Why is diabetes so dangerous with COVID 19

[Crunchymum]

Can someone kindly give me an "answer for dummies"

Why does diabetes put you at such risk?

www.diabetes.co.uk/your-guide-to-the-coronavirus-should-i-be-worried/

I think it's about being able to control it when ill.
E.g my medication makes me violently sick if I have an illness like bad cold or flu. Then of course it doesn't work.
It's a complication you can do without when ill anyway.

Mine is usually under control when well. I'm sure someone can explain better than me though.

I read that it was because patients with diabetes have weakened immune response.

“People with diabetes are more susceptible to developing infections, as high blood sugar levels can weaken the patient's immune system defenses. In addition, some diabetes-related health issues, such as nerve damage and reduced blood flow to the extremities, increase the body's vulnerability to infection.”

www.verywellhealth.com/what-are-the-common-infections-with-diabetes-1087622

Type 1 diabetic here. I know that illness can raise levels which make it harder to fight infection, so that will play a large part. "Diabetics" are also apparently more prone to catching things although, personally, I've not really found that is the case.

However, I also think the danger that is talked about with Corona is more for Type 2 diabetics. I think this because they are generally older, and also they often have other issues (as it can be caused by excess weight, for example which in itself causes other problems.)

Hence a 60+ year old 'diabetic' who also has high cholesterol, and heart issues is far more at risk than a, say, 30 year old Type 1 who has no other issues other than an uncooperative pancreas!

Make no mistake it is dangerous to anyone over about 50.

So. Type1 diabetics can go into ketoasidosis when unwell. Which is super high blood sugars

This is why they have to be careful with sickness bugs etc.

Not a doctor, just a scientist, but think probably at least 3 reasons, linked:

• Standard difficulty controlling blood sugars when ill, which can lead to dangerously high or low blood sugars, a medical emergency in itself.
• More susceptible to infection.
• One of the things killing people with Covid-19 is when the body's immune system kind of overreacts in an inappropriate way. This can put huge pressure on organs like the kidney, to clear the toxins, fluid etc, caused by this over-reaction. In the most serious cases this can cause organ failure and death. I don't know for sure about the pancreas, but I'd imagine an already poorly functioning pancreas would be affected by the overreaction too, and could fail entirely. One of the reasons the elderly and ill, and especially the elderly ill, aren't doing so well is that often their vital organs are already not working properly, so can't cope when they need to step up.

Make no mistake it is dangerous to anyone over about 50.

Based on what evidence?

@Pollaidh can you tell me more about your last point, and whether it would or could apply to Type 1’s as much as 2’s?

20% need hospital of which 5% itu

Pretty much any infection is made more difficult with diabetes in the mix. I'm type 1, less sure about how those with type 2 are impacted.

With type 1, fighting off infection tends to make blood sugars rise which can result in a condtion known as DKA if not caught early. DKA in itself is almost always going to need to be managed in hospital and can be fatal, which with the expected pressure on beds is a worry. www.nhs.uk/conditions/diabetic-ketoacidosis/

Even managing the high blood sugars has its problems, I've needed close to 3 times my usual amount of insulin when I'll. Get it wrong and the resulting hypo can be a nightmare, especially with any kind of sickness bug where eating the much needed sugar and keeping it down can be difficult.

It’s not a normal bug it has protein spikes that are similar to Ebola and HIV. So pretty aggressive.

@JemimaPyjamas I'm afraid I don't know enough to answer that. What kills is inflammation due to the disordered immune response, sepsis, and lack of oxygen to the organs.

I've just had a quick look at the literature around sepsis, but it's confused. Diabetics are more likely to get sepsis, but that's usually more due to the increased prevalence of skin sores. There are few papers looking at outcomes of sepsis in diabetics, and even fewer that distinguish between insulin-controlled/not or by Type, and also few that account for confounding factors (things that confuse the picture, like people with Type II tending to have other problems like heart disease, which makes outcomes poorer).

This paper ccforum.biomedcentral.com/articles/10.1186/cc7707
says kidney failure is more likely in sepsis with diabetes, but (good news here) lung failure is lower, and the lung failure is more likely to kill.

The same paper, a large survey of effects of diabetes in critical care, referencing a number of other studies, concludes that the picture is very complex.

Please speak to your diabetes care team if worried, although it looks like even the consultant might not be able to answer your question.

Your body has to work 5x harder when sugars are out of range (about about 8mmol)
If you are also fighting an infection on top of that your body is under a massive amount of stress.
And the bloods are unpredictable when ill.

I don’t tend to catch stuff more often than anyone else though, and so far I haven’t found I usually get more ill and I’ve been t1 for 26 years. However obviously I’ve never had coronavirus before so I’m not complacent about it. I’m more concerned that in the event of needing medical treatment I’d just be written off when the service is overwhelmed, because supposedly that’s what Italy is doing.

@Pollaidh thank you for your reply. It looks as if you are coming across the same problem as me when trying to find information, the sepsis info for example. I don’t have any complications due to being Type 1 and I’ve heard (there are probably links but I am typing this on my phone while I’m out with the dog) A lot of the complications to do with being diabetic tend to be with type twos. I really wish the two were separated more, with a situation like this, for example, you don’t really get a clear picture to weigh up realistic risk

They looked at cases in China for January and February 2020. Death rate estimates for each age group:
0-9 < .01%
10-19 .02%
20-29 .09%
30-39 .18%
40-49 .40%
50-59 1.3%
60-69 4.6%
70-79 9.8%
80+ 18%

The death statistics there don't separate out those with co-morbidities. Though obviously the older you get the more co-morbidities you tend to develop.

There are separate statistics coming out which look at co-morbidities. No one has yet separated into age x + c co-morbidity. Or even 80 years old but no co-morbidities, someone who could potentially do surprisingly well. Are the co-morbidities the main problem, the age independently of co-morbidities, or, as is more likely, is it an as yet unknown combination of both.