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NEW YORK (REUTERS) – Mario Buelna, a 28-year-old healthy father, caught a fever and began having trouble breathing in June. He soon tested positive for Covid-19. Weeks later, after what seemed like a recovery, he felt weak and began to vomit. At 3 a.m. on August 1, he passed out on the floor of his home in Mesa, Arizona.
Paramedics rushed him to a nearby hospital, where doctors placed him in intensive care after saving him from a coma. They told him that he could have died. His diagnosis, type 1 diabetes, left him stunned and scared. He had no history of the disease.
“Covid caused it,” Buelna said, told by doctors.
Buelna’s ordeal and similar cases reflect a new concern about the dangerous relationship between diabetes and Covid-19 that is being urgently studied by doctors and scientists around the world.
Many experts are convinced that Covid-19 can trigger the onset of diabetes, even in some adults and children who do not have traditional risk factors.
It is already well documented that people with diabetes face much higher risks of serious illness or death if they contract Covid-19. In July, US health officials found that nearly 40 percent of the people who died with Covid-19 had diabetes.
Now, cases like Buelna’s suggest that the connection between diseases is bidirectional.
“Covid could be causing diabetes from scratch,” said Dr. Francesco Rubino, diabetes researcher and chair of metabolic and bariatric surgery at King’s College London.
Dr. Rubino leads an international team collecting patient cases globally to unravel one of the greatest mysteries of the pandemic. Initially, he said, more than 300 doctors have requested to share cases for review, a number he expects to increase as infections reappear.
“These cases come from all corners of the world and from all continents,” Dr. Rubino told Reuters.
In addition to the global registry, the US National Institutes of Health is funding research on how coronavirus can cause high blood sugar and diabetes.
In these situations, symptoms can quickly escalate and be life-threatening. These cases can take months to show up after exposure to Covid-19, so the full scope of the problem and long-term ramifications may not be known until well into next year.
More intense research is needed to definitively prove, beyond mounting anecdotal evidence, that Covid-19 is triggering diabetes on a large scale.
“We have more questions than answers at this point,” said Dr. Robert Eckel, president of medicine and science for the American Diabetes Association. “We could be dealing with a whole new form of diabetes.”
‘Absolutely scary’ diagnosis
Type 1 diabetes occurs when the body’s immune system mistakenly destroys insulin-producing cells in the pancreas, preventing the regulation of blood sugar levels. About 1.6 million Americans have the disease.
Type 2 diabetes is more common, affecting about 30 million Americans. These patients still produce insulin, but over time their cells become resistant to insulin, allowing blood sugar to rise.
Cases of type 1 diabetes have previously been associated with other viral infections, including previous influenza and coronaviruses. Infections are known to stress the body and increase blood sugar levels.
But this tends to occur in people predisposed to the disease. Only a few of them eventually develop diabetes, and scientists still don’t fully understand why.
This year, doctors are also seeing that some people without type 2 diabetes risk factors, such as being older or being overweight, experience a diabetic emergency after exposure to Covid-19.
In type 1 diabetes, initial symptoms can include extreme thirst, fatigue, frequent urination, and weight loss.
Arthur Simis had no idea that those were signs of the disease. This summer, he and his wife, Sarah, noticed that their 12-year-old son, Atticus, appeared thin and slept a lot. They thought he was stressed from being stuck at home during the pandemic or from experiencing rapid growth.
On July 9, while her symptoms persisted, Simis took her son to an urgent care center near her home in Gardnerville, Nevada. Medical personnel detected dangerously high blood sugar and ketones in his urine, both indicators that Atticus was in diabetic ketoacidosis or CAD.
The doctor told Mr. Simis that his son needed immediate hospital care to avoid falling into a coma due to his newly diagnosed type 1. An ambulance took them 50 miles to the nearest hospital in Reno.
His father spent three nights sleeping next to him in the pediatric ICU. He cried over the phone to his wife, because only one parent could enter, a measure to control coronavirus infections.
“How could he have diabetes?” Simis remembers asking the doctors. “It was absolutely terrifying.”
Simis believes his son had been infected with the coronavirus because the father and his wife experienced symptoms in the spring. The couple went to urgent care but were never tested for coronavirus due to stricter testing criteria at the time. Atticus tested negative for an active coronavirus infection in the ICU, medical records show. But he was never tested for antibodies that could show whether he was exposed weeks before.
Doctors say that’s not unusual in a fast-moving pandemic, as they focus on individual emergencies rather than general research questions. But the lack of testing in many of these cases, they say, can complicate efforts to detect whether and how the coronavirus could be causing diabetes.
Children in intensive care
Initial reports of Covid-related diabetes include more children with cases like Atticus.
In a study published in August, researchers from Imperial College London and several hospitals found that cases of type 1 diabetes among children nearly doubled to 30 between late March and early June, as the pandemic progressed, compared to the same period in previous years. .
Five of the children tested positive for a previous coronavirus infection, but the study authors said many of the children were not tested.
In the United States, Children’s Hospital Los Angeles said the percentage of newly diagnosed type 2 patients who arrived with diabetic ketoacidosis, a life-threatening buildup of acid in the blood, has nearly doubled between March and August compared to the same. period in 2018. and 2019.
Dr Lily Chao, director of the type 2 diabetes clinic there, said the hospital is still investigating whether this increase is due to exposure to Covid-19.
Ms. Brandi Edwards, a registered nurse and diabetes educator at Huntsville Hospital in Alabama, said calls about pediatric cases began to increase in May. She is called upon by doctors when a child arrives in the emergency room or ICU so she can counsel the family on insulin injections, glucose readings, and how daily life will change in the future.
“We have seen more type 1 cases this year than I remember,” Ms. Edwards said. “There were three children in the pediatric ICU at the same time. That is very rare.”
Eviction notice
After surviving a diabetic emergency, the life of a newly diagnosed patient can be overwhelming. Medications and other supplies to control diabetes can cost hundreds of dollars each month, and long waits to see an endocrinologist are common in many areas.
Mr. Buelna, the Arizona patient, is still waiting for his Medicaid plan to approve a continuous glucose monitor more than two months after his diagnosis. The illness put him out of work for weeks and ruined his family’s finances.
His wife, Erika, is eight months pregnant and they have a three-year-old daughter, Katalina. The family received an eviction notice on August 2, while Mario was in the ICU, and they depend on a food bank for some meals.
Buelna said she fell into a depression at the hospital, without family visits and credits her sister with cheering her up on the phone calls.
“I want to improve so that I can see my children grow up,” he said. “I’m not ready to go yet.”
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