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Diabetes Health

Novel Coronavirus and Coronavirus Disease

Dr Bharat Purandare explains how you can protect yourself from this recent global pandemic

In December 2019, a cluster of unusual pneumonia cases were reported from Hubei province in China, in and around the city of Wuhan. Scientists discovered that this respiratory disease is caused by a novel virus belonging to the coronavirus family and named it nCoV 2019. This viral disease has similarities with two previously reported epidemics of SARS (severe acute respiratory syndrome) in 2003 and MERS (middle-east respiratory disease) in 2014. World health organization (WHO) in early February 2020, has declared this epidemic as a public health emergency of international concern (PHEIC).

How does COVID -19 spread?

The virus spreads via droplets or fomites (inanimate objects touched by infected persons such as handkerchief or door knobs). The aerosol generated during coughing and sneezing is also infectious as the virus resides in the nasal or throat secretions of infected persons. People in close contact (within 6 feet of infected person) may get infected.

Symptoms

In a study reported by CDC (Centre for Disease Control) in China, more than 70,000 persons with suspected COVID-19 were studied. Most people have fever and dry cough and muscle pain. Many also reported headache, abdominal pain and diarrhoea. Some of them with serious disease went on to have breathlessness and bloody phlegm. After the virus enters into body, the symptoms show up in 2-14 days (incubation period).

Diagnosis

A test called RT-PCR (real-time polymerase chain reaction) is used to diagnose this disease. Currently only people showing symptoms and, who have travel history to countries reporting COVID-19 infections or those with contact with diagnosed cases are eligible for testing.

Treatment

As of now, there is no definitive treatment for established coronavirus infections. We can only try to prevent it. Infected cases need to be isolated to prevent spread of infection. Most cases are mild and lead to clinical recovery on their own. Various drugs and therapeutic strategies have been tried for the serious patients but no firm conclusions can be drawn. Some new drugs (remdesivir) previously used in other infection (ebolavirus disease) are into clinical trial for treatment of COVID-19. Other supportive treatments such as oxygen support, ventilation and nutrition can be offered to infected patients. Prevent coronavirus infection Preventive measures that work for other respiratory viral infections also work for coronavirus infection (COVID-19). Take everyday precautions:

  • Avoid close contact with people who are sick
  • Clean your hands often
  • Wash your hands often with soap and water for at least 30 seconds, especially after blowing your nose, coughing, or sneezing, or having been in a public place.
  • If soap and water are not available, use a hand sanitizer that contains at least 60 per cent alcohol.
  • To the extent possible, avoid touching high-touch surfaces in public places – elevator buttons, door handles, handrails, handshaking with people, etc. Use a tissue or your sleeve to cover your hand or finger if you must touch something. Wash your hands after touching surfaces in public places.
  • Avoid touching your face, nose, eyes, etc.
  • Clean and disinfect your home to remove germs: practice routine cleaning of frequently touched surfaces (for example: tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks & cell phones)
  • Avoid crowds, especially in poorly ventilated spaces. Your risk of exposure to respiratory viruses like COVID-19 may increase in crowded, closed-in settings with little air circulation if there are people in the crowd who are sick.
  • Avoid all non-essential travel including plane trips, and especially avoid embarking on cruise ships.

Guidelines about use of mask

Healthy persons need not wear mask at public places. Masks are to be used by persons sick with cough and cold and health-care workers. Proper use and disposal of mask is necessary to derive maximum benefit out of it.

Coronavirus and Diabetes

People with Diabetes have lowered immunity and are deemed to be in a high risk category for developing the infection. The body’s health and well-being is dependent on the immune system. In people with Diabetes, compromised insulin effect in the body can have lasting complications, especially on immunity. People with high or unmanaged blood sugar levels have compromised blood flow. This inhibits the body’s immunity against several infections and lowers the body’s healing capacity. Hence, it usually takes a little longer than usual for people with Diabetes to recover from any illness.

The American Diabetes Association website states that people with Diabetes are more likely to experience severe symptoms and complications when infected with a virus. If Diabetes is well-managed, the risk of getting severely sick from COVID-19 is about the same as the general population. When people with Diabetes do not manage their Diabetes well and experience fluctuating blood sugars, they are generally at risk for a number of Diabetes-related complications. Having heart disease or other complications in addition to Diabetes could worsen the chance of getting seriously ill from COVID-19, like other viral infections, because your body’s ability to fight off an infection is compromised.

Viral infections can also increase inflammation in people with Diabetes. This is also caused by above-target blood sugars, and both could contribute to more severe complications. When sick with a viral infection, people with Diabetes do face an increased risk of DKA (diabetic ketoacidosis).

If you feel like you are developing symptoms, call your doctor. People with Diabetes who have a blood glucose meter should frequently test their blood sugar levels. By testing more often, you will be empowered with a clearer picture of how your blood sugar levels are responding, giving you the opportunity to improve your well-being. Speak with your doctor about how often you should check your blood sugar levels.

Dr Bharat Purandare, MD, DNB (Medicine) is an Infectious Disease Physician in Pune.

 

Before you get sick, make a plan

Gather your supplies:

·         Phone numbers of your doctors and healthcare team, your pharmacy and your insurance provider

·         List of medications and doses (including vitamins and supplements)

·         Simple carbs like honey, sugar, jam to help keep your blood sugar up if you are at risk for lows and too ill to eat.

·         If a state of emergency is declared, get extra refills on your prescriptions so you do not have to leave the house.

·         If you can’t get to the pharmacy, find out about having your medications delivered.

·         Always have enough insulin for the week ahead, in case you get sick or cannot refill.

·         Extra supplies like rubbing alcohol and soap to wash your hands

·         Have enough household items and groceries on hand so that you will be prepared to stay at home for a period of time.

Talk/email your healthcare team about the following: ·

·         When to call your doctor’s office (for changes in food intake, medication adjustments, etc)

·         How often to check your blood sugar

·         Medications you should use for colds, flu, virus and infections

·         Any changes to your Diabetes medications when you are sick

Source: American Diabetes Association

If you do get sick, know what to do. Here are some common tips, which may vary for each person:

·         Drink lots of fluids. If you’re having trouble keeping water down, have small sips every 15 minutes or so throughout the day to avoid dehydration.

·         If you are experiencing a low (blood sugar below 70 mg/dL or your target range), eat 15 grams of simple carbs that are easy to digest like honey, jam, juice and re-check your blood sugar in 15 minutes to make sure your levels are rising. Check your blood sugar extra times throughout the day and night (generally, every 2-3 hours; if using a CGM, monitor frequently).

·         If your blood sugar has registered high (greater than 240 mg/dL) more than 2 times in a row, check for ketones to avoid DKA.

·         Call your doctor’s office immediately, if you have medium or large ketones (and if instructed to with trace or small ketones).

·         Be aware that some CGM sensors are impacted by paracetamol. Check with finger stick test to ensure accuracy.

·         Wash your hands and clean your injection/infusion and finger-stick sites with soap and water or rubbing alcohol.

Source: American Diabetes Association

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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