Doctors probe whether COVID-19 is causing diabetes
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[October 19, 2020]
By Chad Terhune
(Reuters) - Mario Buelna, a healthy
28-year-old father, caught a fever and started having trouble breathing
in June. He soon tested positive for COVID-19.
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 Simis family, Atticus, Sarah, Arthur and Ophelia, pose for a
photo in Gardnerville, Nevada, September 24, 2020. Simis
family/Handout via REUTERS
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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