Dr. Niveditha Navin

For almost two years now, COVID-19 has changed the way we live our lives, and continues to affect millions of people around the world. Flattening the curve, with simple, practical information has always been the priority, so when I planned to write this article, I wanted to come up with a fresh angle by sharing my personal experience.

We are aware that COVID-19 is strongly associated with comorbidities such as hypertension, diabetes, obesity, cardiovascular disease, and respiratory system diseases, but for some, COVID-19 has led to lasting health issues, especially newly diagnosed diabetes. Diabetes is an increasing health problem, and a well-known contributor to this epidemic. What we may not be aware of is that there is a two-way relationship between COVID-19 and diabetes. On one hand, diabetes is associated with an increased risk of severe symptoms from COVID-19 infection, and on the other, new-onset diabetes and severe complications such as diabetic ketoacidosis, for which exceptionally high doses of insulin are needed, have been observed in COVID-19 patients [1,2].

In November 2020, a global analysis published in the journal Diabetes, Obesity and Metabolism found that up to 14.4% of people who were hospitalised with severe COVID-19 developed diabetes. But why?

The Covid-19 - Diabetes Connection

In mid February 2021, when everyone thought that the COVID-19 pandemic was slowing, is when I learnt my father had been infected. To make matters worse, hospital tests revealed that he had developed Type 1 diabetes. He was immediately put on insulin injections, but as his sugar levels were dangerously high, he had to be moved to intravenous insulin and was monitored continuously to bring down the sugar levels. Seeing my father under such distress was heart-wrenching, and drove me to find out the exact cause behind the sudden onset of diabetes in an otherwise healthy person with no history of diabetes. I learned that just like my father, there were a handful of people who had spontaneously developed diabetes after being infected with COVID-19.

Through my research, I learned about the diabetes-COVID connection. In type 1 diabetes, the body’s immune cells start destroying pancreatic cells, which are responsible for producing insulin. In my father’s case, the doctors believed that the virus must have destroyed the pancreatic-cells. An experimental study in miniature lab-grown pancreases supports this explanation [3]. Coronavirus that enters beta cells in the pancreas causes an extreme inflammatory state, which damages the cells, and impairs the ability of the pancreas to sense glucose and release insulin, thereby either aggravating or triggering new-onset diabetes [4]. When the body doesn’t make enough insulin to break down sugar it produces high levels of blood acids called ketones in such patients, resulting in a serious complication called diabetic ketoacidosis.

Three main warning signs of COVID-19 onset diabetes

• Increased thirst
• Frequent urination
• Blurry vision and fatigue (also common symptoms of COVID)

Please consult a doctor if you experience any of these symptoms.

NMN support in COVID-19 onset diabetes

COVID-19 patients are at a real risk of complications due to impaired immune function, cytokine storm and defective respiratory function. Several scientific studies show that nicotinamide mononucleotide (NMN), a precursor of nicotinamide adenine dinucleotide (NAD+), may prevent inflammation, and improve immune cell function [5]. Several studies have also shown that NMN restores normal blood sugar levels in diabetic mice [6,7].

Of all studies, here is one that piqued my interest. Huizenga released a study where he used a NMN cocktail (NMN, betaine, sodium chloride and zinc sulfate) to treat older individuals with SARS-CoV-2 infections. Some of these patients also suffered from diabetes, obesity, heart disease and high blood pressure. The NMN cocktail improved patient symptoms greatly, especially reducing fever within two to three days, along with significant reductions in inflammatory markers [8]. This shows NMN is capable of reducing inflammation and protecting the pancreatic cells from damage.

These findings suggest that one day it may be possible for people to take NMN much like a daily vitamin as a way to prevent diabetes, and it is also intriguing to speculate that NMN could be used in the treatment of diabetes. While we await new innovative treatments, staying calm and managing stress is of prime importance, as stress wreaks havoc with blood sugar levels.

About Dr. Niveditha Navin

Dr. Navin is a clinical research specialist, who holds a degree in dentistry. After completing her postgraduate diploma in clinical research, she has experience working as a clinical affairs specialist in the pharmaceutical industry. She is passionate about medicine and wishes to carve a distinct niche in the field of research.

Reference

1. Li, Juyi et al. “COVID-19 infection may cause ketosis and ketoacidosis.” Diabetes, obesity & metabolism vol. 22,10 (2020): 1935-1941.
2. Chee, Ying Jie et al. “Diabetic ketoacidosis precipitated by Covid-19 in a patient with newly diagnosed diabetes mellitus.” Diabetes research and clinical practice vol. 164 (2020): 108166.
3. Yang, Liuliu et al. “A Human Pluripotent Stem Cell-based Platform to Study SARS-CoV-2 Tropism and Model Virus Infection in Human Cells and Organoids.” Cell stem cell vol. 27,1 (2020): 125-136.e7
4. Maddaloni, Ernesto, and Raffaella Buzzetti. “Covid-19 and diabetes mellitus: unveiling the interaction of two pandemics.” Diabetes/metabolism research and reviews, e33213321. 31 Mar. 2020.
5. Li, J. et al.COVID-19 infection may cause ketosis and ketoacidosis. Diabetes Obes. Metab. https://doi.org/10.1111/dom.14057 (2020).
6. J. Yoshino et al., Nicotinamide mononucleotide, a key NAD+ intermediate, treats the pathophysiology of diet- and age-induced diabetes in mice. Cell Metab. 14, 528–536 (2011).
7. Yoshino, Mihoko et al. “Nicotinamide mononucleotide increases muscle insulin sensitivity in prediabetic women.” Science (New York, N.Y.) vol. 372,6547 (2021): 1224-1229.
8. Huizenga, Robert, Dramatic Clinical Improvement in Nine Consecutive Acutely Ill Elderly COVID-19 Patients Treated with a Nicotinamide Mononucleotide Cocktail: A Case Series (August 17, 2020).