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COVID-19 AND DIABETES MELLITUS

  • COVID-19 AND DIABETES MELLITUS An Institutional Experience: Park Hospital, Gurugram

An Institutional Experience: Park Hospital, Gurugram

Dr (Col) M K Dutta,

Endocrinologist & Internal Medicine (Senior Consultant)

The Covid-19 pandemic has changed the course of the world and exposed it, particularly the health care structure to such sheer and frustration.

It is not surprising to see a large number of diabetics, both type 1 and type 2, suffering from the disease and having much increased morbidity and mortality. Increased ICU admission by double, increased mortality in diabetes patients by 3 times and severe disease rates twice of normal population has been seen in the recent epidemic in China. Reports of ACE receptor upgradation requiring anti-hypertensive medication modification are being published. Having been at the forefront in the management of these cases, one finds certain factors aggravating this phenomenon.

  1. Lack of lifestyle modification i.e., improper diet, lack of adequate exercise, improper sleep, increased stress due to financial depravation, loss of jobs, lack of social communication.
  2. Failure to access healthcare due to presumed risk of infection, hospitals converted to Covid hospitals, lack of functioning diabetic and endocrinology OPDs
  3. Lack of information about diabetes monitoring treatment, check-up during this period
  4. No information on medication changes, insulin sick day guidelines, changing schedules of treatment during this period

It has been seen that patients are suffering from rising blood glucose levels due to isolation. Infection with Covid-19 significantly worsens the glycaemic status. There is lack of understanding among basic doctors caring for the disease. Very few endocrinologists are available on the ground in the care of diabetic patients, the job being left to young residents, physicians and nurses who find it an increasingly difficult job to control hyperglycaemia, fluids and electrolytes. The frequent use of steroids and stress of infection worsens the situation with added rise in metabolic control due to concurrent comorbidities and the use of inotropes.

We at Park Hospital Gurugram have treated many patients suffering from Covid-19 and found that a large number are diabetics who suffer from poor immunity leading to an increased risk of moderate to severe Covid-19 infection. There is a need to step up glycaemic monitoring with frequent blood glucose measurements and early appropriate use of insulin in basal bolus regimen to achieve glycaemic control. There have been cases of severe DKA who have been managed with IV fluids, electrolyte correction, insulin infusion and bicarbonate depending on the severity of acidosis which is also further complicated by lactic acidosis and uraemic acidosis. Factors like dehydration, fever, sepsis, use of multiple medications, inotropes and frequent steroids make the situations truly challenging.

We have preferred to discontinue Metformin in these serious situations though DPP-inhibitors and insulin find a place in diabetic management.

Also very important is the role of regular monitoring of blood glucose levels at home and maintenance of normal blood glucose with regular use of prescribed medications which include oral hypoglycemic agents, GLP1 analogues, insulin subcutaneous, insulin pump therapy and treatment of concurrent illnesses. The role of exercise which includes atleast 150 mins of aerobic exercise and 2 days of resistance training on a weekly basis cannot be over emphasized.

The role of maintaining a regular balanced diabetic diet which is high in protein and unsaturated fats and avoidance of high carbohydrate load and saturated fats is emphasized to maintain appropriate body weight and muscle.

Consult the best Endocrinologist around you for any hormone-related issues

  • Consult the best Endocrinologist around you for any hormone-related issues

Dr. (Col.) Manoj Kumar Dutta

MBBS, MD (Medicine), DNB (Endocrinology)

Endocrinologist

Why should you visit your Endocrinologist for your diabetes control?

As you are aware diabetes is on the rise.

Endocrinologists are the specialists who deal with control of diabetes and metabolic disorders.

Your endocrinologist will start by taking a detailed history of your diabetes including the presence of diabetes in your family.

The endocrinologist will look into your blood glucose, HbA1c, lipid, renal function tests and evaluate for any target organ damage with other tests like biothesiometry, nerve conduction studies, funduscopy, ECG etc.

Why should you visit your Endocrinologist for your diabetes control?He will assess for other hormonal problems like PCOS, thyroid, adrenals.

