To say that the pandemic has been hard for all of us would be an enormous understatement. Isolation from friends and family, loss, and financial stress are only part of covid-related challenges. Unfortunately, certain groups of people have been hit harder than others—especially people living with diabetes.

We still have so much to learn about COVID, but certain patterns and risk factors become apparent as more research comes out. Diabetes, along with other chronic conditions like high blood pressure, significantly increases the risk of severe disease of dying from coronavirus. But why?

Clinical Lead Diabetes Care Specialist Molly Wagman, MS, RDN, CDCES, sat down with 9am.health's Medical Advisor Tricia Santos Cavaiola, MD, Endocrinologist and Assistant Professor at UC San Diego to dive into what we know about diabetes and COVID. Here's what they discussed:

  • What happens if a person with diabetes gets COVID?
  • Does COVID increase the risk of getting seriously ill when you have diabetes?
  • Why does diabetes increase the risk of long-COVID?

While we understand this can feel like a scary topic, we think sharing the latest research is essential. It’s also reassuring to know that well-managed diabetes reduces the risk of severe disease. We hope Dr. Cavailoa’s information can help you feel better prepared to keep yourself well.

What happens if a person with diabetes gets Covid?

There's no way to tell if COVID will cause a mild or more severe case of COVID, but as mentioned earlier, having diabetes does increase your risk of becoming sicker than someone without diabetes.

Before jumping in, it helps to understand what severe illness looks like and how it compares to a more mild case of COVID. A severe case of COVID means someone is more likely to be hospitalized and have a longer stay in the hospital. Severe cases also mean someone is more likely to have complications that require care in the intensive care unit on a ventilator to help with breathing or advanced support for organs like the kidneys.

A mild case can still make you really sick, but it means you can manage your illness at home without needing to go to the hospital for more care.

If you have diabetes and get COVID, it's extra important to check in with your doctor to discuss treatment options, even if you start with mild symptoms.

It's also helpful to know that keeping blood sugar in range is an essential step in keeping yourself safe from more severe diseases. Some research shows that higher blood sugar is linked to worse COVID outcomes (and we will discuss the reasons why below).

Does COVID increase the risk of getting seriously ill when you have diabetes?

The short answer is yes. Scientists and doctors believe there could be a few reasons this happens.

First, you are more likely to get really sick from COVID if you have more than one health condition (also called comorbidities). People with diabetes have a higher risk of having high blood pressure, kidney problems, or heart disease—all linked to severe COVID.

But the diabetes connection goes even further. According to Dr. Cavailoa, science suggests that a big reason diabetes can increase the risk of severe COVID is related to inflammation.

High blood sugar and inflammation can worsen COVID

Inflammation is a way the body defends itself and activates the immune system. If the body senses a problem like an injury or illness, it sends out signals through molecules called cytokines that regulate inflammation. Small amounts of cytokines and inflammation are okay and a normal part of your immune system, but too much can be a problem.

Too many cytokines can cause a cytokine storm, which means the inflammation in the body is so high it damages tissues and organs. The increase in inflammation or the cytokine storm can lead to dangerous levels of inflammation in the lungs, kidneys, or other organs or increase the risk of blood clots—all severe complications linked to COVID.

Dr. Cavailoa shares that studies now suggest that excess inflammation may partially explain why COVID affects people living with type 2 diabetes. Type 2 diabetes is considered an inflammatory health condition, especially when blood sugar is not well controlled. Someone with type 2 already may have more inflammation in the body than someone who doesn't, and COVID makes things worse.

Why does diabetes increase the risk of long-COVID?

Long-COVID (or post-covid) is when symptoms persist after the acute infection is gone. It can last for months with lingering symptoms like fatigue, headaches, dizziness, brain fog, and shortness of breath.

People with type 2 diabetes have a higher risk of long-COVID than those without diabetes. The reasons are still being studied, but it’s likely related to the same reasons why having diabetes increases the risk for severe disease, including inflammation and comorbidities, according to Dr. Cavaiola.

Having COVID can also make diabetes worse, increasing the need for more medication to reach target blood sugar levels.

Why COVID increases the risk of developing diabetes


Interestingly, it's not just that living with diabetes affects the risk of severe illness, but having COVID also can increase a person's risk of developing type 2 diabetes, according to Dr. Cavailoa.

One critical study found that having COVID increased the risk of getting diabetes by 40 percent in the year following infection compared to those who never had COVID, even those who previously had no risk factors for developing diabetes.

The more severe the COVID infection, the more the risk increased, but even people with milder illnesses saw an increased risk. More research is needed to include a more diverse population of people (this study included mostly white male veterans).

Undiagnosed diabetes or limited access to medical care could play a role

Dr. Cavioloa shares some of the potential reasons for the link, including factors that have nothing to do with the disease itself, like access to affordable health care, lack of trust in the medical community, or just concerns about visiting the doctor during the pandemic.

If someone had undiagnosed prediabetes or diabetes, they might just have been discovered when coming to the hospital with COVID.

Medications and stress hormones raise blood sugar

Dr. Cavioloa also explains that stress hormones like cortisol and adrenaline can also cause high blood sugar. If the body is under stress from COVID or given steroid medications—which increase blood sugar—to treat COVID, these can add to the problem.

COVID may alter insulin production, but more research is needed

Researchers are also examining the possibility that COVID could alter the cells that make insulin. Insulin is the hormone that lowers blood sugar, and it's made by the beta cells in your pancreas. COVID may impact how much insulin your body makes, but this explanation is still under debate.

Should you get the Covid vaccine when you have diabetes?

In the interview, Dr. Cavailoa also shares that people with diabetes who are vaccinated are less likely to get COVID. Vaccination also decreases the risk of developing severe COVID or dying if you do get sick.

"Vaccination is a crucial way to protect yourself from a serious illness for everyone, especially when you have diabetes. "

Dr. Cavailoa also says that staying within your target blood sugar range as much as possible is one of the most important steps you can take. As mentioned earlier, higher blood sugar is linked to more inflammation, increasing the risk of severe or long-COVID. 9am.health is all about making diabetes care more accessible and affordable, so you feel empowered to better manage your diabetes.

Online care makes it easier to manage diabetes


We know this information can seem overwhelming, but if we've learned anything during the pandemic, it’s that taking care of your diabetes is so important for reducing your risk of severe disease.

9am.health gives you the flexibility and access to an entire care team in your living room to support you in your health goals. Learn more about what 9am.health can do for you here.