MANAGING HIGH BLOOD SUGAR IS KEY TO REDUCING COVID-19 COMPLICATIONS: STUDY

Sep 17, 2020 | Healthy Tips

MANAGING HIGH BLOOD SUGAR IS KEY TO REDUCING COVID-19 COMPLICATIONS: STUDY

By: Kara-Marie Hall, RN, BSN, CCRN

Key Takeaways:

  • Researchers at Michigan Medicine are using a targeted algorithm to help manage blood sugar levels in COVID-19 patients.
  • High blood sugar (hyperglycemia) is linked to severe illness in those with COVID-19. 
  • Having a severe case of COVID-19 can also cause high blood sugar in people who do not have diabetes.
  • Aggressive management of high blood sugar in patients with COVID-19 appears to reduce their risk of long-term health consequences associated with the virus.

Researchers at Michigan Medicine have created a management tool that could improve outcomes for patients with high blood sugar (hyperglycemia) and COVID-19. The research, which was published ahead of print on August 11 in the journal Diabetes, shows a two-way relationship between blood sugar levels and COVID-19.

According to the researchers, having high blood sugar can put patients at risk for more severe illness if they contract COVID-19. The reverse also appears to be true: patients with COVID-19 also are at risk for high blood sugar levels, even if they do not have diabetes.1

“Based on current evidence, it’s fair to say that the COVID-19 virus, particularly in its most severe forms, leads to much higher blood glucose levels,” study senior author Rodica Pop-Busui, MD, PhD, tells Verywell. Pop-Busui adds that having high blood glucose levels can also lead to worse outcomes for patients with COVID-19.

If left uncontrolled, the inflammation from COVID-19—often called a “cytokine storm”—can cause complications when coupled with inflammation caused by hyperglycemia.1 It also increases the likelihood of needing mechanical ventilation.

What Is Hyperglycemia?

Sugar (glucose) is necessary for proper organ function. Glucose enters your organs’ cells through a hormone called insulin. If the amount of glucose in your body exceeds the amount of insulin available, the glucose builds up in your blood and causes high blood sugar levels, known as hyperglycemia.

Hyperglycemia is typically defined as a blood sugar level of at least 180 mg/dl or greater when measured one to two hours after eating.2 However, the defined range varies among health organizations. Diabetes mellitus (type 1, type 2, and gestational) is the most common cause.

Michigan Medicine Introduces Hyperglycemia Management Teams

The researchers at Michigan Medicine designed a personalized, targeted clinical algorithm—a set of guidelines that helps healthcare providers make decisions—to help frontline healthcare workers without adding to their already heavy workload.

To put the guidelines into practice, the researchers launched several hyperglycemia management teams that were tasked with:

  • Checking patients’ glucose values through venous and arterial blood specimens rather than bedside glucose checks (because it’s more convenient)
  • Creating timely insulin dose adjustments multiple times a day
  • Reducing the number of glucose checks for most patients to every six hours

Not only did the algorithm lower patients’ glucose levels to an acceptable target range (generally 150-180 mg/dL), it also lessened the burden on frontline health care workers.

“We developed this early in the course of the pandemic, and we have continued to adapt and improve it based on lessons learned daily on the frontlines,” Pop-Busui says. “Others have started to use variations of this algorithm as well.”

What This Means For You:

If you have diabetes or even prediabetes, keeping your blood sugar levels well-controlled can help you reduce the risk of complications if you contract COVID-19.

COVID-19 Can Trigger Hyperglycemia

The Michigan Medicine researchers also found that some of the COVID-19 patients who had been referred to them for treatment developed high blood sugar levels even though they did not have diabetes.

“The severe inflammatory reaction triggers insulin resistance and high blood sugar even in people who may not have had known diabetes, but could have been in a prediabetic state,” Pop-Busui says.

A recent study published in the Journal of Medical Virology corroborates this idea, showing that out of 184 patients hospitalized with COVID-19, about 24% of patients were prediabetic.3

What is Prediabetes?

Prediabetes is a precursor to type 2 diabetes. According to the Centers for Disease Control and Prevention, more than 1 in 3 Americans have prediabetes. Over 84% of people with prediabetes are unaware that they have it.4

However, factors beyond diabetes and prediabetes can contribute to high blood sugar.

“[Patients with hyperglycemia] may also simply have stress hyperglycemia, which can occur from the stress of illness,” Roma Gianchandani, MD, another author of the Michigan Medicine study, tells Verywell,

Regardless of whether patients have prediabetes, diabetes, or stress hyperglycemia, Pop-Busui says their high blood sugar levels need immediate and sustained treatment.

Risks of Untreated Hyperglycemia

Romy Block, MD, an endocrinologist and co-founder of Vous Vitamin, tells Verywell that long-term, high blood sugars can directly injure blood vessels. Several health problems can result from this damage, including:

“In many medical conditions, tightly controlled sugars can decrease the duration of illness and decrease the [number of] days spent in the hospital,” Block says.

Treatment for hyperglycemia usually includes the administration of insulin—either given intravenously (directly into your vein) or under the skin—to bring down high blood sugar levels. 

