Task force unveils guidelines for treating diabetic COVID-19 patients on steroids

DiabetesIndia, the Indian task force on diabetes, has released guidelines for the doctors to help them manage hyperglycemia (high blood sugar) in COVID-19 patients on steroids.

The advisory points out that as per International Diabetes Federation, India has 77 million (7.7 crore) people with diabetes; 25.2 million (2.52 crore) people with pre-diabetes (impaired fasting glucose or impaired glucose tolerance); and 43.9 million (4.39 crore) people who are undiagnosed, as diabetes is often asymptomatic.

The advisory prescribes phamacotherapy for three types -- stress hyperglycemia (a condition of temporary rise in blood glucose in individuals without diabetes); newly diagnosed diabetes; and uncontrolled diabetes.

Doctors have been requested to follow the guidelines while treating COVID-19 patients:

All patients must be educated in diet and lifestyle aspects along with self-monitoring of blood glucose (SMBG).

Get HbA1c done with high performance liquid chromatography (HPLC) method.

Check liver function (LFT), renal function and cardiac function.

Check the pharmacokinetics of the steroid being used and advise the patient on timing of SMBG.

Monitor FBG (fasting blood sugar) using a glucose meter daily.

Check for ketones in the blood if blood glucose is >300 mg/dl using capillary blood ketone strips.

The advisory urges doctors to administer either short acting human insulin; or rapid acting analog (aspart, lispro, glulisine); or ultrafast acting insulin (aspart).

At the time of discharge the patient should be apprised of the following:

Comprehensive diabetes management including diet and lifestyle advice.

Risks associated with hyperglycemia and hypoglycemia.

Blood glucose monitoring at home and dosage adjustment.

Self-Injection technique and site rotation.

Foot care and sick day rules.

Advice on reducing insulin as steroid dosage gets tapered.

Those with ‘stress induced diabetes’ should continue monitoring and should seek the help of a physician for prevention of diabetes in the future.

Health experts have pointed that uncontrolled diabetes, coupled with COVID-19 is the reason behind the spike in mucormycosis (black fungus) cases.

AIIMS director Dr Randeep Guleria linked the rise in infections to the “irrational use of steroids” in the treatment of COVID-19.