COVID-19 INFECTION IN PEOPLE WITH DIABETES

Authors: Sten Madsbad, Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark

The COVID-19 infection is a double challenge for people with diabetes. Diabetes has been reported to be a risk factor for the severity of the disease and at the same time patients have to control glucose in a situation with a decreased and more variable food intake.

Background

COVID-19 (Coronavirus Disease-2019) is caused by the coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2), which has spread quickly to more than 160 countries across the world.1 The spreading mechanism of the virus is primarily by transmission of respiratory droplets between people.1 The incubation time is on average 6–8 days, followed by 1–2 weeks of symptomatic disease. It is characterised by a wide spectrum of symptoms including coughing, fever, myalgia and respiratory problems such as viral pneumonia, and respiratory failure. In worst cases, these can lead to death.2–11 Time from first onset to hospital admission has been on the average 6–7 days.2–11 A proportion of the infected are without symptoms (yet remain infectious) or have only mild symptoms.2–11

Diabetes as a risk factor

Diabetes is a risk factor for hospitalisation and mortality of the COVID-19 infection. Diabetes was a comorbidity in 22% of 32 non-survivors in a study of 52 intensive care patients.2 In another study of 173 patients with severe disease, 16.2% had diabetes, and in further study of 140 hospitalised patients, 12% had diabetes.3,4 When comparing intensive care and non-intensive care patients with COVID-19, there appears to be a twofold increase in the incidence of patients in intensive care having diabetes.11 Mortality seems to be about threefold higher in people with diabetes compared with the general mortality of COVID-19 in China.2–11

The number of comorbidities is a predictor of mortality in COVID-19. In addition to diabetes, the other common comorbidities were hypertension, in about 20% of cases, cardiovascular disease (16%), and lung disease (6%).2–11 Indeed, people with diabetes are a high-risk group for severe disease. Notably, diabetes was also a risk factor for severe disease and mortality in the previous SARS, MERS (Middle East respiratory syndrome) coronavirus infections and the severe influenza A H1N1 pandemic in 2009.12–4

What explain the increase risk of diabetes?

It is a fact that people with diabetes are at increased risk of infections including influenza and for related complications such as secondary bacterial pneumonia. Diabetes patients have impaired immune-response to infection both in relation to cytokine profile and to changes in immune-responses including T-cell and macrophage activation.15 Poor glycaemic control impairs several aspects of the immune response to viral infection and also to the potential bacterial secondary infection in the lungs.16 It is likely that many of the patients with diabetes in China have been in poor metabolic control when infected by COVID-19.

Many patients with type 2 diabetes are obese and obesity is also a risk factor for severe infection.17–9 It was illustrated during the influenza A H1N1 epidemic in 2009 that the disease was more severe and had a longer duration in about twofold more patients with obesity who were then treated in intensive care units compared with background population.14,17,18 Specically, metabolic active abdominal obesity is associated with higher risk.17-9 The abnormal secretion of adipokines and cytokines like TNF-alfa and interferon characterise a chronic low-grade in abdominal obesity and may induce an impaired immune-response.. 17–9 People with severe abdominal obesity also have mechanical respiratory problems, with reduced ventilation of the basal lung sections increasing the risk of pneumonia as well as reduced oxygen saturation of blood.20  Obese subjects also have an increased asthma risk, and those patients with obesity and asthma have more symptoms, more frequent and severe exacerbations and reduced response to several asthma medications. 20

Lastly, late diabetic complications such as diabetic kidney disease and ischaemic heart disease may complicate the situation for people with diabetes, making them frailer and further increasing the severity of COVID-19 disease and the need for care such as acute dialysis. Some findings indicate that COVID-19 could cause acute cardiac injury with heart failure, leading to deterioration of circulation.11

The most frequent comorbidities to COVID 19 are hypertension and diabetes. Both diseases are often treated with angiotensin-converting enzymes (ACE) inhibitors. Coronavirus binds to target cells through angiotensin-converting enzyme 2 (ACE2), which expressed in the epithelial cells in the lungs, blood vessels and in the intestine.21,22 In patients treated with ACE and angiotensin II receptor blockers, expression of ACE2 is increased.23 Therefore, it has been suggested that ACE2 expression may be increased in these two groups of patients with hypertension and diabetes, which could facilitate infection with COVID-19 and increase the risk of severe disease and fatality.

https://www.touchendocrinology.com/insight/covid-19-infection-in-people-with-diabetes/

4 Ways Diabetes Can Affect Your Eyes

Diabetes is a condition that is caused when blood sugar levels within the body becomes too high and can affect people of all ages. There are various side-effects of having diabetes and it is a condition that should be taken seriously and monitored closely. Looking after your eyes when you have diabetes is vital as having the condition can cause eye problems, which if not looked after correctly, can lead to deterioration and potential irreversible eye damage. In this article I will look at 4 ways diabetes can affect the eyes.

