Does Covid-19 Trigger Diabetes - Which is the Chicken and Which is the Egg?

February 06, 2022

Does COVID Trigger Diabetes - The Chicken or the Egg?

I smell a rat. COVID-19 isn't just a nasty cold. Once you have recovered from your loss of smell or taste, long-term follow-up may show that you have become diabetic. The CDC just published a study showing that for people under age 18, their risk of becoming diabetic is 2.66 fold (Hazard Ratio) greater after COVID infection. Another study published in Cell Metabolism examined 3,700 cases of COVID-19 showed that about half developed high blood glucose when ill with the virus. If intubated, the number was about 90%. Of those who died, fully 77% had high blood glucose. Said differently, high blood glucose increased the risk of intubation 15 fold and death 3.6 fold. Goodness! The relationship of this virus to diabetes is explosive. Which came first, the virus or the diabetes? Do they depend upon each other?

Now, in the Cell Metabolism paper, Dr. Lo, the author, noted that C-peptide, a marker of insulin production was not low. That means folks are still making insulin. It's not like the virus is knocking off beta cells in the pancreas. That is what happens in Type -1 diabetes which is an insulin-dependent disease. So it's not pancreas failure that's happening. What they did find was that patients with high blood glucose were producing extremely low levels of adiponectin. It's fat cell failure! 

Adiponectin is made by fat cells and is meant as an instruction to other cells to take up glucose. When you get overweight, your adiponectin drops, and that is part of the dilemma of being obese. You can tell when you have lost enough weight because your adiponectin levels start to rise which correlates with blood sugar getting better. Without adiponectin, your cells aren't talking to each other in the normal fashion. And we now know that the COVID-19 virus attacks fat cells and can replicate in them. The same paper reported that another feature of dysregulated COVID-19 metabolism was the elevation of triglycerides, which we also see in diabetics.

What's going on? Hmmm. It feels like the picture of COVID-19 is beginning to coalesce. Doing quality, randomized-placebo controlled trials in the midst of a pandemic is no mean feat. But we do know the COVID virus is the most aggressive virus at hi-jacking your energy metabolism. Now we have the link showing that fat cells, where energy is meant to be stored also get broken, and stay broken. This long-term effect speaks to some alteration in the fat cells' DNA, but that has not been demonstrated or proven yet. Long-term diabetes takes decades off your life. Renal failure, dialysis, cognitive decline, heart disease all follow.

This wicked virus is not just a cold. It is one of the most dangerous viruses we have to navigate in our lives. Ramping up your immune system early by vaccination is the only sure means by which you can avoid all those complications. The complications of the virus are orders of magnitude more problematic than the vaccine.

www. What will Work for me? The story of glucose metabolism and the management of being overweight is central to longevity. If we want to live a long and healthy life, controlling our weight and blood glucose is key. There is no other virus that has quite the monkey wrench capability of disrupting your ability to metabolize glucose. And no other virus leaves you will long-term disease quite like this. (Some maintain infection: Epstein Barr, Shingles, Herpes, Hep B, Hep C. Those are all prolonged infections.) This long-term complication shifts the summary risk-benefit of vaccination versus native infection dramatically to the vaccination side. "Get the jab". Medical students today will be studying the long-term effects of this deadly virus for their entire careers.

References: Live Science, Science News, MMWR-CDC, Cell Metabolism, Cell and Biosci., Int Jr Prev Med

Pop Quiz

1. Which happens first: the chicken or the egg?                                    Answer: Not to be glib, it is clear that having high glucose puts you at greater risk of COVID. But developing COVID may also push you into diabetes. There is a continuum of risk here.

2. As best we know, pancreas cells in folks with COVID are still producing when hormone that proves their beta cells are still making insulin?                          Answer: C-peptide

3. What hormone is dramatically lower in folks with COVID who develop high glucose?                    Answer: Adiponectin.

4. Who else has low levels of adiponectin?                            Answer; overweight.

5. If I get COVID and develop diabetes, it will get better when I get better from the virus? T or F                   Answer: Oops! No, sorry. It appears to be a long-term state, once triggered. Could be long-term infection is lurking in fat cells. That's a reasonable hypothesis. Research on the fly is always preliminary and fraught with error. But there it is.

This column is written by Dr. John E Whitcomb, MD, Brookfield Longevity, Brookfield, WI. (262-784-5300)