How do you reduce your risk of “death” and organ damage from COVID-19 infection?
Updated: Jun 24
In Australia, we have successfully controlled COVID-19. It will never be “0”. Trying to achieve this is near impossible as we have seen. If we could, we wouldn’t be having this discussion. We would all be safe. If you don’t get infected with COVID-19, you cannot be hospitalised with or die from COVID-19.
Preventing infection is simple. Stay home if unwell, distance, hand hygiene.
But what is about prolonged high blood glucose that leads to worse outcomes when infected with COVID-19. It is now known that high blood glucose levels can make the gut (intestine) barrier leaky. But how does this help us understand what happens in the lungs where most of the action is taking place with COVID-19 infection. Is there leaky lungs? Does higher blood glucose make the lungs leaky and more susceptible to infection as it does in the gut?
Investigators have tested cells in what is called “in vitro” (in laboratory) situation, testing the permeability of the cell wall (the ability of the cell wall to let virus particles through the cell barrier). At this point let me help you visualise a very simple model.
Imagine that the lung membranes are made of lots of cells, tied together, like a fence with palings butting up tight and tied together. In the two dimensional image that I have created in your mind, obviously you can see over the fence. Our organs are 3 dimensional. In the laboratory, glucose was added and these membranes were examined under microscopes to see what happened to the membranes (the fence). They then infected the medium that the cells were in with influenza virus. What they looked at was the integrity (how much stays intact and tight) of the membrane “fence” and how permeable (how leaky and how much virus was let through), the “fence” had become.
This is where things got interesting. Under high blood glucose conditions there is rapid breakdown of the integrity of the “fence”, making the cell more susceptible whereas with normal and safe blood glucose levels the breakdown of the “fence” is much slower and much more gradual.
With respect to permeability (leakiness of the cell wall) we are looking at how much virus can get through the cell wall infecting the cell. In this instance, again with higher blood glucose levels the cell wall becomes much leakier compared with normal glucose levels where the barrier stays intact and is essentially resisting virus entry. What level caused the breakdown?
Let’s go back to the fence palings and rope tying everything together. The fence palings are the epithelial cells and the rope is the tight junctions (figure 1) holding the cells together. When the glucose levels were normal the tight junctions stayed tight, when the glucose levels were increased (over 10 mmol), these junctions became loose and opened the membranes.
Now, a laboratory is not real life, so the hypothesis had to be tested in real life – “in vivo”. In this instance mice were used to test whether leaky lungs resulted from increased blood glucose and viral infection. They tested steady glucose, fluctuating glucose and HbA1c. The answer was yes, leaky membranes did happen as it did in the laboratory. Variable blood glucose was worse than steady blood glucose. Conclusions were that you needed a good HbA1c to prevent viral infection becoming too severe and you need steady blood glucose without big fluctuation to prevent infection entering cells and organs.
Mice are not human beings. So what does all this mean for us?
1. HbA1c is important. To prevent severe viral disease, we need a HbA1c less than 7%
2. To prevent the breakdown of the membranes, that allows virus entry, we need to prevent glucose variability.
The best evidence comes from studies from the earliest infected people. In figure2, we can see that people with diabetes infected with severe COVID-19 had significantly worse death rates than those without diabetes.
Could the mice model be proven in humans? In figure 3 those with diabetes who had blood glucose levels between 4 to 10 mmol, had an 85% less risk of death compared with those who had poor blood glucose control with levels over 10 mmol.
The message is clear.
You need 100% of blood glucose to below 10 mmol, and of these 80% need to be between 4 and 8.5 mmol. If you achieve this you will have achieved a HbA1c less than 7% and you have achieved steady blood glucose with minimal glucose variability. You are protecting yourself against a COVID event if you became infected. COVID can’t distinguish between a person with or without diabetes It is the blood glucose level that creates the environment for a virus to be able to penetrate the membranes and create inflammation and damage to the organs.
TAKE HOME MESSAGE
TRANSFORM YOUR HEALTH IN DIABETES DURING THE COVID-19 PANDEMIC.
AIM FOR 100% OF YOUR BLOOD GLUCOSE TO BE LESS THAN 10 MMOL, AND 80% TO BE BETWEEN 4 AND 8.5 MMOL.
TEST MORE OFTEN.
RESPOND TO THE NUMBERS.
IN THE NEXT POST I WILL SHARE WITH YOU HOW 78% OF MY PATIENTS ACHIEVED THIS GOAL AND TRANSFORMED HOW THEY LIVE WITH THEIR DIABETES.