1.     Diabetic Retinopathy

Diabetic retinopathy is probably the most commonly known complication of having diabetes and must be taken seriously as it can lead to blindness. Diabetic retinopathy affects the retina, which is the back of eye. The retina is the part of the eye that converts the light we see into signals which are sent to the brain via the optic nerve, this is then processed by the brain into the images that we see. Diabetic retinopathy is caused when the small blood vessels on your retina become blocked, leak or grow abnormality due to the high blood sugar levels. There are 3 types of diabetic retinopathy;

1.     Background diabetic retinopathy - this type is the very early changes to the retina, it doesn't normally affect sight but must be monitored carefully to ensure it doesn't become worse.

2.     Diabetic maculopathy - this type is when the background diabetic retinopathy has developed on or around the macular. The macular is crucial when giving good vision as it provides central vision. Having diabetic maculopathy can affect sight.

3.     Proliferative diabetic retinopathy - this type is caused when background diabetic retinopathy become worse. When the blood vessels become damaged or blocked in a large area by the above two types it causes a reduced supply of blood to the retina. The body tries to compensate this by growing new vessels on the retina's surface, but these vessels tend to be very weak and bleed, which in turn can affect the vision. The bleeding also can cause scarring which pulls on the retina, this can cause a retinal detachment. While retinal detachments can be fixed, sometimes this may not be possible, leading to impaired vision or blindness.

Samer Hamada is a distinguished consultant ophthalmologist and cornea surgeon performing eye surgeries at his practice, Eye Clinic London. With nearly two decades' experience, Mr. Hamada is recognised as a leading expert in the field of cataract, refractive lens exchange (RLE) and corneal surgeries.

Please visit http://eyecliniclondon.com/

Please call 0800 197 8808 for friendly advice and information.

Article Source: http://EzineArticles.com/expert/Samer_Hamada/2204774

Article Source: http://EzineArticles.com/9949720

Article Source: http://EzineArticles.com/9949720

Natural Diabetes Cure - Onion For Diabetes Treatment

A natural diabetes cure that is beneficial is known as onion for diabetes treatment. Onion is well known for its effectiveness against a variety of conditions that include the common cold, diabetes, heart disease, osteoporosis, and other diseases.

Onion contains chemical compounds that are believed to have anti-cholesterol, anticancer, anti-inflammatory, and antioxidant properties like quercetin. The onion shows a single vertical shoot above the ground, while the bulb grows underground; it is a close relative of garlic.

A natural diabetes cure has found that onion has a significant blood sugar lowering action and the main active ingredient is known as allyl propyl disulphide (APDS) as well as diallyl disulphide oxide (allicin).

APDS has the ability to lower blood sugar levels and increase insulin. Other benefits of onion are its cardiovascular effects, have the ability to lower lipid levels, are antihypertensive, and can inhibit platelet aggregation. Onions are essential for diabetes treatment.

How onions lower blood sugar is not exactly known, however research has shown that the properties of onion can block the breakdown of insulin in the liver that prevents the destruction of insulin. Therefore, this means that the body will have higher levels of insulin, which is essential for people with diabetes.

Sue Kennedy is the author of the physician-endorsed e-book "Defeat Diabetes Now," and operates a membership channel devoted to health & wellness. Readers of her book also receive instant access to expert interviews, articles, diet plans and other resources designed to maintain optimum health and prevent disease. Learn how you can defeat diabetes now [http://defeatdiabetesnow.com.au]

Article Source: http://EzineArticles.com/expert/S_Kennedy/187152

Relationship In 60Seconds

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Do These 3 Unexpected Things to Help Manage Your Diabetes

Do These 3 Unexpected Things to Help Manage Your Diabetes

By Sysy Morales

 May 10th, 2017

Month after month and year after year you struggle with checking your blood sugar, taking your medication properly, eating the right foods, exercising enough, and staying away from nights that undo all your two steps forward.

