Why people with diabetes are being hit so hard by Covid-19

Mainstream and social media is ablaze with COVID-19 warnings, as cases seem to be rising rapidly, with not only some U.S. cities (ie, New York & Chicago) implementing lockdowns, but even countries like Germany and France. Even Pfizer’s news that their vaccine has been shown in testing to be 90% effective is not enough to calm global concerns. However, in any problem, even a pandemic, it’s important to focus on finding the root cause of the issue and not just reacting to symptoms.

The Role of Diabetes

You may have heard or read that people with diabetes seem to be suffering worse from COVID-19 symptoms, and are at higher risk of infection. But that is merely scratching the surface, as the risk from and linkage to diabetes is much more severe than we are being told. Consider the below statistics:

• 34 million (M) Americans are diabetic, 90% of which are Type II diabetic
• An additional 90M Americans are pre-diabetic
• At the current rate of diagnosis, by 2025, 50% of Americans will be either diabetic or pre-diabetic. HALF of the U.S. population!
• Worldwide, over 420M adults have diabetes, which is 1 out of every 11 adults on planet earth

During COVID-19, diabetics have been hit very hard by this pathogen.

• Medical records in the U.K. suggest 30% of deaths occurred in people with diabetes, and even after accounting for other factors, the risk from dying from COVID-19 was 3X higher in people with Type I diabetes and 2X higher in people with Type II diabetes
• In the U.S., according to the CDC, over 75% of deaths occurred in people with at least one chronic condition
  • Diabetes was the primary underlying condition in 40% of deaths across all ages
  • In people 65 or younger, diabetes was present in ~ 50% of deaths

Diabetes: A Blood Glucose & Hormone Imbalance

Type I & Type II diabetes are different:

• Type I is an immunogenic anomaly where the body attacks the pancreas, destroying its ability to produce insulin
• Type II is created through insulin resistance, where the body becomes unable to make, process and utilize insulin to remove glucose from the blood and store it in cells

Regardless which diabetes a person has, what has been well-known is that diabetics have a higher infection risk due to the body being compromised in processing glucose, the immune system being weaker and under consistent duress, and blood circulation being compromised. COVID-19 affects people with diabetes more aggressively because of three key elements:

1. Attacks some of the same organ systems that are already compromised in diabetics
2. Accelerates already-present inflammation exponentially, causing a heightened and aggressive immunogenic response, also known as a cytokine storm
3. Attaches to ACE2 receptors, which diabetics tend to have more of lining blood vessels of key organs than non-diabetics

“People who have really poorly controlled diabetes are more susceptible to more severe infection, whether it’s influenza or tuberculosis,” he said. “Elevated blood sugar directly impairs our immune function.”

Daniel Drucker, of the Lunenfeld-Tanenbaum Research Institute at Mt. Sinai Hospital in Toronto

The Role of Diet & Nutrition

Type II diabetes, which represents approximately 90% of the diabetic population, is not only preventable, it is curable through making a step-change in diet. No medication, no magic elixir. But it takes a wholesale shift in three key factors of how we manage our diets:

1. The Quality of ingredients
2. The Mix/Quantity of macronutrients
3. The Frequency of consumption

The first step to making your body more resistant to an infection or pathogen like COVID-19 is making it an inhospitable place for an infection to live. This means getting control over blood glucose and insulin levels. Poor blood glucose controls and high insulin levels are a major contributor to organ malfunction, weight gain and obesity, and poor immune system functioning. People with a combination of diabetes and obesity also typically suffer from hypoventilation, or poor oxygen/C02 exchange, due to compromised lung function, which leads to less oxygen and more C02 in the blood. When an airborne infection like COVID-19 is introduced to a respiratory system that is already in hypoventilation, difficulty breathing will accelerate and become life threatening.

Six Tests

There are actions we can take right now to change most of these situations and improve our foundational health to deal with a virus like COVID-19. The first step is to take stock of our current health, and there are some tests that can be run with a healthcare provider that can clarify whether a person is at serious risk. They are:

1. Fasting plasma glucose test (FPG) or glucose tolerance test (GTT)
2. Hemoglobin A1C test
3. Fasting insulin test. In people who are insulin resistant, fasting insulin levels will typically be higher than normal
4. Lipid Panel, which will identify LDL, HDL and triglycerides
5. High sensitivity CRP, which can detect inflammation and alert to possible insulin resistance
6. Alanine aminotransferase (ALT), which can suggest a fatty liver, one of the classic results of a body that is insulin resistant and pre-diabetic

Dietary Changes

Secondarily, changes in diet are mandatory. Improving the quality of nutrients, decreasing the amount of sugar and carbohydrates in the diet, and introducing intermittent fasting to help enable the body to control insulin are key steps. In one of my previous blogs I highlight some of the important dietary changes necessary to reduce the risk of developing Type II diabetes and ensuring the body does not become insulin resistant. Regardless of whether we have a vaccine in 3 months or years, each one of us can take actions immediately to improve our health, strengthen our immune system and reduce our risk of infection.