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Hospitals Face Challenges In Treating COVID-19 Patients With Diabetes

William and Angela Rentel both contracted COVID-19 this spring. William had a stroke six months after recovering.
Jacob Dean
/
Side Effects Public Media
William and Angela Rentel both contracted COVID-19 this spring. William had a stroke six months after recovering.

This is part two of a two-part series on COVID-19 and diabetes. Read part one here.

William Rentel, a nurse practitioner in Ohio, has Type 1 diabetes but kept his blood sugar well-managed. That changed when he and his wife contracted COVID-19 this spring.

“I found myself needing to use double the amount of insulin I would normally use to get my blood sugar levels as close to normal as possible,” says Rentel, who works at the Ohio State University Wexner Medical Center. “That’s when I knew something was very wrong.”

Having too much blood sugar means it’s not being well regulated by a hormone called insulin. This can damage blood vessels supplying vital organs.

And though other severe illnesses can cause elevated blood sugar levels, COVID-19 is doing that at a rate that worries health care workers. Even non-diabetics may have a hard time.

“At one point, half of our patients were on insulin,” says Mary Ellen Neal, a nurse and project manager at Indiana University Health Methodist Hospital. “And, of course, we need to control those blood sugars. So insulin is the treatment for that, and often it's either insulin infusions or shots.”

To deliver that kind of care, nurses had to enter a COVID patient’s room to measure blood sugar levels and adjust insulin doses as frequently as every hour, exposing the staff to the virus and using lots of protective equipment.

Now, nurses at Methodist are putting glucose sensors on patients.

“So this technology allows the nurse to look at a device placed outside the room and see what the blood sugar is,” Neal says.

These sensors are typically used by diabetics at home. But the FDA has approved their use in hospitals to manage COVID patients.

Dr. Rodica Pop-Busui, professor of internal medicine at the University of Michigan, says there is a lack of proven treatment protocols that account for all the problems COVID-19 can cause. She and her colleagues have come up with an algorithm that aims to do just that.

“We are not looking only at one time glucose level,” she says. “But we are also looking at the kidney involvement and these markers of inflammation that now we are routinely measuring. And also measure these clotting markers.”

This is even more crucial for patients who have diabetes. Studies show that COVID-19 can cause blood clotting that can lead to strokes.

Pop-Busui says diabetics are already at an increased risk of strokes, so COVID-19 poses a double threat.

“It may be beyond the severe phase just in the hospital,” she says. “So if you continue to have some clotting that may have been not recognized at some point, it can cause problems in your heart or in your brain.”

Back at his home in Columbus, Rentel wonders if this is what might have happened to him. Six months after he recovered from COVID, he had a stroke that left him partially blind.

“Which we hope would recover, but we won’t know for a year,” Rentel says. “My wife has basically had to step in to help me with my daily activities.”

Rentel asked his doctors whether his diabetes or COVID triggered the stroke. 

They felt that our COVID infection is the most probable cause of the stroke," he says. "But we did not get a definitive answer.”

Further studies may offer conclusive answers. Until then, clinicians agree that, as long as the pandemic persists, diabetics need to keep tight control of their blood sugar levels – because a COVID infection could be devastating.

This story was produced by Side Effects Public Media, a news collaborative covering public health.