You’re a perfectly smart individual, completely capable of doing what needs to be done. You read about how people with type 1 and type 2 diabetes do amazing things and quickly realize that some of your excuses fall a little short. You can’t figure out why you aren’t able to manage your diabetes well even though you have the tools and resources you need with which to do it.

Besides, diabetes is just one of a bunch of other problems you have. You too are dealing with relationships and work and finances.

But some people with diabetes are doing well and you wonder if you could be one of them. Deep down you know you could. You just need…something…

Now I don’t know you so I’m only going to ask you to consider the possibility that perhaps, mostly what needs to change are your surroundings.

Your surroundings would include any people, places, or things in your proximity.

The People You Surround Yourself With

Let’s start with people. If you’re an adult you probably have a choice regarding who you spend your time with. Are these quality people? Do they treat you well or poorly? Are they negative? Do they manage to bring you down with their words or actions? Do they abuse themselves and do things you don’t respect?

You might first try telling the people in your life how you feel and what you would prefer from them. If they can’t do any different and are only helping to pull you down, you’ve got to let them go. Your diabetes will eventually destroy your health if you don’t manage it and it won’t help blaming anyone in the end. Not when you get to decide who to spend your time with.

Where I come from there is a saying that says, “Better no company, than bad company”.

Try being a person who is just, honest, hardworking, and virtuous. You’ll alienate the wrong people and attract the right ones. Those qualities will also be major boosts to your arsenal for managing diabetes.

The Places You Live and Work

Now for places. Do you hate where you live or work? If so, are you working on a plan that will slowly get you out of there? It may take 5 years (as it did for me to leave a job I hated) but you’ve got to at least lay out your plan and take steps toward it. We spend a lot of time where we live and work so, again, if that is what brings you down then work towards getting that obstacle out of your way.

Don’t despair if things seem impossible. They always do–especially when we are feeling overwhelmed. Just start writing down what you want and the steps you think you should take to get there. Try to be calm, daydream a bit, get creative, and figure out your escape.

Talk to a loved one about what you are trying to do. Maybe you can get some support. Perhaps someone you trust could also help give you feedback about what you want and why. Go to a rational thinker, not someone who will give you emotional advise, which is great for some things but terrible for your life’s practical maneuvers which require you to be wise.

The Things You Own, Which Own You

There is much value in cleaning up our possessions in a way that will minimize anxiety and stress and maximize efficiency and value. Have you heard of Marie Kondo, the Japanese tidying guru? Her book may not be for everyone but I dare say she is on to something. She recommends owning only what we all need and love.

You know how most people love going to hotels? Well, I spent the last few years staying in dozens of them–three and four-star hotels. And what I discovered was that they are all pretty much terrible. No, really. They are dusty, mildewy, smelly, and the only thing actually going for them is that they are minimalist and tidy.

So when you and I first step in we go into “spa brain” where we get a sense of peace and relaxation even though we are walking on a carpet that contains blood, semen, and urine. Again, no, seriously. A friend contracted MRSA from walking barefoot in a very nice New York City hotel and spent many weeks in a hospital.

Now what if we could come home and feel “spa brain” every day? Don’t you think that would help you stay focused and more relaxed on what you need to do to maintain your healthy habits?

The key is to strip your belongings of things you don’t love, as Kondo recommends and to only keep something if you truly can’t live without it. I got rid of so much stuff recently that I was able to put my diabetes supplies in a pretty box that was previously used for something else. I have been better about changing my syringes and lancets ever since and I also stay on top of what needs to be reordered because everything is so nicely organized.

Check out Kondo’s book from the library or purchase it on Amazon and start making some darn space for a life in which you manage your diabetes and health (let’s face it, those take up enough space on their own).

I Think This Because I Live It

I have done these three things I’m suggesting, not perfectly of course, as we’re all a work in progress. But, I have experienced major changes that have been well worth all the little steps it took to get here. I once felt hopeless and worried that diabetes would kill me at age 40. I thought diabetes was too hard to manage even for just 24 hours. I felt depressed and anxious and didn’t know how to alleviate my symptoms.

I’ve found that for me, it has truly helped to keep quality company, mold my life so I spend my days where I want, doing what I want, and chucking items that are only going to stand in my way, mentally and physically.

In a way, it’s all about removing what isn’t going to support what we want or need. When you remove what isn’t wanted or needed you are left with everything you want and need. It’s quite perfect.

The bit I wrote about how we have to be virtuous and all that…that part is instrumental. Deep down we all recognize quality. When we think and act like quality people we are self-motivated to hold our heads up high and finally treat ourselves with self-respect. The best anti-depressant I’ve ever experienced has been working to be a self-respecting and useful person.

