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 Weeks later, after what had seemed like a recovery, he felt weak and
started vomiting. At 3 a.m. on Aug. 1, he passed out on the floor of
his home in Mesa, Arizona.
Paramedics rushed him to a nearby hospital, where doctors put him in
intensive care after saving him from a coma. They told him he could
have died. Their diagnosis – type 1 diabetes – stunned and
frightened him. He had no history of the disease.
“COVID triggered it,” Buelna said the doctors told him.
Buelna’s ordeal and similar cases reflect a new worry about the
dangerous relationship between diabetes and COVID-19 that’s being
urgently studied by doctors and scientists around the world. Many
experts are convinced that COVID-19 can trigger the onset of
diabetes - even in some adults and children who do not have the
traditional risk factors.
It’s already been well-documented that people with diabetes face
much higher risks of severe illness or death if they contract
COVID-19. In July, U.S. health officials found that nearly 40% of
people who have died with COVID-19 had diabetes. Now, cases like
Buelna’s suggest the connection between the diseases runs both ways.
“COVID could be causing diabetes from scratch,” said Dr. Francesco
Rubino, a diabetes researcher and chair of metabolic and bariatric
surgery at King’s College London.
Rubino is leading an international team that is collecting patient
cases globally to unravel one of the biggest mysteries of the
pandemic. Initially, he said, more than 300 doctors have applied to
share cases for review, a number he expects to grow as infections
flare up again.
“These cases are coming from every corner of the world and every
continent,” Rubino told Reuters.
In addition to the global registry, the U.S. National Institutes of
Health is financing research into how the coronavirus may cause high
blood sugars and diabetes.
In these situations, symptoms can escalate quickly and become life
threatening. These cases may take months to surface after exposure
to COVID-19, so the full extent of the problem and the long-term
ramifications may not be known until well into next year. More
intensive research is needed to definitively prove, beyond the
mounting anecdotal evidence, that COVID-19 is triggering diabetes on
a wide scale.
“We have more questions than answers right now,” said Dr. Robert
Eckel, president of medicine and science at the American Diabetes
Association. “We could be dealing with an entirely new form of
diabetes.”
‘ABSOLUTELY TERRIFYING’ DIAGNOSIS
Type 1 diabetes occurs when the body’s immune system mistakenly
destroys insulin-producing cells in the pancreas, preventing the
regulation of blood sugar levels. About 1.6 million Americans have
the disease.
Type 2 diabetes is more prevalent, afflicting about 30 million
Americans. Those patients still produce insulin, but over time their
cells become insulin-resistant, allowing blood sugar to rise.
Type 1 diabetes cases have previously been associated with other
viral infections, including influenza and previous coronaviruses. It
is known that infections can stress the body and increase blood
sugar levels. But this tends to happen in people predisposed to the
disease. Only some of them eventually develop diabetes, and
scientists still don’t fully understand why.
This year, doctors also are seeing some people without the risk
factors for type 2 diabetes - such as being older or overweight -
experience a diabetic emergency after exposure to COVID-19.
In type 1 diabetes, initial symptoms can include extreme thirst,
fatigue, frequent urination and weight loss. Arthur Simis had no
idea those were signs for the disease.
This summer, he and his wife, Sarah, noticed their 12-year-old son,
Atticus, appeared thin and slept a lot. They figured he was stressed
out from being trapped at home in the pandemic, or going through a
growth spurt.
On July 9, as his symptoms persisted, Arthur Simis took his son to
an urgent care center near their home in Gardnerville, Nevada. The
medical staff detected dangerously high blood sugar levels and
ketones in his urine, both indicators that Atticus was in diabetic
ketoacidosis, or DKA.
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The doctor told Simis that his son needed hospital care immediately to avoid
slipping into a coma from his newly diagnosed type 1. An ambulance took them 50
miles to the nearest hospital in Reno.
His father spent three nights sleeping at his side in the pediatric ICU. He
sobbed on the phone to his wife, because only one parent was allowed inside, a
measure to control coronavirus infections.
“How could he have diabetes?” Simis recalls asking the doctors. “It was
absolutely terrifying.”
Simis believes his son had been infected by the coronavirus because the father
and his wife experienced symptoms in the spring. The couple went to urgent care
but never got tested for the coronavirus because of stricter testing criteria at
the time. Atticus tested negative for an active coronavirus infection in the
ICU, medical records show. But he was never tested for antibodies that could
show whether he was exposed weeks earlier.
Doctors say that’s not unusual in a fast-moving pandemic, as they focus on
individual emergencies rather than big-picture research questions. But the lack
of testing in many of these cases, they say, may complicate efforts to detect
whether and how the coronavirus might be causing diabetes.
CHILDREN IN INTENSIVE CARE
The initial reports of COVID-related diabetes include more children with cases
like that of Atticus.
In a study published in August, researchers at Imperial College in London and
several hospitals there found that cases of type 1 diabetes among children
nearly doubled to 30 during late March to early June - as the pandemic raged -
compared to the same period in previous years. Five of the children tested
positive for a prior coronavirus infection, but the study’s authors said many of
the children were not tested.
In the United States, Children’s Hospital Los Angeles said the percentage of
newly diagnosed type 2 patients who arrived in diabetic ketoacidosis, a
potentially fatal buildup of acid in the blood, has nearly doubled for March
through August compared to the same period in 2018 and 2019.
Dr. Lily Chao, director of the type 2 diabetes clinic there, said the hospital
is still investigating whether this increase is driven by exposure to COVID-19.
Brandi Edwards, a registered nurse and diabetes educator at Alabama’s Huntsville
Hospital, said calls about pediatric cases began to surge in May. Doctors summon
her when a child arrives in the emergency room or ICU so she can counsel the
family on insulin injections, glucose readings and how daily life will change
going forward.
“We’ve seen more type 1 cases this year than I ever remember,” Edwards said.
“There were three kids in the pediatric ICU at the same time. That is so rare.”
EVICTION NOTICE
After surviving a diabetic emergency, life for a newly diagnosed patient can be
overwhelming. Medication and other supplies to manage diabetes can cost hundreds
of dollars every month, and long waits to see an endocrinologist are common in
many areas.
Buelna, the patient in Arizona, is still waiting for his Medicaid plan to
approve a continuous glucose monitor more than two months after his diagnosis.
The disease knocked him out of work for weeks and wrecked his family’s finances.
His wife, Erika, is eight months pregnant and they have a 3-year-old daughter,
Katalina. The family got an eviction notice on Aug. 2, while Mario was in the
ICU, and they rely on a food bank for some meals.
Buelna said he fell into a depression in the hospital, cut off from family
visits, and credits his sister with lifting his spirits in phone calls.
“I want to get better so I can see my kids grow up,” he said. “I’m not ready to
go yet.”
(Reporting by Chad Terhune; Editing by Brian Thevenot)
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