- A new study on diabetic ketoacidosis in Covid-19 patients highlights the need for more alternative treatment solutions amidst the pandemic
- This diabetic complication occurs when too little glucose leads to the build-up of acidic substances called ketones
- In moderate cases, subcutaneous insulin treatment could better decrease the need for bedside care than intravenous insulin
Diabetics are one of the more vulnerable groups when it comes to coronavirus infections, and while their infection susceptibility is the same as that of the average individual, they tend to present with more severe symptoms when testing positive for Covid-19.
One of the more common side effects of the virus in diabetics is the onset of diabetic ketoacidosis (DKA).
This complication occurs when there’s not enough glucose available as a fuel resource and the body starts using fat instead. This creates an acidic byproduct called ketones, which builds up in the blood and starts affecting the kidneys.
When untreated, it can lead to severe illness, coma and even death.
A new clinical perspective published in Endocrine Society’s Journal of Clinical Endocrinology & Metabolism looked at what could be the most effective treatment for this complication in the time of a global medical crisis.
Advice for healthcare workers
Normally, in the early stages of hyperglycemia that precedes DKA, if detected early patients can administer care at home, but with Covid-19 there can be a rapid decline and thus patients should get a full evaluation with laboratory assessment.
In the hospital, DKA is treated with intravenous insulin, but in the pandemic, it can be a complicated process. DKA patients normally have to be admitted to intensive care and their levels monitored almost hourly.
With Covid-19, ICU beds have become a scarce commodity and hospitals are trying to minimise bedside care in order to curb the spread of the virus from patient to healthcare workers.
The study looked at the treatment of two cases where DKA presented itself in Covid-19-positive patients.
One was a woman with a long history of type 2 diabetes, while the other was a man who developed new-onset diabetes – a worrying trend that doctors and researchers have started noticing lately.
DKA is more common in type 1 diabetics – which occurs when they miss insulin doses – but type 2 diabetics are more at risk with Covid-19 because for them the complication is caused by a severe underlying illness.
While the study urges intravenous insulin to be used in severe and complicated cases of DKA, they suggest subcutaneous insulin for mild and moderate cases during the pandemic. This type of treatment doesn’t need constant monitoring, which means the patient doesn’t have to take up a bed in ICU.
“It bears emphasising that it is generally not recommended that hospitals make major changes to their current approach to managing DKA, as this may cause unintended consequences and result in the reverse outcome of requiring more ICU resources and time at the bedside,” added the researchers.
Prevention of DKA at home
While the risks for diabetics are higher, the researchers advise to use self-care where possible and only to use the emergency room when necessary – not when you’ve just tested positive for Covid-19.
Here is some self-care advice for the prevention of DKA:
- Continue home insulin use and reassess your oral therapies if needed.
- Insulin-deficient patients and those taking SGLT2 inhibitors should have ketone testing available to them at home.
- Also if you take SGLT2 inhibitors, discontinue the medication at the first sign of severe flu-like illness to prevent DKA.
- Ensure you have all the necessary supplies on hand at home in case of an emergency.
- If you can afford it, have a three-months supply of medication.
- But most importantly, continue your regular checkups with your healthcare provider and stay up to date with the latest developments regarding Covid-19 and diabetes.
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