It isn’t self-respect to live amongst clutter, surrender to a dead-end job, or to maintain a toxic relationship. These aspects are huge in our lives and we either surround ourselves with an environment that promotes and supports our success, or we don’t.

I don’t have it all figured out and I have a long way to go still but, I get emails from people who want to know what advice I have on how to manage diabetes well and some who ask about relationship and parenting and other topics. So what I’ve shared is what I rely on to help me maintain an A1c between 5-6 %, a healthy marriage, happy kids that I unschool, and work I enjoy.

I’ve noticed that people who manage their diabetes really well do these things, also. You can learn to do them, too if you want. Just pick one and begin.

Photo Credits: Sysy Morales and Web Summit (Flickr), License: CC BY 2.0

Read more about A1c, diabetes and relationships, diabetes management, work.

The Difference Between Type 1 and Type 2 Diabetes

Diabetes: The Difference Between Type 1 and Type 2 Diabetes

Written by Hannah NicholsReviewed by Dr Helen Webberley

Last updated: Fri 24 July 2015

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Diabetes (otherwise known as diabetes mellitus, DM) is described as a metabolic disorder in which the body cannot properly store and use the energy found in food.

More specifically, diabetes is a condition that affects the body's ability to use glucose (a type of sugar) as fuel. Glucose is a form of carbohydrate that comes from foods such as breads, cereals, pasta, rice, potatoes, fruits and some vegetables. Glucose is also synthesized in the liver and is carried in the blood to the rest of the body to fuel cellular processes.

To use glucose as fuel, insulin is required to get the glucose into cells. Insulin is a hormone (a type of chemical messenger) made by specialized cells in the pancreas. Insulin regulates blood glucose by stimulating the removal of glucose from the blood and its uptake into muscle, liver and fat cells where it can be stored for energy.

Sometimes the body does not make enough insulin or the cells do not respond properly to insulin. Blood glucose levels can then become elevated while the cells are deprived of fuel. When blood glucose levels get too high (hyperglycemia) this can cause damage to the tiny blood vessels in the eyes, kidneys, heart and nervous system, which is why diabetes is associated with an increased risk of cardiovascular disease, kidney disease, loss of vision and neurological conditions.

Persistently elevated blood glucose may lead to a diagnosis of prediabetes or diabetes. Prediabetes describes the condition where blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes.

There are three types of diabetes:

• Type 1 diabetes
• Type 2 diabetes
• Gestational diabetes.

Type 1 diabetes used to be known as insulin-dependent diabetes (IDDM), or juvenile-onset diabetes as it often begins in childhood. Type 1 diabetes is an autoimmune condition where the immune system wrongly identifies and subsequently attacks the pancreatic cells that produce insulin, leading to little or no insulin production.

Type 2 diabetes used to be known as non-insulin dependent diabetes (NIDDM) and adult onset diabetes, but it is increasingly common in children, largely due to children being more likely to be obese or overweight. In this condition, the body usually still produces some insulin, but this is not enough to meet demand and the body's cells do not properly respond to the insulin. The latter effect is called insulin resistance, where persistently elevated blood glucose has caused cells to be overexposed to insulin, making them less responsive or unresponsive to the hormonal messenger.

Gestational diabetes occurs in pregnancy and typically resolves after childbirth. People who have experienced gestational diabetes do, however, have an increased risk of developing type 2 diabetes after pregnancy.

You will also see introductions at the end of some sections to any recent developments that have been covered by MNT's news stories. Also look out for links to information about related conditions.

Fast facts on diabetes

• 29.1 million children and adults in the United States - 9.3% of the population - have diabetes (21 million diagnosed, and an estimated 8.1 million undiagnosed).12
• 1.7 million new cases of diabetes were diagnosed in people aged 20 years and older in 2012.
• 15.5 million, or 13.6% of all men aged 20 years or older have diabetes.
• 13.4 million, or 11.2% of all women aged 20 years or older have diabetes.
• 37% of Americans aged 20 years or older have prediabetes.
• Diabetes is present in 15.9% of American Indians/Alaska Natives, 13.2% of non-Hispanic blacks, 12.8% of Hispanics, 9% of Asian Americans, and 7.6% of non-Hispanic whites.
• Diabetes contributed to 231,404 deaths in the US in 2007.2
• $245 billion: Total costs of diagnosed diabetes in the United States in 2012.2
• Only 5% of people with diabetes have type 1 diabetes, which is an autoimmune disease involving caused by genetic, environmental, and other factors.2
• Type 2 diabetes accounts for 95% of diabetes cases and is usually associated with older age, obesity and physical inactivity, family history of type 2 diabetes, or a personal history of gestational diabetes.2
• There is no known way to prevent diabetes type 1. Effective treatment requires the use of replacement insulin.
• Type 2 diabetes can be prevented through healthy food choices, physical activity, and weight management. It can also be managed through lifestyle and diet, although insulin or oral medication may be necessary for some people.

