In an interview with the Sunday Island, Vidya Jyothi Dr. Prasad Katulanda, Honorary Consultant Diabetologist and Senior Lecturer in Clinical Medicine from the University of Colombo, throws light on the urgency of managing diabetes during the pandemic and following safe health protocols. The complications of COVID-19 Virus in people with diabetes are more serious, warns the Consultant.
by Randima Attygalle
Diabetes is today a global epidemic affecting about 422 million people worldwide, World Health Organization (WHO) affirms. The majority of them live in low and middle income countries and 1.6 million deaths are directly attributed to diabetes each year. By 2030, diabetes is predicted to be the seventh leading cause of death by the WHO. Diabetes is today among the top ten causes of death with almost half of deaths occurring in people under the age of 60. One in six live births is also affected by hyperglycaemia in pregnancy. While the prevalence of diabetes has been steadily increasing over the past few decades, COVID-19 pandemic has claimed over one million lives worldwide so far. Over 50 million are infected with the virus. “Diabetes and COVID-19 are like a merge of two pandemics,” observes Vidya Jyothi Dr. Prasad Katulanda, Honorary Consultant Diabetologist and Senior Lecturer in Clinical Medicine from the University of Colombo, who goes on to warn that people with diabetes are more likely to experience severe complications of COVID-19.
“Scientific evidence from China, America and several more countries reflect that obese people, people with diabetes and other non-communicable diseases (NCDs) such as heart disease are at a higher risk of developing severe COVID-induced complications. Higher proportion of people in these groups require ICU care including ventilators,” explains the Consultant. Several reasons are attributed to people with diabetes developing complications of the virus. Those with diabetes, he explains, have a risk for inflammation. This makes is harder to fight the virus and leads to a longer recovery period. The virus also thrives in an environment of elevated blood glucose. “COVID complications occur as a result of an exaggerated response of the immune system- a condition known to be ‘cytokine storm’ where a lot of molecules of the immune system get liberated in large amounts. This amount is much more than a response to fight the infection. Since diabetics are at the risk of increased inflammation, this response gets further exaggerated resulting in higher COVID complications,” explains the Diabetologist calling for strict adherence to safety protocols.People with diabetes are also more prone to clotting of blood. “Post-mortems of COVID-infected patients have revealed blood clots in their lungs resulting in severe lung damage, hence those with diabetes need to be extra careful in taking precautions such as proper use of face masks, regular hand washing, maintaining social distancing and restricting social gatherings and travel,” says Dr. Katulanda.Whilst the management of diabetes during the pandemic is crucial, others in the household should also be equally cautious not to ‘bring the infection home,’ he remarks. “If you have any family member with diabetes, extra measures need to be taken when you return from your work place etc. If any family member is suspected of COVID, it is imperative to isolate him/her without any direct contact with the others.” The safety measures apply to the workplace as well where those with diabetes need to maintain social distancing, hand hygiene etc.Sri Lanka Non Communicable Disease Survey conducted by the Diabetes Research Unit of the Colombo University’s Medical Faculty reveals that in the Colombo city limits alone about 25% or more adults have diabetes. This reflects that one in three adults in Colombo has diabetes and the rate has gone up from 18% in 2016 to 25% now. Moreover, another 30 to 40% have pre-diabetes and only about 30% has perfectly normal blood sugar levels. Sri Lanka Young Diabetes Study too reflects that about 1% of diabetes is due to maternally inherited diabetes and deafness (MIDD). “Sri Lanka being an alarming ‘hot spot’ for Type 2 Diabetes, (adult onset diabetes) even those who are at the risk of diabetes (pre-diabetes) should watch out for their dietary patterns during the pandemic with lockdowns and quarantine curfew becoming a way of life,” warns Dr. Katulanda.
With the pandemic, come challenges to healthy eating. With limited food choices, especially during lockdown/curfew situations, more people are prone to consume starch and less fibre-rich foods. “We have seen some pre-diabetes people converting to diabetics due to this. Many have become obese and fatty liver conditions have got worse- all precursors to diabetes,” points out Katulanda urging people to eat healthy under the circumstances.
A diet of low glycemic index is encouraged with more unrefined carbs (whole grains, low GI rice, less oil and low sugar. Foods with trans-fat such as margarine, other fat spreads, oily meats (bacon, pork, sausages) should also be kept at bay. Adding more green vegetables and local green fruits such as nelli, guava and ambarella to the diet is also helpful. “Those who are likely to take more sugary foods should be conscious of what is called ‘portion exchange’ where they need to compromise on other starchy foods such as white bread, string hoppers etc.”
With regular physical activities such as walking and going to the gym becoming restricted during the pandemic, keeping one’s self fit at home is essential. “While those with a machine such as the treadmill could do a workout, others could do stretching exercises and yoga. Even the elderly with IT skills could get plenty of guidance on line to the best exercises to keep them fit during these trying times,” says the physician. Home gardening is another healthy option which not only keeps one fit but also helps bring fresh garden produce to the table.
Being couch potatoes at home addicted to devices, particularly the phone is means of inviting diabetes upon one’s self, he warns. “With work-from-home arrangements becoming a way of life, people tend to sit before a computer or a phone for longer periods and this makes them even more sedentary.” Taking regular breaks in between working hours to stretch or walk a bit, climb some stairs and limiting the screen time and chat groups could make a person more healthy.