COVID-19: UNDERSTANDING QUARANTINE, ISOLATION AND SOCIAL DISTANCING IN A PANDEMIC

COVID-19: UNDERSTANDING QUARANTINE, ISOLATION AND SOCIAL DISTANCING IN A PANDEMIC

Mar 31, 2020 | Healthy Tips

Plus, 3 ways to protect yourself without freaking out

With coronavirus (COVID-19) dominating the news cycle, you’re starting to throw around words like “quarantine” with an uneasy casualness. But what do these words really mean for your life?

“Quarantine doesn’t have to be a scary thing,” explains infectious disease specialist Steven Gordon, MD. “And it’s an effective way to protect the public.”

Dr. Gordon explains the ins and outs of quarantine and other common terms connected with disease outbreaks.

What does quarantine mean?

Governments use quarantines to stop the spread of contagious diseases. Quarantines are for people or groups who don’t have symptoms but were exposed to the sickness. A quarantine keeps them away from others so they don’t unknowingly infect anyone. 

Quarantines may be used during: 

  • Outbreaks: When there’s a sudden rise in the number of cases of a disease.
  • Epidemics: Similar to outbreaks, but generally considered larger and more widespread.
  • Pandemics: Larger than epidemics, generally global in nature and affect more people.

What’s the difference between isolation and quarantine?

While isolation serves the same purpose as quarantine, it’s reserved for those who are already sick. It keeps infected people away from healthy people to prevent the sickness from spreading. 

Can you be legally quarantined?

According to the U.S. Constitution, yes. The federal government can use isolation and quarantine to protect people from contagious diseases. States also have the authority to institute isolations or quarantines. Breaking a quarantine has consequences that range from a fine to imprisonment. 

But government-mandated quarantines are rare. You have to go all the way back to the infamous Spanish flu pandemic of 1918-1919 for the last enforced, large-scale isolation and quarantine, according to the U.S. Centers for Disease Control and Prevention (CDC). 

In response to suspected or confirmed coronavirus exposure, some have been asked to self-quarantine. And while it’s highly recommended that you do, these quarantines are currently voluntary.

“For anyone who has close contact with someone infected with the coronavirus, it is important that you listen to instructions from your health department,” Dr. Gordon says. 

What exactly is “close contact?” It’s defined as being within approximately 6 feet (2 meters) of someone with COVID-19 for a prolonged period of time. That includes if you are living with, visiting or sharing a healthcare waiting area or room with someone with COVID-19. Or if you have been coughed on by someone with the disease.

Health departments identify close contacts through what’s called contact tracing, Dr. Gordon explains. “They will notify you if they think you have been exposed to a known case and provide you with instructions for next steps,” he says. Unsure if you qualify as having been in close contact? Reach out to your local health department.

What happens when you are quarantined?

While not all quarantines are the same, look to the CDC for how best to do your part. Currently, the CDC recommends: 

  • Make it a staycation: Avoid leaving the house unless absolutely necessary (read: visiting your healthcare provider, though see the next bullet for how to do that). That means no work, school or church and saying no to your cousin’s bat mitzvah. 
  • Call ahead: While your local or state health department will most likely keep tabs on your health, you may need to see your doctor, too. “First, try a virtual visit. Or at least, call ahead first, so that the medical facility can take steps to prevent others from getting infected,” says Dr. Gordon. 
  • Worried about Fido?  At this time, the CDC says there’s no evidence that companion animals, including pets, can spread COVID-19. But it may still be good to still use caution. If you’ve been exposed to COVID-19, avoid “petting, snuggling, being kissed or licked and sharing food [during a coronavirus quarantine],” recommends the CDC. 
  • Have your own stuff: Don’t swap unwashed “dishes, drinking glasses, cups, eating utensils, towels or bedding with other people or pets in your home,” says the CDC. 
  • Wash, rinse, repeat: “Hygiene is an integral part of this, even at home. Handwashing should be your first line of defence when under quarantine,” relates Dr. Gordon. “And don’t forget to cough or sneeze into your elbows or a tissue that you then throw away.”

Other protective measures:

Quarantine isn’t the only way to protect yourself during an epidemic. Dr. Gordon also recommends:

  • Social distancing: Social distancing involves avoiding large gatherings. If you have to be around people, keep 6 feet (2 meters) between you when possible. “Social distancing is pretty much like using common sense,” Dr. Gordon says. “We don’t realize how interconnected we are until we’re asked to avoid people.” But he notes that terms like “mass gatherings” or “congregate settings” are vague. They’re used to describe things like shopping centers, movie theaters or stadiums. But how many people together is too many? “That’s a moving target,” he says. There’s no official definition, though the CDC recently advised that all U.S. events of 10+ people should be cancelled or held virtually.
  • Staying calm: “While fear is normal, educating yourself is a great way to counterbalance your anxiety,” says Dr. Gordon. “Stay informed from reliable sources — but not too intensely. Hyper-fixating on the news can be just as detrimental.”
  • Cooperating with the authorities: Following quarantines and other public health mandates help slow — and stop — the spread of contagious diseases.

Being cooped up inside may seem unbearable. But the time WILL pass, and your forced staycation may save lives.

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