Why Covid-19 is More Severe in Metabolically Ill People

In the headlines the world over we have been seeing how people with diabetes and other metabolic conditions are more likely to have a difficult time with Covid-19. Right here in the UAE as reported by The National, 40% of Covid-19 deaths have been people with diabetes. In this video, Dr Faryal Luhar, who sits on the ingfit Board of Advisors, talks us through WHY this is.

What is actually going on in the body that makes Covid-19 so much more dangerous for people with compromised metabolic health. This is part 1 in a 2-part series, in the next episode she will give us some tips on WHAT to do about it!

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Transcript

It’s Diabetes Awareness Month this month, and today we are going to talk about the link between diabetes and Covid-19. We know that when it comes to Covid-19, most people who are infected with this virus who are experiencing severe outcomes, poor prognoses are typically people who have underlying cardio metabolic conditions, things like cardiovascular health problems, high blood pressure and diabetes. So the question is why is this? Why is it that in particular when it comes to diabetics that they are having such a hard time and are really being hit hard if they contract the Covid-19 virus and most probably are experiencing higher mortality rates with this virus. And so when we talk about diabetes we know that there are 2 types of diabetes, there’s type 1 and type 2, and type 1 is typically a congenital condition, you know a genetic autoimmune type condition where the pancreatic beta eyelet cells that normally produce the insulin are not producing insulin.

So there is no insulin production, and just a reminder for all of you out there, insulin is really important, because it is the hormone that breaks down all of the carbohydrates that we are eating and brings in those glucose molecules into the cells for the cells to use them us fuel. In type 2 diabetes, however it can be something that develops through lifestyle factors, diet, and of course there might be some pre-existing genetic contributing factors. So with diabetes the issue here is that we have a condition of insulin resistance, so in type 2 diabetics the insulin is not performing well, it may be that the pancreas is releasing the insulin, but it’s not doing a great job, and it’s not the right quality of being able to break down those carbohydrates so we end up with hyperglycemia or high blood sugar levels in the blood stream. This alone is already a predisposing factor when it comes to contracting the virus, because high blood sugar levels will increase our susceptibility to contracting viruses and other kinds of pathogens, so it decreases immunity. Some of the other factors though that are linked to the correlation between poor prognosis in those who have diabetes or high blood sugar levels is the fact that most diabetics first of all are going to already either have another metabolic condition, and diabetes itself is an inflammatory condition, so is Covid-19. Covid-19, when it is creating an infection, also creates a very inflammatory situation in the body so we already have that as a double whammy.

Obesity and being overweight is another problem, and the reason for this is that when it comes to obesity this is driven also by inflammation and most people who are overweight or obese have insulin resistance or are already diabetic, right, so inflammation is a major underlying concern here. And the reason for that is that when the infection takes hold, the immune system will send messages for all these inflammatory mediators to be sent out to be able to deal with the infection and the inflammation. This is in a normal situation how the body works to resolve any kind of inflammation, but when it comes to diabetes, what happens is that because of the already dysregulated immune response we end up with an overproduction, an exaggerated influx of what are called cytokines, these inflammatory immune mediators (natural killer cells, interleukins, macrophages and so on) and you end up with something called a cytokine storm, and the cytokine storm unfortunately can be very, very damaging for people who have diabetes. In fact it’s been said that when diabetics contract Covid-19, unfortunately often times they won’t die so much from the viral infection as much as they would from the organ damage and the damage to the vessels and the respiratory tissues that has been caused by the cytokine storm. Other factors include things like how the virus enters the human cell. So on the surface of the human cell, the host cell, we have receptors those are called ACE-2 receptors and the virus has been shown to enter the human cell through the ACE-2 receptors. ACE stands for angiotensin-converting enzyme, and a lot of diabetics are taking ACE-2 inhibitors, and so the theory out there is that it’s possible that because of these medications, and just because of the underlying environment the entry sites are elevated. So, the surface of the host cell produces more entry sites, which allows for more of the virus to enter and then do its damage. Diabetics also have what’s called pro-coagulation, meaning their blood is a little bit thicker than those who don’t have diabetes. This can create issues with blood not being able to flow very nicely and very smoothly through blood vessels. We can have capillary problems, fragility in the vessels, so that the vessels can’t even carry the nutrients that the body needs to be able to fight off the infection.

So, inflammation, again, a driving force, acidity within the body and the blood is also another driving force because this automatically is the perfect recipe for impairing the immune system and inviting viruses and pathogens into the body. It’s really important to appreciate this link, so that we can figure out what to do for people who are either pre-diabetic, diabetic or even people who have high blood sugar levels and might not even be aware of it, so tight sugar control is going to be really crucial, and stay tuned, in the next video we will talk about, now that we KNOW the links, what can we DO? What kinds of natural medicines and other types of therapies, lifestyle therapies can we use to be able to get tighter glucose control to help people who are in this condition when it comes to resolving the Covid-19 infection. I’m Dr Faryal Luhar, thank you so much for tuning in.

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