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By Serena Gordon<\/b>
HealthDay Reporter<\/i><\/p>\n
FRIDAY, Sept. 4, 2020<\/p>\n
A COVID-19<\/a> infection can cause a lot of serious, sometimes lingering health problems, like lung damage, kidney damage and ongoing heart<\/a> issues. Lately, research has suggested it may also cause the sudden onset of insulin<\/a>-dependent diabetes<\/a>.<\/p>\n A new report details the case of a 19-year-old German with asymptomatic COVID-19<\/a> infection who ended up hospitalized with a new case of insulin-dependent diabetes<\/a>.<\/p>\n Five to seven weeks before his diabetes<\/a> developed, the young man’s parents developed COVID-19<\/a> symptoms after an Austrian ski trip. Eventually, the entire family was tested. Both parents tested positive for COVID-19 antibodies, as did the 19-year-old, indicating all had been infected with the coronavirus. However, the son had never had symptoms of the infection.<\/p>\n When the 19-year-old was admitted to the hospital, he was exhausted, had lost more than 26 pounds in a few weeks, was urinating frequently and had left-sided flank pain<\/a>. His blood sugar<\/a> level was over 550 milligrams per deciliter (mg\/dL) — a normal level is less than 140 mg\/dL on a random blood test.<\/p>\n Doctors suspected he had type 1 diabetes<\/a>. He tested positive for a genetic variant that is rarely associated with type 1 diabetes<\/a>, but not genetic variants commonly present in type 1. He also didn’t have antibodies that people with type 1 diabetes<\/a> usually have at diagnosis.<\/p>\n New type of diabetes?<\/b><\/p>\n This left the experts puzzled. Was this type 1 or type 2 diabetes<\/a> or some new type of diabetes<\/a>? If it isn’t type 1 diabetes<\/a>, might this sudden onset diabetes<\/a> go away on its own? And finally, they couldn’t be sure that the COVID-19<\/a> infection caused the diabetes<\/a>. It’s possible it was a preexisting condition that hadn’t yet been diagnosed.<\/p>\n Still, the authors of the study, led by Dr. Matthias Laudes of University Medical Centre Schleswig-Holstein in Kiel, Germany, believe they have a plausible explanation for how COVID-19<\/a> infections could lead to a new and sudden diabetes diagnosis. Their report is in the Sept. 2 Nature Metabolism<\/i>.<\/p>\n Beta cells in the pancreas contain a significant number of so-called ACE2 receptors. These receptors are believed to be where the spike protein from the coronavirus attaches to cells. Beta cells produce insulin<\/a>, a hormone that helps usher the sugar<\/a> from foods into the body’s cells for fuel. The authors theorized that a coronavirus infection, which affects the ACE2 receptors, might also damage beta cells in the pancreas.<\/p>\n This process is similar to what’s believed to occur in type 1 diabetes<\/a>. The immune system mistakenly turns on healthy cells (autoimmune attack) after a viral infection and damages or destroys beta cells, possibly causing type 1 diabetes<\/a>. Someone with type 1 diabetes has little to no insulin. Classic type 1 diabetes requires lifelong insulin injections or delivery of insulin via an insulin pump<\/a>.<\/p>\n Dr. Caroline Messer, an endocrinologist at Lenox Hill Hospital in New York City, said she’s heard there’s been an uptick in autoimmune diabetes since the pandemic started.<\/p>\n She said the authors’ suggestion that beta cells may be destroyed in COVID infections makes sense.<\/p>\n “This could account for the uptick in antibody negative type 1 diabetes,” she said. “It is important for practitioners to be aware of the possibility of insulin-dependent diabetes approximately four weeks after infection in spite of negative [type 1 diabetes] antibodies.”<\/p>\n Sanjoy Dutta, vice president of research for JDRF (formerly the Juvenile Diabetes Research Foundation), said, “I don’t think this is type 1 or type 2 diabetes<\/a>. I think it should be called new onset or sudden onset insulin-dependent diabetes.”<\/p>\n Tracking these cases<\/b><\/p>\n Dutta said there have been enough of these cases in COVID patients that a registry has been created to keep track of their frequency. It includes more than 150 clinical centers throughout the world.<\/p>\n He said people with sudden onset diabetes also seem to have significant insulin resistance<\/a> and need very high doses of intravenous insulin. Insulin resistance<\/a> is more common in type 2 diabetes<\/a>.<\/p>\n He has also read of diabetes cases that have reversed — no longer requiring insulin, which does not happen with type 1 diabetes.<\/p>\n
“We need to know the mechanism behind these cases, and until we get more evidence, we should stay open-minded. We don’t know if it’s beta cell destruction. It’s too soon for this to be boxed in as type 1 diabetes,” Dutta noted.<\/p>\n A new study from the University of Florida may put a damper on the German authors’ theory. They looked at the pancreases of 36 deceased people without COVID, and didn’t find ACE2 in their beta cells.<\/p>\n Their finding “does not provide support to the notion that you’re going to develop diabetes because the coronavirus goes in and destroys an individual’s insulin-producing cells,” senior author Mark Atkinson, director of the UF Diabetes Institute, said in a university news release.<\/p>\n The UF study was just published as a preprint on the website bioRxiv.org. Preprint websites let scientists distribute research quickly. However, information on them has not been peer-reviewed and should be considered preliminary.<\/p>\n Dutta said whatever the mechanism might be, the general public and health care providers should be alert for symptoms of diabetes<\/a> after a COVID-19<\/a> infection. These include extreme fatigue<\/a>, dry mouth<\/a>, extreme thirst<\/a>, frequent urination<\/a> and unexplained weight loss<\/a>.<\/p>\n <\/p><\/div>\n References<\/p>\n
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<\/p>\nQUESTION<\/h4>\n
\n Diabetes is defined best as…<\/span>
\n See Answer<\/span>
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\n SOURCES: Caroline Messer, M.D., endocrinologist, Lenox Hill Hospital, New York City; Sanjoy Dutta, Ph.D., vice president, research, JDRF; Nature Metabolism<\/i>, Sept. 2, 2020; University of Florida Health, news release, Sept. 2, 2020.
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