometimes dry skin itches and can give rise to infection. It is very commonly seen in diabetics. So moisturising, going to a dermatologist for dry skin, and getting it checked. Going for a periodic eye examination annually. It is very important for both men and women to take care of their personal hygiene.

Parekh: People with diabetes are recommended they come in for follow-up diabetes check-up every 3 to 4 months, depending upon their blood sugar control. If you're meeting your treatment goals, visit your doctor every 6 months. Your blood pressure and weight will be checked, and your self-care plan and medicines will be reviewed.

They can also pay attention to the following:

1. Take your medicines for diabetes and any other health problems even when you feel good.
2. Check your feet every day for cuts, blisters, red spots, and swelling.
3. Brush your teeth and floss every day to keep your mouth, teeth, and gums healthy.
4. Stop smoking.
5. Keep track of your blood sugar.

What are the common misconceptions that people generally have about diabetes?
Subhash: The common misconception that people have about diabetes is that the medicines that are prescribed to them will damage their kidneys more than diabetes. This is the most common one but diabetic medication has no such side effects. Yes, there are some side effects, but people need to understand that the disease itself causes much more harm than these medicines can ever cause. So if you leave your diabetes unchecked, from top to bottom your kidneys, heart, brain, your ability to get more infection causes much more problems than these medicines can ever cause. That is the biggest misconception that people have.

Another misconception is that they are very scared of insulin. They think it is the end point, but it is not like that. Sometimes insulin is needed to bring down the sugar level in somebody whose sugar is not being controlled with a variety of tablets, and it is not permanent. They need to realise that when somebody is started on insulin, it doesn't mean that they are going to remain on insulin forever. It is not like that. Insulin can be tapered and stopped as well in type 2 diabetes.

Those who are diagnosed with early stage diabetes where the sugar is not very high even have the possibility of reversing the diabetes. Nothing is set in stone; it is all very individualistic and a combination of how people approach their health, how serious they take healthcare and how serious they are about their health.

The third misconception is that people don't have to bother about their food and can eat whatever they want because they are on medicines or on insulin. People need to know that diet forms an integral part of the treatment regimen, not just tablets or insulin. So, if you take your medicines properly but you do not take care of your diet, you may wonder why your sugar is not under control. You still need to follow a proper diabetic diet even if you take your medicines properly.

Parekh:

1. Eating sugar does not directly cause diabetes. However, consuming a sugary diet can lead to overweight and obesity, which are risk factors for type 2 diabetes.
2. Perhaps because diabetes is so common, some people believe that it is not a serious disease. This is incorrect. There is no cure for diabetes, and there are a host of complications that can occur if a person does not manage the condition well.
3. Overweight and obesity are risk factors for type 2 diabetes and gestational diabetes, but the condition can occur in people of any weight.

What are the foods that diabetic patients need to avoid?
Subhash: People need to avoid refined sugar in all its forms. If not sugar, somehow people start using jaggery because it is also sugar.

Just because it is in another form does not mean that it is not harmful. So refined sugar, jaggery, all need to be avoided. Juices, coconut water need to be avoided because they contain a lot of sugar. There also needs to be carbohydrate portion control - whether it is rice, wheat, ragi, bajra, or whatever. The portion control is more important than the kind of millet or grain they choose to eat. Trans fats need to be avoided because a lot of fried and junk foods can raise your bad cholesterol. Also, diabetic patients should cut down on smoking.

Parekh: Sugar-sweetened, beverages, Trans fats, white bread, rice, and pasta, fruit-flavoured yogurt, sweetened breakfast cereals, flavoured coffee drinks, honey, agave nectar, maple syrup and dried fruits should be avoided.

Many diabetics and their families are usually concerned about them getting wounded as it takes longer to heal. What are the challenges for diabetics in daily life?
Subhash: People don't have to restrict themselves just because they are fearful of the fact that they are going to get hurt and then the wound will not heal. They need to be a little bit more careful, use closed footwear, avoid dry skin, and take care of their personal hygiene. These are the various ways in which they can prevent infection. Just because you are diabetic and prone to get an infection doesn't mean that you should restrict yourself. I think that is completely wrong. A diabetic can do the same activity as a non-diabetic.

Parekh: In people with diabetes, wounds tend to heal more slowly and progress more quickly, so it's important to know what to look out for. Although cuts, grazes, scratches, and blisters can occur anywhere on the body, the feet are one of the most common places of injury. A small wound on the foot can quickly develop into a foot ulcer.

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