Covid And Diabetes: What Is The Connection And Why It Matters?

Coronavirus and Covid are household names. A simple story goes like this: Coronavirus (SARS-CoV-2) is welcome inside our body because we have the receptors for its entry.

By Jamshed Arslan

After entry into our cells, the virus replicates and leads to a disease called Covid-19. However, there is a plot twist: not every tissue has the receptors for viral entry, not everyone suffers from Covid, and most importantly, a vast majority of infected individuals do not show any sign of the disease, while for some, Covid is a death sentence. Your immune system plays a key role in the outcome of infection. Many chronic ailments including diabetes predispose your body to a multi-organ damage. Likewise, once you are infected, Coronavirus can make pancreas its home and predispose you to metabolic diseases including diabetes.

“Diabetes is a risk factor for serious Covid. SARS-CoV-2 infection can lead to pancreatic damage, causing and/or worsening the diabetes.”

In this essay, I will describe the relationship between Covid and diabetes by highlighting the attack of Coronavirus on pancreas.

1. Background

1.1. Pancreas – an organ with exocrine and endocrine functions

Pancreas in your abdomen helps converting your food into fuel, and releases insulin to regulate blood sugar levels. For digesting the food, pancreas secretes many chemicals and enzymes directly into the small intestine. This is the exocrine function of pancreas.

Pancreas has receptors to detect blood sugar levels. When blood sugar is high, pancreatic beta-cells secrete insulin into the blood, which circulates throughout the body, compelling the cells to take up the excess glucose in the blood. This is the endocrine function of pancreas. Sugar is a key fuel that you need for your life. When pancreatic beta-cells fail to produce enough insulin, diabetes ensues.

1.2. Diabetes and weak immune system

When your body cannot maintain the glucose in normal ranges due to pancreatic dysfunction, body cells are starved of a crucial fuel. Additionally, the excess sugar in the blood for a long period of time harms the blood vessels. Nutrient starvation and direct injury are among the mechanisms by which excess blood sugar damages your immune system.

Virus has to struggle against your body’s immune system. One of the leading causes of viral success is body’s weak immune system. Once your police, your immune system, is compromised, virus can sing the song of victory over your lungs, heart, kidney, gut and other organs. Sad news: you have symptomatic Covid now!

2. Covid and diabetes

2.1. Pancreas and Coronavirus

Coronavirus can attack many organs, but Covid may or may not involve multiple organs. Many organs have the receptors to make viral entry possible, such as ACE2. Pancreas also have those receptors, but nobody had actually shown viral infection and replication inside pancreatic beta-cells and others, until now. A multinational team of researchers from Germany, Austria and Canada have recently shown that virus enters the pancreatic beta-cells and others to wreak havoc on your metabolism. Let’s look at the viral attack and its link to your metabolism in a bit more detail.

2.2. Viral attack on pancreas

Roughly, a third of critically ill Covid patients show inflammation of the pancreas called pancreatitis. Virus latches onto the ACE2 receptors and an enzymatic receptor called TMPRSS2 plays a crucial role in the viral entry into the pancreatic beta-cells and others. Once inside, the viral replication follows the similar mechanisms as outlined here (https://www.technologytimes.pk/2021/03/08/covid-vaccine-problem-coronavirus-variants/). The key point is that viral life cycle starts destroying pancreatic cells. When beta-cells are destroyed, pancreas is unable to effectively respond to high blood sugars and therefore cannot cause the body to get its fuel effectively. In such situations, your body decides to use fats as energy source. Bad idea! Liver processes the fat into a fuel called ketones. The problem with ketone fuel, rather than regular glucose fuel, is that too much ketones make your blood acidic. Since enzymes and biomolecules need a particular blood pH to function properly, your entire body is at risk of a life-threatening situation called ketoacidosis.

When the cells of pancreas that secrete digestive juices are destroyed by viral replication, pancreas is unable to adequately secrete digestive juices that could help extract sufficient energy from your breakfast, lunch and dinner. In other words, once pancreas is the home for Coronavirus, you neither properly digest your food, nor are you able to utilize whatever energy you get out of your digested food. This can spiral out of control and people have died because of such phenomena.

2.3. Metabolic syndrome due to Covid

Metabolic syndrome is an umbrella term that includes many insulin-related issues. Attack from Coronavirus in the manner outlined above (section 2.2) directly hampers body’s ability to maintain a healthy metabolism. This means that your body starts storing fats where it shouldn’t, breakdown of fats increases in your body, you cannot maintain a healthy homeostasis, and you are unable to maintain a sufficient energy levels for your daily activities. In other words, Covid can lead to metabolic syndrome.

3. Covid vaccines are safe for diabetics

All the vaccines currently marketed have been tested for their safety and efficacy in the diabetics. So, there is no reason to worry for older people who are currently given a preference for vaccination. Vaccines, like any other intervention, have some side effects, but they are generally minimal. I have explained how the vaccines work and what can be the potential risks of Coronavirus vaccines here (https://www.technologytimes.pk/2021/03/08/covid-vaccine-problem-coronavirus-variants/).

4. Concluding remarks

Take Coronavirus infection seriously. Wear masks, sleep well (https://www.technologytimes.pk/2020/09/03/sleep-well-a-solution-for-coronavirus-during-covid-19-pandemic/), get vaccinated if you can, and properly and frequently wash your hands. Research is still underway to determine long-term consequences of Coronavirus infection, but I hope that above description has convinced you to maintain a reasonable level of fear of Coronavirus. However, considering the fact that we live in a third-world country, I have also outlined the ground realities of Coronavirus infection in my essay here (https://www.technologytimes.pk/2021/01/13/covid-is-a-tale-of-two-different-worlds/). In sum, Coronavirus is still a real threat that can put your life at stake by injuring pancreas. Stay safe!

References

Arslan, J. (2021). Covid is a tale of two different worlds. Technology Times. https://www.technologytimes.pk/2021/01/13/covid-is-a-tale-of-two-different-worlds/

Arslan, J. (2021). Covid vaccine problem: Coronavirus variants. Technology Times. https://www.technologytimes.pk/2021/03/08/covid-vaccine-problem-coronavirus-variants/

Arslan, J. (2020). Sleep well: a solution for Coronavirus during COVID-19 pandemic. Technology Times. https://www.technologytimes.pk/2020/09/03/sleep-well-a-solution-for-coronavirus-during-covid-19-pandemic/

Kusmartseva, I et al. (2020). Expression of SARS-CoV-2 entry factors in the pancreas of normal organ donors and individuals with COVID-19. Cell Metabolism, vol. 32, pp. 1041–1051.

Liu, F et al. (2020). ACE2 expression in pancreas may cause pancreatic damage after SARS-CoV-2 infection. Clinical Gastroenterology and Hepatology, vol. 18, pp. 2128–2130.

Muller, JA et al. (2021). SARS-CoV-2 infects and replicates in cells of the human endocrine and exocrine pancreas. Nature Metabolism, vol. 3, pp. 149–165.

Xiao, F et al. (2020). Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology, vol. 158, pp. 1831–1833.

Jamshed Arslan

Jamshed Arslan

Pharm D (gold medalist); PhD (Neuropharmacology) Skilled in basic and clinical research and scientific writing with over a decade of teaching experience.

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