Effect on Postprandial Blood Glucose in COVID 19 Lockdown – 

CoronavirusDisease 2019 (COVID-19) is a new disease, which within four months of its origin in Wuhan, China, has now spread to more than two hundred countries around the world. It has affected more than 4 million people and has caused more than 290,000 deaths. The knowledge about this disease is still incomplete and evolving. Many clinical studies have shown that the patients of COVID-19, who have underlying diabetes mellitus, develop a severe clinical course, and have been reported as one of the most common comorbidities with higher mortality or deaths.

1.  Also, people with diabetes are at increased risk for pneumococcal infection with a mortality rate as high as 50%. As per the latest study in India, the average postprandial glucose level, i.e. the average ‘post-meal’ glucose level was recorded at an alarmingly high 224.87 mg/dl. The available evidence suggests a failure of current blood glucose (BG) management strategies for patients suffering from both diabetes and COVID-19, especially that of postprandial BG.

As diabetes and hyperglycemia may lead to higher secondary infection risk and mortality 2-4, the BG management of these patients should be better optimized. In the current COVID 19 pandemic, a disruption in food supply due to stockpiling and transportation problems, the major reliance on high-carbohydrate foods serves as a key issue for diabetes management. Indian diet is already rich in carbohydrates. A clinical study conducted among people with type 2 diabetes mellitus had shown that carbohydrates constituted 64.1% of total energy from the diet, higher than that recommended in India. Now, the consumption of carbohydrates has already increased during the lockdown due to the limited availability of fresh vegetables and fruits. Indians also happen to be one of the largest consumers of sweetened food items. Since sweetened food items can be stored for long (even without refrigeration), the consumption of such items has raised during times of lockdown.

Physical activity plays an important role in the management of postprandial hyperglycemia. However, the lockdown has restricted the outdoor physical activities of people with DM. Hence, they should be informed about alternative physical activity programs that can be undertaken within the safe confines of home.

The potential reasons for poor BG management in COVID 19 can be summarised as follows: 

1. Consumption of excess carbohydrate-rich diet during the lockdown.

2. A relative shortage of available professional endocrinologists or diabetologists in designated isolation medical centers, leading to delay or absence of professional advice. 

3. Unavailability of a diabetic diet or personalized diet. 

4. Quarantined in-patients are unable to exercise due to limited indoor space and poor respiratory function. 

5. The anxiety about COVID-19 induces hyperglycemia. 

6. Pancreatic tissue is a potential target of viral infection, leading to glucose metabolism disorders.

Sedentary lifestyle. Carbohydrates are a concentrated source of calories, at 4 calories per gram. Large servings of carbohydrate-heavy dishes like rice, pasta, and bread can contain hundreds of or in some cases, over a thousand — calories. During COVID 19 lockdown, the excess calories could lead to weight gain. This is especially true of sugars and refined carbs, like white flour, since they don't tend to fill you up despite their high-calorie count. Eating too many carbohydrates can affect your blood sugar levels. Blood sugar levels are a source of energy for the cells that acts as a fuel for our active existence. But refined carbs such as white bread and pasta digest very quickly and may spike the blood sugar levels. Excess carbohydrates change into the excess fat of your body. When your body fat reaches an extreme point, this fat causes the arteries’ walls to thicken up. Consumption of saturated fat encourages the plaque in the arteries to build up, thus narrowing the space for blood flow. This causes a disruption in the bloodstream, thus increasing the chances of a heart attack or a stroke. This condition is known as atherosclerosis. 

Consuming too many carbohydrates increases the number of triglycerides in your blood, which then raises the risk of developing heart diseases. It also causes the arteries to swell and blood clots may occur in your heart and blood. Triglycerides beat the amount of good cholesterol in the body, potentially giving you numerous vascular diseases. Recent research shows that people who consumed up to 20 percent of their daily calories from simple sugars increased their risk from dying of heart disease by 38 percent. 

What diabetic patients should follow during the outbreak of COVID 19?

"Seven Treasures” policy (Health education, Balanced nutrition, Physical activity, Standardized medication, Blood glucose monitoring, Regular schedule, and care for Mental health.)·        

“Five No” (no going out, no gatherings, no sedentariness, no stop on medications, no anxiety)·        

“Five Keep” (keep wearing a face mask when you go out, keep hands clean, keep a routine medical check if necessary, keep regular life, keep scientific attitude to COVID-19)·       

 “Five Refuse” (refuse to visit friends, refuse group dining, refuse rumors, refuse to shake hands or hug or kiss) 

Corrective Measures for Management of Diabetes in COVID 19

1. Use regular guidance from physicians for good glycemic control. You can use telephonic or online consultation for the same. 

2. Plan and prepare the diabetic diet in consultation with nutritionists.

3. Follow dietary guidelines.

4. Indoor exercise should be practiced.

5. The frequency of regular monitoring of blood glucose data should be increased.  A new study has suggested that controlling blood sugar levels is the key to fighting COVID-19 infections for people with diabetes. The researchers found that COVID-19 patients with Type 2 diabetes (T2D) were less likely to die if they had their blood glucose well controlled than those with poorly controlled T2D. Also, those with well-managed T2D received less of other medical interventions and had fewer health complications. Therefore, the researchers had suggested that people with diabetes should take extra care to keep their blood sugar under good control during the pandemic.