By Apollo 24/7, Published on - 08 June 2021
Increasing cases of mucormycosis, popularly known as black fungus, are being reported in several states of India. Uncontrolled diabetes mellitus is one of the major factors that increase the risk of mucormycosis in COVID-19 patients. Hence, the diagnosis and management of diabetes has emerged as a priority for healthcare providers at a time when hospitals are overwhelmed with countless cases of severe COVID-19 infections.
Recently, the Ministry of Health and Family Welfare (MoHFW) has revised the guidelines on the diagnosis and management of diabetes among COVID-19 patients at patient management facilities. The new guidelines underline the significance of strictly monitoring diabetic COVID-19 patients as they are at high risk of developing mucormycosis.
Doctors have been advised to screen every COVID-19 patient for hyperglycemia (high blood sugar) as soon as they get admitted to the hospital. The screening guidelines include:
It has been seen that COVID-19 patients who get admitted to the hospital with normal glucose levels often develop hyperglycemia as soon as their infection gets severe or after they start receiving steroids. Hence, checking blood sugar levels of non-diabetic patients 4 times a day, before breakfast, before lunch, before dinner and after dinner, for at least 2 days, is advised to prevent future complications.
Blood glucose levels of high-risk groups, including obese patients, those aged 50 years or above, and those suffering from cardiovascular diseases, must be checked once every 3 to 4 days.
Oral glucose-lowering agents can be prescribed to patients who develop mild COVID-19 symptoms and mild hyperglycemia, which is characterised by a fasting blood glucose of less than 180 mg/dl and post-eating blood glucose of 250 mg/dl. The most potent oral glucose-lowering agent given to COVID-19 patients is a DPP-4 inhibitor, available as sitagliptin, teneligliptin, linagliptin, and vildagliptin.
However, some glucose-lowering drugs may cause a problem in COVID-19 patients and these include:
Insulin is prescribed in the cases where the patient:
COVID-19 patients are delivered insulin in two different ways:
Steroids are known to increase blood sugar levels by increasing insulin resistance and promoting the release of stored glucose from the liver into the blood. It has been noted that methylprednisolone and dexamethasone, two of the most commonly used steroids in COVID-19 patients, can result in hyperglycemia, which is likely to persist throughout the day. Therefore, doctors have prepared guidelines to administer insulin to patients who develop high blood sugar due to steroid treatment. These guidelines include:
These new guidelines have been formulated to highlight the need to monitor the patients suffering from diabetes or abnormally high blood sugar due to the increased threat of black fungus in hospitalised COVID-19 patients. The Health Ministry of India has advised that every patient admitted to the hospital must be screened for high blood sugar at least twice (fasting and after eating) a day. They further added that diabetics must be put on a strict ‘diabetic diet’ to ensure that their blood sugar levels are under control.
Read the entire set of guidelines here.
For any diabetes-related query, you can speak with a diabetologist.
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