He would prescribe diet exercise, oral drugs, GLP1analogues, insulin for sugar and metabolic control.

Your endocrinologist is also an expert in Type 1 diabetes and would start children o insulin pumps.

Besides he will also guide on management of associated obesity, Polycystic ovarian syndrome, Cushings syndrome, drug induced diabetes, Gestational diabetes.

Inpatient management of complications of diabetes including use of sophisticated sensor devices, insulin pumps, insulin infusion protocols and critical care glycemic control are also done by him.

Common diabetes managed by your Endocrinologist are:

  1. Type 1 Diabetes mellitus
  2. Type 2 Diabetes mellitus
  3. Gestational diabetes mellitus
  4. Secondary diabetes mellitus( steroid induced / cushings / Pancreatic)

Why is it important to consult your Endocrinologist for your irregular periods?

Very often the cause of your irregular periods is hormonal imbalance. Your Endocrinologist is the right person to assess you clinically to know if you are suffering from hormonal imbalance like:

Polycystic ovarian syndrome-characterised by excessive facial and body hair, obesity, hypertension, increased cholesterol, insulin resistance.

Cushings syndrome-increased steroid levels in body due to various reasons.

Hypothalamic amenorrhea- due to starvation, diet changes, stress, exercise.

Pituitary disorders – tumors, radiation, trauma, sheehan’s syndrome.

Thyroid disorders – Hypo/hyperthyroidism.

The Endocrinologist evaluates clinically then does hormonal testing to diagnose your condition and prescribes ideal hormonal treatment for the disease.

Why should you visit your Endocrinologist if you are an infertile couple?

Your Endocrinologist is the appropriate specialist doctor to evaluate for both male and female factor infertility. He would look for various anthropometric clinical data, sexual maturation scales, hormonal and chromosomal tests to see if you are suffering from a chromosomal disorder, hypogonadism, pituitary, thyroid, adrenal, ovarian or testicular problem. In addition he is also an expert on pubertal disorders. All these conditions can contribute to infertility.

Why is it important to meet an Endocrinologist if your child is not growing tall enough?

An Endocrinologist is an expert on growth disorders who looks into various aspects of growth and Puberty.

He will look into a detailed family/medical/developmental history followed by painstaking measurements of height, weight, sexual maturation scales, bone age before ordering tests to exclude chronic disease, vitamin deficiency, malnutrition, coeliac disease, hormonal imbalance, growth hormone deficiency, adrenal, bone disorders which can effect height of an individual. He will exclude developmental aberrations like constitutional delay in growth and puberty.

He also excludes chromosomal causes of short stature.

An Endocrinologist performs complicated hormonal stimulation and suppression tests depending on the suspected condition to reach a diagnosis.

Common causes of short stature:

  1. Constitutional delay in growth and puberty
  2. Idiopathic short stature
  3. Syndromic disorders
  4. Pituitary/thyroid/adrenal/testicular disorders

Once diagnosed appropriate treatment is started.

Why should you visit your endocrinologist if your child is precocious (Has early sexual maturation)

– Early sexual maturation can be socially and emotionally a big problem for parents and it is then that an endocrinologist comes to the rescue with the right emotional assurance and performs detailed testing, bone age evaluation, sexual maturity scaling , ultrasound evaluation of testes and ovaries to diagnose the condition and start appropriate treatment to arrest the premature sexual maturation and later allow sexual maturation to occur at an appropriate stage.

Why should you get evaluated by your Endocrinologist if you are having bone problems (pain, easy fractures)

The Endocrinologist is the expert specialist who evaluates the strength of your bones with Dexa scan and looks for causes associated with fragile bones. He does frax assessment to look for risk of fracture. He also evaluates for risk of fracture in postmenopausal women and assesses for hormonal imbalances causing increased osteoporosis. The Vitamin D deficiency state and its treatment are also done by him. In addition he counsels regarding diet, calcium, Vitamin D, hormonal replacement therapy.

Endocrinologist has various agents to use depending on type of osteoporosis and condition of patient which include oral, IV, subcutaneous anabolic and antiresorptive agents.

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