The coronavirus (COVID-19) pandemic has impacted human life in many ways. Though caused by a respiratory virus, its infection involves virtually every organ-system in the body. COVID-19 pandemic has resulted in the biggest disruption to healthcare delivery in living memory. The  pandemic has brought the entire world’s focus onto health and perhaps as never before, humankind is collectively worried about its health.

There is evidence that people suffering from hormone conditions, such as diabetes, obesity, thyroid disease and adrenal diseases, face an increased risk of complications of COVID infection. Studies show that 26% of COVID- 19 patients with a symptomatic disease were obese and 15% had diabetes, and these individuals had worse outcomes and poorer survival compared to non-obese and non-diabetic individuals. COVID-19 patients with obesity, diabetes, and other chronic diseases are more likely to suffer with severe symptoms, enter intensive care units, as well as have an increased risk of death.


Diabetes seems to be a risk factor for acquiring COVID  and it definitely increases the risk for complications and death from COVID. Obesity, hypertension, and cardiovascular diseases are common in people with diabetes and are all linked with adverse outcomes. Diabetes is present in 1 out of 3 patients that enter intensive healthcare units, require ventilators, or patients that are non-survivors. On the positive side, patients with good control of diabetes had significantly lower death rates due to COVID-19.

We will try to answer some common questions regarding  COVID and Diabetes

Q1: Are people with diabetes mellitus at a higher risk of developing COVID-19 infection?

People with type 1 and type 2 diabetes with poor glucose control may be at higher risk of developing COVID-19, similar to any other infections. If you contract COVID-19, the risk of severe disease can be reduced  by keeping glucose and blood pressure under tight control.

Target Blood glucose levels
•    Fasting/ premeal - 80- 130 mg/dl
•    2 hours after food - less than 180 mg/dl
•    Avoid hypoglycemia - less than 70 mg/dl

Q2: What should I do to avoid getting COVID -19 infection?
All people with diabetes should strictly follow the public health guidelines advocated by the government from time to time. These measures include quarantine/lockdown advice, social distancing, hand washing recommendations, safe practices while coughing or sneezing, and universal use of the mask.

Q3: What should I do if I develop COVID-19 infection?
The symptoms of COVID-19 are similar to that of the seasonal flu that most of us develop. However, since it is highly contagious, you must isolate yourself and practice measures to avoid spreading it to your family and friends. Please contact the public health authorities, who will give you instructions on how to proceed further. Do not travel to the hospital in your vehicle.

Q4: What should I do with my medicines if I develop COVID-19?
Continue to manage diabetes, just like you were handling it earlier. Do not discontinue or modify any medications without consulting with your doctor. Strictly do not take any over the counter medications for diabetes or COVID-19, including hydroxychloroquine (HCQS), unless advised by your doctor. Since you may require isolation for suspected COVID-19 infection, make sure that you have enough supplies of your medications (tablets and injections) and glucometer strips for at least a month. Your targets for blood glucose control should be as strict as before.

Q5: I am a person with type 2 diabetes on oral glucose-lowering drugs? How should I manage my diabetes if I get COVID-19?

Please monitor capillary glucose (using glucometer) twice daily and see if you can maintain targets. If you have not made any recent changes in medicines and your HbA1c is less than 7%, you can consider reducing the frequency of glucose monitoring. See where you fit in and decide on the further course of action. If you are a person with type 2 diabetes on insulin, you will need to take all precautions similar to people with type 1 diabetes.

Q6: I am a person living with type 1 diabetes on insulin. What should I do if I get COVID 19 infection?
People with type 1 diabetes are at increased risk of wide fluctuations of blood glucose and diabetic ketoacidosis during infections. Keep yourself well hydrated with water or non-sugary drinks. Continue to monitor blood glucose more closely and urine ketones if glucose is more than 250 mg/dl it is advisable   to get admitted.
Q 7: Will my treatment of blood pressure, cholesterol, or heart disease change during COVID - 19?
It is advisable  to use home blood pressure monitoring and aim for a blood pressure below 140/80 mm Hg. Based on current scientific evidence, all BP medicines are safe, and you should not discontinue any blood pressure medication without discussing it with your doctor. Continuation of drugs that you are using for high cholesterol or heart disease are essential.

Q8: What should I take care of my food and exercise during the COVID season?
People with diabetes should follow the healthy diet patterns advised by their doctors and dieticians. Nonspecific unproven remedies that circulate in social media with claims to improve immunity like honey, lemon, and baking soda may be detrimental for some people with diabetes. Please discuss this with your doctor before using these. Exercise has to be continued, preferably indoor. For outdoor exercises, strictly follow the social distancing protocols.

In brief, people with diabetes should ensure a healthy lifestyle, regular glucose monitoring, and adherence to lifestyle measures and medications during this pandemic.

Obese people have a bad outcome when they contract COVID. Reports have found a strong link between obesity and admission to critical care as well as the use of invasive mechanical ventilation. The high impact of  COVID-19 in patients with obesity and severe obesity is probably related to the deleterious effects of obesity on lung function. Obesity is associated with decreased expiratory reserve volume, functional capacity and respiratory system compliance. Severe obesity causes sleep apnea syndrome and in those with increased abdominal obesity, pulmonary function is further impaired by decreased movement of  diaphragmatic muscles. So keeping yourself healthy by shedding excess body weight is all the more essential in these COVID times

Viral infections are known to trigger autoimmune thyroid disease and subacute thyroiditis- a condition causing inflammation and pain in the thyroid along with increased thyroid hormone levels in the body. There are reports of increased cases of thyroiditis in areas were COVID spread was severe. There is no evidence that those with poorly controlled thyroid disease are more likely to contract COVID. However, it is possible that patients with uncontrolled thyroid disease (especially thyrotoxicosis) may be at higher risk of complications (for example thyroid storm) from any infection. So it is strongly recommend that patients with thyroid disease continue taking their thyroid medications to reduce this risk.

People with other endocrine conditions like adrenal diseases, pituitary diseases and gonadal diseases are thought to have a higher risk of developing severe COVID infection if the underlying condition is not treated adequately. So optimal management of these conditions by are essential to prevent morbidity and mortality due to COVID.

Adapted from the Expert guidance on COVID from the Professional Association of Clinical Endocrinologists (PACE), Kerala

Dr. Jayaprakash P. MD, DM, FACE
Consultant Endocrinologist
Medical Trust Hospital, Kochi

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