The difference between diabetes type 1 and type 2

There are two main types of diabetes, type 1 diabetes and type 2 diabetes. These two diabetes types have several key differences, for instance the differences in cause, symptoms, characteristics, management, incidence, who it affects and what effects the disease has on the body.

The easiest way to find out the differences, as well as similarities between the two, is through comparing the type 1 with type 2 diabetes. Comparisons will be made across the various sections in this page.

Recommended target blood glucose level ranges for non-diabetic and diabetes type 1 and type 2

For the majority of healthy individuals, normal blood glucose level in humans is about 4 mmol/L or 72 mg/dL.3-5

Target glucose levels by type	Glucose levels before meals	Glucose levels 2 hours after meals
Non-diabetic	4.0 to 5.9 mmol/L	Under 7.8 mmol/L
Diabetes type 2	4 to 7 mmol/L	Under 8.5 mmol/L
Diabetes type 1	4 to 7 mmol/L	Under 9 mmol/L
Children with diabetes type 1	4 to 8 mmol/L	Under 10 mmol/L

Diabetic patients measure glucose blood levels using a glucometer, small drop of blood from finger and a test strip.

What causes diabetes type 1 and type 2?

Type 1 diabetes occurs when the body's immune system erroneously attacks the pancreatic beta cells, which produce insulin, destroying these cells and reducing the body's ability to produce sufficient insulin to regulate blood glucose levels.

Type 2 diabetes is a condition where the body does not produce sufficient insulin and the body's cells become resistant to the effects of insulin. This results in the build-up of glucose in the blood while cells are starved of energy. This condition is often a result of persistently high glucose levels as well as obesity and overweight, lifestyle and dietary factors, medications and other issues.

Insulin use not only prevents hyperglycemic emergencies, but is a safeguard that helps to prevent long-term complications of diabetes by correcting fasting and postprandial (after meal) hyperglycemia.

Both of the major types of diabetes typically include different stages of disease, beginning with a state where supplemental insulin is not required to a state that does require exogenous insulin for blood glucose control and survival.

	Diabetes type 16,7	Diabetes type 26,7
Cause	Beta cells in pancreas are attacked by the body's own immune system, therefore reducing insulin production, leading to elevated blood glucose. Insulin is not produced or is produced in insufficient amounts.	Persistently high intakes of dietary sugars leads to excess demands on insulin production, which leads to insulin resistance over time. Receptor cells that have become less sensitive (resistant) to insulin are unable to remove glucose from the blood, leading to higher blood glucose and greater demands on insulin production.
Genetic basis	Possibly. In most cases of type 1 diabetes, the patient would need to inherit risk factors from both parents.	Type 2 diabetes has a stronger link to family history and lineage than type 1.
Bodily effects	Thought to be triggered by autoimmune destruction of the beta cells. Autoimmune attack may occur following a viral infection such as mumps, rubella cytomegalovirus.	Appears to be related to aging, inactive lifestyle, diet, genetic influence and obesity.
Climate	One trigger might be related to cold weather. Type 1 diabetes develops more often in winter than summer and is more common in places with cold climates.	Type 2 diabetes is more common in people with low levels of vitamin D, which is synthesized from sunlight. Vitamin D supports immune function and insulin sensitivity, meaning that those living at a more northerly latitude may face a higher risk of diabetes.13
Diet	Early diet may also play a role. Type 1 diabetes is less common in people who were breastfed and in those who first ate solid foods at later ages.	Obesity tends to run in families, and families tend to have similar eating and exercise habits. Diets high in simple sugars and low in fibre and vital nutrients are more likely to lead to diabetes.

Insulin is like a key that opens up the locks on your body's cells so that glucose (blood sugar) can get inside and be used for energy. If the glucose cannot get into your cells, it builds up in your blood stream. If left untreated, high blood glucose can cause long-term complications.